Women's health (London, England)最新文献

Background: Young refugee women face elevated sexual and reproductive health risks, but their family planning (FP) needs remain understudied.

Objectives: This study aimed to assess FP awareness, contraceptive use and associated factors among young married Rohingya women aged 15-24 years in Cox's Bazar refugee camps and to compare knowledge and use among women who report no desire for additional children.

Design: A prospective cross-sectional survey was conducted between March and April 2023.

Methods: A multistage random sample was used to select 541 married women across 8 refugee camps. Data were collected via interviewer-administered structured questionnaires. Descriptive statistics and multivariate logistic regression were used to identify sociodemographic, informational, and gender-power factors associated with current contraceptive use.

Results: Among 541 participants, 84.7% reported general awareness of FP, but only 27.0% could name a contraceptive brand. Current contraceptive use was 44.9%, and 37.6% of women who wished to avoid pregnancy were not using any method. Factors positively associated with contraceptive use included older age, husband's education, exposure to FP information (adjusted odds ratio (AOR): 1.74; 95% confidence interval (95% CI): 1.06-2.87), fieldworker visits (AOR: 2.00; 95% CI: 1.31-3.04) and awareness of FP centres (AOR: 5.18; 95% CI: 2.30-11.67). Husband-controlled FP decisions were negatively associated with use (AOR: 0.46; 95% CI: 0.30-0.73).

Conclusion: Interventions are needed to enhance women's empowerment, increase contraception use among young women and support local and international organisations in Bangladesh working with refugees by providing more targeted fieldworker visits for education and the delivery of FP services.

Background: Obstetrics and gynecology emergency rooms (OB-GYN ERs) are crucial for treating acute women's health issues. However, utilization of ER services for non-urgent complaints is a challenging issue in the healthcare system and could reflect gaps in the primary healthcare (PHC) setting.

Objectives: To evaluate the epidemiology of OB-GYN ER visits and identify the patterns and predictors of hospital admissions in a referral university hospital in the Eastern Province of Saudi Arabia.

Design: A retrospective, record-based, epidemiological study.

Methods: All OB-GYN ER visits from January to December 2022 were included. Data on patient demographics, triage levels, timing of visits, chief complaints, and admission status were collected. Logistic regression models were used to assess factors associated with hospital admission.

Results: Among 8781 ER visits, the median patient age was 30 years (Interquartile range: 26-36), and 85.30% were Saudi nationals. The majority of visits were triage level IV (71.84%), with only 12.46% resulting in admission. Obstetric complaints (47.44%) were the most common, followed by gastrointestinal and gynecological symptoms. Older age, higher acuity triage levels, the winter season, and visits during night or morning shifts were significantly associated with increased odds of admission. Most presenting complaints had a lower odd of admission when compared to the obstetrics complaints.

Conclusion: The study demonstrates a substantial number of non-urgent OB-GYN ER visits, underscoring gaps in continuity of care. Strengthening PHC services and optimizing referral pathways for women's health may help reduce unnecessary ER utilization and ensure more appropriate use of emergency resources.

Background: There is growing evidence that doulas may buffer poor birth outcomes for marginalized groups by providing social support, health education and advocacy between patients and their medical team.

Objective: This study aims to examine the current environment and scope of work for doulas serving immigrants and refugees.

Design: This study is an extension of the on-going mixed methods, community-engaged Georgia Doula Study. From June to November 2022, researchers conducted in-depth interviews with 22 doulas serving immigrants and refugees in and outside of Metropolitan Atlanta.

Methods: Semi-structured in-depth interviews were conducted. Interviews were recorded and transcribed. Two research assistants independently coded the interviews using Dedoose. Data were examined using thematic analysis.

Results: Four themes emerged for immigrant-serving doulas including: doulas fill the gap of care and societal navigation, doulas are asked to integrate themselves into their client's communities, the relationship between doulas and their clients is mutually empowering, and the landscape included both doula-centered and systems-centered frictions. Doulas reported a high level of desire for their services among immigrants, with positive experiences for both clients and them. However, doulas were frequently the only source of support for immigrant clients and were tasked with navigating the complexities of both new arrival experiences and the complex U.S. healthcare system.

Conclusion: Doulas provide critical support in the navigation of immigrant experiences in the United States-including and beyond pregnancy. Their work with immigrant communities enriches the lives of their clients and improves maternal and child health outcomes. However, revised policies and programming for more holistic perinatal services are needed to facilitate their expansive scope of work.

Background: Endometrial hyperplasia, a precursor to endometrial cancer, is increasing due to rising obesity and lifestyle risks. Scarce data exist on the molecular characterization of endometrial hyperplasia for prognostic and preventive applications,Objectives:This study investigates the expression of core pluripotency stem cell markers in endometrial hyperplasia, given their emerging role in cancer stem cell regulation in various cancers, including endometrial cancer,Design:This is a case-control study utilizing archival endometrial tissue blocks. In this study, we assessed the immunohistochemical expression of NANOG, OCT4, and SOX2 in hyperplastic endometrium compared to benign non-hyperplastic endometrium obtained from women with abnormal uterine bleeding,Results:The investigation included 165 patients (83 cases with endometrial hyperplasia and 82 controls). The prevalence of endometrial hyperplasia in our cohort was 20.8% (of 500 patients). NANOG showed moderate to high expression in 60.2% of endometrial hyperplasia cases, significantly higher than in controls (19.5%), p < 0.0005. OCT4 showed moderate/high expression in 12% of endometrial hyperplasia cases compared to 3.7% of controls (p = 0.045). In comparison, SOX2 was expressed in 18% of endometrial hyperplasia with no significant difference from controls (19.7%), p = 0.823. Logistic regression showed that age and NANOG expression were significant predictors of endometrial hyperplasia risk, with women exhibiting moderate/high NANOG expression having an 11-fold increased risk of endometrial hyperplasia (95% confidence interval of odds ratio: 3.484-35.864, p < 0.001). Using receiver operating characteristic curves, women's age predicted SOX2 expression in endometrial hyperplasia cases (area under the curve (AUC) = 0.867, cutoff = 49 years, Youden's index = 0.722, sensitivity = 100%, specificity = 72.2%, p < 0.001), and NANOG in controls (AUC = 0.734, cutoff = 42 years, Youden's index = 0.37, sensitivity = 68.8%, specificity = 68.2%, p = 0.004).

Conclusion: NANOG shows promise for a potential predictive role in patients with endometrial hyperplasia, with moderate/high expression indicating a higher risk. SOX2's role was unclear but age-related. Further studies are needed to validate these findings and explore hormonal links.

Background: There has been a surge in female incarceration in the United States in the last decade, and research indicates that women who are incarcerated are among the most likely to experience poor health outcomes. Physical activity is known to improve health and research that has explored women's physical activity in incarcerated settings has been mostly conducted in prisons, with little research in jail populations.

Objectives: This project explores jail staff perceptions of differences in access to physical activity between women and men incarcerated in a US jail to identify potential administrative barriers to providing equitable access to physical activity for those incarcerated.

Design: A qualitative descriptive approach utilizing interviews was used.

Methods: Semi-structured interviews focusing on perceptions of how incarcerated individuals at the coed jail participate in physical activity were conducted with 10 correctional staff at the jail. Interview data were analyzed using a thematic analysis approach in order to extract emergent and prominent themes.

Results: Jail staff unanimously agreed on the value and importance of physical activity during incarceration, but expressed challenges related to providing access to physical activity. Those challenges were organized into three salient themes that have a large impact on access to physical activity while incarcerated in jail: Staffing and Jail Layout, Employment Opportunities for People Incarcerated, and Choices and Motivations of Incarcerated People, all of which were heavily influenced by gender.

Conclusion: Importantly, the themes identified above are contextualized within a gendered organizations and managerial framework for corrections that increases administrative burdens and gender inequality and decreases attention on the health and well-being of those incarcerated as well as those that work within correctional settings.

Background: The COVID-19 pandemic exacerbated challenges faced by pregnant women, introducing new risks and intensifying existing disparities, particularly among those routinely experiencing race- and ethnicity-based discrimination. It remains unclear how the pandemic affected perceptions of perinatal quality of care (QoC).

Objectives: To explore mothers' experiences of pregnancy, birth, and the early postpartum period during the early COVID-19 pandemic, attending to both health care encounters and to the broader structural and social forces shaping those experiences.

Design: The COVID-19 Mother Baby Outcomes (COMBO) Initiative is a longitudinal, prospective cohort study investigating maternal-child outcomes among women from a predominantly low socioeconomic status, Latinx community in New York City who delivered during the pandemic. This qualitative substudy analyzed a subset of participants using modified grounded theory.

Methods: Semi-structured interviews explored perinatal and pandemic experiences, perceptions of inequitable or poor treatment, and protective factors among 64 participants purposively sampled from the parent cohort. Analysis focused on 48 transcripts highlighting discrimination-related themes, which were transcribed and systematically coded using both inductive and deductive approaches.

Results: Four themes reflected low perceived QoC: disrupted communication, lack of cultural sensitivity, inaccessibility of resources, and medical distrust. Medical distrust was both a driver and a consequence of perceived care. Central to the other three themes was uncertainty over whether poor QoC reflected pandemic-related disruptions, discrimination, or both, a pervasive ambiguity we term the Murky Waters phenomenon.

Conclusion: Giving birth during the pandemic worsened perceptions of perinatal QoC, with discrimination compounding negative experiences. Findings underscore the link between care quality and trust in medical institutions, highlighting the need for evidence-based crisis protocols that both reduce unnecessary risk while preserving patient agency, particularly for marginalized populations. The pandemic exposed longstanding structural inequities, presenting an opportunity to address these patient-level manifestations and strengthen support for populations facing systemic barriers.

Black women healthcare workers serve as key drivers of health equity, providing quality care to a population that faces a gamut of concerns regarding (1) patient-provider interactions as well as (2) access to care. As such, it is vital to make sure healthcare is an inclusive field where Black women workers are not overly burdened, or uniquely susceptible to burnout. Here, we present the Heroines of Healthcare Model, which is a conceptual framework developed to better understand the well-being and lived experiences of Black women in healthcare professions. Drawing upon interdisciplinary literature, we combine sociological theory, Historical Womanism with social psychological framework, Superwoman Schema to contextualize Black women's labor, and the overall burden of care work. The Heroines of Healthcare Model not only centers the voices of Black women, but also provides a tool for educators, practitioners, and researchers to develop more inclusive policies, curricula, and wellness strategies. By shifting the narrative from deficit to empowerment, the model affirms the value of Black women's contributions and experiences within healthcare, ultimately promoting equity and systemic transformation.

Background: Sexual violence (SV) is a profound human rights violation and public health issue worldwide, with significant physical, psychological, and financial impacts. It disproportionately affects women and has both immediate and long-term consequences. In higher learning institutions (HLIs), SV remains prevalent, particularly in low- and middle-income countries, where addressing it is challenging due to the lack of context-specific, evidence-based interventions. Generating such interventions first requires robust evidence on the prevalence and associated factors of SV within local settings.

Objectives: This study assessed the prevalence of SV and its contributing factors in Tanzania's HLIs, with the aim of providing insights that can inform the design of context-specific interventions to reduce SV in these settings.

Design: This study employed a quantitative, cross-sectional, analytical design.

Methods: The study was conducted among female nursing students at Muhimbili University of Health and Allied Sciences, a public institution, and Herbert Kairuki Memorial University, a private institution, in Dar es Salaam. Data were collected through a self-administered questionnaire and analyzed using the IBM SPSS version 25. The chi-square test was used to assess associations between sociodemographic factors and SV, followed by multiple logistic regression to identify factors independently associated with SV.

Results: Of the 296 participants, 21 (7.1%) reported experiencing SV since enrollment at the university, with fellow students primarily identified as perpetrators. Reporting of SV and legal actions was very low, with only 9.5% reporting incidents and 4.8% taking legal action. Studying at a public university (adjusted odds ratio: 4.939; 95% confidence interval: 1.611, 15.141; p = 0.005) was a statistically significant factor associated with the experience of SV.

Conclusion: This study revealed notable SV prevalence among female students in the two HLIs, especially the public institution. Underreporting and lack of legal action persist, with students often perpetrators. Urgent institutional interventions are needed to raise awareness, promote reporting, and target perpetrators.

Background: Dysmenorrhoea, a common gynaecological issue in women, is characterised by lower abdominal cramps during menstruation impacting quality of life (QoL).

Objectives: This study evaluates the effectiveness, utilisation and safety of Buscopan^® Plus (hyoscine butylbromide (HBB) Plus: 10 mg HBB + 500 mg paracetamol) for self-treating menstrual pain.

Design: This non-interventional, prospective cohort real-world study included women with menstrual pain registered with Carenity, an online patient platform by Else Care SAS.

Methods: Eligible German patients with the mean (standard deviation) age of 34.0 (8.0) years were enrolled between 15 September 2020 and 15 June 2022 and grouped into primary analysis or safety cohorts. A maximum of one to two tablets (thrice daily) were allowed, limited to 3 g paracetamol per day. Primary outcomes were pain intensity difference by mean change and percentage variation in numeric rating scale (NRS) score, percentage of NRS responders and time to pain relief; safety was a secondary outcome. All parameters were measured at 15 min, 30 min, 1 h, or 4 h following the first HBB Plus intake.

Results: Of 1733 eligible women, 94% provided written consent and completed the baseline questionnaire, 56% met all inclusion criteria, 10% completed all intake assessments (primary analysis cohort) and 33% had ⩾1 dose of HBB Plus (safety cohort). Percent decrease in NRS score from baseline was 11.1%, 29.5%, 42.4%, 53.4% and 65.8% at 15 min, 30 min, 45 min, 1 h and 4 h (p < 0.001 at all-time points), respectively. Overall, 90.8% patients were categorised as responders up to 4 h post HBB Plus intake. Median time to first perceptible pain relief and meaningful pain relief was 30.0 and 37.5 min, respectively. In the safety analysis cohort, five non-serious treatment-emergent adverse events were reported.

Conclusion: HBB Plus effectively reduced menstrual pain within 4 h of treatment and was well-tolerated, providing a viable option for self-management of pain and improving QoL.

This editorial serves as an interpretive synthesis of the special collection, Who Cares for Black Women in Health and Health Care, featured in Women's Health. The key objectives of the collection were to (1) explore the experiences of Black women healthcare educators and providers to promote well-being and retention among this group of key stakeholders in population health and to (2) uncover barriers to care that perpetuate health disparities among Black women at large. Upon reviewing and synthesizing the articles included in the collection, the Strong Black Woman trope emerged as a key barrier to health and health care. The essentialist approach to Black women's strength leaves them prioritizing care for others over care for self, subject to perceptions of them as intimidating and able to take on exorbitant workloads, and boxed in emotionally which manifests stress, anxiety, and other chronic illnesses. The way forward for Black women comes with reimaging strength. Specifically, it should include health-related autonomy, collective accountability, and the creation of inclusive spaces.