Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Prevalence of blood-borne viral and sexually transmitted infections among homeless people in Berlin
Full text linkBackground:
Risk factors associated with precarious living conditions make people experiencing homelessness (PEH) also highly vulnerable for blood-borne viral and sexually transmitted infections (BBVSTI) and tuberculosis (TB). The number of PEH in Germany is rising, yet little data is available on the infectious burden among this population. A pilot study assessed the prevalence of BBVSTI, TB, behaviours and access to medical services among PEH.
Methods:
We recruited PEH from April-June 2021 in five low-threshold medical services in Berlin. Behavioural data was collected via questionnaire-based interviews. Serological/molecular testing from venous blood samples was performed for Hepatitis B (HBV), Hepatitis C (HCV), HIV, syphilis and TB and from urine for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT).
Results:
Of 216 participants, 88% (191/216) were male and 73% (158/215) were born abroad. Mean age was 41 years (range 19-68). No health insurance was reported by 57% (123/216) and previous incarceration by 71% (153/214). Of all, 53% (114/216) injected drugs in the last 30 days, and 41% (89/216) reported unprotected sex in the last 12 months. Prevalence of active HBV was 1.9% (4/212), of active HCV 15.9% (34/213), and of HIV 2.8% (6/213). No active TB was diagnosed, while 14.4% (31/216) tested positive for latent TB infection. Active syphilis was found in 1.4% (3/212), NG in 2.0% (4/197), CT in 3.0% (6/197), and serological evidence of HBV vaccination in 26% (56/212). While 44% (96/216) of participants were ever tested for HCV, 71% (36/51) of those with HCV antibodies knew about their infection, 36% (13/36) of them reported previous/current treatment.
Conclusions:
Burden of HCV and HIV was high among PEH in Berlin, and risk behaviours were frequently reported. There is a need to improve access to regular health care, accompanied by low-threshold prevention offers in cooperation with drug and homeless services. A nationwide expansion of the study is planned
Vaginal microbial environment skews macrophage polarization and contributes to cervical cancer development
Full text linkAs a common female reproductive system malignancy, cervical cancer (CC) disturbs numerous women's health. This study demonstrates the role of the vaginal microbial environment (Peptostreptococcus anaerobius) in cervical cancer. Functional assays, including cell proliferation assay, tube formation assay, and immunofluorescence staining, revealed the effect of Peptostreptococcus anaerobius-treated macrophages on cell proliferation and the angiogenesis process. The tube formation assay disclosed the function of Peptostreptococcus anaerobius-treated macrophages on angiogenesis. In vivo assays were also established to explore the impact of Peptostreptococcus anaerobius-treated macrophages on tumor migration. The results revealed that Peptostreptococcus anaerobius-induced macrophages boosted cervical cancer migration and angiogenesis both in vitro and in vivo. Then, this study unveiled that Peptostreptococcus anaerobius-induced macrophage secreted VEGF to stimulate the angiogenesis in cervical cancer. As a whole, Peptostreptococcus anaerobius-induced macrophage facilitates cervical cancer development through modulation of VEGF expression
Gender integration in the blue economy portfolio : review of experiences and future opportunities
Full text linkWomen play a significant role in the Blue Economy sectors, such as in fisheries, aquaculture, processing and trading of marine products, waste management, coastal tourism, conservation activities, and coastal disaster-risk reduction, among others. However, gender norms often prevent women from developing and contributing their full potential in the Blue Economy. Women tend to have fewer opportunities to access education and skills-building activities and have low ownership, access, and control over key productive resources that are basic to their livelihoods. In the labor market, women are present less than men. Women are also affected by Gender-Based Violence (GBV). These risks jeopardize long-term sustainability objectives since women are key players in coastal and marine communities and provide households’ subsistence, particularly in women-headed households. International efforts have shown that more systematically and effectively integrating women in coastal economies along with addressing disparities has decreased gender gaps. These efforts have also delivered an increase in women’s income, improvements in local livelihood activities, and brought positive impacts to marine life conservation. Thus, addressing gender gaps is key for women´s development, and that of their families, communities, and the economy, as well as the progress and sustainability of the Blue Economy
Abortion as essential health care and the critical role your practice can play in protecting abortion access
Full text linkFew obstetrician–gynecologists (ob-gyns) provide abortion care, resulting in abortion being separated from other reproductive health care. This segregation of services disrupts the ob-gyn patient–clinician relationship, generates needless costs, delays access to abortion care, and contributes to stigma. General ob-gyns have both the skills and the knowledge to incorporate abortion into their clinical practices. In this way, they can actively contribute to the protection of abortion access now with the loss of federal protection for abortion under Roe v Wade. For those who live where abortion remains legal, now is the time to start providing abortions and enhancing your abortion-referral process. For all, regardless of state legislation, ob-gyns must be leaders in advocacy by facilitating abortion care—across state lines, using telehealth, or with self-managed abortion—and avoiding any contribution to the criminalization of those who seek or obtain essential abortion care. Our patients deserve a specialty-wide concerted effort to deliver comprehensive reproductive health care to the fullest extent
Why does abortion stigma matter? A scoping review and hybrid analysis of qualitative evidence illustrating the role of stigma in the quality of abortion care
Full text linkAbortion stigma shapes the environment in which abortion is delivered and received and can have important implications for quality in abortion care. However, this has not previously been clearly articulated and evidenced. We conducted a scoping review of existing qualitative evidence to characterize the relationship between abortion stigma and quality in abortion care. Using a systematic process, we located 50 qualitative studies to include in our analysis.
We applied the interface of the WHO quality of care and abortion stigma frameworks to the qualitative evidence to capture manifestations of the interaction between abortion stigma and quality in abortion care in the existing literature. Four overarching themes linked to abortion stigma emerged: A) abortion as a sin and other religious views; B) regulation of abortion; C) judgement, labelling and marking; and D) shame, denial, and secrecy. We further characterized the emerging ways in which abortion stigma operates to inhibit quality in abortion care into seven manifestations of the relationship between abortion stigma and quality in abortion care: 1) poor treatment and the repercussions, 2) gatekeeping and obstruction of access, 3) avoiding disclosure, 4) arduous and unnecessary requirements, 5) poor infrastructure and lack of resources, 6) punishment and threats and 7) lack of a designated place for abortion services.
This evidence complements the abortion stigma-adapted WHO quality of care framework suggested by the International Network for the Reduction of Abortion Discrimination and Stigma (inroads) by illustrating specifically how the postulated stigma-related barriers to quality abortion care occur in practice. Further research should assess these manifestations in the quantitative literature and contribute to the development of quality in abortion care indicators that include measures of abortion stigma, and the development of abortion stigma reduction interventions to improve quality in abortion care
Effect of a community-based multicomponent intervention on cervical cancer behavior among women – a randomized controlled trial
Full text linkBACKGROUND:
Cervical cancer is the leading cause of death worldwide, especially in developing countries. More than one-fifth of newly diagnosed cervical cancer cases are occurring in India. Cervical cancer is a highly preventable and curable cancer compared with other types of cancer, if detected at an early stage. The present study has been carried out to assess whether a community-based, multicomponent, nurse-led intervention program improves cervical cancer screening behavior of women.
MATERIALS AND METHODS:
An experimental randomized controlled trial was carried out by recruiting 419 women in the age group of 30–60 years (246 in the experimental group and 173 in the control group) residing in a selected rural community (selected tribal settlements) of Idukki district of Kerala, India, using multistage cluster sampling. The intervention comprising small group education followed by reinforcement session, telephonic reminders, navigation and guidance for Pap smear, and follow-up visit by the investigator was administered to the experimental group, and the control group did not receive any intervention. Knowledge, attitude, and screening behavior of women related to prevention of cervical cancer were assessed before and twice after the intervention.
RESULTS:
The experimental and control groups were homogenous in all baseline sociodemographic variables. The community-based intervention program was effective in improving knowledge (P < 0.001), attitude (P < 0.001), and screening behavior (P < 0.001) of women regarding the prevention of cervical cancer. A significant moderate positive correlation was found between knowledge and screening behavior (r = 0.408). Significant association was found between knowledge, attitude, and practice regarding prevention of cervical cancer with education, age at the time of marriage, and number of pregnancies.
CONCLUSION:
The community-based, multicomponent, nurse-led intervention program was effective in improving cervical cancer screening behavior among women. Repeated motivation and reinforcement are needed to bring behavioral change and to increase uptake of screening services among rural women
Metabolomics of human semen: a review of different analytical methods to unravel biomarkers for male fertility disorders
Full text linkBackground: Human life without sperm is not possible. Therefore, it is alarming that the fertilizing ability of human spermatozoa is continuously decreasing. The reasons for that are widely unknown, but there is hope that metabolomics-based investigations may be able to contribute to overcoming this problem. This review summarizes the attempts made so far. Methods: We will discuss liquid chromatography–mass spectrometry (LC-MS), gas chromatography (GC), infrared (IR) and Raman as well as nuclear magnetic resonance (NMR) spectroscopy. Almost all available studies apply one of these methods. Results: Depending on the methodology used, different compounds can be detected, which is (in combination with sophisticated methods of bioinformatics) helpful to estimate the state of the sperm. Often, but not in all cases, there is a correlation with clinical parameters such as the sperm mobility. Conclusions: LC-MS detects the highest number of metabolites and can be considered as the method of choice. Unfortunately, the reproducibility of some studies is poor, and, thus, further improvements of the study designs are needed to overcome this problem. Additionally, a stronger focus on the biochemical consequences of the altered metabolite concentrations is also required
The practice of menstrual hygiene management and associated factors among secondary school girls in eastern Ethiopia: The need for water, sanitation, and hygiene support
Full text linkBackground:
During menstruation, school girls face obstacles connected to menstrual hygiene management in schools. Due to their monthly period, up to 20% of girls miss school globally, and one in ten will drop out entirely. Three hundred thirty-five million girls attended school without access to running water or soap. In Ethiopia, 67% of girls have no access to education on puberty and menstrual health; menstrual hygiene management continues to be one of the major problems among school girls. Thus, context-specific assessment of the practice may be useful in developing customized intervention approaches. Thus, the objective of the study was to assess practices of menstrual hygiene management and associated determinants among secondary school girls in East Hararghe, Ethiopia from 1 to 30 December 2020.
Methods:
A school-based cross-sectional survey was undertaken with 486 randomly selected female students. Data were collected by pretested self-administered questionnaire. Descriptive statistical tests and multivariate logistic regression were used to describe the study variables and to examine the association. Statistical package for social science version 23 was used for data analysis, and a p-value of 0.05 was considered as a cut-off point for statistical significance.
Results:
Of the total, 328 (68%) of the study participants practiced appropriate menstrual hygiene. Besides, 350 (72.6%) had a good level of understanding about menstrual hygiene. A higher level of knowledge (adjusted odds ratio = 2.12, 95% confidence interval = 1.28, 3.53), a greater wealth indexed family (adjusted odds ratio = 7.14, 95% confidence interval = 3.98, 12.88), earning permanent pocket money (adjusted odds ratio = 0.495, 95% confidence interval = 0.299, 0.821), and being in grade level (11–12) (adjusted odds ratio = 3.45, 95% confidence interval = 1.75, 4.501) were significant predictors of the good menstrual hygiene practice.
Conclusion:
One-third of the school girls had poor menstrual hygiene practices which may affect their school performance and the reproductive health. Hence, tailored menstrual hygiene information should be given to school girls and parents. Besides, efforts ought to be made for the provision of affordable sanitary materials in schools
Analysis of rapid arc-based radiation therapy on dosimetric parameters in cervical cancer patients with and without bone marrow sparing
Full text linkBackground:
The standard treatment for cervical cancer is chemoradiation therapy. Pelvic radiation is associated with higher dose to bone marrow (BM) causing interrupted treatment due to haematologic toxicity with inferior outcomes. This study aims to evaluate rapid arc technique in sparing pelvic BM and dosimetric parameters for pelvis V5GY, V10GY, V20GY, V30GY, and V40GY dose.
Method:
Twenty one cervical cancer patients were selected for the analysis. Planning target volume (PTV) contours, total pelvic BM and surrounding structures contours were standardised. Two rapid arc based procedures were designed for individual patient. One was done using bone marrow sparing (BMS) constraints while other was performed without BMS constraints. Data for both plans was calculated with regard to PTV, normal structures and pelvic BM. Difference in dose distribution in both groups was analysed using Wilcoxon and Friedman ANOVA test.
Results:
In the presence of BM constraint a significant changes in pelvic BM dose for values of V10GY (p=0.002), V20GY (p=0.002) and V40GY (p=0.025) was observed. The coverage of PTV was found to be unaffected by adding BM constraint.
Conclusion:
The BM is radiosensitive structure so dosage is linked with haemtological toxicity. Increased dose is associated with higher grade of haematological toxicity in pelvic radiotherapy. The study suggests that adding BM constraint in plans reduced the pelvic BM dose while not affecting PTV coverage and dose to bowel, bladder and rectum. Bone marrow constraint in pelvic radiotherapy can be considered for better treatment toleration and to determine its role in decreasing haematological toxicity
Does the new FIGO 2018 staging system allow better prognostic differentiation in early stage cervical cancer? a Dutch nationwide cohort study
Full text linkSimple Summary:
The introduction of a revised staging system (FIGO 2018 staging system) for cervical cancer has led to a significant change in stage allocation for patients with early stage disease. It remains unclear how this change should be translated into treatment options, including less extensive surgery. With this Dutch national study we evaluated whether the revised staging system resulted in a more accurate prediction of overall and recurrence free survival compared to the previous FIGO 2009 staging system. In addition, we assessed other factors which may help the paradigm of treatment. We concluded that the revised FIGO 2018 staging system gives a more precise indication of survival outcomes of women with early stage cervical cancer. In addition, we believe that aside from stage, tumor characteristics, such as LVSI, and depth of invasion should be considered when offering patients less radical or less extensive treatment.
Abstract:
The FIGO 2018 staging system was introduced to allow better prognostic differentiation in cervical cancer, causing considerable stage migration and affecting treatment options. We evaluated the accuracy of the FIGO 2018 staging in predicting recurrence free (RFS) and overall survival (OS) compared to FIGO 2009 staging in clinically early stage cervical cancer. We conducted a nationwide retrospective cohort study, including 2264 patients with preoperative FIGO (2009) IA1, IA2 and IB1 cervical cancer between 2007–2017. Kaplan–Meier analyses were used to assess survival outcomes. Logistic regression was used to assess risk factors for lymph node metastasis and parametrial invasion. Stage migration occurred in 48% (22% down-staged, 26% up-staged). Survival data of patients down-staged from IB to IA1/2 disease were comparable with FIGO 2009 IA1/2 and better than patients remaining stage IB1. LVSI, invasion depth and parametrial invasion were risk factors for lymph node metastases. LVSI, grade and age were associated with parametrial invasion. In conclusion, the FIGO 2018 staging system accurately reflects prognosis in early stage cervical cancer and is therefore more suitable than the FIGO 2009 staging. However subdivision in IA1 or IA2 based on presence or absence of LVSI instead of depth of invasion would have improved accuracy. For patients down-staged to IA1/2, less radical surgery seems appropriate, although LVSI and histology should be considered when determining the treatment plan