BMC Women's Health最新文献

Backgroud: Ovarian cancer is the most fatal of all gynecologic cancers. The need and role of pelvic and para-aortic lymphadenectomy in ovarian cancer patients with clinically normal nodes remains debated.

Objective: To assess the accuracy of sentinel lymph node (SLN) mapping in patients with ovarian carcinoma.

Methods: This is a single cohort quality improvement study conducted from May 1, 2020 to Dec. 31, 2022 at a single institution. Patients undergoing surgery for newly diagnosed ovarian carcinoma of all stages were eligible. All patients were injected with methylene blue into the bilateral ovarian cortex, uterine horns and infundibulopelvic ligaments by the same surgeon, SLN mapping was performed followed by an immediate back-up systematic pelvic and para-aortic lymphadenectomy. Ultrastaging was performed on all SLNs that were negative on original H&E slides. Descriptive statistics were used.

Results: Twenty-nine patients were enrolled. The overall detection rate of SLN in ovarian cancer was 100%, sensitivity was 85.7%, false negative rate was 14.3%, and negative predictive value was 95.7%. The median number of SLNs removed per patient was 8 (range, 1-20) and the median total of lymph nodes removed was 34 (range, 6-66). SLNs were identified in the supra-mesenteric para-aortic basin in 90 (34%) and in the infra-mesenteric para-aortic basin in 86 (32.5%).

Conclusion: In this preliminary study with a small sample size of 29 patients, intraoperative SLN mapping using methylene blue injection demonstrated a high detection rate and promising feasibility and accuracy for identifying lymph node metastases in ovarian cancer.

Introduction: Adolescent girls and young women (AGYW) aged 15-24 years still remain a very important target population for sexual and reproductive health services as their pattern of conduct is more significantly associated with sexual affection . Modern birth control services use among AGYW in Sub-Saharan Africa is still low despite having a high prevalence of unintended pregnancy. Modernbirth controlservices are crucial for sexually active Adolescent Girls and Young Women (AGYW) to prevent unintended pregnancies. This study aimed to explore the barriers to the utilization of modern birth controlservices (including short term methods, long term methods and permanent methods) among AGYW (15-24 years) in Oyam District, Northern Uganda.

Methods: We conducted a qualitative study involving eight focus group discussions (FGDs) each with ten respondents, who were AGYW, aged 15-24 years residing in Oyam district Northern Uganda. The FGDs lasted 60-90 minutes and they were audio-recorded. Audio recordings were transcribed verbatim and Open Code software was used to evaluate the data using both an inductive and deductive thematic approach.

Results: Three main themes emerged as barriers to modern birth control services use. First, opposition to modern birth control including; religious, male and cultural opposition. Secondly, health concerns related to modern birth control methods use such as side effects, rumors and misconceptions. Thirdly, health systems factors such as availability of modern birth control methods and waiting time at the health facilities.

Conclusion: The main barriers to the utilization of modern birth control services among AGYW (15 - 24 Years) in Oyam District, Northern Uganda were opposition to modern birth control, health concerns, health systems factors and rumors and misconceptions. Family and community rumors were important decision-influencing factors when it came to using modern family planning services, implying that modern birth control campaigns should target more than just the individual.

Introduction: Advanced ovarian cancer complicated by malignant bowel obstruction is generally considered a terminal event, especially when deemed inoperable, with an expected survival of only a few weeks. We report the case of a patient who was initially judged inoperable but who survived approximately 40 months without disease progression thanks to an active multidisciplinary approach.

Case presentation: A 76-year-old woman presented with bowel obstruction, massive ascites, and an Eastern Cooperative Oncology Group performance status of 4. Ultrasound-guided peritoneal biopsy confirmed a high-grade serous carcinoma of gynecological origin. After a multidisciplinary team discussion, the patient was deemed unsuited to surgical management. Despite this, she received total parenteral nutritional support and symptomatic control, followed by three cycles of neoadjuvant carboplatin-paclitaxel. This treatment led to a substantial reduction in her disease burden and an improvement in her performance status, permitting interval debulking surgery. The outcome of surgery was optimal cytoreduction (residual disease < 1 cm). Six additional cycles of adjuvant chemotherapy were administered (carboplatin was replaced with nedaplatin after the development of hypersensitivity). Germline breast cancer susceptibility gene 2 mutation was identified, and maintenance olaparib was initiated (300 mg twice daily, later reduced). For approximately 40 months, imaging showed good tumor control with no signs of progression, and serum cancer antigen 125 levels remained within normal limits. The patient ultimately succumbed to therapy-related myeloid neoplasms complicated by bleeding and infection, without evidence of ovarian cancer progression.

Conclusions: Patients with advanced ovarian cancer who are initially diagnosed with an inoperable malignant bowel obstruction may still derive a substantial survival benefit from an integrated multidisciplinary treatment regimen. The findings of this study challenge the current negative prognosis of such patients and highlight the need for prospective studies to further explore the potential benefits of this approach.

Background: Maternal depression is a risk factor for children's emotional development,but its specific mechanisms of impact on young children in China,particularly the roles played by child gender and sole status,remain unclear.Clarifying the mediating role of negative parenting styles and the moderating effects of these factors is crucial for developing targeted interventions.

Context: This study is situated within the context of rapid changes in contemporary Chinese family structures.Currently,China has entered a new phase characterized by the "Universal Two-Child" and "Three-Child" policies.The roles of child gender and family size in the family emotional environment require urgent exploration.

Methods: A cross-sectional survey was conducted with 726 mothers of young children in China.The Chinese versions of the Center for Epidemiological Studies Depression Scale,the Parenting Style Scale,and the Children's Emotional Competence Scale were used.Data were analyzed using correlation,mediation,and multi-group analysis to examine the mediating role of negative parenting styles and the moderating effects of child gender and sole status.

Results: The multi-group structural equation modeling analysis supported the moderated mediation model.Maternal depression had significant direct effects on children's emotional competence for girls (b = -0.26,95% CI [-0.40,-0.11]) and non-only children (b = -0.41,95% CI [-0.61,-0.20]),but not for boys or only children.Negative parenting styles served as a significant mediator in all groups,with indirect effects of -0.43 (boys),-0.29(girls),-0.54 (only children),and -0.31(non-only children).Measurement invariance tests confirmed the validity of cross-group comparisons.

Conclusion and implications for practice: Maternal depression impairs young children's emotional development both directly and indirectly through negative parenting styles,with the strength of these effects varying by child gender and family structure.This study suggests that it is essential to strengthen attention to maternal mental health by utilizing community support and psychological counseling to promptly alleviate depressive emotions,thereby reducing the occurrence of negative parenting behaviors at the source.Additionally,targeted parent education programs should be implemented to guide parents in mastering scientific parenting methods,creating a more favorable emotional development environment for vulnerable groups such as boys and only children.

Background: Uterine fibroids (UF) is a common gynecology tumor that in some cases may require hysterectomy. It is hypothesized that deficiency in fat-soluble vitamins might be a risk factor for UF. The aim of this systematic review was to evaluate the relationship between fat-soluble vitamins and UFs.

Methods: This systematic review was conducted on published articles in PubMed and Web of Science till Feb 2024 using a comprehensive search strategy.

Results: Of the initial 9161 identified articles, 31 (overall population of 55189 participants), including 17 case-control studies, 6 clinical trials, four cross-sectional studies, three cohort studies, and one Mendelian epidemiological study were reviewed. Majority of the studies evaluated the relationship between serum vitamin D and UF incidence and size. None of the reviewed studies evaluated the relationship between vitamin K and UF.

Conclusions: Vitamin D supplementation and intake of animal sources of vitamin A could reduce UF size. There is not enough evidence regarding the effect of vitamin K and E on UF size.

Background: High fertility rates in sub-Saharan Africa underscore the importance of contraceptive use in managing population growth. While previous studies have linked women's empowerment to contraceptive behavior, this study adopts a multidimensional approach, emphasizing decision-making autonomy, resource access, and negotiation skills. By examining these distinct dimensions, the study provides a more comprehensive understanding of how empowerment influences modern contraceptive use among women in Tanzania, offering insights for targeted reproductive health strategies.

Methods: This cross-sectional study analyzed data from the 2022 Tanzania Demographic and Health Survey (TDHS), which focuses on 8236 currently married, non-pregnant women aged 15-49 years. The empowerment indicators included participation in household decision-making, attitudes toward intimate partner violence, negotiation of sexual relationships, property ownership, and social independence. Descriptive and bivariate analyses were conducted, followed by multivariate logistic regression to assess associations. The analyses incorporated complex survey design adjustments for national representativeness.

Results: Modern contraceptive use was reported by 34.9% of women. The significant factors associated with greater contraceptive use included education, household wealth, employment, media exposure to family planning messages, and empowerment indicators. Women participating in all three household decision-making domains (AOR 1.64, 95% CI 1.36-1.98), negotiating sexual relationships (AOR 1.41, 95% CI 1.19-1.67), and owning both a house and land (AOR 1.47, 95% CI 1.27-1.70) presented significantly higher odds of modern contraceptive use.

Conclusions: Women's empowerment significantly influences modern contraceptive use. Enhancing women's autonomy, decision-making power, and socioeconomic opportunities should be prioritized in family planning initiatives. Addressing structural and social barriers that limit women's agency will help ensure informed reproductive health choices, ultimately promoting gender equity and sustainable development.

Background: Domestic abuse (DA) and perimenopause are each known to profoundly impact women's health, yet their intersection remains largely unexplored. This study reveals how these experiences collide to create unique vulnerabilities and unexpected opportunities for transformation. This qualitative study explores how DA survivors experience perimenopause, examining the complexity and support needs that emerge when these experiences overlap.

Methods: Fifteen DA survivors participated in focus groups (and one individual interview) facilitated by a community leader of a DA survivors group exploring their perimenopause experiences. Data were analysed thematically using the one sheet of paper (OSAP) technique, with a DA survivor community leader (third author) involved throughout to support ethical engagement and participant well-being. Analysis revealed how trauma and hormonal changes interweave to shape help-seeking and survival.

Results: Three interconnected themes emerged: (1) symptom confusion and overlapping conditions - participants struggled to distinguish between trauma responses, hormonal changes, and pre-existing conditions; (2) weaponisation and empowerment - perpetrators exploited perimenopausal symptoms for coercive control, yet paradoxically, hormonal changes sometimes catalysed women's decisions to leave; (3) barriers and facilitators - system failures drove survivors toward peer support networks that provided validation unavailable from professional services. Participants described heightened anxiety, mood changes, and sleep disturbances intensified by current or past abuse. The weaponisation of perimenopausal symptoms represents a previously unreported form of coercive control. Conversely, some participants described perimenopause as a moment of emotional clarity, contributing to decisions to leave relationships with an abusive partner.

Conclusions: The intersection of DA and perimenopause creates unique vulnerabilities that current UK support systems fail to address. Healthcare providers require training to recognise how trauma and hormonal symptoms can mask or mimic each other. The finding that perimenopause can serve as both a tool of abuse and a catalyst for liberation challenges deficit-focused narratives around both DA and perimenopause. Integrated, trauma-informed approaches are urgently needed across healthcare and support services.