Women's health (London, England)最新文献

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.

Background: During the menopause transition, one in three women experiences abnormal uterine bleeding. Few studies have evaluated the probability of hysterectomy associated with abnormal uterine bleeding during the menopause transition.

Objectives: To estimate the risk of hysterectomy associated with abnormal uterine bleeding, specifically prolonged or heavy menstrual bleeding, during the menopause transition.

Design: Prospective cohort studyMethods:We used data collected in the Study of Women's Health Across the Nation, a community-based, longitudinal cohort that followed women from pre- to post-menopause. It includes 1200 White (45.4%), Black (15.4%), Japanese (20.8%), and Chinese (18.4%) women, from three study sites that participated in a sub-study and provided at least 1 year of prospectively recorded menstrual calendars. Calendars ascertained bleeding days, menstrual interference with life in four domains (work, daily life, sexual life, and relationships), menopausal hormone therapy, and smoking. At baseline and 12 annual follow-up visits, information on surgeries, body mass index, pelvic pain, and socio-demographic characteristics was obtained. Multivariable Cox proportional hazard models were used to assess the relationships of hysterectomy with prolonged menstrual bleeding, heavy menstrual bleeding, and covariates.

Results: Women who reported prolonged menstrual bleeding had an elevated hazard of hysterectomy (hazard ratio = 2.35, 95% confidence interval = 1.20-4.61), adjusting for pelvic pain, hormone use, and race/ethnicity; hazard ratios were attenuated after adjusting for life interference. The association of heavy menstrual bleeding with hysterectomy was not statistically significant (hazard ratio = 1.34, 95% confidence interval = 0.42-4.30). The adjusted hazard ratio for hysterectomy increased 1.5-fold for each domain in which bleeding interfered with a woman's life. Pelvic pain, hormone therapy, and Black race were also significant predictors of hysterectomy risk.

Conclusion: Prolonged menstrual bleeding during the menopause transition, particularly when accompanied by interference in one or more domains of a woman's life, increased the risk of hysterectomy. Counseling women about non-surgical therapeutic options, and estimating the proximity of menopause, may mitigate against this increased risk.

Background: Research suggests that women with polycystic ovary syndrome (PCOS) are more likely to suffer from mental health disorders, emotional distress, and have altered hormone profiles (e.g., higher androgens). Past research suggests facial emotion processing is affected by hormones (e.g., androgens), mental health-related disorders, and may be altered in PCOS.

Objectives: The present study examined whether facial emotion recognition (FER) differs between women with and without PCOS symptoms.

Design: Observational case-control design.

Methods: Three groups of participants (women with provisional PCOS, women without PCOS, and men; N = 178) completed a FER task that involved identifying emotions (anger, disgust, fear, happiness, sadness, surprise, or neutral) in images of emotional faces. Overall emotion recognition and emotion-specific accuracy were examined. PCOS symptom severity and provisional diagnoses were also assessed in women via self-report measures, including the polycystic ovary syndrome questionnaire.

Results: Women with provisional PCOS had significantly lower emotion recognition accuracy than those without PCOS, and emotion-specific differences were found for fear and disgust. A significant linear effect also emerged for overall FER, revealing men as the least accurate, followed by women with provisional PCOS, and then women without PCOS.

Conclusions: The results suggest that women with PCOS may have difficulty with emotion recognition, especially fear and disgust. The sex difference in emotion recognition was in line with previous research. These findings are consistent with the theory that androgens affect emotion recognition and suggest implications for PCOS symptoms on women's emotional well-being and socioemotional functioning.

Background: Uterine fibroids (UFs) are the most common benign tumours of the uterus and are often asymptomatic. However, there is a high incidence of symptomatic fibroids among Black women, with many presenting late for treatment.

Objective: We examined the patterns and risk factors associated with the late presentation of UF in Black women.

Designs: Mixed methods study design: A quantitative and qualitative approach.

Methods: An interviewer-administered questionnaire was used to obtain information about the late presentation of UF from 138 women at the Gynaecology clinic of the University College Hospital, Ibadan, Nigeria. For the qualitative component, in-depth interviews were conducted with eight women experiencing symptomatic fibroids. The odds of late presentation were analysed across socio-demographic, obstetrics and clinical characteristics, along with the type of diagnosis, using logistic regression with a statistical significance level set at p < 0.05. Qualitative data were examined through an inductive thematic analysis, focusing on emerging themes.

Results: The mean age of participants was 36.80± 7.24 years, with a significant proportion (62.3%) presenting late, more than 6 months after the onset of symptoms and 65.1% having multiple UFs. Factors associated with late presentation included age (AOR = 4.000; 95% CI 0.086-0.0730), parity (AOR = 3.299; 95% CI 1.150-9.464) and presenting with subfertility or infertility (AOR = 0.070; 95% CI 0.020-0.249). The qualitative findings highlighted how situational factors such as inadequate knowledge of the condition, aversion to surgery, negligence, cultural misconception and financial constraints contributed to late presentation.

Conclusion: A significant number of women, particularly older and nulliparous individuals, sought care late for symptomatic UFs. Increased sensitization and targeted educational interventions are needed to encourage early presentation and timely treatment. Implementing effective health strategies that address the reasons for late presentations will improve health outcomes for women with symptomatic fibroids.

Background: Women with disabilities have a similar desire for pregnancy as their non-disabled peers but experience more ambivalence and doubt about their intention to have a child. While many have healthy pregnancies, they face higher risks and trade-offs in health, function, and independence.

Objectives: To review the literature on pregnancy in women with physical disabilities to guide interventions and clinical care guidelines.

Eligibility criteria: Abstracts were reviewed if they were original research on pregnancy involving adult women with physical disabilities. Both qualitative and quantitative studies were included, with no restrictions on language or publication year.

Sources of evidence: PubMed, Scopus, and CINAHL Complete and reference lists of eligible articles.

Charting methods: Abstracts were eligible for full-text review if they were (1) original research, (2) in humans, (3) about pregnancy, and (4) involved adult women with physical disabilities. Data were extracted by independent reviewers using Covidence software and assessed with a customized critical appraisal guide.

Results: Five major topics characterized 171 reviewed articles: (1) rates of pregnancy, fertility, and termination or loss; (2) pregnancy complications and infant outcomes; (3) effects of pregnancy on physical function disease activity; (4) maternal care; and (5) social and interpersonal dimensions of pregnancy. Most studies were conducted in the Americas and Europe, and high-income countries used a quantitative design and were assessed to have a moderate risk of bias.

Conclusions: This review highlights the need for future research to (1) build a stronger evidence base for tailored maternal care, (2) examine disability discrimination's impact on pregnancy outcomes, (3) develop interventions to reduce disability-related inequities, and (4) improve disability competence among maternal care providers.

Background: Black women, relative to their Black male and White counterparts, may be more prone to experiencing racism and sexism in academic and other professional settings due to the "double jeopardy" or stigma of being both Black and a woman. Few studies have quantitatively studied how Black women in academic and professional spaces may mitigate the oppressive circumstances experienced by engaging in a coping strategy called identity shifting.

Objectives: This study used an intersectional framework to investigate the relationships between the strong Black woman (SBW) stereotype, gendered racial identity centrality (GRIC), identity shifting, and mental health outcomes among 289 Black women (M_age = 29.46 years, SD = 10.74). It was hypothesized that there was a significant positive relationship between endorsement of the SBW schema, GRIC, and identity shifting. Additionally, we hypothesized the relationship between SBW and identity shifting is moderated by mental health such that more (a) depressive (b) and anxiety symptoms will result in a stronger relationship between stereotype endorsement and identity shifting strategies.

Design: This study employed a quantitative, cross-sectional design using data collected in 2019 and 2020 from a larger validation study.

Methods: Participants were recruited through emails, campus flyers, text messages, and social media postings. After providing informed consent, participants completed a 30- to 40-min online survey via Qualtrics.

Results: There was partial support for the first hypothesis. While greater endorsement of the SBW stereotype by Black women did result in engagement with more identity shifting strategies, the relationship between these strategies and GRIC was not significant. The second hypothesis was not supported as mental health variables did not moderate the relationship between SBW and identity shifting.

Conclusion: The importance of examining the gendered racial experiences of Black women is discussed, along with the importance of addressing SBW and identity shifting in academia and in professional workspaces.