Sexual Reproductive Health and Rights Repository (Aga Khan University)
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The association of menstruation and leisure-time physical activity among Korean female university students: a preliminary study
Get PDFAn active lifestyle elicits many health benefits. This study's aim is to understand the actual of leisure time physical activity (LTPA) of female university students in Korea who are experiencing stress due to, e.g., study and employment. LTPA is the degree of exercise participation in leisure time; it is cardiovascular and strength-based behavior occurring within recreation, exercise or sport and provides a positive effect on life satisfaction and psychological well-being. LTPA has been recommended as a method of reducing menstrual symptom severity. However, a lack of evidence exists to support a clear relationship between LTPA and menstruation in female university students. Health consciousness (HC) refers to the degree of interest in one's health, and Korean female university students pay considerable attention to their body shape, diet habits, and LTPA. This study investigated female university students (K University in Gangwon-do, D University in Busan, and U University in Ulsan) in three metropolitan cities in Korea. Specifically, after seeking cooperation from the person in charge of each university, the purpose of this study was explained. In addition, after promising to provide coffee coupons to students who wish to respond to the survey, cooperation was sought in recruiting research subjects through the person in charge of each university. In addition, a total of 36 surveys that did not have contents filled in fully or gave inconsistent answers were excluded among all survey participants. Chi-square test, t-test and univariate one-way ANOVA, and Pearson's correlation coefficient analysis were performed for between groups (HC, LTPA, intention to participate in LTPA). The LTPA results in relation to the menstruation patterns of Korean female college students are shown. First, there were no significant differences between menstruation (regular vs. irregular) and general LTPA during non-menstrual time periods (χ2 = 5.828, p < 0.212). However, female university students with regular menstruation patterns had higher LTPA after menstruation compared to female university students with irregular menstruation. Second, there were significant differences in the relationships among HC (p = 0.000), amount of LTPA (p = 0.002), and intention to perform LTPA (p = 0.002), according to the menstruation patterns (regular vs. irregular) of Korean female university students. In other words, those with regular menstruation patterns showed higher HC, amount of LTPA and intention to participate in LTPA than those with irregular menstruations. Third, there were significant differences in the relationship among HC (p = 0.000), amount of LTPA (p = 0.000), and intention to participate in LTPA (p = 0.000) according to LTPA of Korean female university students. Causation cannot be inferred from correlational studies. Therefore, female university students ultimately have different HC and participation in LTPA depending on menstruation regularity
“We feel like everybody's going to judge us”: black adolescent girls’ and young women's perspectives on barriers to and opportunities for improving sexual health care, including PrEP, in the Southern U.S
Get PDFBlack adolescent girls and young women (AGYW) are disproportionately affected by HIV in the southern U.S.; however, PrEP prescriptions to Black AGYW remain scarce. We conducted in-depth interviews (IDIs) with Black AGYW ages 14-24 in Alabama to explore opportunities for and barriers to sexual health care including PrEP prescription. Twelve AGYW participated in IDIs with median age 20 (range 19-24). All reported condomless sex, 1-3 sexual partners in the past 3 months, and 6 reported prior STI. Themes included: 1) Stigma related to sex contributes to inadequate discussions with educators, healthcare providers, and parents about sexual health; 2) Intersecting stigmas around race and gender impact Black women's care-seeking behavior; 3) Many AGYW are aware of PrEP but don't perceive it as an option for them. Multifaceted interventions utilizing the perspectives, voices, and experiences of Black cisgender AGYW are needed to curb the HIV epidemic in Alabama and the U.S. South
Hands-on training courses for cervical cancer screening, diagnosis, and treatment procedures in low- and middle-income countries
Get PDFIn 2018, there were approximately 570,000 new cases of cervical cancer worldwide. More than 85% of cases occurred in low- and middle-income countries (LMICs), primarily because of poor access to screening and a limited number of medical providers trained to diagnose and treat cervical precancerous lesions. Our objective was to provide locally arranged, hands-on training courses for medical providers in LMICs to learn to perform cervical cancer screening, diagnosis, and treatment procedures. The courses included didactic lectures and hands-on training stations using low-cost simulation models developed by bioengineers and students at Rice University in Houston, TX, United States, and the Malawi Polytechnic in Blantyre, Malawi. The hands-on training stations included visual inspection with acetic acid (VIA), colposcopy, cervical biopsy, endocervical curettage, loop electrosurgical excision procedure (LEEP), and thermal ablation. Provider pre- and postcourse confidence levels in performing the procedures were evaluated. From February 2017 to January 2020, we arranged 15 hands-on training courses in seven cities across six countries (El Salvador, Mozambique, Trinidad and Tobago, Lesotho, Malawi, and Nepal). Overall, there were 506 participants. The average number of participants per course was 38 (range 19-92). The participants included doctors, nurses, and midwives. The course duration varied from 1 to 3 days. Increased confidence in performing VIA, colposcopy and cervical biopsy, ablation, and LEEP was reported by 69%, 71%, 61%, and 76% of participants, respectively. Our findings suggest that locally arranged, hands-on cervical cancer prevention training courses in LMICs can improve provider confidence in performing cervical cancer screening, diagnosis, and treatment procedures. These courses are part of a larger strategy to build local capacity for delivering and improving cervical cancer prevention services in LMICs
Cervical cancer – times… they are a changing: a report from the Society of Gynecologic Oncology journal club
Get PDFIn January 2021, the Society of Gynecologic Oncology (SGO) Clinical Practice and Education Committees launched a “Journal Club” webinar series to invite national experts to discuss literature pertaining to common clinical scenarios encountered by the members of SGO. On December 13, 2021, SGO hosted its third journal club focused on the use of immunotherapy in cervical cancer. Charles A. Leath, III from the O’Neal Comprehensive Cancer at the University of Alabama and Leslie M. Randall from Massey Cancer Center at Virginia Commonwealth University discussed the recently published KEYNOTE-826 trial (Colombo et al., 2021) and Jyoti Mayadev from the University of California, San Diego Moores Cancer Center discussed GOG-9929 (Mayadev et al., 2020). Renata Urban from the University of Washington and Christine S. Walsh from the University of Colorado served as moderators. The following is a report of the journal club presentation
Impact of the initial site of metastases on post-recurrence survival for neuroendocrine cervical cancer
Get PDFObjective:
To summarize the risk factors and emphasize the prognostic importance of the site of recurrent neuroendocrine cervical cancer (NECC).
Methods:
We enrolled 88 patients who developed recurrence after radical surgery for pathological stage I–IVa primary NECC between January 2003 and 30 December 2020 and classified these cases into 7 groups based on the initial recurrence. The risk factors for post-recurrence survival (PRS) were analyzed by Kaplan–Meier and Cox regression methods.
Results:
Among 88 NECC patients, nearly all patients (95.50%) experienced progression within 3 years. The time to progression was significantly longer in patients with lung recurrence than in patients without lung recurrence (p = 0.008). After the first recurrence, the median follow-up was 11.1 months (range 2.37–65.50 months), and the 5-year PRS was only 20.6%. The depth of invasion in the primary surgery, number of recurrent sites, abdominal organ recurrence were correlated with PRS by univariate analysis. Multivariate analyses revealed that the number of recurrent sites (p = 0.025) and abdominal organ recurrence (p = 0.031) were independent prognostic factors. Notably, the combination of immune checkpoint inhibitors and chemotherapy, with or without surgery, showed a 43.8% objective response rate in recurrent NECC.
Conclusion:
Patients with abdominal organ recurrence need more sophisticated therapy. The combination of immune therapy and chemotherapy might be an opportunity for recurrent NECC
Improving human papillomavirus (HPV) testing in the cervical cancer elimination era: the 2021 HPV LabNet international proficiency study
Get PDFBackground:
Proficient Human Papillomavirus (HPV) genotyping services are essential to support HPV and cervical cancer elimination strategies, in particular to support HPV vaccine research.
Objectives:
To perform a global HPV genotyping proficiency study, with evaluation in relation to previous proficiency studies.
Study design:
The proficiency panel contained 44 coded samples (40 samples containing one or more purified HPV types (HPV6/11/16/18/31/33/35/39/45/51/52/56/58/59/68a/68b) in human DNA, 1 human DNA control and 3 DNA extraction controls). Proficiency required detection of both single and multiple infections of 50 International Units of HPV 16/18, of 500 genome equivalents for other HPV types and no false positivity.
Results:
One hundred and thirty-two laboratories submitted 211 datasets. Most assays used (182/211 datasets) were commercially available. An all-time high of 75% of the datasets were 100% proficient. One or more false positives were found in 17.5% of datasets. Among laboratories who participated in the 2019 proficiency study, full proficiency increased from 25% in 2019 to 60% in 2021. The high overall proficiency was mostly attributable to a large number of new laboratories, which used similar assays.
Conclusions:
The worldwide deterioration in comparability and reliability of HPV testing found in 2019 is now reversed and an overall increase in proficiency is found
Menstrual cycle disturbances after COVID-19 vaccination
Get PDFIntroduction:
After COVID-19 vaccination, women of reproductive age reported changes in their menstrual cycle.
Materials and methods:
A retrospective study was carried out after a survey on social networks that included women aged 18–41 years with normal cycles according to International Federation of Gynecology and Obstetrics and who were vaccinated (complete schedule for two doses, except J&J/Janssen or incomplete with a single dose). Women with following conditions were excluded: pregnant or lactating women; history of diseases that cause menstrual irregularities or early menopause: anorexia, bulimia, polycystic ovary syndrome, hypothyroidism, obesity, or low weight; hysterectomized or oophorectomized patients; and high performance athletes.
Results:
Overall, 950 women completed the survey between July and September 2021. In total, 408 women met the inclusion criteria, and 184 reported the following characteristics: frequency (normal 43.47%, infrequent 25%, and frequent 31.53%), regularity (regular 51.08%, irregular 42.93%, and absent/amenorrhea 5.97%), duration (normal 65.21%, prolonged 26.08%, absent/amenorrhea 8.69%), and volume (heavy 41.84%, light 20.65%, and absent/amenorrhea 6.52%).
Conclusions:
SARS-CoV-2 infection and COVID-19 vaccination can influence the menstrual cycle and cause alterations
Knowledge, attitude, and practice of preconception care and associated factors among obstetric care providers working in public health facilities of West Shoa Zone, Ethiopia: a cross-sectional study
Get PDFPreconception care is biomedical, social, and behavioural care provided for a woman or couple before conception occurs or throughout their reproductive year. In Ethiopia, it’s reported that the majority of health care providers had poor knowledge and practice of preconception care. The institution-based cross-sectional study was conducted among 359 obstetric care providers to assess knowledge, attitude, and practice of preconception care in West Shoa Zone, Ethiopia. A stratified, simple random sampling technique selected five hospitals, 46 health centers, and study participants. Pretested and structured questionnaires were used to collect data. Data were entered into Epidata and exported to SPSS for analysis. Bivariate and multivariate logistic regressions were employed to identify an association between the independent predictors and the outcome variables. In this study, 173(48.2%) and 124(34.5%) of the obstetric care providers had good knowledge and practice of preconception care, respectively. Two-thirds 255(71%) of providers had a favorable attitude toward preconception care. The odds of having good knowledge were higher among Midwives’ providers [AOR: 2.03, 95%CI: 1.09–3.77] and had training on HIV testing [AOR: 3.5, 95%CI: 1.9–6.4]. The presence of a library [AOR: 1.7, 95%CI: 1.04–2.85] and internet access [AOR: 3.4, 95%CI: 2.0–5.8] in working health facility had a higher odds of good knowledge about preconception. Degree and above holders [AOR: 3.1, 95%CI: 1.5–6.1] also had higher odds of good preconception knowledge than diploma holders. Similarly, the odds of having good practice of preconception care were higher among health care providers: who did screening for reproductive life plans [AOR: 3.7, 95%CI:1.8–7.4], worked in maternity and child health unit [AOR:4.2,95%CI:2.0–8.6], perceive all health facilities should give preconception care services [AOR:2.3,95%CI:1.2–4.3], and perceive all health care providers should provide preconception services [AOR:3.0, 95%CI: 1.7–5.5]. This study found that more than half of obstetric care providers’ had poor knowledge, favorable attitude, and poor practice of preconception care. Provision of training, carrier development, and installation of internet and library services should be enhanced
Elagolix treatment in women with heavy menstrual bleeding associated with uterine fibroid: a systematic review and meta-analysis
Get PDFBackground:
Elagolix is effective and safe for treating menorrhagia in women with uterine fibroid. However, it is reported to be associated with hypoestrogenism that can be alleviated by adding estradiol/norethindrone acetate. This systematic review and meta-analysis aimed to determine the effectiveness of elagolix treatment in women with heavy menstrual bleeding associated with uterine fibroid by comparing: elagolix versus placebo and elagolix versus estradiol/norethindrone acetate.
Methodology:
The Cochrane Central Register of Controlled Trials (CENTRAL 2021, Issue 3 of 12), MEDLINE databases (1980 to December week 1, 2020), and trial registries for relevant randomized clinical trials were used. All randomized clinical trials were reviewed and evaluated. Random effects models were used to estimate the dichotomous outcomes and mean differences with 95% confidence intervals. Data for risk of bias, heterogeneity, sensitivity, reporting bias and quality of evidence were assessed.
Results:
Four randomized controlled trials with 1949 premenopausal women from 323 locations were included. Elagolix improved menstrual blood loss of less than 80 ml (RR 4.81, 95% CI 2.45 to 9.45; four trials, 869 participants; moderate quality evidence) or more than 50% reduction from baseline (RR 4.87, 95% CI 2.55 to 9.31; four trials, 869 participants; moderate quality evidence) compared to placebo. There was no difference in menstrual blood loss of less than 80 ml (RR 1.08, 95% CI 1.00 to 1.16; five trials, 1365 participants; moderate quality evidence) or more than 50% reduction from baseline between the elagolix (RR 1.08, 95% CI 1.01 to 1.15; five trials, 1365 participants; high quality evidence) and elagolix with estradiol/norethindrone acetate. In both comparisons, elagolix has reduced the mean percentage change in uterine and fibroid volume, improved symptoms, and health-related quality of life. More patients had hot flush, and bone mineral density loss in the elagolix treatment compared to both placebo and elagolix with estradiol/norethindrone acetate.
Conclusions:
Elagolix appeared to be effective in reducing heavy menstrual bleeding caused by uterine fibroid and combination with estradiol/norethindrone acetate was able to alleviate the hypoestrogenism side effects in premenopausal women
Racial and ethnic disparities in postpartum care in the Greater Boston area during the covid-19 pandemic
Get PDFImportance:
Racial and ethnic disparities in postpartum care access have been well identified in the United States. Such disparities could be exacerbated by the COVID-19 pandemic because of amplified economic distress and compromised social capital among pregnant women who belong to racial or ethnic minority groups.
Objective:
To examine whether the COVID-19 pandemic is associated with an increase in the existing racial and ethnic disparity in postpartum care access.
Design, Setting, and Participants:
This was a retrospective cohort study using electronic health records data. Multinomial logistic regressions in an interrupted time series approach were used to assess monthly changes in postpartum care access across Asian, Hispanic, non-Hispanic Black (hereafter, Black), non-Hispanic White (hereafter, White) women, and women of other racial groups, controlling for maternal demographic and clinical characteristics. Eligible participants were women who gave live birth at 8 hospitals in the greater Boston, Massachusetts, area from January 1, 2019, to November 30, 2021, allowing for tracking 90-day postpartum access until March 1, 2022.
Exposures:
Delivery period: prepandemic (January to December 2019), early pandemic (January to March 2020), and late pandemic (April 2020 to November 2021).
Main Outcomes and Measures:
Postpartum care within 90 days after childbirth was categorized into 3 groups: attended, canceled, and nonscheduled.
Results:
A total of 45 588 women were included. Participants were racially and ethnically diverse (4735 [10.4%] Asian women, 3399 [7.5%] Black women, 6950 [15.2%] Hispanic women, 28 529 [62.6%] White women, and 1269 [2.8%] women of other race or ethnicity). The majority were between 25 and 34 years of age and married and had a full-term pregnancy, vaginal delivery, and no clinical conditions. In the prepandemic period, the overall postpartum care attendance rate was 75.2%, dropping to 41.7% during the early pandemic period, and rebounding back to 60.9% in the late pandemic period. During the months in the late pandemic, the probability of not scheduling postpartum care among Black (average marginal effect [AME], 1.1; 95% CI, 0.6-1.6) and Hispanic women (AME, 1.3; 95% CI, 0.9-1.6) increased more than among their White counterparts.
Conclusions and Relevance:
In this cohort study of postpartum care access before and during the COVID-19 pandemic, racial and ethnic disparities in postpartum care were exacerbated following the onset of the COVID-19 pandemic, when postpartum care access recovered more slowly among Black and Hispanic women than White women. These disparities require swift attention and amelioration to address barriers for these women to obtain much needed postpartum care during this pandemic