BMC Women's Health最新文献

Introduction: Human papillomavirus (HPV) is one of the most important sexually transmitted infections. In most cases, HPV infection resolves on its own, but some types of HPV infection cause genital warts, and some can cause various types of cancer, such as cervical and anal cancer. The psychological impact of HPV infection on individuals is significant. Hence, this study aimed to assess the impact of motivational interviewing on the anxiety, stress, and depression levels of women with HPV.

Methods: This randomized controlled study utilized a pretest-posttest research design with a control group and involved 62 HPV patients from healthcare centers affiliated with Babol University of Medical Sciences, Iran. In 2023.06.11 after we received ethics code. The patients were divided into two groups: an experimental group consisting of 31 individuals and a control group also comprising 31 individuals. The allocation to these groups was determined using the blocked randomized allocation technique based on pretest scores of MS. The experimental group received motivational intervention over five sessions, while the control group received routine intervention. All participants completed the DASS-21 questionnaire before and immediately after the interventions. The significance level was set at 0.05.

Results: The mean age in the intervention group was 33.58 ± 6.14 and in the control group was 34.96 ± 7.04 years. The effect of the intervention group was significant in decreasing the total score with Effect-size = 0.954 (P < 0.001). Thus, a significant decrease was observed in depression with an effect size of 0.932, anxiety with an effect size of 0.943, and stress with an effect size of 0.185, respectively with P < 0.001, P = 0.009, and P = 0.001. Anxiety, depression, and stress scores in the intervention group decreased by more than 50% on average compared to the control group.

Conclusion: The results of the current research indicated that motivational interviewing may effectively enhance mental health in patients with HPV by reducing anxiety, depression, and stress. Additionally, it can offer useful recommendations to healthcare professionals for successful follow-up and improvement of the mental well-being of these patients.

Trial registration number: IRCT20230531058348N1, Approval Date: 2021.10.10.

Background: Sexual violence, a global concern, disproportionately affects women. In Kenya, over 40% of women experience intimate partner violence, reflecting a pressing need for understanding and addressing this issue. Sub-Saharan Africa faces a 18.7% prevalence with deep-rooted determinants like unequal power relations and cultural practices. Consequences from unwanted pregnancy to trauma hinder development goals. This study focuses on sexual violence among Kenyan women aged 15-49, aiming to inform policies and contribute to a safer, more equitable society.

Methods: This study analyzed 2022 Kenya Demographic Health Survey data. It used a two-stage cluster sampling method, surveyed 32,156 women aged 15-49, examined determinants of sexual violence, and employed statistical analysis to identify significant predictors.

Results: This study revealed several significant factors associated with the risk of sexual violence among women in Kenya. Educational attainment emerged as a key determinant, with women holding primary or secondary education showing higher odds of experiencing sexual violence compared to those with higher education. Desire for children also played a significant role; women whose partners desired more children had higher odds of experiencing sexual violence compared to those with mutual or differing desires for children. Domestic violence exposure was strongly associated with sexual violence, as women who experienced domestic violence had 8.69 times the odds of experiencing sexual violence. Additionally, partner alcohol consumption increased the likelihood of sexual violence, as did cultural attitudes, with women who believed that a wife's refusal of sex justified physical violence facing higher odds of sexual violence.

Conclusions and recommendations: This study identifies key factors, including education, domestic violence, alcohol consumption, and cultural attitudes, that increase sexual violence risk. Recommendations include education, addressing domestic violence, promoting healthy relationships, and challenging harmful norms.

Objective: To evaluate the efficacy of urine-based human papillomavirus detection in detecting high-grade cervical lesions (CIN2+) compared to cervical cytology examination.

Method: The data of 458 patients with cytological abnormalities and/or positive human papillomavirus test results were retrospectively selected from December 1, 2017, to March 31, 2022, at the Beijing Obstetrics and Gynecology Hospital affiliated with Capital Medical University. Cervical cytology and urine samples were used to detect human papillomavirus status and analyze the correlation between the results and cervical biopsy results.

Results: Among the selected 458 samples, 386 were positive for human papillomavirus through cervical cytology examination, with a detection rate of 84.3%. Out of 458 urine samples, 362 were positive, with a detection rate of 79.0%. The data shows a high consistency between cervical cytology and urine sample testing, with a kappa value of 0.637 (P < 0.01). The most prevalent subtypes in cervical samples included HPV16, HPV58, and HPV52, while the detection rates of HPV16 and HPV58 subtypes were relatively high in urine samples. The comparison of subtype distribution between cervical and urine samples showed that the positivity rate of HPV44 subtype was consistent, both at 3.9%. Among the five HPV subtypes corresponding to the HPV nine-valent vaccine, the kappa value of HPV16 in cervical and urine samples was 0.791 (P < 0.05), the kappa value of HPV52 was 0.766 (P < 0.05), HPV18 was 0.762 (P < 0.05), HPV33 was 0.539 (P < 0.01), and HPV31 was 0.458 (P < 0.05). Among 458 specimens, the sensitivity of human papillomavirus detection in cervical cytology was 96.7%, with a specificity of 20.2% (P < 0.01). The sensitivity of human papillomavirus detection in urine samples was 85.2%, with a specificity of 23.2% (P < 0.01).

Conclusion: Urine human papillomavirus testing, as a non-invasive screening method, has significant application effects. The screening results are highly consistent with cervical cytology screening and may improve the compliance of women who do not want to undergo invasive gynecological examinations. This screening method simplifies the screening process and has great potential in screening cancer lesions and preventing cervical cancer.

Objective: Following a significant relaxation of restrictions in China on December 7, 2022, after a surge in SARS-CoV-2 infections, an uptick in women presenting with menstrual disorders was observed in clinics. This study aimed to explore the alterations in menstrual characteristics and associated factors post SARS-CoV-2 infection.

Methods: A cross-sectional online survey was conducted among 869 non-amenorrheic adult Chinese females (aged 18-53) to study the changes in menstrual characteristics and other infection-related factors post initial SARS-CoV-2 infection. The reported menstrual changes (group A) were compared to the reported no menstrual changes (group B). Data collected included basic individual-level information such as age, height, weight, menstrual history, reproductive and menstrual disorders, chronic diseases, SARS-CoV-2 vaccination status, COVID-19 symptoms, and changes in menstrual characteristics (regularity, period volume, and degree of dysmenorrhea) post SARS-CoV-2 infection.

Results: Of the 869 participants, 442 (50.9%, group A) reported alterations in at least one menstrual characteristic; 171 (19.7%) experienced an extended menstrual cycle, and 122 (14.0%) reported a decrease in menstrual volume. Participants who reported menstrual changes (group A) were more likely to have pre-existing chronic diseases (7.7% vs. 3.0%, P = 0.003) and exhibit more symptoms of COVID-19 during the acute (4.94 vs. 4.03, P < 0.001) and recovery (4.37 vs. 3.41, P < 0.001) phases. These participants were also more likely to report fever as a COVID-19 symptom (93.4% vs. 86.9%, P = 0.001) and experienced a longer duration of fever (2.25 vs. 1.96 days, P = 0.001) as compared to group B. Notably, group A with chronic diseases, fewer vaccine doses, and more COVID-19-related symptoms experienced more frequent menstrual changes post COVID-19 (P < 0.05) than group B.

Conclusion: Participants with chronic diseases, fewer vaccination doses, and more COVID-19-related symptoms may experience more frequent menstrual changes post COVID-19 infection according to the self-report results in this study.

Purpose: The aim was to investigate the value of the application of a progesterone-primed ovarian stimulation (PPOS) protocol in patients with ovarian endometriosis (OEM) combined with diminished ovarian reserve (DOR).

Materials and methods: A retrospective analysis of 95 patients with OEM combined with a DOR who underwent in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) was conducted between March 2020 and February 2024 at the Reproductive Center of Xuzhou Central Hospital. Patients were divided into two groups on the basis of the ovarian stimulation protocol used: the PPOS group (n = 60, 60 cycles) and the GnRH agonist downregulation group (n = 35, 35 cycles). General data, ovarian stimulation outcomes, and pregnancy outcomes were compared between the two groups.

Results: There were no statistically significant differences between the two groups in terms of general data (P > 0.05). Compared with the PPOS group, the GnRH agonist group presented significantly more Gn days and higher Gn dosages (P < 0.05). However, there were no significant differences between the groups in terms of the number of oocytes retrieved, metaphase II oocyte rate, fertilization rate, cleavage rate, high-quality embryo rate, or cycle cancellation rate (P > 0.05). Additionally, no significant differences were observed in the embryo transfer parameters, endometrial thickness, embryo implantation rate, clinical pregnancy rate, ectopic pregnancy rate, or early miscarriage rate (P > 0.05).

Conclusions: In patients with OEM combined with DOR, the PPOS protocol had pregnancy outcomes comparable to those of the downregulation protocol, with the added advantage of being more cost-effective.

Background: Excessive exposure to heavy metals has been linked to various health problems, including organ damage, neurological disorders, and reproductive and developmental abnormalities. However, the relationship between heavy metals exposure and uterine fibroids remains uncertain. To explore this association, we conducted a cross-sectional study among American women.

Methods: We utilized data from three cycles of the National Health and Nutrition Examination Survey (NHANES, 1999-2006) to evaluate the association between uterine fibroids and blood heavy metal levels, including lead (Pb), cadmium (Cd), and mercury (Hg). Weighted logistic regression, restricted cubic spline (RCS), Bayesian kernel machine regression (BKMR), and subgroup analyse were used to examine the potential relationships between blood heavy metals and uterine fibroids.

Results: Of the 4502 American women studied, 542 (12.04%) had uterine fibroids. Elevated levels of all heavy metals were significantly more common in women with uterine fibroids (P < 0.001). Blood Hg levels were notably associated with uterine fibroid prevalence in the adjusted model (OR = 1.41, 95% CI: 1.06-1.89, p = 0.03). Similar patterns were partly observed for blood Pb and Cd. Age and marital status were significant interaction factors concerning Hg exposure (P for interaction < 0.05). A dose-response relationship with an inflection point at 7µmol/L was identified for Hg, and BKMR models indicated a positive association between mixed heavy metal exposure and uterine fibroid risk.

Conclusions: Exposure to blood heavy metals, particularly Hg, is significantly associated with an elevated risk of uterine fibroids. Further prospective studies are necessary to confirm these findings.

Background: An increasing number of studies indicate that the gut, cervical, and vaginal microbiota may play crucial roles in the development of cervical cancer (CC). However, the interactions between the microbiota and the host are yet unknown. To address this gap, a systematic review and meta-analysis were conducted to assess the microbiota alterations in a variety of body locations, including the gut and genital tract.

Methods: Electronic searches of PubMed, Embase, Web of Science, and the Cochrane Library were conducted to retrieve eligible papers published from January 1, 2014, to January 1, 2024 (PROSPERO: CRD42024554433). This study was restricted to English-language studies reporting on alpha diversity, beta diversity, and relative abundance, as well as on patients with CC whose microbiota had been analyzed via next-generation sequencing technologies. To assess the risk of bias (RoB), we utilized the Newcastle‒Ottawa Quality Assessment Scale (NOS) and the ROBINS-I tool. For the meta-analysis, we employed Review Manager 5.4.

Results: Thirty-six eligible studies were included in this review. The Chao1 index (SMD = 0.96, [95% CI: 0.71, 1.21], I² = 0%) and the Shannon index (SMD = 1.02, [95% CI: 0.53, 1.50], I² = 85%) values from vaginal samples were significantly greater in patients than in the controls. In the cervical samples, the Shannon index value (SMD = 1.29, [95% CI: 0.61, 1.97], I² = 93%) significantly increased, whereas the Chao1 index value did not significantly differ (SMD = 0.50, [95% CI: -0.46, 1.46], I² = 89%). The Shannon index value (SMD = 0.25, [95% CI: -0.22, 0.72], I² = 38%) did not significantly differ across the gut samples. The majority of studies (19/25) indicated that the patients and noncancer controls differed significantly in terms of beta diversity. Cancer-associated changes were observed, with a dramatic decrease in the Lactobacillus genus and significant increases in pathogenic bacteria, including the Anaerococcus, Peptostreptococcus, Porphyromonas, Prevotella, and Sneathia genera. Additionally, the impact of antineoplastic therapies on microbial diversity was inconsistently reported across several studies.

Conclusion: This systematic review elucidates the microbiota alterations associated with the prevalence of CC and its response to anti-tumor therapies, aiming to provide insights for future research directions and precision medicine strategies to enhance women's quality of life.

Prospero registration: CRD42024554433.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with metabolic and hormonal abnormalities. This study aimed to evaluate the comparative efficacy of pharmacological interventions on these outcomes.

Methods: We conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs) assessing pharmacological treatments for PCOS. Searches in PubMed, MEDLINE, Embase, and Web of Science were conducted up to October 20, 2023. Eligible studies were RCTs with at least 12 weeks of follow-up and outcomes including body weight (BW), body mass index (BMI), waist circumference (WC), testosterone, sex hormone-binding globulin (SHBG), lipid profiles, HOMA-IR, fasting blood glucose (FBG), and fasting insulin (FINS).

Results: Twenty-nine RCTs with 1476 participants were included. The combination of standard therapy with GLP-1 receptor agonists significantly reduced BW (MD= -3.44; 95% CI= -6.20 to -0.67), BMI (MD= -2.05; 95% CI= -3.55 to -0.55), and WC (MD= -4.39; 95% CI= -6.75 to -2.02) compared to standard therapy alone. Orlistat significantly lowered testosterone (SMD= -2.16; 95% CI= -3.84 to -0.48) and increased HDL-C levels (SMD = 0.90; 95% CI = 0.02 to 1.79) compared to placebo. The combination therapy also reduced HOMA-IR (MD= -1.29; 95% CI= -2.38 to -0.21) and FBG (SMD= -1.80; 95% CI= -3.04 to -0.55) compared to placebo.

Conclusion: Combining standard therapy with GLP-1 receptor agonists offers superior efficacy in improving metabolic and hormonal outcomes in women with PCOS. Orlistat effectively reduces androgen levels. These findings support the use of combination pharmacotherapy for comprehensive management of PCOS.

Background: Women were more prone to consuming alcohol as a coping mechanism for COVID-19 pandemic stressors than men. Worldwide evidence shows increased consumption during the social restriction phases, adversely impacting women's health. The study aimed to describe women's alcohol use throughout the restriction phases of the COVID-19 pandemic in São Paulo, Brazil.

Method: A cross-sectional self-report survey was conducted by telephone with women who sought primary health care services. The sample comprised 3252 women, and 1308 (40%) reported consuming alcohol. The independent variable was the timing of the COVID-19 pandemic's restriction phases. The AUDIT-C was used as a measurement instrument. The covariates included sociodemographic factors, lifestyle characteristics, and outcomes related to COVID-19 infection. Univariate and bivariate models were used for analysis. A negative binomial distribution with zero inflation was used for the AUDIT-C score as the outcome variable in the entire sample.

Findings: Women's alcohol consumption during the COVID-19 restriction phase was compatible with moderate-risk use 3.5 (SD = 2.9). Binge drinking was observed in 41.8% of the participants. Alcohol consumption was 28.9% higher in the transition phase of social restriction than in the restriction and flexibilization phases. Hospitalization for COVID-19 and losing a loved one due to COVID-19 were associated with alcohol consumption.

Conclusions: Women presented a moderate-risk pattern of alcohol use. This consumption was higher during the restriction phase of the pandemic in South America's largest city. Therefore, this study provides critical reflections on women's patterns of alcohol consumption. It reveals this population's social and clinical vulnerability, which might be considered in future health policies and programs.

Background: Hysteroscopic surgery, a minimally invasive technique prevalent in gynecology, exhibits an overall complication rate between 0.22% and 3.7%. Pulmonary bleeding post-hysteroscopy represents an exceedingly rare complication with only three reported cases to date; two involving high-viscosity solutions and one with hypertonicity solutions. Negative-pressure pulmonary hemorrhage, a seldomly encountered and lethal complication, manifests post-upper airway obstruction, with minimal documented cases, none within hysteroscopic procedures.

Case presentation: Regarding the case study, a 38-year-old female underwent hysteroscopic surgery and received 1600 milliliters of isosmotic low-viscosity uterine distension media (physiological saline) during the procedure. The patient experienced a transient upper airway obstruction lasting one minute due to anesthetic medication. 1 h after surgery, she exhibited positional coughing, expectorated pinkish diluted sputum, and displayed symptoms of hypoxemia. Physical examination revealed bilateral moist rales in the lung fields, while cardiac auscultation did not detect any abnormal murmurs. Diagnostic procedures included chest CT, echocardiography, and complete blood count. The chest CT illustrated diffusely reticular and patchy ground-glass opacities in both lungs, confirming the diagnosis of pulmonary edema with pulmonary bleeding. Treatment with dexamethasone and furosemide led to rapid improvement, meeting discharge criteria within 24 h post-surgery. Postoperative follow-ups showed no discomfort symptoms in the patient, with normal chest X-ray results.

Conclusions: In conclusion, the observed upper airway obstruction during hysteroscopic surgery seemingly reduced the safe absorption threshold of isosmotic uterine distension media. Therefore, gynecologists and anesthesiologists should remain vigilant about this potential complication.