Women's health (London, England)最新文献

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.

Background: Violence against women (VAW) poses a serious threat to the psychological and physical health of women. Food insecurity is both a cause and outcome of VAW, with further consequences for women's health. The COVID-19 pandemic exacerbated economic insecurity and, as a result, the cycle of VAW and food insecurity, demonstrating that VAW survivors have multifaceted needs when healing from situations of violence.

Objectives: To explore meanings of food and experiences of food insecurity among VAW survivors accessing supportive services during the COVID-19 pandemic, with the goal of informing holistic and trauma-informed service delivery.

Design: This analysis is based on qualitative data collected as part of the mixed-methods community-based Marginalization and COVID-19 (MARCO)-VAW study.

Methods: We applied reflexive thematic analysis to qualitative interview data from 10 survivor participants who accessed VAW services in the Greater Toronto Area, Canada during the COVID-19 pandemic and supplemented it with interview data from 18 staff participants working on those services.

Results: We generated three themes relevant to meanings of food and experiences of food insecurity among VAW survivors: (1) power dynamics as barriers to food and achieving independence for survivors of VAW, (2) intersection between food insecurity and motherhood, and (3) reclaiming food independence and power after abusive situations.

Conclusions: Food security and autonomy promoted healing and provided a sense of independence for VAW survivors living in or transitioning out of both violent situations and shelters during the COVID-19 pandemic. To better support VAW survivors, organizations that support survivors need to be appropriately resourced to provide food-related programming, supports, and diverse food options, including during public health emergencies, when economic precarity and social isolation increase. Gender-transformative policy is necessary to prevent gender-based and intersectional inequities in violence and food insecurity.

This editorial addresses the critical yet often overlooked issue of sexual health among migrant and refugee women. With nearly half of the world's 281 million international migrants being women, their unique health challenges demand urgent attention. As a conceptual discussion, this editorial does not present empirical data but rather synthesizes existing literature and expert insights to explore the multifaceted barriers these women face, including financial constraints, language obstacles, cultural taboos, and social exclusion. We examine the complex interplay between acculturation and sexual function, emphasizing how cultural transitions influence sexual well-being. The discussion explores how cultural background shapes sexual attitudes, highlighting the need for culturally sensitive approaches in healthcare delivery. We propose multifaceted solutions, including developing culturally competent healthcare services, implementing targeted education programs, and improving research methodologies. This editorial aims to break the silence surrounding these issues and calls for concerted efforts to address the sexual health needs of migrant and refugee women, ultimately fostering healthier, more equitable societies.