Women's health (London, England)最新文献

Background: Emergency contraception (EC) can prevent up to 95% of unplanned pregnancies if used correctly. Despite efforts to enhance its accessibility, cost and cultural stigmas persist as formidable barriers.

Objective: This study assessed the knowledge and practices of EC use and determined the associated factors among the female undergraduate students of Northern Uganda.

Design: This was a descriptive, institutional-based cross-sectional study conducted among the female undergraduate students of Lira University in Northern Uganda.

Methods: Data were collected from 328 female undergraduates who were surveyed using self-administered questionnaires after obtaining informed consent from them. Data were analyzed using Statistical Package for Social Sciences (SPSS) and presented as frequencies and percentages, and binary and multiple logistic regressions were used to determine the association between the outcome variable and the independent variables. Results were presented as odds ratios with 95% confidence intervals, and associations were considered statistically significant at p ⩽ 0.05.

Results: The response proportion was 328/334 (98%). Majority of the participants were 18-23 years old (233/328; 71.0%), had a consistent sexual partner (221/328; 67.4%), and unmarried (206/328; 62.8%). Almost all the participants (315/328; 96%) had heard about EC, where 150/328 (45.7%) learned about EC from health professionals and 135/328 (41.2%) learned about EC from family members and friends. The most well-known brand of EC was Postinor-2 (Levonorgestrel), as reported by 130/328(39.6%) participants. Of the study participants, 200/328 (61.0%) were knowledgeable about the correct timing of EC. Regarding practices of EC use, 214/328 (65.2%) used EC, of whom 122/214 (57.0%) acquired EC from the pharmacy, and most of the participants who had used EC used Postinor-2 (92/214; 43.0%). Of those who used EC, 175/214 (81.8%) used it to prevent unplanned pregnancy, and 182/214 (85.0%) participants used it with the correct timing. The factors that were associated with EC use were being a student who was studying at the Faculty of Health Sciences (adjusted odds ratio (AOR): 4.27, CI: 1.61, 10.09, p ⩽ 0.003) and the absence of a consistent current sexual partner (AOR: 8.63, CI: 4.49, 16.59, p ⩽ 0.00).

Conclusion: Participants showed good EC knowledge and usage, but gaps persist. Factors like being a student who was studying at the Faculty of Health Sciences, and lack of a consistent current sexual partner correlated with EC use. Consistent education efforts are needed to address knowledge gaps, focusing on diverse EC forms, reliable information, and affordability.

Registration: Not applicable.

Background: Women with previous hypertensive disorders of pregnancy (HDP) have increased risk of cardiovascular disease (CVD). Overweight is a modifiable risk factor for both conditions. Anthropometric indices such as waist circumference, hip circumference, waist-to-hip ratio, estimated total body fat, a body shape index, waist-to-hip-to-height ratio, and index of central obesity improve estimation of cardiovascular death risk in the general population as compared to body mass index (BMI).

Objectives: We aimed to assess whether alternative body mass composition indices associate more strongly with postpartum blood lipid levels, as a proxy for CVD risk, than BMI. We also aimed to investigate whether associations differ between women with previous normotensive or hypertensive index pregnancies.

Design: In this cross-sectional study, we examined 296 women 1 or 3 years after an index pregnancy that was normotensive (n = 116) or complicated by a hypertensive pregnancy disorder, including preeclampsia (n = 133) or gestational hypertension (n = 47).

Methods: Uni- and multivariable regression analyses, adjusted for age and smoking, were conducted to evaluate associations between postpartum body mass composition indices and blood lipids. p < 0.05 was considered statistically significant.

Results: Median BMI and overweight rates were higher in women with previous HDP than in controls (23.9 kg/m² versus 22.8 kg/m² and 44.4% versus 30.2%, both p ⩽ 0.03). No body mass composition indices in any pregnancy complication group showed stronger associations with adverse lipid levels than BMI. However, women with previous HDP more often displayed significant associations between adverse body mass composition indices and adverse lipid levels, compared with controls.

Conclusion: Alternative anthropometric measurements are not better suited to evaluate circulating lipids as proxy for CVD risk after HDP, compared to BMI. We hence recommend using BMI in CVD risk assessment after HDP due to its current widespread use and feasibility.

Introduction: The provision of well-woman services to women is a very good intervention for promoting good health and well-being among women. Despite data needed to inform increasing accessibility to well-woman services, there is limited information about client's satisfaction with well-woman services.

Objective: This study was conducted to determine factors influencing women's satisfaction with well-woman services at Manhyia Government Hospital.

Design: An analytical cross-sectional study was conducted among women attending the well-woman clinic at the Manhyia Government Hospital, Kumasi from 10 May 2023 to 15 November 2023.

Methods: A systematic sampling method was employed. A pretested structured questionnaire was used to collect data on participants' socio-demographic and clinical characteristics, health-facility-related factors, barriers to utilization and client satisfaction. A face-to-face interview was conducted for every woman included in the study. Data were analyzed using multivariable logistic regression analysis. p-Value for statistical significance was set at p < 0.05.

Results: Of the 344 women who were recruited for the study, majority (65.7%) of them were satisfied with care at the well-woman clinic. About 59.3% of the women were willing to continue care at the clinic. The age range was 18-60 with mean of 34.6 ± 12.0 years. Some of the challenges the women reported in accessing well-woman services at the clinic included long waiting times (17.7%) and inadequately skilled staff (8.1%). After adjusting for significant variables in the multivariable logistic regression analysis (adjusted odds ratio (AOR)), comfortability of the waiting area (AOR: 7.71, 95% CI: 1.54-38.60), <6 months duration of accessing care (AOR: 8.82, 95% CI: 3.25-23.98) and friendly attitude of health workers (AOR: 27.03, 95% CI: 4.28-170.83) were significantly associated with the client's satisfaction with well-woman services.

Conclusion: There was high satisfaction with well-woman services at the clinic, and this was associated with factors such as duration of service, comfortability of the waiting area and the attitude of health workers. Training more skilled staff and expanding the clinic will help improve well-woman services.

Background: The Coronavirus Disease (COVID-19) has had a significant impact on healthcare organizations, leading to a reduction in screening. The pandemic period has caused important psychological repercussions in the most fragile patients.

Objectives: This study aimed to assess the levels of depression, anxiety, peri-traumatic stress, and physical symptoms in patients undergoing colposcopy during the COVID-19 pandemic and to compare these data with the post-pandemic period.

Design: This longitudinal study included 96 individuals undergoing colposcopy, aged between 22 and 64, who were examined between March 2020 and December 2023.

Methods: Participants were assessed at four distinct time points, referred to as T0, T1, T2, and T3. T0 encompassed the pandemic period, ranging from March 2020 to August 2020, while T1 occurred 1 year later, T2 and T3 correspond to data collected in 2022 and 2023. Statistical analysis was conducted to assess the impact of the COVID-19 pandemic on various psychological variables. Descriptive statistics, including means, standard deviations, and frequency distributions, were calculated for each psychological variable within each time period.

Results: Our findings revealed a significant reduction in peri-traumatic stress and pain levels in the post-pandemic (from 2021 to 2023) period compared to the pandemic period. Conversely, anxiety and depression levels exhibited a statistically significant increase in the post-pandemic period and then gradually decrease in the subsequent follow-up.

Conclusion: This study provides valuable insights into the profound impact of the COVID-19 pandemic on psychological distress experienced during the pandemic period itself, as well as its enduring effects on anxiety and depression in the subsequent period.

In 2023, a breast cancer risk assessment and a subsequent positive test for the BRCA-2 genetic mutation brought me to the uncomfortable intersection of a longstanding career as an advocate for high-quality medical evidence to support shared patient-provider decision making and a new role as a high-risk patient. My search for studies of available risk-management options revealed that the most commonly recommended approach for women with a ⩾20% lifetime breast cancer risk, intensive screening including annual mammography and/or magnetic resonance imaging beginning at age 25-40 years, was supported only by cancer-detection statistics, with almost no evidence on patient-centered outcomes-mortality, physical and psychological morbidity, or quality of life-compared with standard screening or a surgical alternative, bilateral risk-reducing mastectomy. In this commentary, I explore parallels between the use of the intensive screening protocol and another longstanding women's health recommendation based on limited evidence, the use of hormone therapy (HT) for postmenopausal chronic disease prevention, which was sharply curtailed after the publication of the groundbreaking Women's Health Initiative trial in 2002. These declines in HT utilization were followed by marked decreases in breast cancer incidence, providing a compelling lesson on the critical importance of a solid evidentiary basis for women's health decisions. Known harms accompanying the benefits of breast screening-overdiagnosis, psychological effects, and mammography-associated radiation-exposure risks-make empirical measurement of patient-centered outcomes essential. Yet, published research on intensive screening of women at high breast cancer risk has largely ignored these outcomes, leaving patients, providers, and guideline developers lacking the evidence needed for best practice. Outcomes research is both feasible and urgently needed to inform care decisions and health policy for this patient population.

Background: Menstrual pain can significantly impact adolescents' well-being and functioning. Despite the prevalence of adolescent menstrual pain, information about adolescents' experiences seeking treatment is limited.

Objectives: We examined retrospective reports of help-seeking in adolescence among menstruators to better understand perceptions and experiences of interacting with the healthcare system due to menstrual pain.

Design: This study used an embedded mixed-methods design in which the qualitative and quantitative data were collected concurrently.

Methods: Young adults aged 18-25 who experienced menstrual pain in adolescence completed an online, mixed-methods survey of help-seeking experiences. Responses were analyzed using descriptive statistics and reflexive thematic analysis.

Results: Across participants (N = 590, M_age = 21.78 years), 41% sought treatment for menstrual pain in adolescence and of these 43% found the treatments they were offered ineffective. Three themes were generated related to why treatment was perceived as unsuitable: "Side effects and risks of pharmacological treatment," "treatment not tailored to the individual," and "treatment seen as a band-aid solution." Participants perceived the treatment options as limited and likely not addressing the underlying cause of their pain. Four themes were generated related to perceived improvements to treatment seeking. Participants recommended that healthcare providers: "Go beyond contraceptives," "share and demonstrate expertise," "investigate menstrual pain," and "listen and do not dismiss." Participants reported that having more information, feeling validated, and understanding treatment recommendations would improve their experience.

Conclusion: Participants perceived that their menstrual pain-related treatment needs were unmet in adolescence, despite being offered treatments that align with treatment guidelines for adolescent menstrual pain. Findings suggest that improving explanations about treatment provided to youth, along with improving communication and menstrual education, may lead to more optimal help-seeking experiences among adolescents.

Background: Despite the government's effort to reduce the prevalence of anaemia among reproductive-age women globally, it continues as a significant public health issue, especially in low- and middle-income countries. Iron-folic acid (IFA) supplementation is a widely used intervention to prevent anaemia, but compliance remains a major challenge. There is a lack of literature examining IFA supplementation compliance during pregnancy and its impact on preventing and controlling anaemia during post-pregnancy in the East Africa region.

Objective: This study aims to investigate compliance with IFA supplementation during pregnancy and its impact on post-pregnancy anaemia among reproductive-age women in East Africa.

Design: This study was designed as a cross-sectional survey.

Methods: This study used data from 43,200 reproductive-age women from 2015 to 2022 demographic and health survey datasets. We used multilevel mixed-effect logistic regression analysis to identify associated factors with IFA supplementation compliance during pregnancy. Furthermore, a propensity score matching (PSM) analysis was used to determine the effect of IFA supplementation compliance on anaemia after pregnancy among women.

Results: The level of compliance with IFA supplementation during pregnancy was 31.33% (95% confidence interval (CI): 30.89, 31.77), whereas the prevalence of anaemia among reproductive-age women was 32.08% (95% CI: 31.64, 32.52). Maternal education, the timing of antenatal care (ANC) visits, wanted index pregnancy (last pregnancy), wealth status, healthcare access, mass media exposure and ANC services from skilled healthcare providers were significantly associated with compliance with IFA supplementation among pregnant women. The PSM analysis indicated a significant positive association between IFA supplementation compliance during pregnancy and prevention of post-pregnancy anaemia among reproductive-age women, with an average treatment effect on the treated (ATT) of 25.55% (ATT = -0.2555, 95% CI: -0.3440, -0.1669, p < 0.0001).

Conclusion: Despite universal IFA supplementation, anaemia remains prevalent in East African countries due to low level of compliance with IFA supplementation. Targeting individual and socio-economic factors during IFA supplementation promotion helps to prevent anaemia after pregnancy. Further research is recommended to gain deeper insights.

Background: Women experiencing substance use during their pregnancies or after the birth of a child report being fearful of losing their children based on care, stigmatized when seeking assistance, and barriers to care such as having to provide the same information to different providers, and having to repeat their lived experiences with substance use in detail. Particularly these service barriers can be confusing, complicated, and difficult to follow, which could lead to non-compliance or not seeking services.

Objectives: We evaluated components of a service coordination program for women experiencing substance use, their children, and larger families who help with caregiving. We examined stakeholder interest in the program, feasibility providing services over time, and initial program effectiveness.

Design: Participant enrollment and outcomes as well as service coordination activities provided over a 4-year period was gathered across three demonstration site locations (a birthing hospital, reunification program, and home visiting program).

Methods: Program information was gathered from needs assessment data, health survey data from enrolled caregivers and infants, training evaluations, and budget recordings of direct aid. In this mixed method design, we examined potential differences between baseline and the last assessment for women and children enrolled in the program. We also utilized univariate analyses of variance to examine the main effects of maternal and infant characteristics on final maternal and infant outcomes.

Results: Three sites enrolled 182 women and families for program services. Patient navigators provided direct aid, training, goal setting, and service coordination and planning. Families remained in the program, on average, 655 days and were satisfied with the services received. Respondents thought the program elements were easy to implement within the rural setting. The program effectively addressed basic needs, violence (p < 0.001; η² = 0.34 (0.05-0.53)), infant development (p < 0.02; η² = 0.51 (0.13-0.61)), and maternal depression (p < 0.05; η² = 0.9 (0.00-0.22)). Select outcomes did differ by site.

Conclusion: A service coordination model utilizing a patient navigator role to coordinate client services coupled with an approach that serves the infant and caregiver needs was feasible and desirable by all stakeholders within a rural setting. Service coordination effectively impacted select caregiver and infant outcomes.

Femicide is a global phenomenon; yet there is no commonly accepted understanding of what counts as femicide. Different disciplines and approaches offer different definitions. Defining the term femicide is not only a purely lexical matter but also involves the aspect of data collection. Owing to the lack of a standardized definition, data collected by countries under this label are not comparable and cannot be used for global or regional estimates to provide an indication of the scale of this phenomenon. One tool to fight this silent war against women is certainly medical-legal diagnosis, with everything that the body of a victim of femicide can reveal. Autopsies are crucial; they can help differentiate between female homicide and femicide and the search for a formal, agreed-upon definition of femicide may be derived precisely from forensic pathology research and necropsy evidence. The autopsies performed and studies written on femicide cases are of extraordinary importance because they make it easy to identify which anatomical districts are most affected, which weapons are most frequently used, and where the bodies of victims of femicide are most often found. To curb this phenomenon, it is essential to act on several levels, starting with the national one. It is necessary to develop a data collection and processing system involving both law enforcement and forensic centers. It is also emphasized the relevance of creating a universal database that can be easily consulted, along the lines of the one that already exists in the United States.

Background: Menstruators facing period poverty often struggle with menstrual hygiene and waste management, which can result in harmful short- and long-term health outcomes such as urinary tract infections, yeast infections, and vulvar contact dermatitis. Research indicates that 42% of menstruators in the United States have difficulty affording period products. Traditional methods of distributing period products through social services may unintentionally undermine menstruators' agency, leading to disempowerment and inefficient resource allocation. Period product pantries are a novel approach aimed at addressing period poverty, inequity, and inadequate menstrual health education in the United States.

Objectives: This paper aims to examine the development, organization, and implementation of two distinct period product pantry networks in Ohio and New York. It seeks to compare the advantages and challenges of grassroots versus nonprofit-led models and to provide practical insights for future pantry operators.

Design: The study examines two models of period product pantries: a grassroots effort led by three local residents in Ohio and an initiative spearheaded by a nonprofit organization in New York. The design includes a comparative analysis of both models' organization, funding methods, and operational structures.

Methods: The authors gathered data on the construction, operation, and usage of two pantry networks, focusing on factors such as accessibility, community engagement, and sustainability. The study employed a combination of qualitative methods, including interviews with organizers, and a review of organizational documents to analyze the effectiveness and scalability of each model.

Results: Both pantry networks increased accessibility to period products in low socioeconomic neighborhoods, which are disproportionately affected by period poverty. The grassroots model, while resource-limited, fostered strong community ties and local engagement. The nonprofit-led model benefited from dedicated staff and a more stable funding structure but faced bureaucratic challenges. Despite their differences, both models demonstrated the potential to empower menstruators by preserving their dignity and autonomy.

Conclusions: Period product pantries represent an innovative and equitable approach to addressing period poverty and inequity. The analysis of the two models offers valuable insights for organizations and individuals interested in establishing similar initiatives. While each model has its unique benefits and challenges, both are effective in empowering menstruators and providing accessible menstrual hygiene products to those in need.

Registration: Not applicable.