Women's health (London, England)最新文献

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: There is increasing evidence that menstrual changes (MC) should be considered as an adverse event resulting from COVID-19 vaccination. However, the contributing health factors are still poorly understood.

Objectives: The aim was to analyze the characteristics and factors influencing MC after the administration of the severe acute respiratory syndrome coronavirus 2 vaccine.

Design & methods: A retrospective observational study of currently menstruating women (N = 14,550) in Spain was conducted during the month of December 2021 using an online survey. Among others, general characteristics of the menstrual cycle, medical history, and adverse events following vaccination-including MC-were recorded. Bivariate logistic regression analysis was performed to determine the influencing factors.

Results: 45.0%-50.9% of respondents reported experiencing mostly transient MC after both doses of COVID-19 vaccine, including different spotting (41.6%-49.0%), longer periods (26.5%-29.5%) and/or heavier flow (28.7%-31.6%). Binary logistic regression analysis showed that some of the inter-individual factors that may be involved in this unexpected event are age (dose 2: adjusted odds ratio (aOR): 1.02; 95% confidence intervals (CI): 1.02-1.03), heavy menstrual flow (dose 1: aOR: 1.12; 95% CI: 1.00-1.25), use of short- (dose 1: aOR: 1.38; 95% CI: 1.24-1.54) to medium-term contraception (dose 1: aOR: 1.31; 95% CI: 1.09-1.57), number of previous pregnancies (dose 1: aOR: 1.11; 95% CI: 1.03-1.19), pre-existing diagnoses of certain clinical conditions-including endometriosis (dose 1: aOR: 1.33; 95% CI: 1.11-1.59)-and suffering from other vaccine adverse events.

Conclusion: Currently menstruating women may experience MC after COVID-19 vaccination. Further research is warranted to address the influencing factors, considering their heterogeneity according to the geographical background of the target population. This kind of evidence could prove instrumental in the context of future viral outbreaks, helping healthcare professionals to provide scientifically up-to-date information to patients for making informed decisions regarding their well-being, particularly in societies where menstruation remains a taboo subject.

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.

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women, linked to metabolic, hormonal, and psychological issues. Management typically involves lifestyle changes, including increased physical activity and reduced sedentary behaviour.

Objectives: To compare the health profiles and behaviours of women with and without PCOS.

Design: This study analysed data from the UK Biobank, which is a prospective cohort study.

Methods: Women with PCOS in the UK Biobank were identified, while age- and body mass index (BMI)-matched controls were randomly selected. Data on factors associated with PCOS severity and self-reported lifestyle behaviours were analysed. Group differences were tested for significance, and participants were categorised by health behaviours to assess morbidity risk.

Results: The study included 319 women with PCOS (mean age: 43.9 years) and 638 in each control group. Significant differences (p < 0.05) were observed in anthropometric (e.g. body weight, BMI, waist and hip circumference, and body fat), cardio-metabolic (e.g. blood pressure, triglycerides, and glycated haemoglobin), and androgenic (e.g. sex hormone-binding globulin) indices. Differences were most pronounced between PCOS and age-matched controls but remained when BMI was also considered. Women with PCOS engaged in less vigorous physical activity and had higher screen time and sedentary behaviours. Those with the lowest physical activity and highest sedentary time had the worst health profiles and highest morbidity risk, regardless of group.

Conclusion: Women with PCOS exhibit poorer health despite only slight lifestyle differences. Across all participants, lower physical activity and higher sedentary behaviour were linked to increased health risks. Further research is needed to clarify causal relationships between lifestyle factors and PCOS.

Background: Nearly half of people report birth-related complications, which is thought to be a risk factor for postpartum depression (PPD).

Objectives: The goal of this systematic narrative review and meta-analysis was to provide an updated examination of the literature linking specific maternal birth complications and PPD.

Design: A systematic review was conducted focused on studies examining associations between specific maternal birth complications and PPD symptoms/and or diagnoses, along with meta-analyses to quantify the magnitude of associations for specific experiences. The review protocol was not pre-registered.

Methods: Searches were completed using PsycINFO and PubMed databases. We used four eligibility criteria: (a) article available in English, (b) study included a measure of dimensional or diagnostic depression, (c) include discrete experience of birth-related complication, and (d) included a statistical test of the bivariate association between depression in the postpartum period and a measure of birth-related complication. We excluded studies of newborn intensive care or infant health conditions, rather than maternal birth complications directly impacting the pregnant person's health. All analyses were conducted using Comprehensive Meta-Analysis Software. We considered patterns in sampling, measurement, and analytic designs. To address publication bias, we examined funnel plots and calculated Egger's test.

Results: The review (61 studies; 1,853,282 total participants) revealed four categories of maternal birth complications (i.e., cesarean, preterm birth, pain, laceration). Both the narrative review and meta-analysis support positive associations between maternal birth complications overall and PPD symptoms and diagnoses (odds ratio, OR = 1.47, p < 0.001), with specific associations observed for cesarean deliveries (non-emergency: 1,792,725 participants; OR = 1.30, p < 0.001; emergency: 14,199 participants; OR = 1.48, p = 0.001), preterm birth (39,291 participants; OR = 1.97, p < 0.001), and pain (3,708 participants; OR = 1.75, p = 0.009). ORs were small-to-medium in magnitude. Laceration alone was not significantly associated with PPD (3,356 participants; OR = 1.18, p = 0.692).

Conclusions: This study expands upon previous research and provides nuanced perspective on the relationship between different types of maternal birth complications and PPD. This review was supported by a Ford Foundation Predoctoral Fellowship and 1F31MH135650-01.

Nicotine use during pregnancy remains a widespread problem in obstetrics, leading to complications such as intrauterine growth restriction, preterm birth, stillbirth, and sudden infant death syndrome. Consistent education by medical personnel is essential, as no medication or supplement has been found to prevent the dangers of nicotine use during pregnancy. If a pregnant woman is unable to quit nicotine despite intensive efforts, vitamin C, with its antioxidant properties, may help mitigate these risks, as suggested by some studies. This review summarizes current knowledge based on publications related to vitamin C, nicotine, and pregnancy. Research was conducted on the medical literature platforms PubMed and Cochrane Library, using all relevant studies to provide a comprehensive overview of the topic. The identified studies primarily examined the impact of maternal smoking and nicotine on placental function, as well as the respiratory, cardiac, neuronal, and bone systems of the offspring. They suggest that vitamin C has a generally positive preventive or protective effect, though no study has shown complete compensation for the damage caused by nicotine. Nicotine abstinence remains the most crucial preventive measure. If this is not achievable despite intensive efforts by medical personnel, vitamin C supplementation during pregnancy may be considered. With a very low side effect profile, a daily dose of up to 500 mg can be recommended. However, further studies are necessary to provide reliable data on the effectiveness and appropriate dosage, given an ethically justifiable study approach.

Background: Robotics-assisted surgery (RAS) offers several advantages over traditional laparoscopic surgery, such as enhanced precision, dexterity, and ergonomics, and allows stable movements with tremor filtering and motion scaling. The new multi-modular Hugo™ RAS system is commercially available in certain countries and is used in urological, gynecological, and general surgical procedures.

Objectives: To document the experience with the use of the Hugo™ RAS system in 20 patients who underwent surgery for various gynecological conditions at a hospital in Hyderabad, India.

Design: Real-world single-center study.

Methods: Twenty patients (45.3 ± 6.5 years) who were admitted to a tertiary care center (September 2022-2023) underwent hysterectomy (n = 18), accessory and cavitated uterine mass excision (n = 1), and myomectomy (n = 1) using the Hugo™ RAS system. The evaluated outcome parameters included docking time, console time, blood loss (intraoperative and postoperative), length of hospital stay, postoperative complications, and postoperative pain perception measured as per visual analog scale (VAS) scores at multiple time points.

Results: The mean docking time was 6.3 ± 2.0 min, and the mean console time was 86.9 ± 20.3 min. Blood loss (intraoperative and postoperative drain) was 103.5 ± 62.4 mL, not requiring blood transfusion for any patient. Per hospital norms, each patient had a hospital stay lasting for 2 days. None of the patients experienced immediate postoperative complications. Minor late complications were observed in two patients. Postoperative pain perception decreased with time. VAS scores were 3.2 ± 0.4 (1 h), 2.2 ± 0.4 (6 h), and 1.0 ± 0.0 (12 h), and no pain was perceived 1 week after surgery.

Conclusion: Based on initial experience, the Hugo™ RAS system provides favorable results for gynecological patients, with benefits including efficient docking time, short surgery duration, minimal blood loss, short hospital stay, few postoperative complications, and low pain perception. Future studies comparing the Hugo™ RAS system with other robotic surgical platforms in gynecological procedures are essential.