BMC Women's Health最新文献

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.

Background: It has been reported that the cognitive responses to physical activity (PA) in postmenopausal women vary by parity status, and women with higher parity show a significant association between PA and cognitive function. However, the potential pathways mediating the relationship between PA and cognitive function in women with higher parity remain unclear. The objective of this study was to examine this association in Chinese cohort and further investigate the mediating pathways.

Methods: A total of 2296 postmenopausal women were enrolled from the Baoshan District, from April to December 2020. All participant information was collected through interviewer-administered questionnaires or measurements, including personal information, medical history, lifestyle, body mass index (BMI), cognitive function, nutritional status, and depression status. In this cross-sectional study, generalized linear regression models and the chain-mediation analysis were used to examine the relationship between PA and cognitive function and the mediating pathways.

Results: There was a significant relationship between PA and cognitive function in the high-parity group (≥ three births). In the fully adjusted generalized linear regression model, PA was significantly associated with cognitive function [β: 0.795, 95% confidence interval (CI): 0.251-1.340, P < 0.05]. The chain-mediation analysis showed that depression and nutritional status were two significant mediators, contributing 37.96% of the indirect effect of the overall effect.

Conclusions: Our findings suggest that PA is beneficial for women (≥ three births) to maintain cognitive function, and these benefits are mediated by depression and nutritional status.

Background: Endoscopic surgery provides good cosmetic results while ensuring therapeutic outcomes. This study aimed to evaluate the efficacy, safety, and cosmetic outcome of endoscopic surgery for benign breast tumors.

Methods: In total, 108 patients were enrolled and divided into endoscopic or open surgery groups based on the patients' voluntary decisions. Surgical information, complications, postoperative pain, and postoperative cosmetic scores were compared.

Results: The endoscopic surgery group and open surgery group included 46 and 62 patients, respectively. Patients who underwent endoscopic surgery had longer operative times (p < 0.001) and postoperative hospital stays (p = 0.045), and there was no significant difference in intraoperative blood loss between the two groups (p = 0.501). The overall postoperative complication rate was 13% in the endoscopic group and 25.8% in the open group (p = 0.103). Postoperative pain scores were similar in both groups. Cosmetic scores were better in the endoscopic group (p = 0.002), especially regarding nipple shape and wound scarring.

Conclusions: Endoscopic surgery is safe and effective for treating benign breast tumors and offers improved cosmetic results compared to open surgery.