Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Relationships between adiposity distribution and metabolic health in preconception women in South Africa
Get PDFObjective:
Adipose tissue is a central regulator of metabolic health and a contributor to systemic inflammation. Patterns of adiposity deposition are important to understand for optimizing health. This study aimed to asses relationships between adiposity deposition and metabolic and inflammatory biomarkers in South African women prior to conception.
Methods:
Non‐pregnant, healthy women (n = 298) were recruited for this cross‐sectional study via home visits. Body composition was measured by Dual X‐ray Absorptiometry. Inflammation markers C‐reactive protein (CRP), alpha1‐acid glycoprotein (AGP), hemoglobin A1c (HbA1c), and blood pressure were scored according to risk. A summative metabolic health risk score was created for women with obesity. Generalized regression models assessed relationships between adiposity deposition and outcomes with adjustment for potential confounders.
Results:
Obesity was present in 22% of women (mean age = 20.93 years). Fat mass index was associated with inflammation and metabolic health risk (β = 0.58; p < 0.01). Visceral fat, trunk:limb ratio, android:gynoid ratio, body mass index, weight, and waist circumference were positively associated with CRP, AGP, and metabolic health risk (p < 0.01). Weight was associated with Hba1c (β < 0.01; p < 0.05). Participants with obesity and low metabolic health risk had lower fat mass index and visceral fat than participants with obesity and higher metabolic health risk.
Conclusions:
Black South African women accumulated excess adipose tissue in abdominal regions. While fat mass and body mass were associated with inflammation and metabolic health risk, women with obesity and with lower fat mass index and lower visceral adipose tissue were metabolically protected. Identification of women at risk for metabolic disease preconception could help ensure future healthy pregnancies and prevent transference of risk to offspring
Universal health coverage: Sexual and reproductive health and rights on the agenda
Get PDFAction for Global Health (AfGH) and Countdown 2030 Europe are cross-European networks engaged in global debates
on the 2030 Agenda for Sustainable Development and its implementation. Countdown 2030 Europe has a specific
focus on sexual and reproductive health and family planning in developing countries, whilst AfGH works across health
issues and promotes universal health coverage as a key instrument to achieve the universal right to health.
This paper builds upon a previous version1 jointly written by Action for Global Health and Countdown 2030 Europe 2. It seeks to show how the World
Health Organisation (WHO) definition of universal health coverage (UHC) and its vision of the social determinants of health underpinning UHC relate to
sexual and reproductive health and rights (SRHR) and the enabling factors which affect SRHR. It argues that UHC cannot be truly achieved without
addressing SRHR as a matter of priority, and that an approach to UHC which is grounded in human rights is critical for making progress on SRHR.
It acknowledges that, some aspects of SRHR continue to be deprioritised and will continue to require ongoing and additional focus and activism. It
concludes with some key messages and recommendations on what it means to achieve universal access to SRHR
Predictions of cervical cancer identification by photonic method combined with machine learning
Get PDFCervical cancer is one of the most commonly appearing cancers, which early diagnosis is of greatest importance. Unfortunately, many diagnoses are based on subjective opinions of doctors—to date, there is no general measurement method with a calibrated standard. The problem can be solved with the measurement system being a fusion of an optoelectronic sensor and machine learning algorithm to provide reliable assistance for doctors in the early diagnosis stage of cervical cancer. We demonstrate the preliminary research on cervical cancer assessment utilizing an optical sensor and a prediction algorithm. Since each matter is characterized by refractive index, measuring its value and detecting changes give information about the state of the tissue. The optical measurements provided datasets for training and validating the analyzing software. We present data preprocessing, machine learning results utilizing four algorithms (Random Forest, eXtreme Gradient Boosting, Naïve Bayes, Convolutional Neural Networks) and assessment of their performance for classification of tissue as healthy or sick. Our solution allows for rapid sample measurement and automatic classification of the results constituting a potential support tool for doctors
Woman and girl-centred care for those affected by female genital mutilation: a scoping review of provider tools and guidelines
Get PDFBackground:
A woman and girl centred, rights-based approach to health care is critical to achieving sexual and reproductive health. However, women with female genital mutilation in high-income countries have been found to receive sub-optimal care. This study examined documents guiding clinicians in health and community service settings in English-speaking high-income countries to identify approaches to ensure quality women and girl-centred care for those with or at risk of female genital mutilation.
Method:
We undertook a scoping review using the integrative model of patient-centredness to identify principles, enablers, and activities to facilitate woman and girl-centred care interactions. We developed an inclusion criterion to identify documents such as guidance statements and tools and technical guidelines, procedural documents and clinical practice guidelines. We searched the databases and websites of health professional associations, ministries of health, hospitals, national, state and local government and non-government organisations working in female genital mutilation in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation tool was used to appraise screened documents.
Findings:
One-hundred and twenty-four documents were included in this scoping review; 88 were developed in the United Kingdom, 20 in Australia, nine in the United States, three in Canada, two in New Zealand and two in Ireland. The focus of documents from the United Kingdom on multi-professional safeguarding (62), while those retrieved from Australia, Canada, Ireland, New Zealand and the US focused on clinical practice. Twelve percent of the included documents contained references to all principles of patient-centred care, and only one document spoke to all principles, enablers and activities.
Conclusion:
This study demonstrates the need to improve the female genital mutilation-related guidance provided to professionals to care for and protect women and girls. Professionals need to involve women and girls with or at risk of female genital mutilation in the co-design of guidelines and tools and evaluation of them and the co-production of health care
Nomogram predicting lymph node metastasis in the early-stage cervical cancer
Get PDFBackground:
Accurately predicting the risk level of lymph node metastasis is essential for the treatment of patients with early cervical cancer. The purpose of this study is to construct a new nomogram based on 2-deoxy-2-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and clinical characteristics to assess early-stage cervical cancer patients’ risk of lymph node metastasis.
Materials and Methods:
From January 2019 to November 2020, the records of 234 patients with stage IA-IIA [International Federation of Gynecology and Obstetrics (FIGO) 2018] cervical cancer who had undergone PET/CT examination within 30 days before surgery were retrospectively reviewed. A nomogram to predict the risk of lymph node metastasis was constructed based on it. The nomogram was developed and validated by internal and external validation. The validation cohorts included 191 cervical cancer patients from December 2020 to October 2021.
Results:
Four factors [squamous cell carcinoma associated antigen (SCCA), maximum standardized uptake value of lymph node (nSUVmax), uterine corpus invasion in PET/CT and tumor size in PET/CT] were finally determined as the predictors of the nomogram. At the area under the receiver operating characteristic curve cohort was 0.926 in the primary and was 0.897 in the validation cohort. The calibration curve shows good agreement between the predicted probability and the actual probability. The decision curve analysis showed the clinical utility of the nomogram.
Conclusion:
We had established and verified a simple and effective nomogram, which can be used to predict the lymph node metastasis of cervical cancer patients before surgery
The effectiveness of sexual health counseling based on cognitive-behavioral therapy on sexual satisfaction and inefficient sexual beliefs of primigravida women
Get PDFBACKGROUND:
Pregnancy may change sex life, this period may be associated with decreased sex, and this is due to fear of miscarriage, nausea and vomiting, fear of harm to the fetus, fatigue, and fear of ruptured membranes. Midwives could help them to improve their sexual life during this period. One of the important approaches to improving sexual life during pregnancy is cognitive-behavioral therapy (CBT). This nonmedical approach could improve misconceptions about sex during pregnancy. The aim of this study was the effect of sexual health counseling based on CBT on sexual satisfaction and inefficient sexual beliefs of primigravida women.
MATERIALS AND METHODS:
This was a randomized clinical trial study, the research population being 52 pregnant women who were randomly divided into groups, the experimental (26) and the control (26). Before the sexual health counseling based on CBT, the Sexual Satisfaction Questionnaire and the Inefficient Sexual Beliefs Questionnaire were filled by both the groups. These standard questionnaires were completed three times (before, immediately, and 4 weeks after intervention). After pretest, eight sexual health counseling sessions (90 min) were performed for the experimental group. The control group received routine care. Data analysis was performed by using descriptive statistics tests, ANOVA, and post hoc tests by Bonferroni method in SPSS version 22. P < 0.05 was considered statistically significant.
RESULTS:
The mean score of inefficient sexual beliefs in the interventional group before intervention, immediately after the intervention, and 1 month later was obtained 22.85 ± 9.57, 12.92 ± 7.25, and 7.86 ± 13.88, respectively (P < 0.001). The mean score of sexual satisfaction before the study, immediately after the intervention, and 1 month later was 88.77 ± 11.89, 95.62 ± 9.27, and 94.65 ± 8.28, respectively, in the experimental group (P < 0.001).
CONCLUSION:
Sexual health counseling based on CBT could reduce inefficient sexual beliefs and increase the sexual satisfaction of the primigravida women during pregnancy, but most participants preferred fewer sessions
Preconception risk factors and health care needs of pregnancy-planning women and men with a lifetime history or current mental illness: a nationwide survey
Get PDFObjectives:
While depression and anxiety are common in women and men of reproductive age, preconception interventions to optimize the health of individuals with mental illness before pregnancy is limited and focuses primarily on psychotropic medication management. Comparing individuals with depression, anxiety, and comorbidity to those with neither condition, we identified areas of preconception care optimization related to psychosocial risk factors, general physical health, medication use, and uptake of high-risk health behaviours. We also investigated differences in preconception health care use, attitudes, and knowledge.
Method:
We conducted a nationwide survey of 621 women (n = 529) and men (n = 92) across Canada who were planning a pregnancy within five years, including those with lifetime or current depression (n = 38), anxiety (n = 55), and comorbidity (n = 104) and those without mental illness (n = 413). Individuals with depression, anxiety, and comorbidity were compared to individuals without mental illness using logistic regression, adjusted for age, sex, and education level.
Results:
Individuals with a lifetime or current mental illness were significantly more likely to have several risk factors for suboptimal reproductive and perinatal outcomes, including increased rates of obesity, stress, fatigue, loneliness, number of chronic health conditions, and medication use. Further, they were more likely to have high-risk health behaviours including increased substance use, internet addiction, poorer eating habits, and decreased physical activity. By assessing depression, anxiety, or both separately, we also determined there was variation in risk factors by mental illness type.
Conclusion:
Our nationwide study is one of the first and largest to examine the preconception care needs of women and men with a lifetime or current mental illness who are pregnancy-planning. We found this population has many important reproductive and perinatal risk factors that are modifiable via preconception interventions which could have a significant positive impact on their health trajectories and those of their future children
Tracking sleep, temperature, heart rate, and daily symptoms across the menstrual cycle with the oura ring in healthy women
Get PDFBackground and Objective:
The ovulatory menstrual cycle is characterized by hormonal fluctuations that influence physiological systems and functioning. Multi-sensor wearable devices can be sensitive tools capturing cycle-related physiological features pertinent to women’s health research. This study used the Oura ring to track changes in sleep and related physiological features, and also tracked self-reported daily functioning and symptoms across the regular, healthy menstrual cycle.
Methods:
Twenty-six healthy women (age, mean (SD): 24.4 (1.1 years)) with regular, ovulatory cycles (length, mean (SD): 28.57 (3.8 days)) were monitored across a complete menstrual cycle. Four menstrual cycle phases, reflecting different hormone milieus, were selected for analysis: menses, ovulation, mid-luteal, and late-luteal. Objective measures of sleep, sleep distal skin temperature, heart rate (HR) and vagal-mediated heart rate variability (HRV, rMSSD), derived from the Oura ring, and subjective daily diary measures (eg sleep quality, readiness) were compared across phases.
Results:
Wearable-based measures of sleep continuity and sleep stages did not vary across the menstrual cycle. Women reported no menstrual cycle-related changes in perceived sleep quality or readiness and only marginally poorer mood in the midluteal phase. However, they reported moderately more physical symptoms during menses (p < 0.001). Distal skin temperature and HR, measured during sleep, showed a biphasic pattern across the menstrual cycle, with increased HR (p < 0.03) and body temperature (p < 0.001) in the mid- and late-luteal phases relative to menses and ovulation. Correspondingly, rMSSD HRV tended to be lower in the luteal phase. Further, distal skin temperature was lower during ovulation relative to menses (p = 0.05).
Conclusion:
The menstrual cycle was not accompanied by significant fluctuations in objective and perceived measures of sleep or in mood, in healthy women with regular, ovulatory menstrual cycles. However, other physiological changes in skin temperature and HR were evident and may be longitudinally tracked with the Oura ring in women over multiple cycles in a natural setting
The clinical aspects and prognostic factors concerning survival in patients with recurrent cervical cancer after radical hysterectomy and adjuvant chemoradiotherapy
Get PDFPurpose:
To investigate the recurrence patterns and prognostic factors of patients with recurrent cervical cancer after radical hysterectomy with node dissection (RHND) followed by adjuvant radiotherapy (RT)/concurrent chemoradiotherapy (CCRT).
Methods:
The medical records of 153 patients with pre-operative International Federation of Gynecology and Obstetrics stage IB-IIA cervical cancer, who were treated with RHND followed by adjuvant RT/CCRT at the Liaoning Cancer Hospital between January 1, 2012 and May 31, 2018, were retrospectively analyzed.
Results:
The median disease progression-free survival time was 16 months, and 75.2% (115/153) of patients had a relapse within two years. The survival of patients with multi-site relapse was significantly lower in comparison to those with relapse in a single site (p < 0.001). The survival rate of patients with distant metastasis (DM) and combined recurrence (DM with localregional recurrence [LR]) was significantly lower than that of patients with only LR (p = 0.006, p < 0.001). Furthermore, the survival rate of patients with combined recurrence was significantly lower than that of patients with only DM (p = 0.046). Multivariate analysis showed that resection margin involvement, para-aortic and common iliac lymph node metastasis, DM, no treatment after disease relapse, and early disease relapse were independent prognostic factors associated with poor survival.
Conclusion:
Most of the cervical cancer patients who received initial RHND followed by adjuvant RT/CCRT had a relapse within two years. Resection margin involvement, para-aortic and common iliac lymph node metastasis, DM, no treatment after recurrence, and early disease relapse were found to be prognostic factors in patients with recurrent cervical cancer after RHND followed by adjuvant RT/CCRT