Women's health (London, England)最新文献

Background: Vilaprisan is a selective progesterone receptor modulator with demonstrated efficacy in the management of uterine fibroids (UFs).

Objectives: To evaluate the safety and efficacy of vilaprisan in Japanese women with UFs and heavy menstrual bleeding (HMB).

Design: Open-label, parallel-group, Phase 3 randomized clinical trial.

Methods: Japanese women with UFs and HMB were randomly assigned 1:1 to receive vilaprisan (2 mg/day) for either four treatment periods (TPs) of 12 weeks each separated by one bleeding period (Arm A1) or two TPs of 24 weeks each separated by two bleeding periods (Arm A2). The primary endpoint was the incidence of treatment-emergent adverse events (TEAEs).

Results: Of 179 women enrolled, 151 were included in the full analysis set and 148 in the safety analysis set. TEAEs occurred in 79.1% of women, with the majority being mild; events were evenly distributed across both treatment arms. Study drug-related TEAEs were observed in 44.6% of women, and serious TEAEs were reported in 3.4% of women. During the treatment phase, the mean (standard deviation) number of bleeding days per 28 days decreased to 1.40 (1.34) days in Arm A1 and 1.42 (0.82) days in Arm A2 from respective baseline values of 5.1 (2.3) and 5.2 (2.0) days. Median time to onset of amenorrhea was 4 days in TP1 in both arms, and 4 days in TP2 in Arm A1. Absence of bleeding for the last 28 days was more common in TP1 (Arm A1: 91.89%, Arm A2: 89.19%) than TP2 (Arm A1: 80.85%, Arm A2: 85.71%).

Conclusion: In this study, vilaprisan 2 mg/day was found to be well tolerated and efficacious in Japanese women with UFs and HMB. However, the study sponsor later terminated the overall clinical development of vilaprisan due to potential safety concerns from long-term rodent studies.

Registration: The ASTEROID 8 study was registered at https://clinicaltrials.gov/ (registration number: NCT03476928).

Background: Menstrual cycles are a natural part of many people's health, yet are subject to stigma and misinformation, which can affect the experience of menstrual-related symptoms and overall well-being.

Objectives: The study explored how perceptions of the menstrual cycle are associated with symptom severity and their impact on daily life, including work, social activities, and intimate relationships.

Design: A cross-sectional observational study.

Methods: An anonymised online survey, distributed through social media, email, and newsletters. Participants aged 18 and older who menstruated in the previous 12 months were included. Demographic data, menstrual cycle characteristics, and self-reported symptom severity were collected. Perceptions of menstruation were measured using a 5-point Likert scale. Nonparametric statistical tests, including Kruskal-Wallis, chi-square, and Spearman's rank-order correlation, were used for data analysis.

Results: In total, 4735 responses were included in the analysis. Positive perceptions of menstruation were associated with lower reported pain levels and reduced disruption to daily activities, including work and academic performance. Notably, 90.71% reported that menstrual symptoms disrupted their work, with 31.8% taking time off in the past 12 months. Intimate relationships were affected for 84.31% of participants, with significant correlations between comfort in seeking support from partners and the disruption of intimacy (r_s(8) = -0.117; p < 0.001). Participants who viewed menstruation positively experienced fewer mental health symptoms, such as depression and anxiety, compared to those with negative perceptions. The study found that positive perceptions of the menstrual cycle were associated with less severe symptoms and a reduced impact on daily activities.

Conclusions: The findings suggest an association between menstrual perceptions in shaping the experience of symptoms and their broader psychosocial impacts. Enhancing menstrual health literacy and promoting positive perceptions could improve individual health outcomes and societal attitudes. Future public health policies should integrate menstrual health education and supportive workplace policies to enhance the quality of life for those who menstruate.

Registration: Not applicable.

Background: Early resumption of sexual intercourse after childbirth poses significant health risks, including infections, unintended pregnancies, and adverse maternal outcomes. Despite the importance of postpartum sexual health, it remains an overlooked issue, particularly in sub-Saharan Africa, where early sexual resumption is highly prevalent.

Objective: To examine the prevalence and factors associated with early sexual resumption among postpartum women in sub-Saharan Africa, providing insights to inform targeted interventions and policies to improve postpartum health.

Design: A community-based cross-sectional study design.

Methods: Data from the most recent Demographic and Health Survey conducted between 2019 and 2024 across sub-Saharan African countries were used. A total weighted sample of 65,292 postpartum women was included in the analysis. A multilevel mixed-effects model with robust Poisson regression was fitted to identify factors associated with early resumption of sexual intercourse. The deviance statistic was used to assess model fitness. In the multivariable regression analysis, adjusted prevalence ratios with 95% confidence intervals (CIs) were calculated to estimate the strength of associations, with statistical significance set at p-value <0.05.

Results: The prevalence of early resumption of sexual intercourse was 65.27% (95% CI: 64.91, 65.64). Women's age, educational level, employment status, religion, wealth index, media exposure, family size, whether the child was alive, parity, a woman's desire for more children, and place of residence were statistically significant factors associated with the early resumption of sexual intercourse.

Conclusion: About two in three postpartum women resumed sexual intercourse early after childbirth. Targeted postpartum counseling, family planning access, and media campaigns are crucial to raising awareness of early sexual resumption risks, particularly among those desiring more children, wealthier, and rural women. Psychosocial support for bereaved mothers and workplace policies supporting postpartum women can help reduce contributing pressures.

Background: Transgender (trans) women living with HIV often face barriers to accessing inclusive and comprehensive primary and HIV care.

Objectives: We aimed to (1) describe differences in trans women's disclosure of their trans identity and comfort discussing trans identity and trans-specific healthcare needs, based on physician type, and (2) report on the prevalence of negative trans-specific experiences with HIV physicians and any provider-related factors associated with comfort.

Design: Data of trans participants in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) were analyzed across three waves (2013-2018).

Methods: Descriptive statistics explored disclosure of trans identity and comfort discussing trans-specific healthcare needs with family physicians versus HIV physicians. Fisher's exact tests of association explored the relationship between provider-related factors and self-reported comfort. Prevalence of negative trans-specific experiences with HIV physicians was reported.

Results: At baseline, of 54 trans women, 39 (72.2%) had a physician who supervised their HIV care in the year preceding (HIV physician). Among this subset, 94.9% had disclosed their trans identity and 82.1% reported feeling comfortable discussing trans-specific healthcare needs with this physician. Of the 27 (50.0%) who reported having a regular family physician other than their HIV care provider, 92.6% had disclosed their trans identity and 88.9% were comfortable discussing trans-specific healthcare needs. The most prevalent negative trans-specific experience with HIV physicians reported cumulatively was being told by the physician that they did not know enough about trans-related care to provide care (16.7%).

Conclusion: Our findings demonstrate a high prevalence of disclosure of trans identity to physicians among our trans participants. Our findings suggest trans women have similar comfort discussing trans-specific healthcare needs with their family and HIV physicians; however, negative experiences with HIV providers indicate the need for gender-affirming, trans-specific provider training.

Introduction: Post-abortion family planning (PAFP) is an essential component of post-abortion care (PAC) and a recommended family planning high-impact practice. Although PAFP uptake remains low, determinants of its uptake, especially in humanitarian settings, are not well understood.

Objective: To identify the factors associated with PAFP uptake and examine whether women's perceptions of person-centered PAC quality of care (QoC) were associated with PAFP uptake among women receiving PAC in refugee settings in Uganda.

Design: We administered a cross-sectional prospective morbidity survey (PMS), part of a larger study using the abortion incidence complications methodology to estimate abortion incidence in all 13 refugee settlements in Uganda.

Methods: We analyzed data from a PMS of 341 women with post-abortion complications who received PAC in the 13 refugee settlements. PAFP uptake was measured by asking patients if they left the health facility with a family planning method (Yes/No) after completing PAC. The quality of PAC was assessed using a modified 19-item Person-Centered Abortion Care scale. We used logistic regression to identify factors independently associated with PAFP uptake among women receiving PAC in refugee settings in Uganda.

Results: PAC patients in refugee settings in Uganda reported medium to high levels of QoC, with deficits mainly observed in the communication and autonomy subdomain. Women's own perception of QoC was not significantly associated with whether a PAC patient leaves with a method across models. Earning money in the past month before the survey (adjusted odds ratio (aOR) = 3.215; 95% confidence interval (CI) 1.124-9.199) and having a desire to leave with a family planning method (aOR = 270.532; 95% CI 78.921-927.348) were associated with PAFP, after controlling for women's, facility level, and provider characteristics.

Conclusion: Our findings highlight persistently low uptake of PAFP in refugee settings in Uganda, underscoring the need for targeted interventions that both increase family planning use and uphold reproductive autonomy. There is a need to strengthen family planning counseling as part of PAC provision and improve the quality of PAC services with particular attention to communication and patient autonomy.

Background: Science recognizes the anxieties, depression, stress, and "turbulences" that women face in doctoral studies, but women's mental health in this context is still little addressed, even though it is a critical aspect for the well-being, persistence, and success of women doctoral candidates, who continue to be underrepresented in many professional fields.

Objectives: The study aims to evaluate the relationship between academic motivation, psychological capital, and university academic performance (UAP) and to identify factors of female mental health success.

Design: A cross-sectional, mixed-methods study was conducted with a sample of 108 female doctoral students from a university in Lima, during the first quarter of 2024.

Methods: In the quantitative phase, three standardized scales were administered to assess academic motivation, psychological capital, and university academic performance (UAP). In the qualitative phase, interviews were conducted to gather relevant information on mental health.

Results: The findings emphasize five important points: (1) levels and the relationship between psychological capital, academic motivation, and performance, (2) motivational behavior according to study cycles, (3) risk and protection profiles, (4) protective functions, and (5) mental health success factors. The results indicate that 36% of the women have a low level of psychological capital, 34% have a medium level of academic motivation, and 37% have a high level of UAP, likewise "Intrinsic Motivation toward Accomplishment" is the positive core where most of these women converge. Significant differences were found between the study cycles with academic motivation and "University Academic Performance," and a significant gap between these variables. The risk profile (which limits performance) and the protective profile which allows high performance are determined; this positive profile is identified by women who present a high level of "Self-efficacy." The study demonstrates that "Psychological Capital" and "Academic Motivation" along with the dimensions of "Self-efficacy" and "Intrinsic Motivation to Experience Stimulation" serve protective functions. Fourteen success factors for women's mental health were identified and organized into four main approaches: Optimism, Hope, Resilience, and Self-efficacy.

Conclusion: Limitations and future projections are discussed. The practical implications include implementing psychological support programs, fostering intrinsic motivation, integrating psychological assessments, establishing support networks, and making tailored curricular adjustments.

Influential guidelines have supported the role of metformin in the management of polycystic ovary syndrome (PCOS) for a number of years. However, regulatory approvals for this therapeutic indication are still exceptional and exist only in a few countries, including for the originator, Glucophage®. PCOS is an insulin-resistant state, which drives hyperandrogenism and anovulatory infertility. The metabolic action of metformin involves amelioration of insulin resistance, which helps to resolve hormonal and metabolic disturbances and increases ovulation, pregnancy, and live birth rates relative to placebo. A combination of metformin with clomifene citrate (another widely used treatment for PCOS) is more effective than either alone and is a useful option in women with clomifene-resistant PCOS. Combining metformin with letrozole (1st-line agent for ovulation induction in women with PCOS and no other infertility risk factors) is not more effective than letrozole alone. Continuing metformin to the end of the 1st trimester at an effective dose (e.g. 1000-2000 mg/day) may help to reduce the rate of miscarriages. Metformin also has an adjunctive role in women with PCOS receiving assisted reproduction technology (ART) using the long gonadotrophin-releasing hormone agonist protocol, where it appears to increase the pregnancy rate and to reduce the risk of ovarian hyperstimulation syndrome. There is no role for metformin in women receiving short ART protocols. Where a successful pregnancy is achieved, metformin is generally safe for the mother and neonate. Further research is needed to define with greater precision the optimal dosage and times to initiate and discontinue metformin in women with PCOS who achieve pregnancy.

This discussion article discusses the integration of planetary health into nursing practice and education, highlighting the transformative potential of this approach in improving global health outcomes. Planetary health emphasizes the interdependence between human health and the health of our planet's ecosystems, advocating for a sustainable approach to healthcare. This article explores how nursing practice can incorporate planetary health principles to address environmental determinants of health and promote sustainable practices. It also discusses the role of nursing education in preparing future practitioners to understand and act on the links between environmental sustainability and health. By aligning nursing education with planetary health objectives and fostering leadership in this area, the nursing profession can contribute significantly to addressing global health challenges, advocating for systemic changes, and implementing practices that protect both human and environmental health.

Background: Gender differences in the associated health outcomes of different forms of intimate partner violence (IPV) are understudied. The long-term effects of IPV on specific physical health conditions are also under-researched in comparison to the effects on general health and mental health.

Objectives: To examine gender differences in the association between IPV and specific physical health conditions, accounting for differences in the types and number of types of IPV experienced.

Design: We used data from the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional survey using a stratified, multistage random sampling design to cover the household population of England aged 16 years and older.

Methods: Descriptive and multivariable regression analyses of 4120 women and 2764 men who had ever had a partner. Lifetime IPV by types (physical, sexual, psychological, and economic), any lifetime and recent IPV, the number of IPV types experienced, and multiple chronic health conditions experienced over the past 12 months were included in the analyses.

Results: Gender differences were observed in both the prevalence of IPV and associated health conditions. Women were more likely to experience any type and a higher number of IPV types than men. Women's exposure to any lifetime and 12-month IPV were significantly associated with an increased likelihood of reporting 12 and 11 conditions, respectively, while men's exposure to any lifetime and 12-month IPV were significantly associated with 4 and 1 conditions, respectively. Specific IPV types had varied health impacts, particularly among women. A cumulative association was evident for women but not for men.

Conclusion: Healthcare systems need to be mobilised to address IPV as a priority health issue for the female population. Our findings highlight the need for gender-informed approaches in IPV intervention strategies and healthcare provision, emphasising the development of IPV-responsive healthcare systems and comprehensive IPV curricula in medical and health training.

Background: Female genital mutilation (FGM) is a human rights violation that still affects more than 3 million girls aged 0-14 years each year. To achieve the Sustainable Development Goal 2030 agenda, efforts have been made at the local, national and international levels to end the practice by the year 2030. However, the recent COVID-19 pandemic may have reversed the progress made due to increased rates of early marriage of girls, violence against children and school closures during lockdowns. Although some surveys have examined changes in FGM prevalence over the COVID-19 period, changes at the national and sub-national levels among 0-14 years old girls have not been quantified.

Objectives: This study aimed to understand the potential impacts of the COVID-19 pandemic on the likelihood of FGM among girls aged 0-14 years, and whether it affected progress towards the elimination of FGM.

Design: We used Bayesian hierarchical regression models implemented within the integrated nested Laplace approximations frameworks.

Methods: We modelled the likelihood and prevalence of FGM among girls aged 0-14 years before and after the COVID-19 pandemic in Nigeria, with respect to individual- and community-level characteristics, using Bayesian hierarchical models. We used the 2018 Demographic and Health Survey as the pre-COVID-19 period and the 2021 Multiple Indicator Cluster Survey as the post-COVID-19 period.

Results: At the state level, FGM prevalence varied geographically and increased by 23% and 27% in the northwestern states of Katsina and Kana, respectively. There were 11% increase in Kwara and 14% increase in Oyo. However, at the national level, the prevalence of FGM was found to decrease from 19.5% to 12.3% between 2018 and 2021. Cultural factors were identified as the key drivers of FGM among 0-14 years old girls in Nigeria. The changes in the likelihood of girls undergoing FGM across the two time periods also varied across ethnic and religious groups following COVID-19 pandemic.

Conclusion: Our findings highlight that FGM is still a social norm in some states/regions and groups in Nigeria, thereby highlighting the need for a continued but accelerated FGM interventions throughout the country.