Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Resveratrol against cervical cancer: evidence from in vitro and in vivo studies
Get PDFCervical cancer affects many women worldwide, with more than 500,000 cases diagnosed and approximately 300,000 deaths each year. Resveratrol is a natural substance of the class of phytoalexins with a basic structure of stilbenes and has recently drawn scientific attention due to its anticancer properties. The purpose of this review is to examine the effectiveness of resveratrol against cervical cancer. All available in vitro and in vivo studies on cervical cancer were critically reviewed. Many studies utilizing cervical cancer cells in culture reported a reduction in proliferation, cell cycle arrest, and induction of apoptosis. Apart from apoptosis, induction of autophagy was seen in some studies. Importantly, many studies have shown a reduction in the HPV oncoproteins E6 and E7 and increased levels of the tumor suppressor p53 with resveratrol treatment. A few studies examined the effects of resveratrol administration in mice ectopic-xenografted with cervical cancer cells showing reduced tumor volume and weight. Overall, the scientific data show that resveratrol has the ability to target/inhibit certain signaling molecules (EGFR, VEGFR, PKC, JNK, ERK, NF-kB, and STAT3) involved in cervical cancer cell proliferation and survival. Further in vivo experiments and clinical studies are required to better understand the potential of resveratrol against cervical cancer
circRNA_0000285 knockdown suppresses viability and promotes apoptosis of cervical cancer cells by sponging microRNA-654-3p
Get PDFCervical cancer (CC) is one of the most common gynecological tumors worldwide. Several studies have reported that circular RNAs (circRNAs) play important roles in various types of diseases, including cancer. Thus, the present study aimed to investigate the role of circRNA_0000285 in CC development. Dual-luciferase reporter and RNA pull-down assays were performed to verify the binding region between circRNA_0000285 and miR-654-3p. The expression levels of circRNA_0000285 and miR-654-3p were analyzed in CC and the corresponding normal tissues, as well as in SiHa, HeLa, and NC104 cells using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). In addition, the effect of circRNA_0000285 inhibition on cell viability, apoptosis, and the expression of apoptosis-related markers was assessed using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide), flow cytometry, and Western blotting assays, respectively. The results verified that miR-654-3p directly targeted circRNA_0000285 expression. circRNA_0000285 was overexpressed and miR-654-3p expression was downregulated in CC tissues and cells compared to that in control. Moreover, circRNA_0000285 knockdown suppressed the viability and promoted the apoptosis of CC cells, which was accompanied by the downregulated and upregulated expressions B-cell lymphoma-2 (Bcl-2) and Bcl-2 associated X (Bax), respectively. The ratio of Bax/Bcl-2 levels also increased following circRNA_0000285 knockdown. However, these findings were abrogated after miR-654-3p inhibitor treatment. Hence, circRNA_0000285 knockdown suppressed cell viability and promoted apoptosis by targeting miR-654-3p in CC
Practices and predictors of menstrual hygiene management material use among adolescent and young women in rural Pakistan: A cross-sectional assessment
Get PDFBackground:
In low- and middle-income countries (LMICs), women often use inappropriate materials to manage menstruation, which can threaten their health. Improper practices can also have critical downstream consequences beyond physiologic health, including restricting adolescent girls’ access to academic pursuits.
Methods:
We used cross-sectional data collected through a structured questionnaire from the menstruating adolescents and young women 15-23 years of age living in rural Pakistan (n = 25 305). We aimed to describe menstrual hygiene management (MHM) practices and generate a predictive model of the socioeconomic and demographic factors related to the use of MHM materials. Beliefs and barriers around MHM were also summarized. The outcome variable included: those who practiced appropriate and inappropriate MHM practices. Logistic regression was used to generate the predictive model, with results presented as odds ratios (OR) and 95% confidence interval (CI).
Results:
Inappropriate MHM practices were reported by 75% (n = 19 006) of participants. The majority 61.9% (n = 15 667) reported using old cloths, 12.6% (n = 3191) used nothing, and 0.5% (n = 136) used old cloth with a sanitary pad. One-fourth of participants reported appropriate MHM material use, including 16.2% (n = 4087) sanitary pads, 8.6% (n = 2167) new cloth, and a few reported using sanitary pads with new cloth 0.2% (n = 45). Inappropriate MHM practices were more common in lowest wealth quintile (OR = 4.41; 95% CI = 2.77-7.01, P < 0.0001), followed by those with no education (OR = 3.9; 95% CI = 3.36-4.52, P < 0.0001).
Conclusions:
The study indicates the need for multi-sectoral efforts to introduce MHM-specific and MHM-sensitive interventions to improve MHM practices, ranging from the availability of low-cost MHM materials to the inclusion of MHM education in school curriculums and within the community platforms
WHO Standards-based questionnaire to measure health workers’ perspective on the quality of care around the time of childbirth in the WHO European region: development and mixed-methods validation in six countries
Get PDFObjectives:
Develop and validate a WHO Standards-based online questionnaire to measure the quality of maternal and newborn care (QMNC) around the time of childbirth from the health workers’ perspective.
Design:
Mixed-methods study.
Setting:
Six countries of the WHO European Region.
Participants and methods:
The questionnaire is based on lessons learnt in previous studies, and was developed in three sequential phases: (1) WHO Quality Measures were prioritised and content, construct and face validity were assessed through a Delphi involving a multidisciplinary board of experts from 11 countries of the WHO European Region; (2) translation/back translation of the English version was conducted following The Professional Society for Health Economics and Outcomes Research guidelines; (3) internal consistency, intrarater reliability and acceptability were assessed among 600 health workers in six countries.
Results:
The questionnaire included 40 items based on WHO Standards Quality Measures, equally divided into four domains: provision of care, experience of care, availability of human and physical resources, organisational changes due to COVID-19; and its organised in six sections. It was translated/back translated in 12 languages: Bosnian, Croatian, French, German, Italian, Norwegian, Portuguese, Romanian, Russian, Slovenian, Spanish and Swedish. The Cronbach’s alpha values were ≥0.70 for each questionnaire section where questions were hypothesised to be interrelated, indicating good internal consistence. Cohen K or Gwet’s AC1 values were ≥0.60, suggesting good intrarater reliability, except for one question. Acceptability was good with only 1.70% of health workers requesting minimal changes in question wording.
Conclusions:
Findings suggest that the questionnaire has good content, construct, face validity, internal consistency, intrarater reliability and acceptability in six countries of the WHO European Region. Future studies may further explore the questionnaire’s use in other countries, and how to translate evidence generated by this tool into policies to improve the QMNC
Cervical cancer knowledge and attitude among a cohort of female schoolteachers in Salem city – a cross-sectional survey
Get PDFThe present study aimed to assess the knowledge and attitude of female schoolteachers toward cervical cancer.
Materials and Method:
A cross-sectional study was conducted among 256 Government female schoolteachers aged 22–60 years in Salem city, Tamil Nadu. A self-administered questionnaire which assessed the levels of knowledge (6 items) and attitude (4 items) regarding cervical cancer was employed and responses were recorded on a three-point Likert scale. Data were analysed using Statistical Package for Social Sciences (SPSS) software version 20.0.
Results:
Overall adequate knowledge and good attitude regards to cervical cancer was observed among 60% and 66.8% of schoolteachers, respectively. Participants in the age range of 31–45 years (p = 0.007), primary schoolteachers (p = 0.004) and Hindus (p = 0.001) displayed significantly adequate levels of knowledge compared to their respective counterpart. Likewise, based on attitude subjects possessing postgraduation (p = 0.001) and middle schoolteachers (p = 0.009) had significant good attitude scores. Significant linear correlation was observed knowledge with class teacher (r = 0.136, P = 0.03) and religion (r = 0.208, P = 0.001) whereas attitude with qualification (r = 0.165, P = 0.008) and class teacher (r = 0.206, P = 0.001) which are positive predictors. Moreover, knowledge had a significant positive correlation with attitude (r = 1.000, P = 0.000).
Conclusion:
Primary care physicians partnering network with schoolteachers having adequate knowledge and good attitude acts as a workforce to support cervical cancer screening and human papillomavirus vaccination
Deep learning for per-fraction automatic segmentation of gross tumor volume (GTV) and organs at risk (OARs) in adaptive radiotherapy of cervical cancer
Get PDFBackground/Hypothesis:
MRI-guided online adaptive radiotherapy (MRI-g-OART) improves target coverage and organs-at-risk (OARs) sparing in radiation therapy (RT). For patients with locally advanced cervical cancer (LACC) undergoing RT, changes in bladder and rectal filling contribute to large inter-fraction target volume motion. We hypothesized that deep learning (DL) convolutional neural networks (CNN) can be trained to accurately segment gross tumor volume (GTV) and OARs both in planning and daily fractions’ MRI scans.
Materials/Methods:
We utilized planning and daily treatment fraction setup (RT-Fr) MRIs from LACC patients, treated with stereotactic body RT to a dose of 45-54 Gy in 25 fractions. Nine structures were manually contoured. MASK R-CNN network was trained and tested under three scenarios: (i) Leave-one-out (LOO), using the planning images of N- 1 patients for training; (ii) the same network, tested on the RT-Fr MRIs of the “left-out” patient, (iii) including the planning MRI of the “left-out” patient as an additional training sample, and tested on RT-Fr MRIs. The network performance was evaluated using the Dice Similarity Coefficient (DSC) and Hausdorff distances. The association between the structures’ volume and corresponding DSCs was investigated using Pearson’s Correlation Coefficient, r.
Results:
MRIs from fifteen LACC patients were analyzed. In the LOO scenario the DSC for Rectum, Femur, and Bladder was >0.8, followed by the GTV, Uterus, Mesorectum and Parametrium (0.6-0.7). The results for Vagina and Sigmoid were suboptimal. The performance of the network was similar for most organs when tested on RT-Fr MRI. Including the planning MRI in the training did not improve the segmentation of the RT-Fr MRI. There was a significant correlation between the average organ volume and the corresponding DSC (r = 0.759, p = 0.018).
Conclusion:
We have established a robust workflow for training MASK R-CNN to automatically segment GTV and OARs in MRI-g-OART of LACC. Albeit the small number of patients in this pilot project, the network was trained to successfully identify several structures while challenges remain, especially in relatively small organs. With the increase of the LACC cases, the performance of the network will improve. A robust auto-contouring tool would improve workflow efficiency and patient tolerance of the OART process
Experiences of menstrual inequity and menstrual health among women and people who menstruate in the Barcelona area (Spain): a qualitative study
Get PDFIntroduction:
Menstrual health and menstrual inequity have been neglected in social, economic, healthcare and political spheres. Although available evidence is scarce, it already suggests a link between experiencing menstrual inequity (which refers to the systematic disparities in accessing menstrual health and education, menstrual products and spaces for menstrual management, among other aspects) and menstrual health outcomes. The aim of this study was to explore experiences of menstrual health and menstrual inequity among women and people who menstruate aged 18–55 in Barcelona and surrounding areas (Spain).
Methods:
A qualitative study, using a critical feminist perspective, was conducted. Sampling was purposeful and selective. Recruitment was through sexual and reproductive health centres, social media and snowball sampling techniques. Thirty-four semi-structured photo-elicitation interviews were conducted between December 2020 and February 2021. Interviews took place in sexual and reproductive health centres, public spaces, and by telephone. Data were analysed using Reflexive Thematic Analysis.
Results:
Three themes were identified: “Systemic neglect of menstruation and the menstrual cycle”, “When “the private” becomes public: menstrual management” and “Navigating menstrual health: between medicalization and agency”. Experiences of menstrual inequity appeared to be widespread among participants. They referred to the impact of having to conceal menstruation and the barriers to managing menstruation in public spaces. Choosing menstrual products was often influenced by price and availability; several participants reported menstrual poverty. A general lack of menstrual education was described. Menstrual education was usually gained through personal experience and self-learnings, or through families and friends. Menstruation and the menstrual cycle had a significant impact on participants’ day-to-day. Accessing and navigating the healthcare system was challenging, as participants mostly reported feeling dismissed and almost exclusively offered hormonal contraception as a panacea to address menstrual health.
Conclusions:
The impact of menstrual inequity appears to be far-reaching. Multidimensional structural policies should promote agency in individuals and communities to enable opportunities for menstrual education, access to menstrual products, healthcare services and adequate menstrual-management facilities. Health professionals’ training is also necessary to improve access to and quality of menstrual healthcare. Policies need to be inclusive of non-binary and trans people, and vulnerable populations
Understanding the trauma of menstrual irregularity after covid vaccination: a bird’s-eye view of female immunology
Get PDFThe intricacies in various signaling routes involved in the menstrual cycle can be impacted by internal as well as external stimuli, and the role of stress, be it physical, psychological, or social, in disturbing the process could be debilitating for a woman. The global endeavor of vaccination rose to protect individuals from the severity of COVID-19, but a conjunction of a short-lived menace of menstrual disturbance in the female population came out as an unsettling side effect. An understanding of the immunological panorama in the female reproductive tract (FRT) becomes important to fathom this issue. The close-knit microenvironment in the FRT shows active microbiota in the lower FRT, but the latest findings are ascertaining the presence of low-biomass microbiota in the upper FRT as well. Concerted signaling, wherein inflammation becomes an underlying phenomenon, results when a stressor elicits molecules of the inflammatory cascade. Learning lessons from the gut microbiota, we need to address the exploration of how FRT microbiota would impose inflammation by manipulating the immune response to vaccines. Since there is a prominent sex bias in the immune response to infectious diseases in women and men, the role of sex hormones and cortisol becomes important. The treatment regimen may be considered differently in women who also consider their ovarian cycle phases. Women exert robust immune response to antigenic encounters via cell-mediated and humoral arms. The inclusion of women in vaccine trials has been marginalized over the years, which resulted in unwanted high dosage administration of vaccines in women
Prophylactic use of antibiotics for sexually transmitted infections: awareness and use among HIV PrEP users in Belgium
Get PDFDoxycycline prophylaxis has been shown to reduce the incidence of chlamydia and syphilis infections in various studies, but researchers are worried about increasing antimicrobial resistance (AMR).1 Although not currently recommended, STI prophylaxis has been reported in high-risk men who have sex with men, with proportions ranging from 2% to 10%.2 We assessed the awareness and use of STI prophylaxis among HIV pre-exposure prophylaxis users in Belgium in a nested cross-sectional online survey in December 2021 and January 2022. Participants were recruited through social media, HIV reference centres and social/sexual networking applications. A total of 187 participants completed the survey. The median age was 46 years (IQR 38–53). The majority were born in Belgium (161/187, 86.1%) and identified themselves as male (183/187, 97.9%). Fifty-four participants (28.9%) had ever heard of STI prophylaxis, 21 (11.3%) knew someone who used it and 6 (3.2%) reported having used STI prophylaxis themselves. Three users reported taking it only after sex and three both before and after sex. Two had used doxycycline, one azithromycin, one amoxicillin and antibiotic was unknown in two cases. Two participants reported having taken STI prophylaxis in the previous month, two in the previous 1–6 months and two >12 months ago. Two participants had obtained these antibiotics through an HIV/STI clinic, one from a sex partner and three reported using leftovers. Although the use of STI prophylaxis was limited in our sample, a substantial proportion of participants were aware of STI prophylaxis or knew persons using it, suggesting that this phenomenon may be more common than initially thought. Another concern is that some antibiotics with a high propensity to induce AMR or no efficacy in reducing the occurrence of bacterial STIs were used. Sensitisation of patients and healthcare providers is needed, as well as further research on the net benefits and risks of STI prophylaxis
Current knowledge of physicians’ dual practice in Iran: A scoping review and defining the research agenda for achieving universal health coverage
Get PDFBackground:
Physicians’ dual practice (simultaneous practice in both public and private sectors) may be challenging for achieving universal health coverage. The purpose of this review is to identify the types of available evidence in physicians’ dual practice in Iran and define the research agenda for achieving universal health coverage (UHC).
Methods:
We conducted a scoping review of the literature using Arksey and O’Malley’s approach. We searched Embase, PubMed, the Cochrane Library, Scopus, Web of Science core collection, as well as internal databases including the National Magazine Database (Magiran) and the Scientific Information Database (SID) until August 3, 2020. Studies published in Persian or English and investigating physicians’ dual practice in the health system of Iran were included. Each step of the study was performed by two of the present researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) recommendations were used to conduct this study and report the findings.
Results:
Fourteen studies were included in the current review. The findings were categorized and synthesized into five themes including the forms of dual practice, the extent of dual practice, the motivators and factors affecting dual practice, the policy options, and the consequences of dual practice. There were limited evidence on the nature, types, and prevalence of this phenomenon for different provinces and medical specialties and on health policy options in Iran. There seems to be a methodological gap (a gap in the type of study and its method) in the subject area. Most studies have only used quantitative or qualitative study methods and based on the self-report of research samples in most of the included studies.
Conclusions:
More research is required at national level on the nature, types, and prevalence of this phenomenon, focusing on clarifying the root causes of this phenomenon and on the effects of dual practice on the indicators of accessibility to health services, especially for vulnerable populations, the quality of care provided, and equity, and on complex policy research on health policy options in Iran. The research questions proposed in the present study can help to bridge the knowledge gap in this area. Additional studies should address issues related to the quality of data collection in physicians’ dual practice