BMC Women's Health最新文献

Background: Cuproptosis is a novel form of cell death, acting on the tricarboxylic acid cycle in mitochondrial respiration and mediated by protein lipoylation. Other cancer cell death processes, such as necroptosis, pyroptosis, and ferroptosis, have been shown to play crucial roles in the therapy and prognosis of ovarian cancer. However, the role of cuproptosis in ovarian cancer remains unclear.

Methods: The expression profiles of 10 cuproptosis-related genes were extracted from GSE140082. Kaplan-Meier survival and Cox proportional hazards regression were used to identify prognostic genes for constructing risk models. Following this, Least Absolute Shrinkage and Selection Operator regression was employed to construct a risk score model. Next, a nomogram was constructed to predict overall survival in ovarian cancer. Ultimately, our analysis compared the two groups across various dimensions, including clinical characteristics, tumor progression, metabolism-related pathways, immune landscape, and drug sensitivity.

Results: MTF1 and LIAS were identified as protective factors in ovarian cancer, with patients in the higher risk group being significantly associated with poorer survival. Furthermore, integrating the risk score with clinical characteristics in the nomogram demonstrated high specificity and sensitivity in predicting survival. A higher propotion of M2 macrophages, follicular helper T cells, and resting mast cells was observed in the high-risk group. Additionally, the IC50 values of Dasatinib, Bortezomib, Parthenolide, and Imatinib were significantly lower in the high-risk group.

Conclusions: The study highlights the prognostic significance of cuproptosis-related genes and provides new insights into developing pharmacological therapeutic strategies targeting cuproptosis for the prevention and treatment of ovarian cancer.

Background: Prenatal maternal smoking, lower birthweight, and shorter breastfeeding duration have all been associated with an earlier age at menopause in daughters. We estimated the extent to which birthweight-for-gestational-age z-score and breastfeeding duration mediate the effect of prenatal maternal smoking on time to natural menopause in daughters.

Methods: Using pooled data from two prospective birth cohort studies - the 1970 British Cohort Study (n = 3,878) followed-up to age 46 years and the 1958 National Child Development Study (n = 4,822) followed-up to age 50 years - we perform mediation analysis with inverse odds weighting implemented in Cox proportional-hazards models.

Results: Prenatal maternal smoking was associated with lower birthweight z-scores [β: -0.29; 95% CI -0.34, -0.24] and reduced breastfeeding duration [RRR_< 1month: 0.90; 95% CI 0.79, 1.02; RRR_{≥ 1 month}: 0.66; 95% CI 0.59, 0.73 relative to women who were never breastfed]. Greater z-score for birthweight [HR: 0.96; 95% CI 0.91, 1.01] and longer breastfeeding duration [HR_{≥ 1 month}: 0.84; 95% CI 0.74, 0.96] were associated with lower hazards for earlier age at natural menopause. The total effect of prenatal maternal smoking on the time to natural menopause in daughters was estimated as a HR of 1.13 [95% CI 1.02, 1.24]. Birthweight z-score and breastfeeding duration jointly explained an estimated 14% of the total effect [HR_NIE: 1.02; 95% CI 0.99, 1.05].

Conclusions: The consequences of smoking during pregnancy on the earlier experience of natural menopause in daughters may partly be offset by intrauterine growth and longer breastfeeding duration to the extent that they mediate the risk of earlier menopause. However, since the extent of mediation by birthweight z-score and breastfeeding duration is small, other factors, including the direct effect of maternal smoking in utero, may play a more important role.

Background: Ovarian cancer is a leading cause of mortality worldwide. The third most prevalent gynecological cancer globally, following cervical and uterine cancer, and the third leading cause of cancer-related mortality among women in Sub-Saharan Africa, including Ethiopia. The time ovarian cancer patients have to wait between diagnosis and initiation of treatment are the indicators of quality in cancer care and influence patient outcomes. Despite extensive studies in the field, little is known about the strength of the association between ovarian cancer survival and waiting time. So, the main purpose of this study is to assess the effect of waiting time on ovarian cancer survival in oncology centers in Addis Ababa, Ethiopia.

Methods: A facility-based retrospective cohort study was conducted with a total of 561 study participants included. The main outcome of interest for this study was death due to ovarian cancer. The authors compared the ovarian cancer patients with waiting times ≤ 10 weeks and waiting times > 10 weeks for overall survival rate using the log rank test. The incidence density rate of mortality was calculated for each group variable. The effect of waiting time on ovarian cancer mortality was estimated using the Cox proportional hazards model at the 5% level of significance.

Results: The incidence density rate of mortality among ovarian cancer patients for waiting time ≤ 10 weeks was found to be 10.85 (95%CI, 9.10-12.98) per 1,000 person years observation, while for waiting time > 10 weeks the mortality rate was found to be 18.05 (95%CI, 15.33-21.23) per 1,000 person years observation. In the Cox regression analysis after full adjustments for confounder variables, the mortality event risk was 36% higher among waiting time > 10 weeks women (AHR = 1.36; 95%CI = 1.05-1.75) as compared to waiting time ≤ 10 weeks.

Conclusions: We have found that the incidence density rate of mortality among ovarian cancer patients was significantly higher in waiting time > 10 weeks groups. Therefore, future policy and clinician programmers should consider the impact of waiting time from diagnosis until to get the first treatment more carefully.

Background: Good knowledge about the ovulatory cycle plays an important role in reducing unwanted pregnancies and unsafe abortions among adolescent females. However, in Ghana, knowledge of the ovulatory cycle among adolescent females is not well studied. Thus, this study sought to assess adolescent females' knowledge regarding the ovulatory cycle and its determinants in Ghana.

Methods: This study used data from the 2022 Ghana Demographic and Health Survey. It comprised a sample of 2,835 adolescent females (Mean age = 16.9, standard deviation ± 1.42). Multilevel multivariable logistic regression was used to analyse the determinants of ovulatory cycle knowledge among Ghanaian adolescent females. Four models were fitted incorporating individual and community levels. All associations were considered statistically significant at 95% confidence level in the fixed effect results. The random effects were quantified in terms of Intra-Class Correlation (ICC) and Primary Sampling Units (PSUs) variance.

Results: The level of knowledge about the ovulatory cycle was 24.6% (95% CI=23.0-26.0%). Adolescent females with secondary/higher education (AOR = 2.36; 95% CI = 1.26-4.43), at least one child (AOR = 2.01; 95% CI = 1.40-2.89), used traditional contraceptives such as rhythm, withdrawal methods (AOR = 2.26; 95% CI = 1.52-3.67), menstruated in the last six weeks (AOR = 2.01; 95% CI = 1.08-3.57) and media exposure to family planning messages (AOR = 1.89; 95% CI = 1.52-2.35) had higher odds of having good knowledge about the ovulation cycle. At the community level, respondents who resided in communities with high literacy levels had higher odds of having good knowledge of the ovulatory cycle (AOR = 1.62; 95% CI = 1.14-2.31).

Conclusions: Knowledge of the ovulatory cycle among adolescent females in Ghana is low and this may be contributing to unwanted pregnancies. Public health interventions on the ovulatory cycle should target adolescent females who have lower levels of education and those who do not use contraceptives.

Background: Although abortion was completely decriminalized in Canada 36 years ago, barriers to pregnancy prevention and termination persist across the country, such as travel and information gaps. Research demonstrates incarcerated people face barriers to family planning care, yet there is no systematic data collection of sexual and reproductive health experiences and outcomes among incarcerated people in Canada. The aim of this study was to explore family planning care experiences among women and gender diverse people who have experienced incarceration in Canada.

Methods: We conducted a qualitative community-based research study using focus groups for data collection and reflexive thematic analysis to generate key themes. Our study team included members with lived experience of incarceration. We conducted recruitment in partnership with community organizations. We asked about accessing abortion and contraception while incarcerated and on release.

Results: We conducted six focus groups with 35 recently incarcerated participants. Five themes emerged: (1) Competing health needs; (2) Institutional barriers to care; (3) Mistreatment and unethical care; (4) Health knowledge gaps; and (5) Challenges to care-seeking in community.

Conclusion: People in prison experience concurrent unmet health needs that crowd out sexual and reproductive health. Prison procedures and perceived unethical professional behaviours impinge care-seeking. Information about abortion and contraception is not readily available in prison. Barriers to care persist upon release. Family planning professionals may improve care for people who experience incarceration by recognizing concurrent mental health needs; anticipating impact of prior negative experiences on care-seeking; challenging limitations to health education in prison; and addressing post-release challenges for patients.

Background: Although highly prevalent, most perinatal mental health and substance use disorders often go unrecognized, undiagnosed, and untreated. Perinatal Psychiatry Access Programs have emerged as a successful model to increase the capacity of front-line maternal health care providers to address perinatal mental health conditions through education, consultation, and increased resources and referrals.

Methods: This model has been adapted in South Carolina to include direct access to mental health treatment in response to inadequate maternity care and mental health services, including a large proportion of rural, Medically Underserved Areas in Primary Care and Mental Health Healthcare Provider Shortage Areas throughout the state. Moms IMPACTT [Improving Access to Perinatal Mental Health and Substance Use Disorder Care Through Telehealth and Tele-mentoring] leverages statewide partnerships and a virtual care model to provide: 1) people who are pregnant or within 1 year postpartum with immediate access by phone or internet to a clinician trained in perinatal psychiatric care coordination to assess and refer to an appropriate level of perinatal psychiatry services; 2) communication and care coordination with the person's healthcare provider, as appropriate; and 3) healthcare provider training and real-time psychiatric consultation for the management and treatment of perinatal mental health and substance use disorders. Adaptations to this care model have demonstrated benefit including increase access to care for patients with perinatal mental health and substance use disorders and support for frontline health providers serving this population.

Results: Within the first 12 months, the Mom's IMPACTT program served people from 45 of the 46 counties in South Carolina. There were 938 encounters, 96% of which resulted in telehealth or teleconsultation with a care coordinator or program psychiatrist. Treatment was provided to 881 perinatal patients (54.6% White, 26.1% Black, 6.2% Hispanic) of whom 51.8% were insured by Medicaid, 89.7% resided in counties designed as fully Medically Underserved Areas, and 38.9% lived in counties designed as fully rural. Most calls were received directly from perinatal patients, with 60.7% (548/903) of patients requesting mental health support. Additionally, the program completed 22 consultations, and trainings with 443 healthcare providers throughout the state.

Conclusions: Adaptations made to psychiatry access program evident in Moms IMPACTT appear to be successful in meeting the specific needs of birthing people in the state of South Carolina. Suggestions and considerations are included to replicate the success of Moms IMPACTT program elsewhere.

Background: Persistent infection with high-risk human papillomavirus (HPV) is a significant risk factor for cervical cancer. HPV typing and cytology are conducted in women of appropriate age to assess the risk of cervical lesions and to guide the need for further diagnostic procedures such as colposcopy, cervical biopsy, or treatment. This article explores methods to predict the risks of high-grade precancerous cervical lesions based on high-risk HPV typing.

Methods: We conducted a retrospective analysis of HPV typing data from 158,565 women, including 19,707 who underwent ThinPrep cytologic testing (TCT), 7,539 who had colposcopy examinations, and 4,762 who had biopsies. We evaluated the sensitivity, specificity, and risk parameters of high-grade lesions associated with high-risk HPV types.

Results: (1) The overall prevalence of HPV infection was 17.89%, with the most prevalent types being HPV52 (4.44%), HPV58 (2.10%), HPV53 (1.96%), HPV81 (1.85%), HPV42 (1.75%), and HPV16 (1.44%). (2) The sensitivity and specificity of detecting high-grade lesions in TCT, colposcopy, and biopsy, based on high-risk HPV typing, demonstrated a strong linear correlation with the infection rate of each type. (3) HPV16 was confirmed to have a higher risk of CIN2 + in biopsies using a self-defined risk parameter. (4) The top five HPV types with the highest PPVs and pathogenicity risks in biopsies were HPV45, HPV16, HPV58, HPV33, and HPV18.

Conclusion: In Changsha, China, HPV52, HPV58, and HPV53 were the most prevalent and contributed significantly to high-grade lesions. After adjusting for infection rates, a self-defined risk parameter was proposed as a measure of the intrinsic risks of high-grade lesions associated with high-risk HPV types. Focused monitoring of prevalent high-risk HPV types such as HPV45, HPV16, HPV58, HPV33, and HPV18, which show the highest pathogenicity risks, is recommended in our region.

Medullary thyroid carcinoma is a neuroendocrine tumor derived from thyroid C-cells. It is a rare aggressive tumor, known to metastasize to lymph nodes, liver, bones, and lungs. We report a case of a young patient with a family history of breast cancer, who developed breast metastases six months post-treatment for medullary thyroid carcinoma. The breast lesion was initially considered benign in ultrasound. Unlike the high prevalence of primary mammary malignancies, metastases to the breast are uncommon, and account for only 0.2-2.7% of all malignancies affecting this organ. This case emphasizes the need for thorough and continuous monitoring of patients with Medullary thyroid carcinoma, even in unusual locations, to ensure early detection and appropriate management. New lesions on imaging should be interpreted with caution to avoid underdiagnosing metastasis. Immunohistochemical analysis confirmed the metastatic origin, underscoring the challenges in distinguishing between primary and secondary breast tumors. This case contributes to the limited literature on MTC breast metastases and advocates for heightened clinical awareness regarding atypical metastatic sites in thyroid cancer patients.