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

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatological conditions, predominantly affecting women with mortality rates of 4.8-48%. Antibiotics are common triggers. They cause painful mucous membrane erosions in various body parts. Treatment involves steroids, creams, and therapy. Pregnant women with SJS-related vaginal stenosis face challenges of delivery route.

Case report: A 34-year-old primigravida woman presented at term with vaginal stenosis consequent to a 10-year-history of Stevens-Johnson syndrome triggered by cephalosporin. On pediatric Pederson speculum examination, vaginal stenosis, adhesion, scarred cervix, telangiectasis of the vaginal mucosa, and moderate bleeding after examination were noted. The risks of severe genital tract laceration and excessive bleeding from vaginal birth was discussed with the couple. Shared clinical decision making was reached to undergo a cesarean delivery.

Conclusion: SJS and TEN can result in severe genital complications in women, sometimes requiring cesarean sections due to genital scarring.

Introduction: Cesarean delivery (CD) facilitates delivery of the baby through an incision and is performed in situations where vaginal delivery poses risks to the mother, baby, or both. Over 1.2 million CDs are performed in the United States annually.

Methods: An interdisciplinary council was created to drive regular data analysis and sharing, interdisciplinary collaboration, and standardized processes to reduce surgical site infections (SSI) following CD. The standardized infection ratio (SIR), a summary measure used to track hospital-acquired infections at a national, state, or local level over time, was used. Bundle components included pre- and postsurgical education and access to follow-up, peri- and intraoperative practice changes, and a risk stratification tool for postoperative dressing selection.

Results: The bundle was initiated in April 2022. After use was established for 6 months, the SIR was evaluated in the fourth quarter of 2022. For this one quarter, the expected SIR for the hospital was 2.64, and the calculated SIR measured 0.38. In 2022, which included 3 months prebundle and 9 months postbundle, the expected SIR was 10.57, with a calculated SIR of just 0.66 for the full year. In 2023, the expected SIR was 11.10, with a calculated SIR of 0.27. The SSI rate reflects an observed 75% reduction in SSI between the years 2021 and 2023. Zero SSI have been observed from January to May 2024. For the patients who underwent planned CD, 98% received the full perioperative obstetric bundle.

Discussion: The ongoing analysis and sharing of data, the implementation of standardized processes, and interdisciplinary collaboration were imperative to the success of this hospital's quality improvement project to reduce SSI for patients undergoing CD.

Importance: Hypertensive disorders of pregnancy (HDP) are a group of high blood pressure disorders during pregnancy that are a leading cause of maternal and infant morbidity and mortality. Data on the trend in the incidence of HDP among the Medicaid population during coronavirus disease of 2019 (COVID-19) are lacking.

Objective: To determine the trends in the annual incidence of HDP among pregnant Medicaid-insured women in Louisiana before and during the COVID-19 pandemic (2016-2021).

Methods: A total of 113,776 pregnant women aged 15-50 years were included in this study. For multiparous individuals, only the first pregnancy was used in the analyses. Women with a diagnosis of each type-specific HDP were identified by using the International Classification of Diseases, 10th revision (ICD-10) codes. The annual incidence of HDP was calculated for each race and age subgroup. For each type-specific HDP, the annual age-specific incidence was calculated.

Results: The incidence of HDP increased from 10.5% in 2016 to 17.7% in 2021. The highest race/ethnicity-specific incidence of HDP was seen in African American women (19.2%), then White women (13.1%), followed by other women (10.7%).

Conclusion and relevance: HDP remains a very prevalent and significant global health issue, especially in African American women and during the COVID-19 pandemic. Severe HDP substantially increases the risk of mortality in offspring and poses long-term issues for both mother and infant. HDP prevention holds particular relevance for the Medicaid population, given the health care disparities and barriers that impact quality of care, leading to an increased risk for HDP.

Objective: To measure and assess the relationship of patient safety culture to reducing cesarean overuse.

Study setting: Maternity care hospitals in Michigan.

Study design: Cross-sectional observational design, combining individual survey data with hospital characteristics using existing databases. Multivariate Poisson regression assessed the associations between survey scores and hospital nulliparous term singleton vertex cesarean rates. Factor analysis determined the scalability of survey items.

Data collection methods: Electronic survey distributed at the hospital site level.

Principal findings: A total of 3091 clinicians from 54 out of 57 eligible hospitals completed the survey. Confirmatory factor analysis demonstrated best fit with a univariate model with two local factors. The new scale encompassing both local factors, including vaginal birth microculture and safety culture, is entitled "Unit Norms." The safety culture subdomain demonstrated an association with a reduction in hospital cesarean rate [-0.15; 95% CI: -0.27 to -0.04; incident rate ratio (IRR) 0.86], parallel to but lower in magnitude to vaginal birth microculture (-0.18; 95% CI: -0.35 to -0.02; IRR 0.84).

Conclusions: Vaginal birth microculture remains the strongest predictor of cesarean delivery overuse; however, safety culture characteristics, including teamwork, psychological safety, and communication, correlate with lower cesarean delivery rates. Measuring these aspects of hospitals' culture may be important for other areas of quality improvement initiatives focused on quality and safety.

In 2022, the US Supreme Court decision in Dobbs v. Jackson Women's Health Organization to overturn federal law safeguarding abortion rights led to considerable national debate on abortion and reproductive rights. We report the findings of a survey of academic scientists' perspectives regarding abortion rights, state policies, and the impact of the 2022 Supreme Court decision in Dobbs v. Jackson. Furthermore, we look at how academic scientists' institutions acted to address the Dobbs decision. Using a 2023 cross-sectional survey, we address the following research questions: (i) What are scientists' views of abortion rights? (ii) How have scientists responded to the 2022 Supreme Court decision in Dobbs v. Jackson Women's Health Organization? and (iii) How are their views different from that of the general public with regard to Dobbs v. Jackson and abortion rights in general? Findings show that abortion was a key factor influencing scientists' voting decisions. We also highlight substantial differences between scientists' perspectives and those of the general population and reveal gender differences of opinions within the scientific community. We conclude by presenting the actions implemented by universities and scholars in response to the Dobbs decision and discuss the implications our results have for both policy and practice.

Introduction: Parental leave yields significant health benefits for parents and children. While many medical associations endorse parental leave, it is unknown what parental leave they provide for their employees.

Objective: To assess parental leave policies of national physician societies for their employees including paid versus unpaid and parity between birth mothers and non-birthing parents.

Methods and materials: A cross-sectional analysis in 2023 examined parental leave policies of national physician societies, including the American Medical Association (AMA), American Osteopathic Association (AOA), and six specialty societies: American College of Obstetricians and Gynecologists (ACOG), American College of Osteopathic Obstetricians and Gynecologists (ACOOG), American Academy of Pediatrics (AAP), American College of Osteopathic Pediatricians (ACOP), American Academy of Family Physicians (AAFP), and American College of Osteopathic Family Physicians (ACOFP). Examination of policies included: duration, whether paid or unpaid; qualifications before receiving benefit; and whether non-birthing, adoptive, and foster parents were covered.

Results: Among the eight societies surveyed, two (25%) did not disclose their policies (ACOG, ACOP), and one (12.5%) lacked a policy (ACOOG). Of the remaining five, two (40%) offered paid leave (AMA, AAP), while three (60%) provided unpaid leave in line with legal requirements (AOA, AAFP, ACOFP). Benefits for non-birthing parents mirrored those for birth mothers, although the AMA offered birth mothers enhanced benefits.

Conclusions: Only a minority of surveyed physician societies provide paid parental leave. Physician societies should consider providing paid parental leave for their employees and making their policies publicly available to promote and model the benefit of paid parental leave.

Background: Polycystic ovary syndrome (PCOS) is one of the most common gynecological endocrinopathies in women of reproductive age in the Middle Eastern countries, including Kuwait. This cross-sectional study assessed the prevalence of and examined the factors associated with PCOS status among female university students of health sciences in Kuwait.

Methods: During January 2023, a cross-sectional study was conducted among female students, enrolled in any of the five colleges (i.e., Medicine, Public Health, Dentistry, Pharmacy, and Allied Health Sciences) of Kuwait University. Data were collected using a structured e-questionnaire administered through social media platforms. The prevalence (%) of physician-diagnosed PCOS was computed. The multivariable logistic regression model was used to compute the adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI) for the factors significantly associated with PCOS status.

Results: Of the 588 participants, most were Kuwaiti (86.5%), single (95.6%), and 21-24 years old (59.3%). The prevalence of PCOS was 16.3% (96/588). The risk factors significantly associated with PCOS status were hyperprolactinemia (aOR = 7.67; 95% CI: 3.72-15.83), menstrual irregularities (aOR = 5.12; 95% CI: 2.32-11.31), family history of PCOS (aOR = 3.49; 95% CI: 1.93- 6.29), hirsutism (aOR = 3.58; 95% CI: 2.06-6.21), and male pattern baldness (aOR = 2.06; 95% CI: 1.19-3.58).

Conclusions: This study showed moderately high prevalence of PCOS. Hyperprolactinemia, menstrual irregularities, family history of PCOS, hirsutism and baldness were significantly associated with PCOS status in the study sample. Imparting awareness and early diagnosis may help minimize PCOS burden in this and other similar settings in the region. If implemented, future studies may look at the impact of such efforts.

Background: Monitoring of diabetes by measuring capillary blood glucose using a glucometer.

Objectives: To compare the three most used glucose meters in diabetic patients in a maternity and neonatal center in terms of repeatability, accuracy, and stability.

Methodology: A comparative study on 100 diabetic patients admitted to the various departments of a maternity and neonatal center. For each patient, a capillary measurement was made using each of the three glucometers to be tested (Accucheck^®, On Call^® and Bionime^®) as well as a blood glucose on venous blood, performed in the laboratory using the Siemens X brand plus^® PLC (reference method). The same sample was used to carry out all measurements.

Results and conclusions: The Accucheck^® brand reader and the On Call^® brand thus, show a better correlation for open and closed bottles of test strips'storage, compared with the Bionime^® brand reader. We found that the Accucheck^® and On Call^® readers are comparable in terms of reliability of results and are better than the Bionime^® brand reader. We have found that, first using closed vials give more accurate results for glycemia readers and also, On Call^® and Accucheck^® brand readers are more reliable and accurate than the Bionime^® brand reader.

Introduction: Postpartum period is a critical period for a woman, where the body of the woman is in healing stage. In this situation, there arises the risk for developing anemia, if proper diet is not maintained. So, it is necessary to routinely determine the hemoglobin levels during this period to avoid chances of developing anemia and assist in early diagnosis.

Methodology: A cross-sectional study was carried out at the maternity ward of Kalinga Institute of Medical Sciences Hospital, Bhubaneswar. The study was conducted for a period of 5-6 months by received approval from the concerned institutional committee. The study involved women participants having age above 18 years and who had recently undergone delivery. Written informed consent was taken from all the participants prior to their enrolment for this study.

Results: A total of 670 women were involved in this study and more than 50% of the women were found to be affected by anemia. A Pearson's correlation of 0.87 was observed with sensitivity of 95.69% and specificity of 67.06% between the hematology analyzer and non-invasive EzeCheck device in determining anemia.

Conclusion: Women often neglect their health situations and always prioritize their family's wellbeing and health over their own. This avoidance results in the development of a chronic disease which in the long run becomes difficult to be cured. So, in such situations, it is necessary to inculcate certain routine tests for the women during their healing period (such as postpartum stage) to keep an eye on their health status. Use of non-invasive devices can help in achieving this in a painless and much effective manner with instant reporting of the results.

Objective: This study assessed the diagnostic efficacy of combining 3.0T MRI and molybdenum target X-ray in triple-negative breast carcinoma (TNBC) and its association with the prognosis of sentinel lymph node biopsy (SLNB).

Methods: The retrospective analysis included 128 patients suspected of having TNBC, who underwent 3.0T MRI and molybdenum target X-ray. Sensitivity and specificity were calculated for each imaging technique, and their combined diagnosis was evaluated using the four-table method. Consistency between the imaging techniques and pathological examination was assessed using the consistency checking method. Additionally, changes in imaging indicators were compared among patients with different prognostic indicators.

Results: Among the 128 patients, 86 were diagnosed with TNBC through pathological examination. The sensitivity and specificity of 3.0T MRI for TNBC were 82.56% and 76.19%, respectively. Molybdenum target X-ray exhibited a sensitivity of 77.91% and specificity of 78.57%. The combined diagnosis of the two techniques showed a sensitivity of 90.70% and specificity of 86.36%. There was good agreement between both imaging techniques and pathological examination results. Significant differences were observed in imaging indicators based on tumor diameter, histological grade, and lymph node metastasis.

Conclusion: Both 3.0T MRI and molybdenum target X-ray are valuable in diagnosing TNBC. Additionally, these imaging techniques provide prognostic information and can aid in treatment decision-making. The findings highlight the importance of 3.0T MRI and molybdenum target X-ray in improving the outcomes of patients with TNBC.