Women's health (London, England)最新文献

Background: Choriocarcinoma (CC), a rare and aggressive form of cancer, is composed of cytotrophoblasts and syncytiotrophoblasts. It is present in two subtypes: gestational choriocarcinoma (GCC) and non-gestational choriocarcinoma (NGCC). Recognizing the disparities between GCC and NGCC is essential for the precise staging, prognosis, and determination of the primary treatment strategy.

Objective: This study aimed to differentiate clinical outcomes, treatment responses, and prognostic factors between GCC and NGCC and to introduce innovative tools for personalized treatment strategies.

Design: A retrospective cohort study with Survival Analysis and Nomogram Development.

Methods: We analyzed data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database and identified female patients diagnosed with GCC and NGCC between 2000 and 2020. The clinicopathological features of each group were compared using the chi-square test. Kaplan-Meier curves, log-rank tests, and Cox proportional hazard regression were used to assess overall survival and cancer-specific survival and to determine risk factors. The 5-year survival predicting nomogram was constructed, evaluated, and validated.

Results: The study included 919 patients with 719 CC and 200 patients with NGCC. The NGCC group was characterized by older age, a higher proportion of married individuals, more advanced disease stages, larger tumor sizes, and a higher frequency of surgical interventions than the GCC group. NGCC was associated with worse survival rates than GCC patients.

Conclusions: This study highlights the critical role of chemotherapy in improving the survival of patients with NGCC, in contrast to its limited effect on GCC. The negative prognosis associated with radiotherapy underscores the urgent need for further investigation to optimize its use. In addition, the introduction of the first web-based survival prediction tool and predictive nomogram marked a significant advancement in personalized treatment strategies, enabling improved clinical outcomes by tailoring therapy to individual patients.

Background: The Syrian crisis, severe economic conditions, and the COVID-19 pandemic have significantly impacted the mental health of Syrians, including mothers who have given birth during these difficult times. These conditions have led to an increased prevalence of postpartum depression (PPD), exacerbated by inadequate responses to these crises.

Objectives: The study aims to assess the prevalence of PPD among Syrian mothers during the Syrian crisis, economic crisis, and the COVID-19 pandemic. It also seeks to identify the influence of these factors on the occurrence of PPD.

Design: A prospective longitudinal study was conducted between November 13, 2020 and April 27, 2021, in Damascus, Syria.

Methods: PPD was evaluated among women who visited the Obstetrics and Gynecology University Hospital in Damascus, using the Arabic version of the Edinburgh Postnatal Depression Scale after birth and again 6 weeks later. Pearson's chi-square test and logistic regression were used to investigate the correlation between the variables.

Results: A total of 402 women participated in the study, with only 378 remaining for follow-up at 6 weeks postpartum. The prevalence of PPD was found to be 46% immediately after birth and 25.3% 6 weeks later. Women's house devastation (Sig. 0.033, 95% confidence interval (CI): 1.043-2.801), loss or injury of family members (Sig. 0.018, 95% CI: 1.110-3.008), and a preference for a female child (Sig. 0.034, 95% CI: 0.162-0.931) were significantly associated with PPD. We did not find an impact of COVID-19 pandemic on the prevalence of depression.

Conclusion: Detecting and addressing PPD is crucial, especially during the Syrian crisis, the COVID-19 pandemic, and ongoing economic difficulties, as these factors heighten stress during the postpartum period. Particular attention should be given to displaced mothers and those who have lost family members due to the conflict.

Background: Despite the well-documented benefits of physical activity, particularly strength training, for managing menopause-related physiological changes such as muscle loss and weight gain, few interventions specifically target pre- and perimenopausal women using scalable, remote delivery methods.

Objectives: The purpose of this pilot study was to examine the feasibility and preliminary efficacy of a group-based physical activity and strength intervention delivered via Zoom for pre- and perimenopausal women.

Design: This study was a randomized controlled trial lasting 12 weeks.

Methods: Low active pre- and perimenopausal women between the ages of 40-50 (n = 39) were randomly assigned to a 12-week physical activity strength intervention or a waitlist control. Participants attended the sessions twice per week, which included both a 40-min cardiovascular and strength training component and a 20-min motivational component informed by Self-Determination Theory and Habit Formation Theory. Participants were provided Apple Watch devices to monitor their physical activity.

Results: The physical activity strength intervention appears feasible based on recruitment duration, adherence to the Zoom sessions, retention, and the consumer satisfaction survey. The intervention participants increased their physical activity by 21 min/week, and the control group decreased by 2 min, although the differences were not significant. The intervention participants reported greater positive changes on several of the psychosocial variables, including self-efficacy, habit formation, habit automaticity, self-regulation, goal setting, physical activity enjoyment, physical activity feeling, physical activity revitalization, and physical activity tranquility.

Conclusions: Although there was no evidence that the intervention led to increases in physical activity, this study supports the feasibility of a group-based physical activity strength intervention delivered via Zoom. Additional studies that include larger sample sizes and a longer intervention are needed to better understand the efficacy of the intervention.Registration/clinical trials: https://clinicaltrials.gov/study/NCT05426070.

Background: Ultrasound imaging has become popular among physiotherapists for monitoring diastasis rectus abdominis postpartum, but its reliability requires further exploration.

Objectives: To investigate physiotherapists' intra-tester, inter-tester, and test-retest reliability of inter-recti distance measurement utilizing real-time ultrasound across a mixed women sample.

Design: Reliability study.

Methods: Volunteers comprising nulliparous and parous women of different ages and body mass index participated. Five physiotherapists performed ultrasound measurements, following sonographic training. Four conditions were tested in supine; rest, curl-up, transversus abdominus activation, and transversus abdominus with curl-up. Three locations were randomly measured: umbilicus, 3 cm above the umbilicus, and halfway between the umbilicus and xiphoid process. For intra-tester reliability, each therapist undertook three repeated measurements. For inter-tester reliability, mean inter-recti distance measurements were explored across any two tester combinations within and across sessions. Test-retest reliability explored repeated measurements 5-8 days later. Data were analyzed with intraclass correlation coefficients_2,1.

Results: 54 women (33.2 ± 15.2 years old, body mass index: 24.2 ± 3.7), 19 (35.2%) being parous participated. Intra-tester reliability across each physiotherapist was very good (intraclass correlation coefficients = 0.677-0.989). Intra-session reliability across any two testers yielded very good results (intraclass correlation coefficients = 0.76-0.92), whereas across-session yielded good reliability (intraclass correlation coefficients >0.76) except for one condition (3 cm above umbilicus in combined transversus abdominus and curl-up). Test-retest reliability was also very good (intraclass correlation coefficients = 0.78-0.96). Significant differences in inter-recti distance were found, with parous women showing consistently larger values (p < 0.05).

Conclusion: Physiotherapists, following sonographic training, can reliably measure inter-recti distances in both nulliparous and parous women across active and resting tasks. Thus, ultrasound measurement of inter-recti distance is recommended in physiotherapy practice for monitoring diastasis rectus abdominis and assessing rehabilitation progress. However, sub-umbilical inter-recti distance measurements and the impact of co-contraction on reliability require further research.

Background: Primary testing for high-risk human papillomavirus (HPV) via self-collection can increase cervical cancer screening rates. In the United States, federally qualified health center (FQHC) patients often have low incomes, lack health insurance, are medically underserved, and are screened less than the national average. Implementation of HPV self-collection can increase cervical cancer screenings among FQHCs.

Objectives: To assess the potential impact of implementing HPV self-collection with FQHC patients by considering perspectives of frontline clinical and administrative staff and leadership to identify patient-focused implementation considerations.

Design: This qualitative study utilized focus groups and key informant interviews, and transcripts were analyzed using a coding-based thematic analysis. Emergent themes regarding self-collection implementation perspectives were mapped onto Consolidated Framework for Implementation Research constructs to identify potential facilitators and barriers to implementation for FQHC patient populations.

Methods: Participants from six FQHCs in North Carolina were identified. Forty-five clinical and administrative staff participated in focus groups. One chief executive officer, senior level administrator, chief medical officer, and clinical data manager from each FQHC (N = 24) were interviewed one-on-one. Coding-based thematic analysis was applied to focus group and interview transcripts to uncover emerging themes.

Results: Interviewees indicated that HPV self-collection can be advantageous to patients who do not routinely visit the clinic due to socioeconomic and cultural barriers. Programs must consider these barriers and patient literacy to ensure proper self-collection utilization. For example, FQHC patients may benefit from illustrated instructions for proper self-collection procedures.

Conclusion: Tailoring an HPV self-collection implementation to FQHC patient populations may be an important strategy for increasing screening.

Background: There is a lack of data regarding the current state of lactation accommodations at continuing medical education (CME) events to guide best practice recommendations.

Objective: To evaluate CME attendee attitudes, experiences, and preferences as it pertains to lactation support accommodations at CME events.

Design: A cross-sectional study utilizing an electronic-based survey.

Methods: Surveys were administered electronically to attendees of seven CME courses from August 2022 to October 2023, and de-identified data were collected to a secure database. Attitudes regarding lactation accommodations, personal preferences for lactation accommodations, and experiences with lactation at CME events were analyzed.

Results: Of the 337 survey respondents, 169 had personal experience with lactation and 47 had experience with lactation at a CME course within the past 10 years. The majority of respondents agreed that lactation accommodations should be a priority (n = 264, 83%) and are a medical need (n = 285, 89%). Of those with recent experience lactating at a CME course, only 19% (n = 9) indicated adequate lactation accommodations were provided. Due to inadequate accommodations, 77% (n = 36) of respondents experienced decreased participation in the CME course content, 70% (n = 33) claimed fewer hours of CME credit, and 74% (n = 35) experienced decreased satisfaction in the CME course. Preferences for lactation accommodations included proximity to the meeting, audio-visual streaming of content, privacy, security, and signage supporting lactation in addition to an adequate designated space with access to an electrical plug and water supply.

Conclusions: The current state of lactation accommodations at CME courses is inadequate and contributes to inequitable experiences for lactating participants. Course participants are supportive of lactating healthcare professionals at CME courses and recognize lactation accommodations as a priority. Further work is needed to inform and institute changes to lactation accommodations for healthcare professionals.

Background: The quality of antenatal care (ANC) plays a crucial role in maternal and child health, yet little is known about the actual service content received by pregnant women in rural southern Ethiopia.

Objectives: To explore the factors influencing ANC content utilization in selected rural areas of southern Ethiopia, shedding light on critical gaps in service delivery.

Design: A mixed-methods study.

Data sources: Quantitative data were collected from 851 systematically selected women, and qualitative data from 20 purposefully selected participants including mothers, health extension workers, and healthcare professionals.

Methods: Data were collected using a pre-tested structured interviewer-administered questionnaire. Quantitative data were analyzed using descriptive statistics and a generalized linear model to assess associations between variables. Qualitative data were transcribed, translated verbatim, and processed using Atlas software.

Results: Only 5.7% of women received the full spectrum of ANC services. Weight (82.6%) and blood pressure (82%) measurements were the most commonly utilized services, while height measurement (22%) and counseling on pregnancy-related complications (31%) were significantly underutilized. Key determinants of ANC content utilization included husband support (risk ratio (RR) = 1.82, 95% CI = 1.01-2.43), perception of proximity to a health facility-short (RR = 1.38, 95% CI = 1.08-1.90) and medium (RR = 1.13, 95% CI = 1.00-1.17) distances-early initiation of ANC (RR = 1.6, 95% CI = 1.01-2.20), positive provider-patient interaction-good (RR = 1.22, 95% CI = 1.03-1.41) and medium (RR = 1.18, 95% CI = 1.00-1.27)-and a high wealth index (RR = 1.26, 95% CI = 1.16-1.37).

Conclusions: This study underscores the critical shortfall in comprehensive ANC service utilization in rural Ethiopia. Strengthening health services in underserved areas, actively involving husbands in maternal care, empowering women, and enhancing healthcare provider training and accountability are essential to improving service delivery. A concerted effort is needed to bridge these gaps and ensure that every pregnant woman receives the full spectrum of essential ANC services.

Background: The prevalence of mood disorders and functional decline among older adults, particularly those under socioeconomic vulnerability, has become a significant public health concern. Physical exercise is widely recognized as a key intervention for improving both physical and mental health in older populations. However, the optimal intensity and modality of exercise for enhancing mood and functional capacity in older women under socioeconomic vulnerability remain unclear.

Objectives: To investigate the effects of the intensity and modality of community-based exercise programs on mood profile and physical functional capacity in older women under socioeconomic vulnerability.

Design: This article presents a prospective, randomized, single-blind study.

Methods: Older women under socioeconomic vulnerability (included: n = 116; lost to follow-up: n = 28; analyzed: n = 88) were randomly assigned to 6 months of high-intensity interval training combined with resistance training (n = 25), moderate-intensity continuous training combined with resistance training (n = 37), or resistance training (n = 26) interventions performed twice weekly. Flexibility (seat and reach), handgrip strength, lower limb muscle strength/power (Five-Time Sit-to-Stand), mobility (Timed Up and Go), aerobic performance (6-min walking), and mood profile (Brunel Mood Scale) were assessed before and during follow-up.

Results: All groups had improved (p < 0.05) Five-Time Sit-to-Stand and 6-min walking performance, while high-intensity interval training combined with resistance training and resistance training improved (p < 0.05) Timed Up and Go performance. There were also significant improvements (p < 0.05) in depression (high-intensity interval training combined with resistance training and moderate-intensity continuous training combined with resistance training), anger (resistance training), vigor (high-intensity interval training combined with resistance training and moderate-intensity continuous training combined with resistance training), fatigue (resistance training), confusion (moderate-intensity continuous training combined with resistance training), and total mood disturbance (high-intensity interval training combined with resistance training, moderate-intensity continuous training combined with resistance training, and resistance training).

Conclusion: Six months of community-based exercise was effective for improving functional physical capacity and mood profile in older women under socioeconomic vulnerability, regardless of exercise intensity or modality.

Clinical trial registration: RBR-3y8w4w3.

Background: The federal 30-day waiting period for Medicaid-covered female permanent contraception (PC) is a known barrier to timely fulfillment. In July 2020, West Virginia became the first state to bypass this waiting period by using state funds to support procedures that do not meet the waiting period for federal funding.

Objectives: To assess changes in postpartum fulfillment of PC requests following West Virginia's 2020 Medicaid policy change.

Design: We conducted a retrospective cohort analysis of patients who delivered at ⩾20 weeks of gestation at West Virginia University Hospital in 2019 and 2021, excluding 2020 due to the COVID-19 pandemic and implementation of the policy change.

Methods: We used multivariable logistic regression to assess the association between insurance type and inpatient postpartum PC fulfillment, with interaction terms between year and insurance type to examine policy impact.

Results: Among 423 patients desiring postpartum PC, 61.5% had PC fulfillment before hospital discharge. In 2019, fulfillment was significantly lower for Medicaid patients than those with other insurance (55.0% vs. 73.3%; RD: -0.19; 95% CI [-0.32, -0.06]). By 2021, this difference was no longer significant (54.9% vs. 68.3%; RD: -0.13; [-0.27, 0.003]). In adjusted stratified models for 2019 and 2021, there were no significant differences in odds of fulfillment between patients with Medicaid and other insurance (2019 aOR: 0.55; [0.23, 1.28]; 2021 aOR: 0.92; [0.38, 2.21]; likelihood ratio test p = 0.36).

Conclusion: West Virginia's policy change may have partially reduced one barrier to desired inpatient postpartum PC access; Medicaid fulfillment rates remained stable from 2019 to 2021, whereas fulfillment rates decreased for patients with non-Medicaid insurance. However, non-policy-level obstacles to inpatient postpartum PC remain prevalent.

Menstrual health (MH) research has expanded in recent years, including studies throughout the reproductive life course. However, the experiences of young adults in Latin America and the Caribbean (LAC) remain comparatively underexplored, despite the importance of this life stage. The primary aim of this scoping review was to summarize and synthesize the literature on MH among young adults in the LAC region. Primary studies were included if they explored any aspect of MH among young adults aged 18-24 in university, health service, or community settings within LAC. Studies conducted in secondary school settings or involving specialized populations (e.g., elite athletes, incarcerated individuals) were excluded. Six electronic databases were searched for studies published between January 1, 1980 and October 23, 2024. Data were extracted and synthesized narratively, with key study characteristics summarized in tables. An interactive online evidence-gap map was developed to visualize geographic and thematic representation across the region. A total of 42 studies met the inclusion criteria, with most originating from Brazil (n = 21, 50%) and Mexico (n = 14, 33%). Studies were predominantly conducted in urban locations (n = 29, 69%), and all participants were described as female or women. Common MH experiences reported included menstrual cycle and bleeding characteristics (n = 16, 38%), dysmenorrhea (n = 13, 31%), and premenstrual syndrome (n = 10, 24%). Some studies indicated a negative impact of MH on academic participation (n = 5, 12%) and daily life activities (n = 16, 38%). The review identified significant geographic gaps, with only 21% (7/33) of LAC countries represented. This review highlights significant gaps in MH research among young adults in LAC, especially in rural areas and gender-diverse populations. There is a critical need for inclusive, region-specific research, initiatives, interventions and policies to enhance health, education and economic outcomes.