Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Mental and sexual health of men in times of covid-19 lockdown
Full text linkDue to the worldwide spread of COVID-19, some restrictions were introduced which could lead to the development of distress and somatic symptoms. This survey aimed to study the mental and sexual health of men during the COVID-19 outbreak. An online questionnaire was conducted to collect data on contact with people suspected of infection/infected with the SARS-CoV-2 virus, use of stimulants, and perceived mental and sexual health during isolation among Polish men. They were also asked to answer the Beck Depression Inventory (BDI) and the International Index of Erectile Function (IIEF-15) questionnaire. In total, 606 men with a mean age of 28.46 ± 9.17 years took part in the survey. Fear of contracting the COVID-19 infection had a negative impact on the mental health of 132 men (21.8%). Fear of the health condition of loved ones caused stress and a depressed mood in 253 men (41.7%), and media reports worsened the mental health of 185 men (30.2%). In the BDI, 71.95% of the respondents did not suffer from depressive symptoms, 17.33% were diagnosed with mild depression, 6.11% with moderate depression, and 4.62% had severe depression. The mean score in the IIEF-15 questionnaire in the erectile function domain was 22.27, orgasm—7.63, desire—8.25, satisfaction—10.17, and general satisfaction—6.84. Depressive symptoms indicated more severe sexual functioning disorders (p < 0.001). Fear, following the media, and loneliness were associated with more severe depressive and sexual disorders (p < 0.001). The libido level (p = 0.002) and frequency of sexual activity (p < 0.001) were also lower during the pandemic than before the lockdown. These data showed that the COVID-19 pandemic had a significant impact on male mental and sexual health
Lysophosphatidic acid protects cervical cancer HeLa cells from apoptosis induced by doxorubicin hydrochloride
Full text linkCervical cancer is one of the most common types of gynecological tumors. Lysophosphatidic acid (LPA), as a bioactive lipid medium, plays an important role in numerous physiological and pathophysiological processes, including the stimulation of cell migration and tumor cell invasion. LPA is increased in the plasma of patients with cervical cancer. Doxorubicin hydrochloride (DOX) is used as a first-line drug in the treatment of cervical cancer in clinics, however, the effect and molecular mechanism of LPA on DOX-induced apoptosis in cervical cancer cells remain unclear. Therefore, the present study aimed to explore the effect and underlying molecular mechanism of LPA on DOX-induced apoptosis in cervical cancer cells. HeLa cells were treated as a control group or with LPA (10 µmol/l), DOX (4 µmol/l) or LPA (10 µmol/l) + DOX (4 µmol/l) for 24 h. Using transmission electron microscopy the results demonstrated that LPA reduced cell death and the degree of chromatin aggregation in DOX-induced HeLa cells. Reverse transcription-quantitative PCR demonstrated that LPA significantly downregulated caspase-3 mRNA expression levels in DOX-induced HeLa cells. Moreover, western blotting demonstrated that LPA significantly reduced caspase-3 and cleaved caspase-3 protein expression levels in DOX-induced HeLa, C33A and SiHa cells. Furthermore, flow cytometry demonstrated that LPA may prevent apoptosis in DOX-induced HeLa cells (P<0.05). Using dichloro-dihydro-fluorescein diacetate assay, it was demonstrated that LPA significantly reduced the intracellular ROS levels induced by DOX. In summary, the present study indicated that LPA may protect HeLa cells from apoptosis induced by DOX. These findings have provided experimental evidence that LPA may be a potential therapeutic target for the treatment of cervical cancer
Evaluation of implementation effect of cervical cancer comprehensive treatment patients with whole-course high-quality care combined with network continuation care
Full text linkPurpose:
Discuss the implementation effect of cervical cancer comprehensive treatment patients applying whole-course high-quality care combined with network continuation care.
Methods:
From August 2020 to August 2021, 120 patients who met the inclusion criteria for comprehensive treatment of cervical cancer were divided into the regular group (n = 60) who received conventional care and the joint group (n = 60) who received whole-course high-quality care combined with network continuation care, according to the method of care. The comprehensive treatment cognition level, comprehensive treatment compliance, adverse reaction rate, quality of life questionnaire (QLQ-C30) score, self-rating anxiety/depression scale (SAS/SDS) score, and nursing satisfaction were compared between the two groups.
Results:
After care, the comprehensive treatment cognition score and comprehensive treatment compliance score were higher in the joint group than in the regular group (P < 0.05). After care, the incidence of radiation cystitis and radiation proctitis was lower in the joint group than that in the regular group (P < 0.05). After care, QLQ-C30 scores on symptom domains, functional domains, and single questions were higher in both groups than before care, and were higher in the joint group than in the regular group (P < 0.05). After care, SAS and SDS scores were lower in both groups than before care, and were lower in the joint group than in the regular group (P < 0.05). After care, the joint group was more satisfied with care than the regular group (P < 0.05).
Conclusion:
The implementation of cervical cancer comprehensive treatment patients with whole-course high-quality care combined with network continuation care has an ideal implementation effect, which can significantly increase the patient's cognition and compliance with treatment, the incidence of adverse reactions is less, the quality of life and emotional state have also improved significantly, and care satisfaction has also increased accordingly
The magnitude and associated factors of childbirth fear among pregnant women attending antenatal care at public hospitals in Ethiopia: a cross-sectional study
No full textBackground:
Childbirth fear affects 5–40% of all mothers around the world, and there is mounting evidence that it has harmful impacts on women’s health. It could potentially lead pregnant women to feel isolated and unsupported if not identified. But studies addressing this issue are limited in Ethiopia. Therefore, this study was aimed at assessing the magnitude and associated factors of childbirth fear among pregnant women attending antenatal care at public hospitals in West Wollega Zone.
Methods:
Facility-based cross-sectional study was conducted among 304 pregnant women selected by systematic random sampling from 20 March to 20 April 2020. A structured interviewer-administered questionnaire was adapted and used to collect data. Data were entered into EpiData version 3.1 and exported to IBM SPSS statistics version 26 for analysis. Descriptive statistics were done to calculate frequencies, mean scores, and standard deviation. Bivariate and multivariable logistic regression was used to identify factors associated with childbirth fear. Variables with p < 0.25 in bivariate analyses were selected for multivariable analysis. Finally, statistical significance was declared at p < 0.05.
Results:
Out of the total of 304 participants, 298 completed the interview making the response rate 98%. The overall prevalence of childbirth fear was 28.9% with 95% CI (23.5, 34.2). Mean age of the respondents was 27.60 (SD ± 4.56) years. Having previous pregnancy complications [AOR (95% CI)], [6.949 (2.060 – 23.445), presence of long time during childbirth [AOR (95% CI)], [4.765 (1.161 – 19.564)], presence of episiotomy [AOR (95% CI)], [4.197 (1.107 – 15.917)], low social support [AOR (95% CI)], [.011 (.003 – .050)] were significantly associated with childbirth fear.
Conclusion:
Pregnant women in the study area have a significant level of childbirth fear. Previous pregnancy complications, prolonged labor, labor pain, previous perineal tear, and social support were all found to be significantly linked with childbirth fear. This calls for the need to identify and develop interventions for women to reduce childbirth fear during pregnancy
Impact of the coronavirus disease 2019 (Covid-19) pandemic on cervical cancer screening in gynecological practices in Germany
Full text linkSimple Summary
The outbreak of the coronavirus disease 2019 (COVID-19) is a major challenge for healthcare systems and impedes cancer screening programs worldwide. However, no research has been performed that analyzes the effects of the COVID-19 pandemic on the newly implemented German Cervical Cancer Screening (CCS) program. Here, we showed a severe clinically relevant decrease of patients receiving CCS in Germany between the pre-pandemic time period of 2018–2019 and the pandemic years of 2020–2021. Given that this sudden drop in number of CCS per practice is unlikely, our data suggest a dramatic number of underdiagnosed cervical precancer lesions that may lead to increased cervical cancer burden in the future.
Abstract
Purpose: the aim of this cross-sectional study was to analyze the impact of the COVID-19 pandemic on Cervical Cancer Screening (CCS) in gynecological practices in Germany. Methods: The basis of the analysis was the Uniform Evaluation Standard (EBM) of the Statutory Health Insurance Scheme. This cross-sectional study included all women aged ≥20 years with at least one CCS (clinical and cytological examination) in 223 gynecological practices in Germany during the period 2018–2021. The number of patients with CCS per practice was shown for each year. The average number of patients per year was compared between the pre-pandemic time period (2018, 2019) and the pandemic time period (2020, 2021) using Wilcoxon tests. Analyses were conducted separately for clinical investigations and cytological investigations and were also stratified by age group (20–34, 35–50, >50 years). Results: CCS in gynecological practices significantly decreased in Germany between the pre-pandemic time period of 2018–2019 and the pandemic years of 2020–2021. This decrease was observed in all age groups but was stronger in women aged 20–34 (−25.6%) and weaker in women aged >50 (−15.2%). Conclusions: We found a statistically and clinically relevant decrease of patients receiving CCS in gynecological practices in Germany. This finding is even more exceptional because the new screening algorithm with direct invitations for each patient started in 2020 and was supposed to lead to a higher number of patients in its first years. However, the observed decline in the detection of cervical precancer lesions may lead to increased cervical cancer burden. Risk-based screening strategies and further measures are necessary to adapt to the ongoing COVID-19 pandemic and return to pre-pandemic CCS numbers
A multistate competing risks framework for preconception prediction of pregnancy outcomes
Full text linkBackground:
Preconception pregnancy risk profiles—characterizing the likelihood that a pregnancy attempt results in a full-term birth, preterm birth, clinical pregnancy loss, or failure to conceive—can provide critical information during the early stages of a pregnancy attempt, when obstetricians are best positioned to intervene to improve the chances of successful conception and full-term live birth. Yet the task of constructing and validating risk assessment tools for this earlier intervention window is complicated by several statistical features: the final outcome of the pregnancy attempt is multinomial in nature, and it summarizes the results of two intermediate stages, conception and gestation, whose outcomes are subject to competing risks, measured on different time scales, and governed by different biological processes. In light of this complexity, existing pregnancy risk assessment tools largely focus on predicting a single adverse pregnancy outcome, and make these predictions at some later, post-conception time point.
Methods:
We reframe the individual pregnancy attempt as a multistate model comprised of two nested multinomial prediction tasks: one corresponding to conception and the other to the subsequent outcome of that pregnancy. We discuss the estimation of this model in the presence of multiple stages of outcome missingness and then introduce an inverse-probability-weighted Hypervolume Under the Manifold statistic to validate the resulting multivariate risk scores. Finally, we use data from the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial to illustrate how this multistate competing risks framework might be utilized in practice to construct and validate a preconception pregnancy risk assessment tool.
Results:
In the EAGeR study population, the resulting risk profiles are able to meaningfully discriminate between the four pregnancy attempt outcomes of interest and represent a significant improvement over classification by random chance.
Conclusions:
As illustrated in our analysis of the EAGeR data, our proposed prediction framework expands the pregnancy risk assessment task in two key ways—by considering a broader array of pregnancy outcomes and by providing the predictions at an earlier, preconception intervention window—providing obstetricians and their patients with more information and opportunities to successfully guide pregnancy attempts
Sexually transmitted infections and female reproductive health
Full text linkWomen are disproportionately affected by sexually transmitted infections (STIs) throughout life. In addition to their high prevalence in women, STIs have debilitating effects on female reproductive health due to female urogenital anatomy, socio-cultural and economic factors. In this Review, we discuss the prevalence and impact of non-HIV bacterial, viral and parasitic STIs on the reproductive and sexual health of cisgender women worldwide. We analyse factors affecting STI prevalence among transgender women and women in low-income settings, and describe the specific challenges and barriers to improved sexual health faced by these population groups. We also synthesize the latest advances in diagnosis, treatment and prevention of STIs
Feasibility and acceptability of technology-supported sexual health education among adolescents receiving inpatient psychiatric care
No full textMental illness in adolescence is associated with high-risk sexual behaviors including multiple sex partners, infrequent or inconsistent condom use, and nonuse of contraception. Inpatient psychiatric care represents a promising setting to provide sexual health education. This pilot study investigates the feasibility and acceptability of online sexual health education in this group by assessing usability and impact on short-term psychosocial outcomes. We administered online modules on healthy relationships, pregnancy prevention, condom use, and sexually transmitted infection (STI) prevention to youth. We evaluated outcomes using a single group, pre/post-intervention design. One quality improvement session assessed staff acceptability of the programming. Participants included 51 inpatients (mean age = 15.3; 61% female; 57% Hispanic or Latino; 55% heterosexual). Overall, the program was feasible to administer and highly acceptable to youth (84-89% liked the modules, 98-100% found them easy to use, 96-100% found them credible, 91-98% said information would lead to healthier dating relationships, and 78-87% would refer to a friend). Youth who completed modules demonstrated improvement in several outcomes: attitudes and norms towards violence (p < 0.001), intention to use a method of birth control other than condoms if having sex in the next 3 months (p < 0.001), condom knowledge (p < 0.001), condom use self-efficacy (p < 0.001), condom beliefs (p = 0.04), HIV/STI knowledge (p < 0.001), and perceived susceptibility to STI (p < 0.01). The quality improvement session revealed high acceptability by nursing staff on the unit. This intervention could be useful and efficacious in an inpatient setting and larger studies are warranted to understand its full impact
Lack of awareness, body confidence and connotations of sex: an interpretative phenomenological analysis of barriers affecting the decision to attend initial cervical cancer screening
Full text linkThis study sought to understand how cervical cancer screening (CCS) awareness, sexual connotations and body image influenced the likelihood of CCS uptake in women yet to attend. Eleven females, aged 23–24, yet to attend CCS, were purposefully sampled. Interview transcripts were analysed using interpretative phenomenological analysis, generating three superordinate themes: (1) building screening expectations, (2) confronting sexual connotations and (3) growing pains. Findings demonstrated how a lack of awareness of CCS and the sexual connotations implicit in CCS acted as a barrier to attendance, exacerbated by negative body image comparisons between oneself and online or social media-based images. The perceived sexual connotations of CCS, and the resulting embarrassment, bolsters the case for self-screening, removing the need to attend clinic screening appointments. Reconceptualising screening using a theoretical model of the relationship between body image disturbances and body-focused screening behaviours among women, could lead to the development of pro-screening social media interventions
Analysis of the clinical value of MAGE-A9 expressions in cervical cancer tissues and PBMC
Full text linkObjective:
The aim of this study is to explore the expressions and clinical significance of melanoma-associated antigen-A9 (MAGE-A9) in cervical cancer tissues and peripheral blood mononuclear cells (PBMC).
Methods:
108 patients who were scheduled to undergo cervical conization or extensive hysterectomy between March 2019 and January 2021 due to cervical lesions were selected by convenient sampling. According to postoperative pathological results, the patients were divided into a cervical cancer group (n = 64) and cervical intraepithelial neoplasia (CIN) group (n = 44). The expression levels of MAGE-A9 mRNA in cervical lesion tissues and PBMC were detected by real-time fluorescence quantitative PCR, and the expression of MAGE-A9 protein in lesion tissues was detected by immunohistochemistry. The correlation between MAGE-A9 mRNA expressions in cancer tissues and PBMC and serum tumor markers in patients with cervical cancer and the relationship between MAGE-A9 protein expression in cancer tissues and clinicopathological characteristics were analyzed, and a receiver operating characteristic curve (ROC curve) was drawn to explore the diagnostic value of MAGE-A9 mRNA expressions in cancer tissues and PBMC on cervical cancer.
Results:
The expression levels of MAGE-A9 mRNA in cervical lesion tissues and PBMC in the cervical cancer group were significantly higher than those in the CIN group (P 0.05). The areas under the ROC curves of MAGE-A9 mRNA in lesion tissue and MAGE-A9 mRNA in PBMC were 0.925 and 0.900 in the diagnosis of cervical cancer (P < 0.05).
Conclusion:
The expressions of MAGE-A9 in cancer tissues and PBMC of patients with cervical cancer are upregulated, which is related to the levels of serum tumor markers and the progression of disease. MAGE-A9 is expected to become an important marker for the diagnosis of early cervical cancer