Women's health (London, England)最新文献

Background: There is increasing evidence that menstrual changes (MC) should be considered as an adverse event resulting from COVID-19 vaccination. However, the contributing health factors are still poorly understood.

Objectives: The aim was to analyze the characteristics and factors influencing MC after the administration of the severe acute respiratory syndrome coronavirus 2 vaccine.

Design & methods: A retrospective observational study of currently menstruating women (N = 14,550) in Spain was conducted during the month of December 2021 using an online survey. Among others, general characteristics of the menstrual cycle, medical history, and adverse events following vaccination-including MC-were recorded. Bivariate logistic regression analysis was performed to determine the influencing factors.

Results: 45.0%-50.9% of respondents reported experiencing mostly transient MC after both doses of COVID-19 vaccine, including different spotting (41.6%-49.0%), longer periods (26.5%-29.5%) and/or heavier flow (28.7%-31.6%). Binary logistic regression analysis showed that some of the inter-individual factors that may be involved in this unexpected event are age (dose 2: adjusted odds ratio (aOR): 1.02; 95% confidence intervals (CI): 1.02-1.03), heavy menstrual flow (dose 1: aOR: 1.12; 95% CI: 1.00-1.25), use of short- (dose 1: aOR: 1.38; 95% CI: 1.24-1.54) to medium-term contraception (dose 1: aOR: 1.31; 95% CI: 1.09-1.57), number of previous pregnancies (dose 1: aOR: 1.11; 95% CI: 1.03-1.19), pre-existing diagnoses of certain clinical conditions-including endometriosis (dose 1: aOR: 1.33; 95% CI: 1.11-1.59)-and suffering from other vaccine adverse events.

Conclusion: Currently menstruating women may experience MC after COVID-19 vaccination. Further research is warranted to address the influencing factors, considering their heterogeneity according to the geographical background of the target population. This kind of evidence could prove instrumental in the context of future viral outbreaks, helping healthcare professionals to provide scientifically up-to-date information to patients for making informed decisions regarding their well-being, particularly in societies where menstruation remains a taboo subject.

Background: The quality of antenatal care (ANC) plays a crucial role in maternal and child health, yet little is known about the actual service content received by pregnant women in rural southern Ethiopia.

Objectives: To explore the factors influencing ANC content utilization in selected rural areas of southern Ethiopia, shedding light on critical gaps in service delivery.

Design: A mixed-methods study.

Data sources: Quantitative data were collected from 851 systematically selected women, and qualitative data from 20 purposefully selected participants including mothers, health extension workers, and healthcare professionals.

Methods: Data were collected using a pre-tested structured interviewer-administered questionnaire. Quantitative data were analyzed using descriptive statistics and a generalized linear model to assess associations between variables. Qualitative data were transcribed, translated verbatim, and processed using Atlas software.

Results: Only 5.7% of women received the full spectrum of ANC services. Weight (82.6%) and blood pressure (82%) measurements were the most commonly utilized services, while height measurement (22%) and counseling on pregnancy-related complications (31%) were significantly underutilized. Key determinants of ANC content utilization included husband support (risk ratio (RR) = 1.82, 95% CI = 1.01-2.43), perception of proximity to a health facility-short (RR = 1.38, 95% CI = 1.08-1.90) and medium (RR = 1.13, 95% CI = 1.00-1.17) distances-early initiation of ANC (RR = 1.6, 95% CI = 1.01-2.20), positive provider-patient interaction-good (RR = 1.22, 95% CI = 1.03-1.41) and medium (RR = 1.18, 95% CI = 1.00-1.27)-and a high wealth index (RR = 1.26, 95% CI = 1.16-1.37).

Conclusions: This study underscores the critical shortfall in comprehensive ANC service utilization in rural Ethiopia. Strengthening health services in underserved areas, actively involving husbands in maternal care, empowering women, and enhancing healthcare provider training and accountability are essential to improving service delivery. A concerted effort is needed to bridge these gaps and ensure that every pregnant woman receives the full spectrum of essential ANC services.

Background: The prevalence of mood disorders and functional decline among older adults, particularly those under socioeconomic vulnerability, has become a significant public health concern. Physical exercise is widely recognized as a key intervention for improving both physical and mental health in older populations. However, the optimal intensity and modality of exercise for enhancing mood and functional capacity in older women under socioeconomic vulnerability remain unclear.

Objectives: To investigate the effects of the intensity and modality of community-based exercise programs on mood profile and physical functional capacity in older women under socioeconomic vulnerability.

Design: This article presents a prospective, randomized, single-blind study.

Methods: Older women under socioeconomic vulnerability (included: n = 116; lost to follow-up: n = 28; analyzed: n = 88) were randomly assigned to 6 months of high-intensity interval training combined with resistance training (n = 25), moderate-intensity continuous training combined with resistance training (n = 37), or resistance training (n = 26) interventions performed twice weekly. Flexibility (seat and reach), handgrip strength, lower limb muscle strength/power (Five-Time Sit-to-Stand), mobility (Timed Up and Go), aerobic performance (6-min walking), and mood profile (Brunel Mood Scale) were assessed before and during follow-up.

Results: All groups had improved (p < 0.05) Five-Time Sit-to-Stand and 6-min walking performance, while high-intensity interval training combined with resistance training and resistance training improved (p < 0.05) Timed Up and Go performance. There were also significant improvements (p < 0.05) in depression (high-intensity interval training combined with resistance training and moderate-intensity continuous training combined with resistance training), anger (resistance training), vigor (high-intensity interval training combined with resistance training and moderate-intensity continuous training combined with resistance training), fatigue (resistance training), confusion (moderate-intensity continuous training combined with resistance training), and total mood disturbance (high-intensity interval training combined with resistance training, moderate-intensity continuous training combined with resistance training, and resistance training).

Conclusion: Six months of community-based exercise was effective for improving functional physical capacity and mood profile in older women under socioeconomic vulnerability, regardless of exercise intensity or modality.

Clinical trial registration: RBR-3y8w4w3.

Background: The federal 30-day waiting period for Medicaid-covered female permanent contraception (PC) is a known barrier to timely fulfillment. In July 2020, West Virginia became the first state to bypass this waiting period by using state funds to support procedures that do not meet the waiting period for federal funding.

Objectives: To assess changes in postpartum fulfillment of PC requests following West Virginia's 2020 Medicaid policy change.

Design: We conducted a retrospective cohort analysis of patients who delivered at ⩾20 weeks of gestation at West Virginia University Hospital in 2019 and 2021, excluding 2020 due to the COVID-19 pandemic and implementation of the policy change.

Methods: We used multivariable logistic regression to assess the association between insurance type and inpatient postpartum PC fulfillment, with interaction terms between year and insurance type to examine policy impact.

Results: Among 423 patients desiring postpartum PC, 61.5% had PC fulfillment before hospital discharge. In 2019, fulfillment was significantly lower for Medicaid patients than those with other insurance (55.0% vs. 73.3%; RD: -0.19; 95% CI [-0.32, -0.06]). By 2021, this difference was no longer significant (54.9% vs. 68.3%; RD: -0.13; [-0.27, 0.003]). In adjusted stratified models for 2019 and 2021, there were no significant differences in odds of fulfillment between patients with Medicaid and other insurance (2019 aOR: 0.55; [0.23, 1.28]; 2021 aOR: 0.92; [0.38, 2.21]; likelihood ratio test p = 0.36).

Conclusion: West Virginia's policy change may have partially reduced one barrier to desired inpatient postpartum PC access; Medicaid fulfillment rates remained stable from 2019 to 2021, whereas fulfillment rates decreased for patients with non-Medicaid insurance. However, non-policy-level obstacles to inpatient postpartum PC remain prevalent.

Menstrual health (MH) research has expanded in recent years, including studies throughout the reproductive life course. However, the experiences of young adults in Latin America and the Caribbean (LAC) remain comparatively underexplored, despite the importance of this life stage. The primary aim of this scoping review was to summarize and synthesize the literature on MH among young adults in the LAC region. Primary studies were included if they explored any aspect of MH among young adults aged 18-24 in university, health service, or community settings within LAC. Studies conducted in secondary school settings or involving specialized populations (e.g., elite athletes, incarcerated individuals) were excluded. Six electronic databases were searched for studies published between January 1, 1980 and October 23, 2024. Data were extracted and synthesized narratively, with key study characteristics summarized in tables. An interactive online evidence-gap map was developed to visualize geographic and thematic representation across the region. A total of 42 studies met the inclusion criteria, with most originating from Brazil (n = 21, 50%) and Mexico (n = 14, 33%). Studies were predominantly conducted in urban locations (n = 29, 69%), and all participants were described as female or women. Common MH experiences reported included menstrual cycle and bleeding characteristics (n = 16, 38%), dysmenorrhea (n = 13, 31%), and premenstrual syndrome (n = 10, 24%). Some studies indicated a negative impact of MH on academic participation (n = 5, 12%) and daily life activities (n = 16, 38%). The review identified significant geographic gaps, with only 21% (7/33) of LAC countries represented. This review highlights significant gaps in MH research among young adults in LAC, especially in rural areas and gender-diverse populations. There is a critical need for inclusive, region-specific research, initiatives, interventions and policies to enhance health, education and economic outcomes.

Background: Primary testing for high-risk human papillomavirus (HPV) via self-collection can increase cervical cancer screening rates. In the United States, federally qualified health center (FQHC) patients often have low incomes, lack health insurance, are medically underserved, and are screened less than the national average. Implementation of HPV self-collection can increase cervical cancer screenings among FQHCs.

Objectives: To assess the potential impact of implementing HPV self-collection with FQHC patients by considering perspectives of frontline clinical and administrative staff and leadership to identify patient-focused implementation considerations.

Design: This qualitative study utilized focus groups and key informant interviews, and transcripts were analyzed using a coding-based thematic analysis. Emergent themes regarding self-collection implementation perspectives were mapped onto Consolidated Framework for Implementation Research constructs to identify potential facilitators and barriers to implementation for FQHC patient populations.

Methods: Participants from six FQHCs in North Carolina were identified. Forty-five clinical and administrative staff participated in focus groups. One chief executive officer, senior level administrator, chief medical officer, and clinical data manager from each FQHC (N = 24) were interviewed one-on-one. Coding-based thematic analysis was applied to focus group and interview transcripts to uncover emerging themes.

Results: Interviewees indicated that HPV self-collection can be advantageous to patients who do not routinely visit the clinic due to socioeconomic and cultural barriers. Programs must consider these barriers and patient literacy to ensure proper self-collection utilization. For example, FQHC patients may benefit from illustrated instructions for proper self-collection procedures.

Conclusion: Tailoring an HPV self-collection implementation to FQHC patient populations may be an important strategy for increasing screening.

Background: There is a lack of data regarding the current state of lactation accommodations at continuing medical education (CME) events to guide best practice recommendations.

Objective: To evaluate CME attendee attitudes, experiences, and preferences as it pertains to lactation support accommodations at CME events.

Design: A cross-sectional study utilizing an electronic-based survey.

Methods: Surveys were administered electronically to attendees of seven CME courses from August 2022 to October 2023, and de-identified data were collected to a secure database. Attitudes regarding lactation accommodations, personal preferences for lactation accommodations, and experiences with lactation at CME events were analyzed.

Results: Of the 337 survey respondents, 169 had personal experience with lactation and 47 had experience with lactation at a CME course within the past 10 years. The majority of respondents agreed that lactation accommodations should be a priority (n = 264, 83%) and are a medical need (n = 285, 89%). Of those with recent experience lactating at a CME course, only 19% (n = 9) indicated adequate lactation accommodations were provided. Due to inadequate accommodations, 77% (n = 36) of respondents experienced decreased participation in the CME course content, 70% (n = 33) claimed fewer hours of CME credit, and 74% (n = 35) experienced decreased satisfaction in the CME course. Preferences for lactation accommodations included proximity to the meeting, audio-visual streaming of content, privacy, security, and signage supporting lactation in addition to an adequate designated space with access to an electrical plug and water supply.

Conclusions: The current state of lactation accommodations at CME courses is inadequate and contributes to inequitable experiences for lactating participants. Course participants are supportive of lactating healthcare professionals at CME courses and recognize lactation accommodations as a priority. Further work is needed to inform and institute changes to lactation accommodations for healthcare professionals.

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.