Women's health reports (New Rochelle, N.Y.)最新文献

Background: Provoked vestibulodynia (PVD) is a chronic pain condition affecting the vulvar vestibule, often triggered by minimal touch or pressure. It is underdiagnosed and poorly understood, leading to significant impacts on women's quality of life.

Objective: This study aims to identify the demographic and clinical characteristics of PVD among women in Israel.

Materials and methods: A cross-sectional study was conducted using an online questionnaire completed by a self-selected sample of adult women. Weighted estimates of vulvodynia prevalence and characteristics were determined.

Results: Out of 250 participants, 196 women (78%) met the diagnostic criteria for PVD. High rates of comorbid conditions were observed, including depression (33%), anxiety (43.3%), and other comorbidities (60%). The mean time from first consulting a physician to diagnosis was 2.5 years, with symptoms persisting for an average of 8 years. Physical therapy emerged as the most effective treatment modality.

Conclusions: PVD is a challenging condition to diagnose and treat, often leading to significant delays in diagnosis and prolonged suffering. The high prevalence of comorbid conditions underscores the need for comprehensive treatment approaches. Improved diagnostic protocols and more effective treatment options are essential to enhance the quality of life for women with PVD.

Background: This study aimed to evaluate the safety and effectiveness of ganirelix acetate for Chinese women undergoing ovarian stimulation (OS) in real-world clinical practice.

Methods: This multicenter (16), prospective, single-arm, observational, post-authorization safety study included 1025 Chinese women receiving at least one dose of ganirelix during OS. Safety endpoints were collected until 5 weeks after embryo transfer. The investigator assessed the causality and seriousness of an adverse event (AE). Effectiveness and neonatal outcomes were collected from medical records and phone call follow-ups. The study had a probability of >95% to observe an AE occurring at 0.3% with a sample size of 1000.

Results: The occurrence of overall AEs, drug-related AEs, and serious AEs (SAEs) was 12.1% (124/1025), 1.3% (13/1025), and 2.4% (25/1025), respectively. None of the SAEs were drug related, according to the investigator. Two (0.2%) patients discontinued treatment due to an AE. The most reported AE was ovarian hyperstimulation syndrome (4.8%, 49/1025), among which 21 cases were reported as SAE. The proportion of patients with a premature luteinizing hormone (LH) rise >10 IU/L) was 2.5% (26/1025), and one patient had a premature ovulation. The live birth rate was 34.9% (358/1025) per start cycle with a cumulative live birth rate of 42.1% (432/1025). Neonatal malformations occurred in 1.3% (7/523) of the neonates.

Conclusions: This study indicates that the safety profile and effectiveness of ganirelix were clinically acceptable, and no new safety signals emerged in real-world clinical practice for Chinese women with OS. The study was registered on Chinadrugtrial.org (identifier: CTR20150284) (http://www.chinadrugtrials.org.cn) and ENCePP.eu (identifier: EUPAS8737) (https://catalogues.ema.europa.eu).

Introduction: Perinatal intimate partner violence (IPV) and perinatal cannabis and nicotine product use are common and associated with negative maternal-infant health outcomes. Substance use coercion (SUC), which involves abusive partners' controlling behaviors related to substance use, has not been studied for cannabis and nicotine products. Perinatal individuals may be particularly vulnerable to SUC, and this study aims to explore how cannabis and nicotine SUC manifests among perinatal survivors.

Methods: We conducted virtual, semi-structured, 45-minute retrospective interviews with 19 IPV advocates and 15 perinatal IPV survivors. Participants were recruited through local IPV agencies and an online recruitment repository. Audio-recorded interviews were transcribed and analyzed using a deductive-inductive thematic analysis approach. Two research team members individually coded each transcript and met to resolve discrepancies.

Results: Key themes emerged relating to survivors' use, interpersonal coercive tactics, and systems-level control. Specific findings included (1) survivors using substances to cope; (2) abusive partners coercing survivors through withholding, controlling, and punishing substance use; (3) shame and stigma are key drivers of coercion; (4) partners hinder cessation efforts; and (5) child protective services and health care are systems used by abusive partners to control and manipulate perinatal survivors of IPV.

Discussion: The findings demonstrate that cannabis and nicotine products are used to coerce and control survivors of IPV. Future work should focus on developing survivor-centered interventions within systems to better support perinatal IPV survivors using cannabis and nicotine products. This study highlights the impact of cannabis and nicotine SUC on perinatal individuals and underscores the need to consider SUC when providing resources or treatment.

Introduction: While there is extant literature surrounding barriers to reproductive care in the unhoused population-especially regarding access to contraception-little attention has been given to patient perspectives and the quality of care that is received. The unhoused population, which is disproportionately persons of color and low income, has a higher prevalence of psychiatric and physical disabilities. This is a population that has historically been a victim of eugenics and coercive practice.

Study objective: The purpose of the study is to qualitatively understand the experiences of currently unhoused women with pregnancy, birth control, and sterilization, as well as analyze their perspectives in their clinical encounters over their lifetime.

Materials and methods: Participants (n = 10) were recruited from two shelters in a midwestern city. The sample consisted of those assigned female at birth, are currently experiencing homelessness, and have experience with obstetrical and gynecological health care. A semistructured interview was conducted with each participant utilizing a question bank. Audio was recorded, transcribed, and coded for themes.

Results: The main themes coded from the interviews were negative birthing and/or sterilization experience, lack of shared decision-making for birth control and/or sterilization, pressure to undergo sterilization and/or go on birth control, the desire for a nonjudgmental provider, and sexual violence experience.

Conclusions/implications: Our data indicate that women experiencing homelessness (WEH) may prefer contraceptive conversations that are trauma-informed and rooted in a shared decision-making model, which in turn may help WEH develop more agency around their reproductive health care. This pilot study also emphasizes the need for more qualitative research to evaluate experiences directly in the population of interest.

Background: Depression and anxiety are prevalent in the perinatal period and may contribute to adverse maternal and child health outcomes. A focus on multilevel protective factors may be effective in promoting well-being and increasing quality of life (QOL) in the perinatal period while simultaneously reducing or preventing depression and anxiety symptoms. We tested a conceptual model that posits specific personal, social, and community factors affecting depression, anxiety, and QOL among pregnant and postpartum individuals.

Methods: Four hundred and thirty-eight pregnant or postpartum individuals completed a 121-item cross-sectional survey composed of validated tools that assessed multilevel protective factors, health behaviors, and mental health outcomes. Confirmatory factor analysis (CFA) was constructed to evaluate a 3-part conceptual model against measured indicators of well-being. A structural equation model (SEM) was then fit to test the pattern of associations between our latent structure and three end points: depression, anxiety, and QOL.

Results: The CFA fit the data well (comparative fit index [CFI] = 0.907, Tucker-Lewis index [TLI] = 0.876, root-mean-square error of approximation [RMSEA] = 0.092) supporting the proposed conceptual approach to measuring well-being. The SEM fit well (CFI = 0.964, TLI = 0.941, RMSEA = 0.059), and all three end points were predicted in the hypothesized direction. Social factors predicted reduced anxiety symptomatology, personal and community resources predicted reduced depressive symptomatology, and social resources predicted increased QOL. In addition, we found that collective community resources were associated with social and personal resources, and social resources directly affected personal resources, showing the benefit of multiple levels.

Conclusions: Our findings suggest that both the collection of and interplay between certain personal, social, and community-level resources may prevent and protect against depression and anxiety and promote QOL. Our conceptual model provides a framework to inform future interventions and clinical practice to better assess and promote maternal well-being during the perinatal period.

Background: It is more than two decades since the Organisation of African Unity's historic Abuja Summit, yet the fight against human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related maternal deaths in the region remains as critical as ever. This study examined four key dimensions to inform future actions: cross-national comparison of current HIV/AIDS-related maternal deaths, temporal trends in mortalities (for pre- and post-Abuja periods), variations across age groups and birth cohorts, and potential policy levers to drive progress.

Methods: Poisson regression-based age-period-cohort models were fitted to the Global Burden of Disease Study 2021 (GBD 2021) data (1982-2021; N = 47,750 HIV/AIDS-aggravated maternal mortalities) to estimate age, calendar period, and birth cohort effects on mortalities for each of the 54 African countries.

Results: Notable variations in HIV/AIDS-aggravated maternal deaths were observed across Africa. In 2021, 16 of the 54 countries had age-standardized mortality rates near zero, while 38 countries reported rates ranging from 0.07 to 0.95 per 100,000 women. Mortality rates rose sharply from the early 1980s, peaked during the 1990s and early 2000s, and generally declined after the Abuja Summit; however, the trajectories varied considerably across the continent. Mortality also increased with age, with substantial heterogeneity in country-level patterns. In more than two-thirds of countries, cohort comparisons relative to a 1967 baseline showed marked increases in mortalities in recent birth cohorts.

Conclusions: Given the marked variations in HIV/AIDS-aggravated maternal mortality among African populations, this study advocates for context-specific, life-course strategies to drive progress toward universal health coverage and improved maternal health across Africa.

Background: While the efficacy of brexanolone, a U.S. Food and Drug Administration-approved infusion treatment for postpartum depression (PPD), has been demonstrated in controlled trials, few reports are available describing its real-world effectiveness.

Methods: Leveraging real-world clinical data, the current report describes the characteristics and treatment outcomes of a sample of women (N = 150) receiving brexanolone treatment for PPD in a residential-style outpatient treatment center with up to 12 months of follow-up. The sample had a mean age of 30.0 years (SD = 4.5), with almost one-third (31.3%) on hormonal birth control, and most (91.3%) were taking concomitant psychiatric medications.

Results: Participants reported significant decreases in depression and anxiety symptoms from pretreatment to posttreatment that were sustained across a 12-month follow-up. Edinburgh postnatal depression scale (EPDS) scores decreased from pretreatment (M = 19.9, SD = 4.1) to posttreatment (M = 10.5, SD = 4.5, p < 0.001, within-group effect size [Cohen's d] of 2.2). At 12 months follow-up, EPDS scores remained significantly lower among the retained subset of patients (N = 64, M = 9.2, SD = 6.5). Among a subset who underwent formal assessments for anxiety, scores on the perinatal anxiety screening scale decreased from pretreatment (M = 60.1, SD = 17.1) to posttreatment (M = 33.3, SD = 22.1, p < 0.01, within-group effect size of 1.4). Response and remission rates for depression were 68.7% and 46.7%, respectively, posttreatment, and 73.4% and 60.9%, respectively, at 12-month follow-up. Importantly, 15 participants had a diagnosis of bipolar depression and were prescribed an antipsychotic or mood stabilizer at the time of treatment, there were no episodes of mania or hypomania reported during the follow-up period.

Conclusions: Given the shared mechanism of action between brexanolone and the recently approved oral medication for PPD, zuranolone, the applicability of findings and relevance to the more accessible oral drug, zuranolone, are explored.

Introduction: To compare the clinical outcomes of laparoscopic myomectomy via single-port approach (SPLM) and conventional multiport laparoscopic myomectomy (MPLM).

Methods: A retrospective analysis was conducted on 149 patients with uterine fibroids, including 77 who underwent MPLM and 72 who underwent SPLM. Patient baseline characteristics and perioperative indicators were compared to evaluate surgical efficacy.

Results: No significant differences were observed between the two groups in demographic characteristics, fibroid number, or maximum fibroid diameter (p > 0.05). The SPLM group had a higher proportion of anterior wall fibroids (45.8% vs. 26.0%) and subserosal fibroids (38.9% vs. 18.2%) compared to the MPLM group (p < 0.05). The SPLM group showed significantly better outcomes in total operative time (99.85 ± 33.65 minutes vs. 120.91 ± 49.48 minutes), time to postoperative gastrointestinal recovery (1.40 ± 0.55 days vs. 1.69 ± 0.47 days), and 24-hour postoperative visual analog scale (VAS) score (2.33 ± 0.65 vs. 2.70 ± 0.84) (p < 0.05). No significant differences were found in intraoperative blood loss, postoperative complication rates, or hospital stay between the two groups in the overall analysis. However, based on the four influencing factors, further stratified analysis within each factor revealed that SPLM was more advantageous for treating single fibroids, fibroids less than 8 cm in diameter, and intramural fibroids, demonstrating significantly shorter operative times than MPLM (p < 0.05). Surgeon A demonstrated superior outcomes in both operative time and intraoperative blood loss when performing myomectomy via the single-port laparoscopic approach compared to the multiport technique (p ≤ 0.05).

Conclusion: SPLM is a safe and effective surgical approach. For single intramural fibroids less than 8 cm in diameter, it demonstrates superior operative efficiency compared to conventional MPLM, particularly regarding operative time. When performed by the senior surgeon, the advantages of SPLM become even more pronounced in both operative duration and intraoperative blood loss.

Background: A need exists to incorporate evidence-based tracking methods that measure menstrual cycle (MC) variability to describe the data quality provided by an app. The study purpose was to assess the agreement between an app's cycle phase identifications and a modified version of the three-step method (m3stepMC) of hormone verification.

Materials and methods: Participants across Canada were recruited to track their MC over 3 months by entering data into a female-health MC tracking app (the app) while collecting measures of ovulation and salivary hormones around the late-follicular (FP) and mid-luteal (MLP) phases, respectively. Bland-Altman plots assessed the limits of agreement (LoA) between the identified days within each of the app's predetermined phases and the m3stepMC-identified days when MC dates aligned between the methods. Pearson's correlations (r) were used to examine the effect size of relationships between variables.

Results: Participants' (n = 25) mean age was 29.3 ± 4.24 with self-reported mean cycle lengths of 27.3 ± 2.38 days. The agreement between the app's estimated (1) end of phase one and the estimated start of the mid-FP was 0.6 ± 1.66 days (95% LoA: 2.65-3.85; r = 0.66), (2) end of phase two and the identified luteinizing hormone (LH) surge day and midpoint of phase three and the estimated 48-hour ovulatory window post-LH surge day were -0.6 ± 1.71 days (95% LoA: -3.95 to 2.75; r = 0.64), and (3) phase four and the estimated MLP day verified by salivary hormones and the start of the app's phase five and the estimated late-luteal midpoint day were -2.2 ± 0.97 (95% LoA: -4.13 to -0.32; r = 0.94).

Conclusion: This study describes the agreement between a m3stepMC tracking method and hormone measures and an app's predetermined MC phase system in eumenorrheic cycles when MC dates aligned between methods.

Background: Diabetes during pregnancy poses significant risks to maternal and fetal health. This study explores health care providers' perspectives on factors influencing pregnant women with type 2 diabetes management in Thailand.

Methods: A qualitative descriptive study based on the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework. Semi-structured interviews were conducted with 13 physicians and nurses from two public hospitals (urban and rural areas). Directed content analysis was used to analyze the data, with themes and subthemes derived from initial codes based on the NIMHD framework.

Results: Thirteen health care providers participated, including 10 nurses and 3 physicians. Three major themes emerged. Each theme was categorized into NIMHD domains of influence, including biological, behavioral, physical/built environment, and sociocultural environment. Theme 1: Individual-level factors include biological vulnerability and mechanisms in diabetes risk, maternal and neonatal complications, unplanned pregnancy and unawareness of preexisting diabetes, lifestyle behavior factors contributing to diabetes risk, diabetes management during pregnancy, environmental and workplace adjustments for pregnant women, sociodemographic challenges in diabetes management during pregnancy, and culture and beliefs in pregnancy care. Theme 2: Interpersonal-level factors include maternal responsibility for a safe pregnancy, family involvement in pregnancy care, promoting diabetes awareness and healthy lifestyle in schools and workplaces, and the role of social media and digital platforms in maternal health. Theme 3: Community-level factors include the role of community functioning in maternal health, access to healthy and safe food in the community, and cultural shifts toward convenience food options.

Discussion: Emphasizing these factors requires a coordinated approach involving health care providers, families, communities, schools, workplaces, and policymakers. Tailored interventions promoting diabetes screening, healthy lifestyles, and supportive environments for pregnant women, particularly those from disadvantaged backgrounds, are crucial. Future research should focus on developing culturally sensitive, community-based strategies to overcome barriers to care and improve diabetes management during pregnancy.