BMC Women's Health最新文献

Background: People who experience disadvantage in childhood-broadly defined as hardship across various social, economic, and health domains-tend to continue experiencing disadvantage in adulthood. This is especially the case for women, who experience greater disadvantage than men across the lifespan and face unique structural barriers to overcoming it. This study examined whether social support in early adulthood acts as a modifiable pathway out of childhood disadvantage for Australian women.

Methods: Data from a subsample of the Australian Longitudinal Study on Women's Health 1989-95 cohort (N = 8,755) were analysed. Latent Class Analysis identified childhood disadvantage profiles from retrospectively recalled adverse childhood experiences. Path analysis examined the longitudinal effect of childhood disadvantage on multidimensional adult disadvantage outcomes (financial hardship, educational attainment, psychological distress) via social support.

Results: Three profiles of childhood disadvantage emerged: disadvantaged (33% of sample), moderate (43%), and advantaged (24%). Women from disadvantaged backgrounds had poorer adult outcomes across finances, education, and distress, while women from advantaged backgrounds reported the opposite. This relationship was partially explained by the fact that women from less advantaged backgrounds had lower social support in early adulthood.

Conclusions: Our findings suggest that reduced social support represents a currently under-recognised pathway through which childhood disadvantage perpetuates adult disadvantage for Australian women. Interventions to enhance social connectedness and support, particularly for women and girls from disadvantaged backgrounds, may therefore be a promising area for future public health research and policy development.

Background: Provoked vestibulodynia (PVD) is a chronic vulvar pain condition often associated with pelvic floor muscle hypertonicity. Botulinum neurotoxin type A (BoNT-A), a neuromuscular transmission blocker, has been proposed as a potential treatment to alleviate PVD-related symptoms. However, its clinical efficacy and safety remain uncertain.

Objective: To systematically assess the efficacy and safety of BoNT-A injections in women with PVD through a meta-analysis of randomized controlled trials (RCTs).

Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. A comprehensive search of MEDLINE, Embase, and Cochrane Library databases was performed up to March 2025 to identify RCTs comparing BoNT-A injections with placebo. Pooled effect sizes were calculated using standardized mean differences (SMDs) or weighted mean differences (WMDs), with 95% confidence intervals (CIs), based on fixed- or random-effects models depending on heterogeneity.

Results: Four RCTs involving 244 women (BoNT-A: n = 143; placebo: n = 101) were included. BoNT-A treatment did not significantly reduce pain (SMD = - 0.13; 95% CI: - 0.39 to 0.13; p = 0.80), nor did it improve sexual function (WMD = - 0.09 points on the FSFI; 95% CI: - 6.42 to 6.25; p = 0.98) or sexual distress (WMD = 0.15 points on the FSDS; 95% CI: - 9.35 to 9.64; p = 0.98). No serious adverse events were reported, and minor injection-site discomfort was the most common adverse effect.

Conclusions: While BoNT-A appears to be well tolerated, current evidence from randomized trials does not consistently support its efficacy in relieving pain or improving sexual function in women with PVD. The limited number of studies and variability in intervention protocols warrant cautious interpretation of these findings.

Trial registration: CRD420251024448.

Disease awareness is key to utilising healthcare services, including vaccinations. Madagascar, with high human papillomavirus (HPV) prevalence (> 36%), marked cervical cancer rates, and low general routine vaccination coverage, faces major challenges in managing HPV-related diseases, mostly because of its fragile health system and the absence of HPV vaccination programmes. This study aimed to assess HPV awareness and vaccination willingness in Madagascar to inform strategies for implementing HPV vaccination programmes in the country. A cross-sectional survey among adults was conducted in the Boeny and Matsiatra Ambony regions. HPV awareness and willingness to be vaccinated against HPV were analysed using Poisson regression. Overall, the level of HPV awareness was low (4.6%; 95% CI: 3.8-5.6). Urban residency (aPR = 1.7; 95% CI: 1.1-2.6), higher education (aPR = 2.1; 95% CI: 1.1-4.0), and recent contact with healthcare services (aPR = 1.8; 95% CI: 1.2-2.6) were associated with greater HPV awareness. HPV vaccination willingness was generally high (67.0%; 95% CI: 65.0-69.0) but was significantly higher among participants aware of HPV (aPR = 1.4; 95% CI: 1.2-1.5). Most participants received ample information on general routine vaccinations, with healthcare workers (HCWs) reported as the most reliable source of information (48.6%). This study shows that improving knowledge about HPV could increase the success of HPV vaccination programmes in the country. In addition, the study highlights the importance of education in terms of health literacy, stressing that efforts to reach rural populations with lower levels of education are crucial.

Background: The First 1000 Days (from conception to a child's second birthday) is a key developmental period, with implications for the child across the lifespan. However, while an emerging body of research demonstrates the impact of maternal wellbeing on child wellbeing and development, to date, little research has focused on the wellbeing of women with refugee backgrounds during the First 1000 Days. The present qualitative study aimed to explore the experiences and impacts to wellbeing for women from Syria and Afghanistan living in South Australia in the First 1000 Days.

Methods: A total of 43 participants were included in the study. Fourteen Syrian women, 14 Afghan women, and 15 healthcare providers participated in group and individual semi-structured interviews, recruited through community and service networks and snowball sampling. Data were analysed using reflexive thematic analysis.

Results: Four themes were identified: 'Autonomy and decision-making' which included decision making around family planning and choosing care; 'Accessing care' including knowing what care was available and the need for culturally responsive care; 'Navigating relationships and accessing family supports in a new environment' which included shifts in marital relationships and engaging with broader social support; and 'Parenting in a new country' which included cultural differences in parenting and maintaining wellbeing while parenting.

Conclusions: Together, these themes identified significant challenges to new mothers in navigating the First 1000 Days and accessing appropriate formal and informal supports over this time of significant change, with impacts on wellbeing. The findings demonstrate the need for relevant and responsive, holistic perinatal and early childhood services that meet the biological, psychological, and social needs of this group of women. Specifically, services should ensure women maintain autonomy in decision-making, are informed of their options and referred to relevant services, and that their unique cultural and resettlement contexts are understood.

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.