Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Association between GSDMB gene polymorphism and cervical cancer in the northeast Chinese Han population
Get PDFObjective: The purpose of this study was to investigate the relationship between GSDMB gene polymorphism and genetic susceptibility to cervical cancer in the Han population in Northeast China.
Methods: In this case–control study, the genotypes and alleles of rs8067378 in the GSDMB gene were analyzed by multiplex polymerase chain reaction (PCR) and next-generation sequencing methods in 482 cervical cancer (CC) patients, 775 cervical squamous intraepithelial lesion (SIL) patients, and 495 healthy women. The potential relationships between the SNP of the GSDMB gene with SIL and CC were analyzed by multivariate logistic regression analysis combined with 10,000 permutation tests.
Results: In the comparison between the SIL group and the control group, the genotype and allele distribution frequencies of rs8067378 SNP of the GSDMB gene were statistically significant (p = 0.0493 and p = 0.0202, respectively). The allele distribution frequencies of rs8067378 were also statistically significant in the comparison between high-grade cervical squamous intraepithelial lesion (HSIL) and low-grade cervical squamous intraepithelial lesion (LSIL) groups with control group ( p = 0.0483 and p = 0.0330, respectively). Logistic regression analysis showed that after adjusting for age, the rs8067378 SNP of the GSDMB gene was significantly associated with the reduced risk of SIL under the dominant model (p = 0.0213, OR = 0.764, CI = 0.607–0.961) and the additive model (p = 0.0199, OR = 0.814, and CI = 0.684–0.968), and its mutant gene G may play a role in the progression of healthy people to LSIL and even HSIL as a protective factor. However, there was no significant association between cervical cancer and its subtypes with the control group (p > 0.05). After 10,000 permutations, there was still no correlation that has provided evidence for the accuracy of our study.
Conclusion: The results of this study showed that rs8067378 single nucleotide polymorphism of the GSDMB gene may reduce the risk of SIL and protect the susceptibility to cervical precancerous lesions in the Northeast Chinese Han population, but it has no significant correlation with the progression of cervical cancer
“My motivation was to save”: a qualitative study exploring factors influencing motivation of community healthcare workers in a cervical cancer screening program in Dschang, Cameroon
Get PDFBackground:
Cervical cancer is a major public health issue among women in Cameroon and uptake of screening programs remains a challenge in many low- and middle-income countries. Community healthcare workers can play an important role in promoting cervical cancer services. This study aimed to explore factors affecting the motivation of community healthcare workers in a cervical cancer screening program in Dschang, Cameroon.
Methods:
A qualitative approach including 11 in-depth individual interviews with community healthcare workers was used. The interviews were audio-recorded, transcribed and coded using thematic analysis assisted by ATLAS.ti software.
Results:
Four women and seven men aged between 21 and 77 years old were interviewed. Community healthcare workers had high motivation. Factors affecting motivation were divided into individual and environmental level, based on a theoretical framework. Factors with a positive influence on motivation were mainly on the individual side while impeding factors were mainly associated with the environmental level.
Conclusions:
Key interventions to improve motivation among community healthcare workers include: (i) more training and supportive supervision; (ii) evaluation of remuneration systems by workload; and (iii) provision of job-enabling resources such as uniforms, cellphone cards and transport
Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina
Get PDFExamining the current incidence rates of HIV and STIs among racial and ethnic minority and rural residents is crucial to inform and expand initiatives and outreach efforts to address disparities and minimize the health impact of these diseases. A retrospective, cross-sectional study was conducted using Medicaid administrative claims data over a 2-year period (July 2019-June 2021) in South Carolina. Our main outcomes of interest were claims for chlamydia, gonorrhea, syphilis, and HIV. Any beneficiary with at least one claim for a relevant diagnosis throughout the study period was considered to have one of these diseases. Descriptive analyses and multivariable regression models were used to estimate the association between STIs, HIV, race and ethnicity, and rurality. Overall, 158,731 Medicaid beneficiaries had at least one medical claim during the study period. Most were female (86.6%), resided in urban areas (66.6%), and were of non-Hispanic Black race/ethnicity (42.6%). In total, 6.3% of beneficiaries had at least one encounter for chlamydia, 3.2% for gonorrhea, 0.5% for syphilis, and 0.8% for HIV. In multivariable models, chlamydia, gonorrhea, and HIV claims were significantly associated with non-Hispanic Black or other minority race/ethnicity compared to non-Hispanic white race/ethnicity. Rural residents were more likely to have a claim associated with chlamydia and gonorrhea compared to urban residents. The opposite was observed for syphilis and HIV. Providing updated evidence on disparities in STIs and HIV among racial/ethnic minority and rural populations in a southern state is essential for shaping state Medicaid policies to address health disparities
Assessing sexual health status among Tunisian ICU healthcare providers in times of the COVID-19
Get PDFIntroduction:
The COVID-19 pandemic has dramatically affected ones well-being. ICU healthcare providers are particularly concerned by this impact which includes physical, mental and socioeconomic repercussions. Others health dimensions could be deeply affected but not well explored such as the psycho-sexual status.
Objectives:
The aim of this study was to assess sexual health status among ICU healthcare providers.
Methods:
This was a cross-sectional study enrolling Tunisian ICU healthcare providers and conducted between July and September 2021. Data collection was based on a self-administrated questionnaire. To assess sexuality, Arabic validated versions of the IIEF-15 and the FSFI was used for male and female respectively. The Fear of COVID-19 Scale and the Rosenberg Self-esteem questionnaire were also used.
Results:
Twenty ICU workers (13 physicians and 7 nurses) were enrolled. The mean age was 28.2 years and the sex ratio was 2.3. All participants were involved in COVID-19 crisis management and 80 % reported an increase in their workload. The mean Rosenberg scale was 27 suggesting a low self-esteem. The mean Covid19 Fear Scale was 26 ± 2. For the IIEF-15 the mean score was 17 ± 3 (moderate erectyl dysfunction) and the most damaged dimension was the intercourse satisfaction. For the FSFI scale, the mean was 23 ± 5 witch (a low sexual dysfunction). A high sexual desire with a lack in the satisfaction dimension was reported in 90% of cases. Only 4 participants have consulted a sexologist.
Conclusions:
COVID-19 has a serious sexual impact in ICU healthcare providers justifying urgent psychological interventions
Up to the TASG: a participatory study on sexual health of trans and non-binary persons in Germany
Get PDFProblem:
Comprehensive data on the sexual health of trans and non-binary people are not available due to lacking focus on these groups and inappropriate study designs that often fail to capture the lived realities of these communities.
Description of the practice:
A participatory study was developed with trans and non-binary representatives with a qualitative part involving single and group interviews as well as the development and roll-out of a quantitative online questionnaire. After securing funding, we started the study in 2020 ensuring community involvement in as many parts as possible.
Results:
A crucial component is the advisory board including people representing a broad spectrum of trans and non-binary communities, organizations, who are also representing a variety of intersectional perspectives, e.g. BIPoC and neurodiverse people. The advisory board provides crucial input to the design and conduct of the study components. For the qualitative part, a unique study design was developed using sexual health & empowerment workshops for trans and non-binary people in a trustful peer setting combined with qualitative data collection. This way, participants of the study truly benefit from participation and the data quality is improved. The quantitative study was created together with >20 community representatives. Items on gender identity, transition, and experiences of discrimination were developed using online workshops and written feedback. The questionnaire was checked by community members to ensure appropriate language. Through diverse community channels and social media, we recruited 58 participants for the qualitative part and more than 2000 participants for the online questionnaire. The results are expected in late 2022.
Lessons:
Involvement of community representatives and the participatory study design ensured strong community support. This enables the capture of meaningful information on the sexual health of trans and non-binary people
Menstrual abnormalities after COVID-19 vaccines: A systematic review
Get PDFSince January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.The objective of this systematic review is to give a comprehensive interpretation of menstrual cycle changes after the COVID-19 vaccination. Additionally, it is imperative to assess reports of menstrual changes following vaccination to dispel concerns that COVID-19 vaccines hinder the likelihood of pregnancy in the long run. A literature review was conducted using digital databases to systematically identify the studies reporting any menstrual abnormalities after the COVID-19 vaccine. Detailed patient-level study characteristics including the type of study, sample size, administered vaccines, and menstrual abnormalities were abstracted. A total of 78 138 vaccinated females were included in this review from 14 studies. Of these, 39 759 (52.05%) had some form of a menstrual problem after vaccination. Due to the lack of published research articles, preprints were also included in this review. Menorrhagia, metrorrhagia, and polymenorrhea were the most commonly observed problems and the overall study-level rate of menstrual abnormality ranged from 0.83% to 90.9%. Age, history of pregnancy, systemic side-effects of COVID-19, smoking, and second dose of COVID-19 vaccine were predictors of menstrual problems after vaccination
Health Information and Monitoring of Sexually Transmitted Infections (SIM study): a single-center, parallel, three-arm randomized controlled trial protocol for enhancing adherence to syphilis treatment and follow-up
Get PDFBackground:
Syphilis has recently resurfaced as a significant public health problem. Since the 2000s, isolated syphilis outbreaks have increasingly occurred in North America, Europe, and Australia; in Brazil, there have been progressive increases in both congenital and acquired syphilis. There are several possible explanations, such as misdiagnosis of acquired syphilis, which could increase the number of untreated transmitters in the population; failure to initiate or complete treatment; and nontreatment of sexual partners (leading to reinfection). Mobile technologies have been successfully used to promote behavior changes and can positively impact treatment and follow-up adherence in patients with infectious diseases. The purpose of this clinical trial is to evaluate treatment and monitoring methods in patients with syphilis, including follow-up by telephone, via a game in a smartphone app, and at public health centers.
Methods:
The SIM study is a single-center, randomized controlled trial with a 12-month follow-up period. The aim is to identify the most effective method of follow-up regarding patient compliance with treatment. The tests will be performed in a mobile unit in easily accessible locations. The goal is to perform 10,000 rapid tests for syphilis. Patients with a confirmed diagnosis according to VDRL tests will be randomized to one of three arms: telephone, smartphone game, or conventional in-person follow-up. All analyses will follow the intention-to-treat principle.
Conclusion:
If we find differences in effectiveness, a major change in the conventional approach for this patient population may be needed, potentially affecting current Brazilian health policy strategies
Sexually transmitted infections among patients attending a sexual assault centre: a cohort study from Oslo, Norway
Get PDFObjectives:
We estimate the prevalence of sexually transmitted infection (STI) among patients after sexual assault, assess the possible value of azithromycin prophylaxis, and identify risk factors for assault-related STI and for not presenting at follow-up.
Design:
Prospective observational cohort study.
Setting:
Sexual assault centre in Oslo, Norway.
Participants:
645 patients, 602 (93.3%) women and 43 (6.7%) men, attending the centre from May 2017 to July 2019.
Outcome measures:
Microbiological testing at the primary examination and at follow-up consultations after 2, 5 and 12 weeks. Estimated relative risk for assault-related STI and for not presenting at follow-up.
Results:
At primary examination, the prevalence of genital chlamydia was 8.4%, Mycoplasma genitalium 6.4% and gonorrhoea 0.6%. In addition, the prevalence of bacterial STI diagnosed at follow-up and possibly from the assault was 3.0% in total: 2.5% for M. genitalium, 1.4% for genital chlamydia and 0.2% for gonorrhoea. This prevalence did not change when azithromycin was no longer recommended from January 2018. There were no new cases of hepatitis B, hepatitis C, HIV or syphilis. We found no specific risk factors for assault-related STI. Patients with previous contact with child welfare service less often presented to follow-up (relative risk (RR) 2.0 (95% CI 1.1 to 3.5)), as did patients with a history of sex work (RR 3.6 (1.2 to 11.0)) or substance abuse (RR 1.7 (1.1 to 2.7)).
Conclusions:
Most bacterial STIs were diagnosed at the primary examination, hence not influenced by prophylaxis. There was no increase in bacterial STI diagnosed at follow-up when azithromycin prophylaxis was not routinely recommended, supporting a strategy of starting treatment only when infection is diagnosed or when the patient is considered at high risk. Sex work, substance abuse and previous contact with child welfare services were associated with not presenting to follow-up
Abortion policy implementation in Ireland: lessons from the community model of care
Get PDFBackground:
In 2018, the right to lawful abortion in the Republic of Ireland significantly expanded, and service provision commenced on 1 January, 2019. Community provision of early medical abortion to 9 weeks plus 6 days gestation delivered by General Practitioners constitutes the backbone of the Irish abortion policy implementation. We conducted a study in 2020–2021 to examine the barriers and facilitators of the Irish abortion policy implementation.
Methods:
We collected data using qualitative in-depth interviews (IDIs) which were conducted in-person or remotely. We coded and analysed interview transcripts following the grounded theory approach.
Results:
We collected 108 IDIs in Ireland from May 2020 to March 2021. This article draws on 79 IDIs with three participant samples directly relevant to the community model of care: (a) 27 key informants involved in the abortion policy development and implementation representing government healthcare administration, medical professionals, and advocacy organisations, (b) 22 healthcare providers involved in abortion provision in community settings, and (c) 30 service users who sought abortion services in 2020. Facilitators of community-based abortion provision have been: a collaborative approach between the Irish government and the medical community to develop the model of care, and strong support systems for providers. The MyOptions helpline for service users is a successful national referral model. The main barriers to provision are the mandatory 3-day wait, unclear or slow referral pathways from primary to hospital care, barriers for migrants, and a shortage and incomplete geographic distribution of providers, especially in rural areas.
Conclusions:
We conclude that access to abortion care in Ireland has been greatly expanded since the policy implementation in 2019. The community delivery of care and the national helpline constitute key features of the Irish abortion policy implementation that could be duplicated in other contexts and countries. Several challenges to full abortion policy implementation remain
COVID-19 vaccine and menstrual conditions in female: data analysis of the Vaccine Adverse Event Reporting System (VAERS)
Get PDFBackground: In reports of adverse reactions following vaccination with the coronavirus disease 2019(COVID-19) vaccines, there have been fewer reports of concern for menstrual disorders in female.
Objective: Our study employed Vaccine Adverse Event Reporting System (VAERS) to investigate and analyze the relationship between COVID-19 Vaccines and menstrual disorders in female.
Methods: We collected reports of menstrual disorders in VAERS from July 2, 1990 to November 12, 2021, and performed a stratified analysis. The potential relationship between COVID-19 vaccine and reports of menstrual disorders was evaluated using the Reporting Odds Ratio (ROR) method.
Results: A total of 14,431 reports of menstrual disorders were included in the study, and 13,118 were associated with COVID-19 vaccine. The ROR was 7.83 (95% confidence interval [95%CI]: 7.39-8.28). The most commonly reported event was Menstruation irregular (4998 reports), and a higher percentage of female aged 30-49 years reported menstrual disorders (42.55%) after exposure to COVID-19 Vaccines. Both for all reports of menstrual disorders (ROR = 5.82; 95%CI: 4.93-6.95) and excluding reports of unknown age (ROR = 13.02; 95%CI: 10.89-15.56),suggest that female age may be associated with menstrual disorders after vaccination with the COVID-19 Vaccines.
Conclusion: There is a potential safety signal when the COVID-19 vaccine is administered to young adult female (30-49 years old), resulting in menstrual disorders in. However, due to the well-known limitations of spontaneous reporting data, it is challenging to explicity classify menstrual disorders as an adverse event of the COVID-19 Vaccines, and reports of adverse reactions to COVID-19 Vaccines in this age group should continue to be tracked