Women's health (London, England)最新文献

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.

Background: Climate change has been described as the greatest health threat of the 21st century. Increased evidence of the linkages between climate change and sexual and reproductive health and rights (SRHR) is essential to achieving full realization of SRHR.

Objective: To understand if and how women and girls' perceived climate vulnerability impacts their SRHR decision-making, behaviors, and outcomes in cyclone-affected communities in coastal Khulna, Bangladesh, we conducted qualitative research using an intersectional climate justice lens.

Design: Climate justice states that the climate crisis is not just an environmental or health problem, it is equally a political and social problem, whereby different communities feel the consequences differently, unevenly, and disproportionately depending on a multitude of factors shaped by intersecting systems of power and oppression. We adopted an intersectional climate justice lens to explore how women and girls' intersecting identities impact their experiences with climate change - particularly extreme weather events - and impact their perceived vulnerability. We employed a two-phased participatory qualitative research design.

Methods: We conducted key informant interviews with local SRHR and climate change experts (n = 10) plus in-depth interviews (n = 15) and community dialog meetings (n = 8) with women and girls of reproductive age (n = 49). Transcripts, activity outputs, and field notes were transcribed verbatim in Bangla, translated to English, and subsequently coded and analyzed thematically using Dedoose.

Results: Participants perceived numerous SRHR outcomes to be worsened by the climate crisis, including unintended pregnancy, sexual and gender-based violence, and pregnancy complications. Impacts were experienced differently across social categories, with overlapping identities including age, marital status, and religion magnifying vulnerability and risks to SRHR. Participants identified comprehensive SRHR and advances toward gender equity as essential for building climate resilience.

Conclusion: Our findings provide actionable recommendations to support the full realization of climate justice and SRHR.

Almost half of all pregnancies worldwide and 34% of pregnancies in high-income countries are considered unintended. Several studies from high-income countries report that women from rural areas are more likely to continue their unintended pregnancy and give birth, while urban women are more likely to have an induced abortion. To explore how rurality influences women's decision making and pregnancy choices following unintended pregnancy by examining the global trends for women who reside in rural areas of high-income countries. This study is a systematic review of qualitative, cross-sectional and mixed-methods studies. A systematic review of peer-reviewed literature, published from January 2000 through to March 2024, retrieved from five databases: CINAHL, Embase, MEDLINE, PsycINFO and PubMed. Restrictions were applied to obtain original research that has been undertaken in high-income countries. The review included studies featuring participants that were either rural women who experience an unintended pregnancy or health care professionals providing direct care to rural women. Nineteen studies met the inclusion criteria and were included in this review. Several factors that influenced rural women's decision making following an unintended pregnancy were identified: access to abortion services; role of health care professionals; temporal factors; social norms and stigma; social factors and determinants; culture, ethnicity and religion; reproductive coercion and abortion legislation. The Social-Ecological Model highlighted the levels of interaction, the role health care professionals, family members and the wider community in supporting or obstructing rural women's decision making. Rural women's pregnancy decision making and reproductive autonomy can be compromised by intimate partners, family members, health professionals and rural culture. Health professionals have a pivotal role in supporting and respecting rural women's decision making when seeking an abortion and ensuring that rural women have timely access to abortion care. Registration number: PROSPERO CRD 42023409917.

Background: Intermammary pilonidal sinus disease (IMPSD) is a rare condition that primarily affects the young population. Due to the absence of standardized guidelines, IMPSD poses significant challenges during management.

Objectives: This scoping review aims to map and characterize the existing literature on IMPSD to provide an overview of clinicopathological characteristics, risk factors, diagnosis, and management.

Eligibility criteria: Studies were included if they were original articles, case reports, or case series that met the inclusion criteria published in English during 2004 to 2024.

Sources of evidence: A search was conducted using MeSH keywords "Intermammary" AND "Pilonidal sinus" in PubMed, Google Scholar, and by citation searching up to date.

Charting methods: The PRISMA ScR guidelines were used as a charting method. Data extraction included demographic characteristics, clinical pathological characteristics, diagnostic methods, treatment approaches, and follow-up outcomes.

Results: Ten articles met the inclusion criteria, including 33 patients with a mean age of 18.7 years. The majority of cases were reported from Turkey, Iraq, and India. Mean body mass index was 28.74 kg/m². Significant other comorbidities included polycystic ovary syndrome in 24% of cases. Large pendulous breasts and wearing tight brassieres were noted as other risk factors. Clinical presentation commonly involved discharging sinuses and painful swellings, with a mean duration of 8 months. Complementary investigations were seldom performed as the diagnosis was mainly clinical. The main modes of treatment included resection with primary closure or resection with secondary healing.

Conclusion: Low prevalence and management challenges highlight the need for further research to establish standardized guidelines and the importance of formulating an individualized plan for the management of IMPSD based on a comprehensive evaluation of clinicopathological characteristics and patient wishes.

Background: Only 52% of pregnant women achieve the recommended amount of physical activity throughout pregnancy. Many studies have aimed to improve health-related outcomes by introducing physical activity interventions during pregnancy. A systematic search summarizing studies using self-reported physical activity measures is necessary, as this is a clinical outcome measure that can be utilized routinely in clinical practice.

Objectives: The purpose of this systematic review was to synthesize, critically appraise, and determine the effectiveness of interventions designed to improve self-reported measures of physical activity in pregnant women.

Design: Systematic review.

Data sources and methods: EBSCO and PubMed were searched from January 1, 2014, through January 1, 2024. A hand search of references was also performed. Included studies must have utilized a randomized controlled trial or clinical trial design where a physical activity intervention was implemented, included healthy pregnant women, and utilized a self-reported physical activity measure pre- and post-intervention. Two reviewers independently appraised each article with the Physiotherapy Evidence Database scale. The Strength of Recommendation Taxonomy was used to make an overall strength of recommendation.

Results: Twelve studies met the inclusion criteria for this systematic review. Seven studies were ranked as "fair" quality, and five studies were ranked as "good" quality. The primary groupings of the interventions included the following: phone or app-based, face-to-face counseling, or group fitness classes/access to local resources. Eight studies provided sufficient data to calculate effect sizes and associated 95% confidence intervals. The largest effect sizes were calculated for the phone or app-based interventions.

Conclusions: A level B strength of recommendation was given to evidence supporting phone or app-based interventions, counseling interventions, and group fitness or access to local resources interventions. Future research should focus on further investigating the use of phone or app-based interventions or counseling interventions to promote physical activity among pregnant women.

Registration: Prospero CRD42024526761.

Background: Women's health is all about managing conditions unique to females, such as polycystic ovary syndrome (PCOS). Here, a mixed-method approach was used to evaluate the knowledge of PCOS among Palestinian women and to elucidate gynecologists' perspectives on its diagnosis and management.

Objectives: The purpose of this mixed-method research was to assess knowledge of PCOS among Palestinian women and develop a greater understanding of gynecologists' experiences treating PCOS.

Design: A mixed-method study was used to evaluate the knowledge of PCOS among Palestinian women and to explore gynecologists' perspectives on its diagnosis and management.

Methods: The qualitative study involved semi-structured interviews with six experienced gynecologists and was reported according to the Standards for Reporting Qualitative Research. Thematic analysis was applied to analyze the data. A cross-sectional quantitative study was then introduced to validate the findings of the qualitative study. It utilized a validated questionnaire that was distributed to Palestinian women, with 584 respondents meeting the inclusion criteria.

Results: The qualitative interviews revealed some important themes related to gynecologists' experiences and perceptions of PCOS, particularly misconceptions and knowledge gaps among PCOS patients. The quantitative study indicated participants to have scant knowledge about PCOS, with an average of 9.6 correct answers out of 21 (45.7%). Participants' main source of knowledge was websites (n = 138, 27%). More than half of the participating women believed that PCOS patients require social support (57.3%). Education and career field were associated with degree of knowledge about PCOS (p-value = 0.000 for each). In addition, diabetes history and PCOS history showed significant relation to PCOS knowledge (respective p-values = 0.046, 0.002).

Conclusion: The results emphasize the importance of PCOS awareness among women and the difficulties gynecologists face during management of PCOS. There is a need to increase awareness of PCOS for women of all ages, standardize PCOS treatment among gynecologists, and encourage healthcare providers to educate women about PCOS.