Women's health (London, England)最新文献

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.

Background: Limited emergency contraception (EC) use contributes to unintended pregnancies and health risks among adolescents and young adults in conflict-affected regions. In Northern Uganda's post-conflict setting, there is a need for research on EC utilization among adolescents and young adults.

Objective: We assessed emergency contraceptive utilization and associated factors among adolescents and young adults in Gulu East Division, Northern Uganda, following 25 years of post-conflict recovery.

Methods: A community-based cross-sectional study was conducted among 400 adolescents and young adults in Gulu East Division using self-administered questionnaires. Data analysis involved descriptive statistics and logistic regression using STATA (StataCorp LLC) to identify factors associated with EC utilization.

Results: Among 400 participants, 322 (80.5%) were aware of EC, but only 173 (43.3%) utilized it. Correlation analysis revealed negative correlations between age and employment status and living arrangement, and a positive correlation between education level and marital status. Multivariate analysis showed that EC utilization was significantly associated with age, education level, employment status, living arrangement, and EC service offer. Women aged 14-19 years and those not offered EC services were less likely to use EC (adjusted odds ratio (aOR) = 0.47), while women with secondary education (aOR = 3.05), employed women (aOR = 2.76), and those living alone (aOR = 9.76) were more likely to use EC.

Conclusion: There is a gap between awareness and utilization of EC among adolescents and young adults in Gulu East Division. Targeted interventions are needed for adolescents and those with limited access to EC services to increase utilization and prevent unintended pregnancies.

Background: Although the survival rate has increased among women with breast cancer, many women experience psychological sequelae, including stress, which affects their quality of life. Healthy lifestyle behaviors are essential for reducing stress in breast cancer survivors and minimizing long-term treatment complications.

Objective: This study examined the temporal relationships among health-promoting lifestyle behaviors (HPLBs) and perceived stress in women with early-stage breast cancer.

Design: This research was a secondary analysis of a longitudinal biobehavioral study of women with early-stage breast cancer funded by the National Institute of Nursing Research.

Methods: This study included a sample of 73 participants. Measures of the study were evaluated at five-time points beginning just before the initiation of chemotherapy until 24 months from the first chemotherapy treatment. General linear mixed models and regression were used for analysis.

Results: Study results showed an inverse association among the health-promoting lifestyle profile (HPLP) with perceived stress (p = <0.0001). The health-promoting lifestyle subscales with the highest means were interpersonal relationships and spiritual growth. In addition, the results demonstrated changes in perceived stress levels from baseline assessment until 24 months from the initial chemotherapy treatment.

Conclusions: This study indicated that HPLBs, selected demographics, and clinical factors have a role in the perception of stress among women with early-stage breast cancer. Future studies, with larger samples, are needed to confirm these findings.

Background: Postpartum women worldwide, despite wishing to delay or avoid pregnancies, often resume sexual activity without family planning, contributing to 121 million unintended pregnancies annually, particularly in sub-Saharan Africa. Postpartum family planning (PPFP) can prevent 71% of unintended pregnancies and reduce maternal and neonatal morbidity and mortality. However, uptake in Uganda is low, at 35%, and data on its use are scarce. Sociocultural barriers, limited access to quality healthcare, and systemic inequities further hinder uptake.

Objective: To assess the level of utilization of PPFP and the contributing factors among postpartum women attending health facilities in a rural district of Northern Uganda.

Methods: A descriptive cross-sectional study was conducted among 483 women within 12-month postpartum, recruited from 5 randomly selected health facilities between October and November 2022. Quantitative data were collected using interviewer-administered questionnaires. Data were analyzed using STATA version 17.0, with descriptive statistics and multivariate logistic regression performed at a 95% confidence interval (CI) to identify predictors of PPFP utilization.

Results: The utilization of PPFP was 41.61% (95% CI: 37.17-46.15). Independent predictors or contributing factors to PPFP utilization included education level (primary-adjusted prevalence ratio (APR): 0.753; 95% CI: 0.641-0.883; p = <0.001), partner's age (APR: 1.203; 95% CI: 1.004-1.443; p = 0.05), parity (APR: 0.755; 95% CI: 0.635-0.897; p = 0.001), uncertainty about timing for next pregnancy (APR: 1.994; 95% CI: 1.09-3.646; p = 0.03), and advice from friends about PPFP methods (APR: 1.358; 95% CI: 1.171-1.575; p = <0.001).

Background: Human immunodeficiency virus (HIV) remains one of the biggest health challenges facing the world, with approximately 39 million people reported to be living with the virus. Despite low prevalence rates in the Middle East and North Africa region, Jordan faces a growing trend of new infections driven by factors such as refugees, migration, and socioeconomic status. Premarital examination is a requirement for Jordanian couples to get married and would play a role in sexually transmitted disease (STD) awareness and prevention, including HIV.

Objectives: The purpose of this research is to assess the impact of premarital examinations on HIV knowledge, attitudes, and stigma in ever-married women aged 15-49 in Jordan.

Design: Cross-sectional design.

Methods: Data were retrieved from the most recent Jordan Population and Family Health Survey, a nationally representative survey of health dynamics. Premarital examinations and comprehensive HIV knowledge were assessed by survey modules covering history of premarital examination and tests performed and respondents' understanding of HIV transmission and prevention. Participants were categorized based on their responses to five key statements about HIV/AIDS.

Results: In this study, there were 14,689 respondents. The mean age (±SD) of the participants was 34.5 (±8.5) years. Most of them (92%) were currently married. More than half of the respondents underwent premarital medical checkups. However, discriminatory attitudes toward people living with HIV were high among respondents. Only 8.7% of the respondents showed adequate comprehensive HIV knowledge; their level of understanding regarding modes of transmission and misconceptions about prevention also varied. The adjusted model showed that there was no significant difference in HIV knowledge between those who had a premarital exam and those who had not. However, higher education levels were associated with better HIV knowledge.

Conclusion: The findings indicate that the level of HIV knowledge among Jordanian women is poor and was not associated with undergoing premarital examination and counseling. This suggests redesigning the mandatory premarital examination and counseling to have stronger STDs and HIV awareness and prevention components. This change may improve knowledge and encourage safer health behaviors, thus helping to combat stigma and misinformed views about HIV in Jordan.

Background: The menopausal transition is a critical phase in a woman's life marked by hormonal fluctuations that can result in a wide variety of physical and psychological symptoms. These symptoms vary in strength and their negative impacts on women's health and well-being. One of the most severe impacts of (peri)menopause is increased vulnerability to suicidality in some women, yet no systematic review has examined the holistic relationship regarding this potential link.

Objectives: To examine the relationship between the menopausal transition and suicidality, and identify menopause-related factors contributing to increased suicide risk.

Design: A systematic review was conducted in accordance with PRISMA guidelines.

Data sources: MedLine, CINAHL, PsychINFO, Web of Science and Cochrane Library were searched for studies addressing both menopause and suicidality. Studies were screened independently by two reviewers. Data extraction focused on suicidal ideation, attempts, and completed suicide among menopausal women. The quality of included studies was assessed using the Mixed Methods Appraisal Tool.

Results: Nineteen studies published between 1987 and 2025 met the inclusion criteria. Of the 19 studies, 16 (84%) reported an association between the menopausal transition and increased suicidality, with 7 studies specifically noting this association in perimenopausal women. Hormonal changes, pre-existing mental health conditions, physical symptoms, and limited social support emerged as key factors associated with increased suicide risk. Three studies did not find a significant link.

Conclusion: There is some evidence of an association between the menopausal transition and suicidality, particularly during perimenopause, though conclusions are limited by study design and heterogeneity. The review highlights the importance of integrating mental health support within menopause care and suggests further research to clarify the mechanisms underpinning suicide risk during the menopausal transition. Enhanced screening and supportive interventions may benefit menopausal women experiencing suicidality.

Background: Maternal infections are responsible for maternal mortality and can lead to adverse pregnancy outcomes such as stillbirth, maternal sepsis, and spontaneous abortion as well as dire outcomes for the neonate. The impact of obstetric infections is largely felt in low- and middle-income countries, with Pakistan being one such country.

Objectives: To assess the frequency of maternal infections, the common sources responsible for their progression and their resulting impact on pregnancy, maternal, and neonatal health outcomes.

Design: An observational cross-sectional study was conducted in a tertiary care, public sector hospital in Pakistan.

Methods: A total of 439 women, either antenatal or postnatal, with symptoms of infection were enrolled. Case report forms were used to collect data on clinical characteristics, type of infection, investigational and diagnostic profile, and pregnancy, maternal, and neonatal outcomes. Frequency and percentages were computed for categorical variables. Comparisons of pregnancy and neonatal outcomes were analyzed by the chi-square test or Fisher's exact through categorization of patients as per the severity of their condition.

Results: The observed frequency of maternal infections was 12% in pregnant or recently pregnant women admitted during the study period. Respiratory tract infection (16.9%) and chorioamnionitis (14.4%) were more prevalent among antenatal women, whereas wound/skin infection (15.5%) and puerperal/genital tract infection (12.3%) were the most common infections observed in postnatal women. Blood transfusion was the most common complication observed in the included women (26.9%). Among the study population, 13.9% had organ dysfunction, primarily cardiovascular (42.6%) and neurological dysfunction (40.9%). Women with severe infection had adverse pregnancy outcomes such as a high number of still births (17.5%). The total number of maternal deaths recorded was 19 (4.32%). Regarding neonatal outcomes, APGAR score, suspicion of infection, and low birth weight were significant across the severity groups. There was no significant difference for neonatal deaths across the three groups.

Conclusion: Infections from various sources contribute significantly toward adverse maternal, pregnancy, and neonatal outcomes. Enforcing infection prevention measures, equipping primary healthcare units with adequate resources and emphasizing antenatal and postnatal care can prevent infections and their related complications. Early detection and management of maternal infections is equally necessary.

Background: There have been impressive advancements made in preventing and treating HIV. However, the impacts have not been experienced equally across demographics in England. African born persons, in particular women of Black African ethnicity, continue to be disproportionately affected by HIV. HIV prevention campaigns have often overlooked social, cultural, and structural factors that shape access to HIV prevention.

Objectives: This paper explores how women of African and Caribbean heritage understand HIV within their social networks, and how they perceive HIV and sexual health services. This insight is needed to develop more inclusive and effective approaches to HIV prevention.

Design: This study adopted a participatory action research framework, acknowledging lived experience as a basis of knowledge.

Methods: Focus groups and one-to-one interviews were used to collect qualitative data from a local community women's group between June 2021 and November 2021. In total, 23 women of African and Caribbean heritage participated in this study. Four women opted to take part in a one-to-one interview, and 19 women participated in one of five focus groups. Data were analysed using an applied thematic analysis.

Results: Three key themes emerged from the data. Enduring fear of HIV rooted in past lived experiences: Fear of HIV derives from traumatic lived experiences, which have shaped trust in health care services in England and limited the acceptance of information about HIV treatment, such as U=U (Undetectable = Untransmittable). Responsibility for HIV transmission and prevention: There was a low perception of HIV acquisition risk, shaped by personal circumstances and stigmatising beliefs. For those acknowledging they may be at risk of HIV acquisition attributed this to the behaviour of their male partners. Motivation to change attitudes and reduce stigma: Participating in this study provided a safe space for women to share their experiences of HIV, ask questions, and learn new information, revealing focus groups as an effective method of raising awareness and reducing stigma.

Conclusions: Multiple factors shape the understanding of HIV and uptake of HIV prevention among women of African and Caribbean heritage. Local, community-specific, and participatory HIV prevention interventions are needed to understand and respond to these factors.

Background: Menopause has been linked to an array of symptoms, often with adverse effects on quality of life, work and relationships. Despite evidence of economic and social impacts, and a growing population of menopausal individuals, there are significant gaps in knowledge regarding menopause. Gastrointestinal (GI) symptoms in peri- and postmenopause are areas of uncertainty that warrant further investigation.

Objectives: Following JBI guidance, this scoping review aimed to systematically map research on GI symptoms in 'natural' peri- and postmenopause, exploring the volume and conduct of research, and variables investigated that could influence symptom experience.

Eligibility criteria: Studies assessing GI symptoms (constipation, diarrhoea, vomiting, nausea, abdominal pain, heartburn, faecal incontinence and bloating) in 'natural' menopause from all publication dates were included. Studies of medical/surgical menopause, with participants on hormone therapies, or not published in English were excluded.

Sources of evidence: Results of comprehensive searches of databases (MEDLINE, Embase, PsycINFO, CINAHL, AMED, Scopus, Web of Science, CENTRAL, ProQuest Dissertations and Theses), trial registries, citation and web-searches were screened against eligibility criteria.

Charting methods: Data were charted in a standardised template, including study designs, populations, countries, GI symptoms studied, methods used for their assessment, and variables investigated. Analyses included frequency counts and percentages, with findings presented in visual and tabular formats.

Results: Overall, 122 studies were included, published between 1981 and 2024. Studies were predominantly quantitative in design, with constipation the most frequently investigated symptom (n = 58), in contrast to vomiting (n = 4). Results highlighted limited studies from South American and African regions, and insufficient reporting of the criteria used to determine menopausal stages and assess GI symptoms.

Conclusions: While many studies were identified, findings indicate evidence gaps and methodological considerations pertinent to researchers and funders, regarding study designs, assessment and reporting of menopausal stages and GI symptoms, and the variables investigated. Recommendations are made for future research.