Women's health (London, England)最新文献

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.

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.