Women's health (London, England)最新文献

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.

Background: Sex and gender disparities persist across biomedical research, clinical care, and health policy, despite increasing recognition of sex-specific disease mechanisms and treatment responses. Underrepresentation of women in clinical trials continues to produce male-centric treatment protocols and insufficient data to support precision care.

Methods: This narrative review applies a translational science framework to examine recurring and cross-cutting gaps in sex and gender health science. Rather than cataloging all disease areas, the review uses three exemplar domains-mental and neurological conditions, autoimmune disorders, and cardiovascular disease-to illustrate patterns observed across the research-to-policy continuum.

Results: Findings reveal persistent issues including underrepresentation of women in research, inadequate sex-disaggregated data, and structural biases that impede equitable evidence development. These challenges appear consistently across basic science, clinical research, guideline development, and health policy translation.

Conclusions: To advance equitable, evidence-based care, recommendations include adopting intersectional frameworks, improving sex-disaggregated data practices, increasing investment in sex-based research, and integrating sex and gender health science into medical education. Addressing these gaps through a translational lens is essential to achieving precision medicine that effectively serves all individuals.

Background: Intimate partner violence (IPV) is the most common form of violence, presenting a significant public health concern, especially for women and girls. Help-seeking can reduce future IPV and mitigate adverse health outcomes, including mental health issues.

Objectives: This study is the first national assessment on IPV, mental health consequences, and associated help-seeking behaviors in Nepal.

Design: A cross-sectional descriptive study.

Methods: Using secondary data from the 2022 Nepal Demographic and Health Survey, this study includes 5178 women aged 15-49 and employs multivariate regression analysis to explore the association between IPV and mental health problems, as well as factors influencing help-seeking behavior for both issues.

Results: Among participants, 31.4% reported ever experiencing IPV, and most (29.4% of all women) in the past 12 months. Of those ever experiencing IPV, 72.0% had not sought help for IPV, and 92.2% of those who did, opted for informal support. A total of 27.6% (n = 1427) of female interviewees reported anxiety symptoms, 21.5% (n = 1110) depressive symptoms, and 7.1% (n = 368) suicidal ideation within the past 2 weeks. These rates were higher among women who had experienced IPV in the past 12 months, with 41.1% reporting anxiety, 33.2% depression symptoms, and 14.1% suicidal ideation. Of the 4194 respondents with symptoms of anxiety, depression, or suicidal ideation who were asked about help-seeking for mental health issues, 19.4% (n = 812) had sought help, primarily from informal sources (93.4%, n = 759). Emotional IPV in the past 12 months increased the odds of anxiety (adjusted odds ratio (aOR) 3.00, 95% confidence interval (CI) 2.08-4.31), depression (aOR 3.09, 95% CI 2.19-4.37), and suicidal ideation (aOR 1.91, 95% CI 1.20-3.04). Sexual IPV increased the odds of anxiety (aOR 2.88, 95% CI 1.67-4.95) and depression (aOR 2.12, 95% CI 1.32-3.41), while controlling behavior heightened the odds of depression (aOR 2.42, 95% CI 2.02-2.89) and suicidal ideation (aOR 2.24, 95% CI 1.25-4.02).

Conclusion: This nationwide study reveals a high prevalence of IPV and related mental health problems among women in Nepal and a low rate of help-seeking behavior, in particular to formal support structures. Stronger health system responses and empowering informal support are essential to improve referrals and raise awareness for violence survivors.

Women with disabilities face significant barriers in accessing maternal healthcare, which increases their risk of adverse pregnancy outcomes, particularly in Africa, where resources are limited. Artificial intelligence (AI) presents a unique opportunity to improve inclusivity and accessibility to antenatal care, skilled birth attendance and postnatal care for these women. This paper explores the potential of AI to address the socio-economic, physical, and institutional barriers that limit the utilisation of maternal healthcare services by women with disabilities. AI-driven technologies, such as virtual assistants, predictive analytics, and wearable devices, can enhance maternal health outcomes by improving monitoring during pregnancy, providing real-time health data, and facilitating access to skilled care. However, the successful implementation of AI in maternal healthcare in Africa faces challenges, including technological infrastructure, data quality, and ethical concerns. Collaborative efforts between governments, healthcare providers, and AI developers are necessary to overcome these challenges and ensure AI tools are inclusive, culturally sensitive, and accessible. Integrating AI into maternal healthcare services could lead to improved maternal outcomes, reduce mortality rates, and promote equity for women with disabilities in Africa.

Background: Cesarean section delivery is a surgical way to safeguard maternal and neonatal health when medical risk is associated with delivering babies. Its rates have been increasing globally over the past few decades, with a significant rise recorded in low- and middle-income countries, which leads cesarean section to crucial public health concerns due to unnecessary surgical interventions and associated risks for maternal and neonatal.

Objectives: This study aims to identify the socioeconomic and demographic determinants contributing to the higher likelihood of cesarean section deliveries among Bangladeshi mothers residing in urban areas.

Design: The initial survey employed a cross-sectional design to collect data.

Methods: This research examined the Bangladesh Demographic and Health Survey (BDHS) dataset to identify the cesarean section among urban mothers. It utilized the chi-square test to measure associations, the Boruta algorithm, and a multivariable logistic regression model with a forest plot.

Results: The study pointed out that urban mothers belonging in richer and richest families (adjusted odds ratio: 2.83, 95% confidence interval: 1.88-4.26 and adjusted odds ratio: 4.79, 95% confidence interval: 3.13-7.34) and higher educational attainment (adjusted odds ratio: 1.89, 95% confidence interval: 1.20-2.99) are significantly correlated with cesarean section. Divisional differences are also robust with the significance of Sylhet (adjusted odds ratio: 0.23, 95% confidence interval: 0.12-0.47) and Chottogram (adjusted odds ratio: 0.50, 95% confidence interval: 0.30-0.83) divisions. Media exposure (adjusted odds ratio: 1.54, 95% confidence interval: 1.27-1.87) and mothers gave birth at the age 20-24 and 25-34 (adjusted odds ratio: 1.67, 95% confidence interval: 1.31-2.14 and adjusted odds ratio: 3.15, 95% confidence interval: 2.03-4.89) are also highly significantly associated with the likelihood of cesarean section. Moreover, mothers working status (adjusted odds ratio: 0.53, 95% confidence interval: 0.43-0.65) and religion (adjusted odds ratio: 2.33, 95% confidence interval: 1.60-3.38) are also correlated with cesarean section.

Conclusion: The study reveals socioeconomic and sociodemographic reasons associated with the increase in cesarean section rates among urban mothers in Bangladesh, highlighting the need for targeted interventions to mitigate cesarean section rates and improve maternal and neonatal health.

Background: The third trimester of pregnancy involves multiple changes to which women need to adapt. When such adaptation to pregnancy is unsuccessful, this can increase the risk to suffer perinatal depression. Yet, an integrative analysis of different forms of adaptation to pregnancy and their specific contributions to perinatal depression is still missing.

Objectives: This study thus aimed to advance knowledge on the role of specific indicators of adaptation to pregnancy as predictors of risk for or protection against perinatal depression.

Design and methods: A randomized non-discriminatory exponential chain methodology was used to recruit a sample of 594 women in their third trimester of pregnancy. The participants completed online assessments, including sociodemographic data and psychological measures. A backward binary logistic regression was conducted to determine which dimensions of problems of adaptation to pregnancy accounted for higher risk to categorize women with clinically significant levels of depressive symptoms.

Results: The proposed model accounted for 17% of the variability in the occurrence of perinatal depression symptoms. Specific indicators of adjustment to pregnancy, such as a having lower positive views of the future with the baby, acceptance of the news of pregnancy, talking with the partner about the future baby, and acceptance of physical discomfort, emerged as protective factors.

Conclusion: Our study identifies key protective factors against perinatal depression in the third trimester, including imagining a positive future with the baby, a positive reaction to pregnancy confirmation, discussing the baby with a partner, and positively experiencing physical discomfort during pregnancy. This study provides a deeper understanding of key aspects of pregnancy adaptation that should be strengthened in clinical practice to reduce the development of depressive symptoms in late pregnancy.

Background: Prospective nutritional and physical activity data are lacking throughout preconception and pregnancy.

Objectives: To evaluate (1) intakes of energy, macronutrients and micronutrients, diet quality and physical activity levels in preconception and in each trimester of pregnancy and (2) adherence to recommendations.

Design: Prospective study.

Methods: Ninety individuals planning a pregnancy in the next year (Quebec, Canada) took part in four online assessments that occurred before conception and during each trimester of pregnancy (T1, T2 and T3). At each assessment, dietary intakes were derived from at least two web-based 24-h recalls, and supplements use was obtained from a web questionnaire. Diet quality was measured via the Healthy Eating Food Index 2019. Physical activity levels were evaluated with the International Physical Activity Questionnaire and the Pregnancy Physical Activity Questionnaire.

Results: Preconceptionally, participants (30.5 ± 3.6 years) had a mean body mass index of 23.5 ± 3.4 kg/m². Energy intakes (kcal/day) increased over time (preconception: 2172 ± 457; T1: 2284 ± 557; T2: 2382 ± 501; T3: 2434 ± 549; p < 0.0001), while Healthy Eating Food Index 2019 total score remained stable (p = 0.10). Although dietary fiber intake (g/day) increased from preconception to T3 (preconception: 23 ± 9; T1: 25 ± 9; T2: 26 ± 10; T3: 27 ± 9; p < 0.0001), more than 80% of individuals had daily dietary fiber intakes below 14 g/1000 kcal at each assessment. From preconception to T3, total intakes (foods + supplements) increased for iron, folate and vitamin D (p < 0.01), especially from preconception to T1. These intakes came mainly from dietary supplements and met recommendations for most individuals (>52%) at each assessment. Physical activity levels (METs - min/week) decreased from preconception to T3 (preconception: 1754 ± 1431; T1: 1518 ± 1124; T2: 1562 ± 1214; T3: 1258 ± 1218; p < 0.0001), whereas most individuals (64%-82%) complied with the physical activity recommendations at each assessment.

Conclusion: Changes in dietary intakes and physical activity levels are observed from preconception to the end of pregnancy. The recommendations are met for most individuals, except for dietary fiber intakes. These results need to be confirmed in a larger, more heterogeneous sample.

Background: Women's health is significantly influenced by the appropriate and timely secretion of female sex steroid hormones. Consequently, awareness of hormonal fluctuations at various life stages is crucial. In 2016, the Japanese Ministry of Health, Labour, and Welfare launched the HealthCareLabo (https://w-health.jp/) interactive women's health information website.

Objectives: This study aimed to investigate user behavior on the website from its inception in March 2016 to December 2022 to enhance its quality and effectiveness.

Design: Retrospective web research.

Methods: Data analysis used Google Analytics to examine website engagement metrics, the number of pages visited per session, feature utilization rates, use access methods, and geographic locations.

Results: Over the 6-year study period, HealthCareLabo attracted 21,575,636 unique users, 26,200,559 sessions, and 53,595,955 page views. Returning users accounted for 10.7%, with an average of 2.05 pages viewed per session and an average session duration of 48 s. "Bounce rate" refers to the proportion of visitors who leave a website after viewing a single page without engaging further. The bounce rate of 67.75% suggests users did not find the content relevant, comprehensible, and actionable. The most frequently accessed page was "Self-check for All Women's Diseases," accounting for 10.95% of total page views. Notably, 64.19% of users were aged 25-44. The bounce rate increased with age, while the average session duration and pages viewed per session decreased. Traffic via social media had the highest average time on pages, most page views, and the lowest bounce rate. Among the top 10 Google Search queries leading to the website, four were related to BMI, with "BMI female" ranking highest and achieving a click-through rate of 48.53%. The Self-check feature was widely utilized, particularly for premenstrual syndrome, with 66% of respondents aged 25-44.

Conclusions: The findings suggest that women of reproductive age are particularly attentive to health-related concerns, including body image and premenstrual syndrome. HealthCareLabo serves as an effective platform for promoting health literacy, with its Self-check feature playing a pivotal role in user engagement.