Women's health (London, England)最新文献

Racial and ethnic disparities in maternal health persist in the United States despite continued efforts to make healthcare more equitable. The COVID-19 pandemic and overturning of Roe v Wade have further widened existing disparities in maternal healthcare. In this era of advanced technology, innovative tools like health information technology (IT) should be leveraged to address and reduce disparities in maternal health outcomes. Ongoing projects have demonstrated the potential for collaboration to prioritize patient autonomy in improving maternal health. However, further research is necessary to evaluate the effectiveness of these interventions in achieving equitable outcomes.

Osteoporosis, characterized by diminished bone mass and microarchitectural degeneration, increases fracture risk, particularly in postmenopausal women (postmenopausal osteoporosis), leading to reduced quality of life and increased mortality. Recent research has highlighted the gut-bone axis, showing how the gut microbiota influences bone health through immune modulation, endocrine regulation, and calcium absorption. Dysbiosis, an imbalance in gut microbiota (e.g., decreased Bacteroidetes and increased Firmicutes), has been linked to osteoporosis by enhancing osteoclast activity and bone loss. Probiotics, such as Lactobacillus strains, promise to increase bone density and alter immune responses. Still, challenges remain in translating these findings to human applications due to issues with dosage and tolerability. Future studies will seek to clarify the function of the gut microbiome in bone health, hence opening the path for tailored therapies aimed at gut flora. Emphasizing postmenopausal osteoporosis, this article will investigate how gut microbiota influences calcium absorption, endocrine regulation, immunological modulation, and bone metabolism. The goal is to develop treatments aimed at gut microbiota to enhance patient outcomes and osteoporosis management. A review of existing literature was conducted, focusing on experimental studies and clinical trials that investigate the relationship between gut microbiota and bone health, including immune and endocrine mechanisms. Relevant studies were selected based on their focus on gut microbiota and bone metabolism, and their findings were synthesized to explore the impact of microbiota modulation on bone health outcomes.

Background: Hepatitis B virus infection remains a global health concern, particularly in resource-constrained countries such as Sierra Leone. Understanding the risk factors for hepatitis B virus among pregnant women can guide public health initiatives, prenatal care, and maternal-child health policies.

Objectives: We assessed the prevalence and risk factors for hepatitis B virus infection among pregnant women in Sierra Leone's Western Area Urban District.

Design: We conducted a facility-based cross-sectional study in five randomly selected hospitals in the Western Area Urban District.

Methods: A cross-sectional study was conducted in five randomly selected hospitals in May 2021. Data were collected from 320 pregnant women using structured questionnaires. Hepatitis B virus infection, identified by hepatitis B surface antigen positivity, was analyzed using descriptive statistics, Pearson's chi-square test, and logistic regression. Variables that were significant in bivariate analysis were included in the multivariable model. All tests were computed with 95% confidence intervals.

Results: The mean age of participants was 26.0 ± 5.7 years, and the prevalence of hepatitis B virus infection was 13.8% (95% confidence interval: 10.4-18.0). Women with no formal education (adjusted odds ratio: 3.69, 95% confidence interval: 1.33-10.22) or primary education (adjusted odds ratio: 8.30, 95% confidence interval: 2.69-25.63) had significantly higher odds of infection. Single women (adjusted odds ratio: 3.05, 95% confidence interval: 1.29-7.22) and those engaging in risky practices, such as toothbrush sharing (adjusted odds ratio: 1.37) or tattooing (adjusted odds ratio: 2.09), were more likely to be infected. Conversely, a history of stillbirth (adjusted odds ratio: 0.20, 95% confidence interval: 0.04-0.99) was associated with reduced odds of infection.

Conclusion: Hepatitis B virus infection was common among pregnant women in Sierra Leone's Western Area Urban District. Education level, marital status, and unsafe practices such as tattooing and toothbrush sharing were significantly associated with hepatitis B virus infection risk. The findings emphasize the urgent need for targeted public health interventions to reduce hepatitis B virus transmission in this population.

Background: Pelvic physiotherapy (PT) is a holistic and evidence-based treatment for chronic pelvic pain (CPP). It is important to understand patient expectations for treatment to improve patient satisfaction and outcomes. The current literature lacks information about patient expectations for CPP pelvic PT.

Objectives: To describe the expectations around treatment and the role of pelvic PT for patients with CPP.

Design: We conducted a qualitative study and interviewed 10 participants who were on the waitlist for CPP PT at Women's College Hospital in Toronto, ON, about CPP and pelvic PT.

Methods: We recruited patients on the pelvic pain PT waitlist who were assigned female at birth, 18 years of age or older, diagnosed with CPP for more than 6 months. The 1 -h long interviews were conducted via Zoom by two PT students before being transcribed with NVivo. Inductive content analysis was used to create themes and categorize the participant data.

Results: We describe three main themes to convey the experiences of participants living with CPP and their expectations for pelvic PT: (1) Expectations are clouded by a lack of understanding, (2) Pelvic PT will provide a new way to get relief, and (3) My role is to be open to try new things.

Conclusions: Pelvic PT should incorporate education regarding CPP, strong therapeutic alliance with the patient, effective communication, and integration of the biopsychosocial approach to care to better meet patient expectations and improve quality of care. This study highlights the critical importance of providing patients with consistent, accurate, and comprehensive education on CPP, pain treatment and self-management strategies, and the role of pelvic PT. By delivering this foundational knowledge early in the patient's treatment plan, we can influence patient expectations, enhance both patient engagement and outcomes in pelvic PT, leading to a more holistic, informed, and effective approach to patient care.

Background: Women with neurofibromatosis type 1 (NF1) have an increased risk of breast cancer and poorer 5-year survival. Current breast surveillance patient information resources may be inappropriate for this cohort due to increased cognitive deficits and cancer worry.

Objectives: This study aimed to develop and evaluate NF1-specific patient-centric educational resources about breast cancer surveillance.

Design: A pilot, prospective longitudinal cohort study was conducted through a Sydney tertiary hospital (Royal North Shore Hospital) adult NF1 clinic and an established breast cancer risk management clinic.

Methods: A brochure was developed with input from stakeholders and women with NF1 participating in breast surveillance. The content was adapted to create a webpage and animation evaluated through clinician and patient surveys. Final iterations of the resources were based on stakeholder feedback.

Results: Nine semi-structured interviews were conducted with women with NF1 after breast surveillance. All considered the brochure acceptable and valuable and supported sharing the resource. Fifty-seven patient and clinician surveys were also completed, with the webpage and animation highly rated regarding acceptability, usefulness, and relevance.

Conclusions: Information in three media has been developed specifically for women with NF1, considering breast surveillance to increase understanding, provide reassurance, and as a memory aid to support clinician consultation.

Background: Obesity is associated with decreased physical performance, especially in older individuals. Some studies have examined the impact of exercise on obesity outcomes as part of a palliative care program.

Objective: This parallel-group randomized controlled trial investigated the effects of water-based aerobic exercise training and vitamin D3 supplementation on body mass index (BMI) and physical performance in postmenopausal women who were overweight or obese and had insufficient or deficient levels of serum vitamin D.

Design: This was an experimental study.

Methods: Forty women were randomly assigned to one of four groups: Water-based training + vitamin D (WTD), water-based training (WT), vitamin D (D), and control. The training program (aerobic-based exercise) and vitamin D3 supplementation were conducted for 8 weeks, three times a week. Measurements were taken before and after the intervention.

Results: The WTD group showed significant improvement in BMI, handgrip strength, and gait speed compared to all other groups (p > 0.05), and significant enhancements in right and left leg static balance and gait speed compared to the D and control groups (p < 0.05). The WT group demonstrated improvements in handgrip strength compared to the control group and enhancements in right and left leg static balance and gait speed compared to the D and control groups (p < 0.05). Vitamin D3 supplementation improved handgrip strength compared to the control group (p < 0.05).

Conclusion: Water-based training with or without vitamin D3 supplementation significantly improved physical fitness indices, with combination showing the most pronounced effects. Vitamin D3 supplementation alone did not have a significant impact on most physical fitness measures.

Background: Symptomatic hand osteoarthritis frequently affects perimenopausal women and is believed to be associated with estrogen deficiency. However, effective medical therapies for symptomatic relief remain limited.

Objective: To compare the effectiveness of menopausal hormone therapy and complementary and alternative medicine in treating symptomatic hand osteoarthritis in perimenopausal women.

Design: Retrospective observational study.

Data sources and methods: We retrospectively reviewed the medical records of 73 perimenopausal Japanese women treated for symptomatic hand osteoarthritis at Kagoshima University Hospital between 2019 and 2022. Fifty-four patients received menopausal hormone therapy, and 19 received complementary and alternative medicine (Kampo formula and/or S-equol supplementation). No patients received additional orthopedic treatments for hand osteoarthritis, such as analgesics, splinting, rehabilitation, or injections. The outcomes included the disability of the arm, shoulder, and hand score and visual analog scale score for hand pain, which were assessed at baseline and 3 months. Two-factor repeated-measures analysis of variance was used to assess condition-by-time interactions, and effect sizes were calculated. For outcomes with significant interactions, post hoc Mann-Whitney U tests were used to compare between-group changes.

Results: Significant condition-by-time interactions were found for the disability of the arm, shoulder, and hand score (F = 12.85, p = 0.0007, partial η² = 0.17) and visual analog scale score (F = 7.39, p = 0.008, partial η² = 0.02), indicating that treatment effects differed between groups over time. Post hoc analyses revealed that the menopausal hormone therapy group showed significantly greater improvements than the complementary and alternative medicine group in both the disability of the arm, shoulder, and hand (10.85 versus -1.75 points, p = 0.003) and visual analog scale scores (27.9 versus 9.17 mm, p = 0.02). The mean improvement in disability of the arm, shoulder, and hand scores in the menopausal hormone therapy group exceeded the minimal clinically important differences, supporting both statistical and clinical significance.

Conclusions: Compared with complementary and alternative medicine, menopausal hormone therapy showed superior efficacy in improving hand pain and dysfunction associated with symptomatic hand osteoarthritis in perimenopausal Japanese women.

Background: Person-centered maternity care (PCMC) is a model that prioritizes respect, dignity, and responsiveness to each woman's needs, values, and preferences during childbirth. It promotes open communication and personalized care, which is crucial for improving maternal satisfaction and increasing hospital-based deliveries. While recognized as a key element of quality maternal care, the implementation of PCMC varies across different countries. This review aims to assess the pooled mean score and key predictors of PCMC in Ethiopia.

Objectives: This review aims to assess the pooled mean score and key predictors of PCMC in Ethiopia.

Design: Systematic review and meta-analysis.

Data sources and methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was performed in international databases, and registers including: PubMed, Cochrane Library, Google Scholar, HINARI, Scopus, Web of Science, and African Journals Online databases. The quality of included studies was evaluated using the Joanna Briggs Institute tool. Heterogeneity was measured with the I² statistic and its p-value, and publication bias was examined through funnel plots and Egger's test. A random effects model was applied to compute the pooled mean score of PCMC, and adjusted β with results presented as 95% confidence interval (CI).

Results: Seven studies, involving 3383 women, were included in the review. The pooled mean PCMC score was 56.75% (95% CI: 55.08, 58.41). The highest scores were reported in Oromia (60.2) and Addis Ababa (59.2), while the lowest was in South Gondar (52.3). Key factors influencing PCMC included educational status (β: -2.7, 95% CI: -3.98, -1.45), complications during childbirth (β: -5.34, 95% CI: -7.24, -3.44), and time of delivery (β: -3.10, 95% CI: -4.10, -2.11).

Conclusion: The pooled mean score of PCMC in Ethiopia is lower than in many other countries. Key determinants include women's education, complications during childbirth, and the timing of delivery. Addressing these factors is crucial for improving the quality of PCMC in Ethiopia.PROSPERO registration number:CRD42024603854.

Background: Familial hypercholesterolaemia (FH) is a genetic condition that significantly increases cardiovascular disease (CVD) risk, particularly in women. Lipid-lowering therapies (LLTs), such as statins and PCSK9 inhibitors, play a crucial role in reducing low-density lipoprotein cholesterol (LDL-C) and preventing CVD. However, women with FH often face disparities in diagnosis, treatment and outcomes.

Objectives: To assess the effectiveness of LLT in reducing CVD incidence among women with FH and identify gaps in current treatment practices.

Design: Systematic review.

Data sources and methods: A comprehensive literature search was conducted in December 2024 across PubMed, EMBASE, Web of Science and CINAHL, guided by the PICO framework. Thirteen studies met the inclusion criteria; six were rated high quality using the Evidence-Based Librarianship tool. Due to heterogeneity in study design and outcomes, a narrative synthesis was performed.

Results: LLT, particularly statins, consistently reduced LDL-C levels and CVD incidence in women with FH. PCSK9 inhibitors and combination therapies offered additional benefit in high-risk cases. Up to an 80% relative risk reduction was observed in women who initiated early and sustained therapy. However, several studies reported that women were less likely to receive intensive LLT, had a delayed diagnosis and were 32% less likely than men to reach LDL-C targets. Data on premenopausal and menopausal women remain limited.

Conclusion: LLTs are effective in reducing CVD risk in women with FH, yet treatment disparities persist. Addressing barriers such as adherence, hormonal influences and access to advanced therapies is essential. Personalised, gender-specific strategies are needed to close care gaps and improve outcomes for this high-risk population.

Schistosomiasis is a parasitic disease mainly prevalent in tropical and subtropical areas, especially in poor settings without adequate sanitation and access to clean water. It is caused by trematode parasites living within the veins of their human host, where they mate and produce fertilized eggs. The eggs are either shed into the environment through feces or urine, or are retained in host tissues where they induce inflammation and then die. The genital form is caused by Schistosoma haematobium and affects both the urinary and genital tracts in up to 75% of infected individuals, both male and female. Female genital schistosomiasis is a challenging and potentially lethal condition and may affect the whole genital tract leading to a wide range of urinary, sexual, and reproductive health problems. The main reasons leading women to health services are infertility and genital nonspecific symptoms including vaginal discharge, pruritus, pelvic pain, dyspareunia, and haematuria. Other severe complications caused by schistosomiasis include increased risk of HIV and HPV infection, genital ulcers, miscarriage, and ectopic pregnancy. We report in the present case study a 23-year-old female with schistosomiasis and ruptured ectopic tubal pregnancy successfully managed in a low-income setting.