Women's health (London, England)最新文献

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.

Background: In Rwanda, legally induced termination of pregnancy (ToP) is permitted under specific conditions such as cases of rape, incest, being a minor, forced marriage or health-related issues.

Objectives: To explore post-ToP mental health outcomes, the circumstances under which women seek ToP services and investigates their relationship with the presence or absence of psychological support.

Design: A quantitative approach using a cross-sectional design was used for this study.

Methods: Data collection recruited 305 women and girls who sought ToP services at eleven selected health facilities in Rwanda from June to August 2022. Life satisfaction, self-esteem, anxiety, and depression/grief were the outcome measures and were measured using the standardized tools. Binary logistic regression (adjusted odds ratios) was used to assess how the circumstances of seeking ToP and the presence or the absence of psychological support predicted mental health outcomes.

Results: The findings indicate that the primary reasons for seeking ToP services include rape, pressure from a partner and fear of missing educational opportunities. There was a strong association between circumstances such as rape and partner pressure with negative mental health outcomes. The study also revealed that only a small proportion of women who received post-ToP psychological support from family, community or healthcare providers, while the majority did not. The absence of psychological support was significantly linked to an increased likelihood of low self-esteem, anxiety, depression, and dissatisfaction with life.

Conclusion: The circumstances under which women seek ToP services significantly impact their mental health post service provision. The findings underscore the critical role of post-ToP support in mitigating negative psychological outcomes. Hospitals should screen depression/grief and offer psychological care support for women undergoing ToP.

Background: Improving understanding of physical activity (PA) during pregnancy can inform future interventions and support the delivery of high-quality prenatal care.

Objectives: Within the longitudinal birth cohort Research Enterprise to Advance Children's Health (REACH), the sub-study REACH-Fitbit sought to understand the prenatal experiences of utilizing an activity monitoring device and best practices for receiving PA information.

Design: REACH recruits gravid patients ⩾18 years old receiving prenatal care and planning to deliver at predefined hospitals. REACH-Fitbit participants had to be <20 weeks gestation with access to a Bluetooth-enabled device. Recruitment (self-selection) for focus groups occurred from completed REACH-Fitbit participants (e.g., delivered their baby).

Methods: A semi-structured moderator guide was utilized to capture feedback on experiences, adherence to protocols, resources, and best practices for measuring PA during pregnancy. Two groups of six participants participated virtually, which included conversations about the overall participant experience, compliance with protocols, and opportunities for knowledge dissemination about PA.

Results: The majority of focus group participants identified as Black, were between 20 and 29 years of age, and had positive feelings about the Fitbit, finding it usable and functional. Participants felt protocol compliance was facilitated by text message reminders and research team support, while barriers included Fitbit application problems, busy schedules, and forgetting. Participants preferred to receive PA information from a trusted healthcare source (e.g., doctor, nurse, or other healthcare provider), though most participants (57%) did not receive PA information during prenatal care. Participants were interested in learning about the safety, type, and amount of prenatal PA in which to engage.

Conclusion: Findings presented here can support compliance in future studies or PA interventions utilizing similar technology. Incentives for compliance with study protocols and enhanced communication with the research team can improve participant engagement. Future work will address the need to communicate the interests of pregnant persons to clinical care teams, specifically, improvements to how providers share information on PA.

Background: Understanding experiences of care for endometriosis is an important source of evidence for supporting the improvement of care quality for this long-term condition. Patient-reported experience measures are a key tool for providing this insight. However, in England, there is no national survey of experiences of endometriosis care, making it difficult to understand where care is working well and how it can be improved.

Objectives: This scoping review aimed to identify and describe existing surveys globally for measuring patient experience of care for people with endometriosis.

Eligibility criteria: The population of interest included people with endometriosis. The concept was questionnaires in any format (e.g. article or web-based) exploring the experience of care for endometriosis in the context of any care setting.

Sources of evidence: PubMed and ProQuest databases were searched between August and September 2024.

Charting methods: Information extracted included study information (e.g. article title, authors, year of publication, research objectives, country), inclusion/exclusion criteria (e.g. population, concept, context) and patient experience measure characteristics (e.g. name of experience measure, number of questions, domains of person-centred care, survey mode and contact approach, development process).

Results: Out of the 209 articles screened, only seven surveys were identified for inclusion in the review. These surveys varied in context, number of items, domains of care, survey mode and contact approach. Most of the surveys focussed narrowly on one aspect of care, such as diagnosis or inpatient treatment, and three surveys included only two questions related to patient experience. Only one survey, the ENDOCARE Questionnaire, covered all eight Picker Principles of Person-Centred Care.

Conclusions: With only a small number of surveys identified and only one capturing all core aspects of person-centred care, there are limited resources available for those wishing to understand and improve care quality for people with endometriosis.

Background: With more elite sportswomen incorporating pregnancy into their athletic careers, it is imperative that they are supported with evidence informed guidelines for healthy, safe pregnancies.

Objectives: To (i) provide a rapid review, which mapped fields of study relevant to what is known about the health and performance-related considerations for pregnant elite sportswomen, and (ii) quantify the overall state of the art since the 2016/2017 International Olympic Committee publications on exercise and pregnancy in recreational and elite athletes.

Eligibility criteria: Original, empirical, peer-reviewed, English-language studies reporting on research conducted with or related to healthy, pregnant elite (international and world-class) sportswomen aged ⩾18 and ⩽40 years were eligible for this review. In addition, all aspects and/or metrics of health and sports performance were considered, and both quantitative and qualitative research designs were included.

Sources of evidence: PubMed, SPORTDiscus and Web of Science were systematically searched. Reviews, book chapters and grey literature were excluded. Reference lists of eligible studies were also searched to identify additional studies of relevance.

Charting methods: Scoping review with expert consultation exercise. Consideration was given to basic numerical analysis of the extent, distribution, and nature of the studies included in the review. Five key stakeholders, including physiotherapists, physicians, applied practitioners and researchers, with expertise in women's and pelvic health, pregnancy and postpartum, breast biomechanics and rehabilitation and training in national and international-level sport took part in an expert consultation process.

Results: Eight studies were identified as part of the literature review, and more than 30 topics were highlighted through consultation as areas of interest and further study related to the health and performance of elite pregnant sportswomen.

Conclusion: In the last decade, an insufficient number of studies have been conducted, related to pregnant international and world-class sportswomen, meaning that the state of the art on this topic for this specific population has not changed to a noticeable degree. Experts in this area still have a plethora of unanswered research questions, such that it is still impossible to take a fully research informed approach to supporting pregnant elite sportswomen.

Background: Somatic complaints are a critical burden to women, particularly to those women who survived intimate partner violence (IPV). The way women feel, perceive, and relate to their own body, that is, interoception, seems to have a significant role in the pathway to somatic complaints. However, to the best of our knowledge, no study has yet explored the relationship between interoception and somatic complaints of women survivors of IPV.

Objectives: To deepen the understanding of the underlying interoceptive mechanisms of somatic complaints experienced by women survivors of IPV.

Design: Cross-sectional study.

Method: Women with (N = 44) and without (N = 52) history of IPV were assessed regarding interoceptive accuracy, interoceptive sensibility, and somatic complaints. Associations between both variables in each group were examined, and a hierarchical regression analysis assessed to what extent somatic complaints were explained by the interoceptive abilities, with the mediating role of IPV group membership.

Results: Women survivors of IPV reported more somatic complaints (p < 0.001), which were negatively associated with interoceptive attention regulation. The opposite association was found in women who have never experienced IPV. For the IPV group, the interoceptive attention regulation, added to age and the index of the violence suffered, explains 43% of the variance in somatic complaints.

Conclusion: The findings suggest that for women with history of IPV, but not for those without, the ability to regulate the attention given to bodily sensations is a mediator of women' somatic complaint. Thereby we suggest that interoceptive attention regulation can be a promising therapeutic aim, for women recovering from IPV.

Background: Gestational weight gain (GWG) impacts both foetal and maternal health outcomes, with excessive GWG in overweight and obese people further increasing the risk of complications for this population. Lifestyle changes including consuming a healthy diet and physical activity are core strategies for management. Since 2020 and the emergence of the COVID-19 pandemic, use of telehealth has increased; however, little is known about the effectiveness of virtually delivered strategies for maintaining healthy gestational weight during pregnancy.

Objectives: To describe the effect of virtually delivered lifestyle interventions on promoting healthy GWG and reducing maternal and foetal complications associated with excessive GWG, with the view to inform future clinical practice.

Design: This systematic review followed preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines and targeted quantitative studies assessing virtually delivered lifestyle interventions for maintaining healthy gestational weight for overweight and obese pregnant individuals aged 18 and older.

Data sources and methods: Six databases (MEDLINE, CINHAL, EMBASE, EMCARE, MIDIRS and APA PsycINFO) were searched using a rigorous search strategy. Data extraction investigated mode of telehealth delivery, intervention type and GWG outcomes. Quality appraisal was conducted using the Critical Appraisal Skills Programme tool and risk of bias was assessed using the Risk of Bias assessment (RoB-2).

Results: Nine studies met inclusion criteria and within those studies, six different telehealth modalities were identified. Interventions varied and included GWG tracking, step counts, diet and exercise goal setting. Effectiveness of studies was inconsistent, with five studies demonstrating lower GWG.

Conclusion: Results suggest that lifestyle interventions delivered via telehealth may be effective at reducing excessive GWG. The development of targeted interventions integrated into obstetric guidelines aimed at reducing excessive GWG via telehealth platforms should be considered as a strategy not only for pandemic situations, but to increase antenatal care and service access.

Registration: PROSPERO International Prospective Register on 26 January 2023 (CRD42023392095).

Background: There are several barriers to fulfillment of desired postpartum permanent contraception (PC). Prior research has primarily focused on the federal Medicaid sterilization policy as a barrier to PC; however, other barriers need to be examined.

Objectives: To explore the levels and intersections of barriers to postpartum PC that exist external to the Medicaid policy.

Design: We interviewed postpartum people with a documented desire for PC and their delivering obstetrician-gynecologist (OB-GYN) at four hospitals in the United States in 2022-2023.

Methods: We used rapid qualitative analysis to create initial key themes and sub-themes, which we further refined using thematic analysis to explore barriers to postpartum PC.

Results: We interviewed 81 postpartum people and 67 OB-GYNs. Barriers were identified across four levels: clinical, physician, hospital, and sociocultural. At the clinical level, participants commented on how they believed individual patient characteristics and medical history can prevent PC fulfillment prior to discharge. At the physician level, participants discussed young age, low parity, and marital status as reasons clinicians decline to provide desired PC. At the hospital level, OB-GYNs described difficulties with scheduling and staffing, and patients described a lack of PC prioritization. At the sociocultural level, participants mentioned numerous barriers to fulfillment of interval PC including finding childcare, getting appointments scheduled quickly, and transportation.

Conclusion: Improving access to postpartum PC should be focused within and across all levels of health disparity determinants. In the cases where immediate PC is not accessible, interventions should be formulated across levels to allow timely access to interval PC. As policy reform alone will not eliminate all barriers to postpartum PC, a multi-level approach to alleviating barriers is required.

Background: Oocyte donation (OD), a treatment with increasing prevalence, introduces challenges in fertility and obstetric care, including pregnancy complications and psychosocial issues. As numerous healthcare providers encounter OD pregnancies, understanding the perspectives of involved stakeholders becomes crucial for improving OD healthcare management.

Objectives: This study explores perspectives regarding counselling and healthcare of women and their partners conceiving through OD.

Design: A qualitative case study design using a descriptive phenomenological approach.

Methods: Three in-depth focus groups with 13 women and 5 partners, who had experienced OD pregnancy and/or delivery after treatment in either a Dutch or foreign centre, were conducted.

Results: The findings show the significance of comprehensive counselling throughout the entire OD process. Preconception counselling was positively evaluated when various subjects were covered, not only the logistical part, but also emotional impact and ethical issues. However, the study revealed variations in type and quality of counselling provided, depending on healthcare provider. Participants often received contradictory information, and desired emotional and peer support. While psychosocial support was available before OD treatment in the Netherlands, it was often lacking in treatment abroad.

Conclusion: To improve OD healthcare management, participants stated various recommendations. Mostly appointed was implementing a (inter)national guideline, which emphasizes the necessity for standardized and comprehensive counselling and healthcare for women and their partners undergoing OD treatment.

Background: Discontinuation of the contraceptive pill is common, but little research has explored women's personal experiences with discontinuation symptoms and associated psychological factors.

Objectives: These studies provide initial cross-sectional data on symptoms associated with discontinuation of the contraceptive pill, focusing on both expected symptoms in current users and experienced symptoms in former users. We examined how psychological factors (e.g., beliefs about medicine, trait anxiety) relate to these symptoms.

Design: Two parallel online questionnaires were administered: One with current and another with former contraceptive pill users (n = 642).

Methods: We analyzed expected discontinuation symptoms in current users and experienced symptoms in former users. Multiple linear regressions assessed the relationships between psychological factors (beliefs about and sensitivity to medicine, trait anxiety, reason for usage, time since discontinuation) and discontinuation symptoms.

Results: In current users, expected symptoms were associated with concerns about (b = 0.32, p < 0.001, 95% CI [0.35, 0.97], f² = 0.10) and perceived necessity of (b = 0.24, p < 0.001, 95% CI [0.22, 0.86], f² = 0.06) the contraceptive pill, perceived overuse of medication (b = 0.17, p = 0.013, 95% CI [0.13, 1.11], f² = 0.03), and trait anxiety (b = 0.21, p = 0.003, 95% CI [0.06, 0.29], f² = 0.05). Former users who indicated non-contraceptive reasons for using the contraceptive pill experienced more discontinuation symptoms (b = 1.68, p < 0.001, 95% CI [0.78, 2.59], f² = 0.03).

Conclusions: These studies provide the first data on contraceptive pill discontinuation symptoms, showing that current users expect them, and former users experienced them. Psychological factors (e.g., trait anxiety) were linked to expected symptoms, suggesting nocebo-like mechanisms. Future research integrating nocebo theory (e.g., addressing negative expectations directly) could help empower women to make informed choices when discontinuing the contraceptive pill.