Background Breast cancer is the most common cancer among women in England. However, participation in the NHS England Breast Screening Programme has consistently fallen below the national minimum standard of 70%. Objectives The present study aimed to identify psychosocial predictors of breast screening uptake among women aged 50-70. Design A cross-sectional questionnaire study was conducted among women aged 50-70 ( n = 250) living in England. Methods The study measured constructs derived from the Extended Health Belief Model, breast cancer awareness, and demographic factors. Binomial logistic regression was used to examine predictors of attendance at participants’ most recent breast screening appointment and intention to attend their next breast screening appointment. Results Educational level, perceived benefits of mammography, and perceived barriers to mammography significantly predicted attendance at participants’ most recent breast screening appointment. Intention to attend future screening was predicted by employment status, perceived susceptibility to breast cancer, and beliefs regarding the benefits and barriers of breast screening practices. Perceived benefits and barriers to mammography emerged as the most consistent predictors across both outcomes. Conclusion This study highlights key psychosocial and demographic determinants of engagement with the NHS England Breast Screening Programme. Findings suggest that interventions aimed at reducing perceived barriers and increasing awareness of the benefits of breast screening may help improve participation, particularly among underserved groups. Enhancing engagement with breast screening has the potential to support earlier detection and improved breast cancer outcomes.
Plain language summary This letter lists seven priorities for future research on autism and menopause. It is written by an early career researcher/assistant professor and a community researcher. Both are neurodivergent themselves.
Background Migrant women’s health and wellbeing are shaped by intersecting structures of gender, race, religion, and postcoloniality. Pakistani migrant women in Norway occupy a particular intersection of these structures, in which collectivistic kinship expectations, patriarchal norms, and postcolonial inheritance interact with Norwegian institutional gatekeeping. Despite a growing Pakistani-origin population in Norway, little qualitative research has examined how the identity work of recent first-generation Pakistani migrant women relates to their psychological and social wellbeing. Objectives This study examined the psychological and social wellbeing implications of identity reconstruction among Pakistani migrant women in Norway, with particular attention to how acculturative challenges, structural exclusion, and gendered nostalgia shape stress, belonging, and adaptation. Design Qualitative study using Interpretative Phenomenological Analysis (IPA) with a postcolonial feminist orientation. The reporting of this study conforms to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Methods Eleven in-depth semi-structured interviews were conducted with Pakistani migrant women aged 20 or older who had migrated to Norway between 2020 and 2023 and were fluent in Urdu and English. Eight interviews were prioritised for in-depth idiographic IPA case work based on rich, idiographic suitability for analysis, and the remaining three were retained as contextual cases. Informational sufficiency was assessed through ongoing analytic memo-writing. Reflexivity, theory triangulation, and multivocality strengthened methodological rigour. Results Five interrelated Group Experiential Themes captured participants’ lived experiences: (1) Resisting and severing gendered expectations, with implications for chronic stress and internalised surveillance; (2) Reconstructing identity in self-exile, with implications for self-efficacy gains and relational isolation; (3) Encountering exclusion in institutions and everyday life, with implications for anxiety, sleep disruption, and stress associated with administrative limbo; (4) Nostalgia, liminality, and limbo, with nostalgia operating as both an emotional regulator and an amplifier of loneliness; and (5) Intergenerational and inter-cohort cultural (dis)identification, with implications for diminished belonging and intra-community alienation. Conclusion Identity reconstruction among Pakistani migrant women in Norway is a health-relevant process in which structural exclusion, gendered norms, and cultural nostalgia converge to shape stress, belonging, and agency. The Identity Meaning-Making Model offers a recursive framework with direct implications for culturally responsive mental health care and equity-driven integration policy.
Background Indonesia has the highest rates of cervical cancer mortality in Southeast Asia, mainly due to poor access to and low uptake of cervical screening. Indonesian midwives are primarily responsible for conducting cervical screening, yet there is very limited research on their relevant knowledge, training and capacity to provide screening. Objective This study explored midwives’ experiences of cervical screening training and their knowledge related to CC, cervical screening using Visual Inspection with Acetic Acid (VIA), and Human Papillomavirus (HPV) DNA testing in East Nusa Tenggara, Indonesia. Design A qualitative study design was employed, based on primary data collected through fieldwork using semi-structured interviews and supplemented by a knowledge assessment questionnaire. Methods Twenty-four midwives across two districts, one semi-urban and one rural, participated. Qualitative data were analysed using a codebook thematic analysis approach, and questionnaire data were descriptively analysed. Results Midwives’ mean knowledge score was 75%, with midwives trained in cervical screening scoring higher than untrained midwives. Our findings highlighted inequitable access to training, with midwives in the more urban district having more access to training and higher knowledge. Midwives emphasised that adequate training and continuous practice of the VIA were crucial to building confidence in service delivery. Key knowledge gaps included poor understanding of the relationships between HPV infection, pre-cancer lesions, cervical cancer and its prevention. Midwives’ poor knowledge of cervical cancer aetiology and asymptomatic pre-cancer lesions resulted in only recruited women who came with associated symptoms. Conclusions Geographical inequality in human resource investment in remote areas limits women’s access to quality cervical screening and impedes progress towards cervical cancer elimination. Supporting midwives through thorough and up-to-date training, including HPV DNA testing, is essential to increase screening access and uptake, and for the transition to HPV DNA testing.
Background Female sex workers (FSWs) in Kenya face high risks of sexually transmitted infections, violence, and economic insecurity, and often continue sex work for livelihood during menstruation despite limited safe and hygienic menstrual management options. Menstrual cups that can be worn during sex (also known as menstrual discs) may offer a discreet solution to improving menstrual health and hygiene (MHH) and reducing health risks from harmful practices. Objective To explore FSWs’ initial perceptions of menstrual discs, anticipated barriers to use, and their potential impacts on livelihood and client interactions prior to receiving and testing them. Design Qualitative descriptive study. Methods Between June and September 2023 seven focus group discussions (FGDs) among 57 FSWs were conducted in Kisumu, western Kenya. During each session, a menstrual disc was passed around for inspection and handling. Discussions were audio-recorded, transcribed, and analysed using thematic analysis to identify key themes. Results Most participants had no prior experience with menstrual discs. Initial concerns included disc displacement or leakage during sex, discomfort with insertion or removal, potential detection by clients, and challenges using discs while consuming alcohol. Despite these concerns, participants expressed strong interest in using menstrual discs, highlighting benefits such as discretion, reduced reliance on disposable products, decreased physical discomfort, and the ability to continue working during menses. Views on disclosing disc use to clients varied, with most preferring not to inform them. Effective implementation was anticipated to require education, peer-led demonstrations, and guidance to prevent sharing or theft. Inadequate water, sanitation, and hygiene (WASH) facilities at sex work venues were highlighted as a key barrier to safe use, particularly for street-based FSWs. Conclusion Menstrual discs designed for use during sex appear acceptable to FSWs and could support safer, more comfortable menstrual management while enabling continued sex work. These findings provide actionable insights for designing MHH interventions that address the unique needs of FSWs.
Background Many patients experience pain during intrauterine device (IUD) placement, and while quantitative studies suggest that some pain management regimens may reduce pain, no universal protocol exists. Recent guidelines recommend offering pain management for IUD placement, yet little is known about how individual patient priorities and experiences with these options vary in clinical practice. Objective To characterize patient experiences with clinical counseling, decision-making, and use of pain management during IUD placement, and to identify preferences for decision-support tools. Design A single-site qualitative analysis of pain-related experiences during IUD placement. Methods We recruited reproductive-aged patients who underwent outpatient IUD placement between February and July 2025. Semi-structured interviews focused on participants’ experiences with pain management during IUD placement. We coded and analyzed transcripts using thematic analysis to identify key themes related to pain management counseling, priorities for pain control, and experience with pain and anxiety medications during placement. Results We interviewed 20 participants who had an IUD placed within 30 days of enrollment. The mean age was 29.8 years, and 75% were nulliparous. We identified four key themes: (1) inconsistency in pain management counseling (e.g., experiences ranging from no mention of pain to comprehensive counseling about medication options); (2) multifactorial decision-making and priorities regarding pain management (e.g., participants weighed factors such as convenience, efficacy, and trust in clinician recommendations when deciding about medications); (3) varied perceived utility of pain management (e.g., some participants perceived meaningful relief from specific medications, while others doubted utility of medications); and (4) desire for standardized information (e.g., participants supported the idea of receiving structured, anticipatory guidance on pain expectations and available options). Conclusions Clinician counseling about pain management for IUD placement remains inconsistent, and patient experiences vary widely. Our findings highlight a need for standardized, patient-centered counseling approaches and offer patient-level insights to inform counseling and care.
Women with pregnancies complicated by hypertensive disorders of pregnancy (HDP) are at significantly increased risk of cardiovascular (CVD) and metabolic diseases. Current international guidelines acknowledge this risk, however the timing, duration and method of CV screening in these high-risk women remain heterogenous. There remains a lack of an evidenced-based approach to the transition of care from hospital to community and longer-term cardiac-metabolic disease prevention. This narrative review examines the optimal timing and duration of cardiometabolic surveillance after delivery, approaches to risk stratification to identify women at greatest risk of future cardiovascular morbidity, and strategies for screening myocardial, vascular, and metabolic health. This review also explores how limited postpartum healthcare resources may be targeted most effectively, with particular emphasis on the transition from hospital to community care during the “fourth trimester” and interventions that promote sustained engagement in long-term behavioural and lifestyle modification. Current evidence supports the potential role of multidisciplinary postpartum cardiovascular clinics in delivering coordinated, risk-stratified care following HDP. These clinics facilitate early optimisation of BP through telemonitoring and patient-led medication titration, while integrating lifestyle interventions tailored to PE phenotypes and individual CV risk profiles. Future research should focus on validated risk stratification tools to identify and personalise postpartum interventions to women who are most at risk of CV morbidities. This should include risk prediction, targeted interventions based on risk profiles, and integrated care pathways in the community to optimise long-term maternal CV outcomes.
BackgroundDeficiencies in patient information undermine informed consent and patient safety in gynaecological care. When clinical communication fails, women turn to digital peer communities, directly affecting health access and decision-making. Hysteroscopy procedures are at heightened risk of this failure: pre-procedural information is routinely unstandardised, and anxiety affects up to 80% of patients, impairing attendance and completion.ObjectivesThis study investigated women's information needs following hysteroscopy referral, using naturally occurring online data to identify behavioural targets to improve care and patient safety.DesignA framework analysis of naturalistic online forum data.MethodsData were purposively sampled from threads containing "hysteroscopy" in the title, posted on Mumsnet.com. A total of 5,671 posts were extracted from 343 discussion threads and analysed inductively using Framework Analysis. Themes were mapped to the Theoretical Domains Framework, with key behaviour change techniques identified using the Behaviour Change Technique Taxonomy.ResultsWomen were unable to access clear, foundational information about hysteroscopy. Given this deficit, four critical domains of basic information need were identified: 1) navigating procedural processes, 2) anticipated pain trajectories, 3) managing the recovery phase, and 4) diagnostic outcomes and aftercare. Repeated information-seeking queries suggest an 'information neglect continuum': virtual peer support fulfils a compensatory role where formal communication was perceived as insufficient. Behavioural mapping identified actionable intervention points to strengthen patient instruction, repositioning informational integrity as a core component of clinical quality, not an adjunct to it.ConclusionsRoutine hysteroscopy communication fails to provide the structured guidance women need to consent to and recover from the procedure. Self-initiated information-seeking within a virtual support network revealed deficits not captured by conventional service evaluation. This study establishes how digital social support mitigates clinical information failures and confirms which information components patients prioritise. These represent priority intervention targets with direct implications for informed consent, procedural attendance and patient safety.
Social media has emerged as a valuable source of patient-generated data, offering insights into the lived experiences of individuals with endometriosis. While social listening research provides important perspectives on pain, treatment decisions, and community support, the interpretation of online narratives requires careful consideration. Experiences shared publicly may not fully represent the broader endometriosis community, as individuals with particularly distressing or positive experiences may be more likely to post, while others may remain silent because of privacy concerns, stigma, or personal preference. Furthermore, peer narratives can complement clinical expertise but may also contribute to the dissemination of incomplete or non-evidence-based health information, potentially influencing treatment decisions and disease management. The role of social media algorithms also warrants attention, as algorithmic amplification may increase the visibility of emotionally engaging or controversial narratives over nuanced medical information. Nevertheless, social media remains an important space for understanding how patients articulate symptoms, interpret medical advice, and navigate chronic illness while reducing isolation and stigma. We propose viewing social media as both a source of patient experience and a dynamic environment where experiences and health information are negotiated. Triangulation with qualitative interviews, clinical data, and participatory methods may strengthen its contribution to patient-centered endometriosis research.
Background Deficiencies in patient information undermine informed consent and patient safety in gynaecological care. When clinical communication fails, women turn to digital peer communities, directly affecting health access and decision-making. Hysteroscopy procedures are at heightened risk of this failure: pre-procedural information is routinely unstandardised, and anxiety affects up to 80% of patients, impairing attendance and completion. Objectives This study investigated women’s information needs following hysteroscopy referral, using naturally occurring online data to identify behavioural targets to improve care and patient safety. Design A framework analysis of naturalistic online forum data. Methods Data were purposively sampled from threads containing “hysteroscopy” in the title, posted on Mumsnet.com . A total of 5,671 posts were extracted from 343 discussion threads and analysed inductively using Framework Analysis. Themes were mapped to the Theoretical Domains Framework, with key behaviour change techniques identified using the Behaviour Change Technique Taxonomy. Results Women were unable to access clear, foundational information about hysteroscopy. Given this deficit, four critical domains of basic information need were identified: 1) navigating procedural processes, 2) anticipated pain trajectories, 3) managing the recovery phase, and 4) diagnostic outcomes and aftercare. Repeated information-seeking queries suggest an 'information neglect continuum': virtual peer support fulfils a compensatory role where formal communication was perceived as insufficient. Behavioural mapping identified actionable intervention points to strengthen patient instruction, repositioning informational integrity as a core component of clinical quality, not an adjunct to it. Conclusions Routine hysteroscopy communication fails to provide the structured guidance women need to consent to and recover from the procedure. Self-initiated information-seeking within a virtual support network revealed deficits not captured by conventional service evaluation. This study establishes how digital social support mitigates clinical information failures and confirms which information components patients prioritise. These represent priority intervention targets with direct implications for informed consent, procedural attendance and patient safety.
Background Women’s empowerment plays a crucial role in the wellbeing of families by affecting nutrition and health. Women’s Empowerment in Nutrition Index (WENI) was recently developed in rural South Asia, but requires validation in new contexts. Objective The study aimed to evaluate the psychometric validation of the WENI, the level of nutritional empowerment and factors associated with nutritional empowerment among pregnant women in Southern Ethiopia. Design A facility-based cross-sectional study design was employed. Methods The study was conducted among 392 pregnant women from March 10 to May 30, 2025. The structural validity of the WENI was assessed using Exploratory and Confirmatory Factor Analysis (EFA/CFA) to identify latent constructs of empowerment. Kaiser-Meyer-Olkin (≥ 0.60) and significant results in Bartlett’s Test (p < 0.05) were used for confirming sampling adequacy. Independent factors were identified using a hierarchical negative binomial multiple regression with adjusted incidence rate ratios (aIRRs) calculated, considering statistical significance at p < 0.05. Results Factor analysis revealed a six-factor structure with an internal consistency (Cronbach’s alpha = 0.86), and convergent and discriminant validities (AVE=0.50, CR=0.70). The model demonstrated strong fit indices (CFI= 0.94; RMSEA<0.06). A significant relationship was found between WENI scores and maternal and child nutrition outcomes (p<0.001), with 51.5% of women being nutritionally empowered. Empowerment was higher in women free from intimate partner violence (aIRR = 1.12), those receiving nutritional counseling (aIRR = 1.33). Conversely, empowerment rates were lower in women with no formal education (aIRR = 0.76) and those in the lowest wealth quintile (aIRR = 0.82). Conclusion This study confirmed that nutritional empowerment, measured via a 21-item tool, improves maternal health and food security. However, social norms and a “knowledge-agency gap” persist. Interventions must shift from basic education to actively promoting women’s control over resources, gender equality, and stronger community-based support systems to be truly effective.
This correspondence comments on Grove et al.’s autistic-led qualitative study on the health and wellbeing of autistic women and gender-diverse people. It argues that oral health should be considered within autism-aware women’s healthcare because toothbrushing, dental attendance, oral pain, sensory distress, and communication barriers may affect daily living, access to care, and overall wellbeing. The letter proposes a practical integration pathway based on simple oral-health screening, autism-aware dental referral, sensory and communication adaptations, and collaboration with primary care, mental health, and women’s health services. This approach does not imply causality, but supports more holistic, person-centred care.
Background Globally, intimate partner violence and sexual violence (IPV/SV) are prevalent among women and can lead to numerous and overlapping service needs. Co-located service models for IPV/SV aim to reduce burden on survivors and increase timely engagement in services by streamlining access to immediate and longer-term support. These models involve multiple cross-disciplinary partners and require a high level of tailoring and adaptation to the local and agency context. Consequently, fidelity measurement approaches need to be adaptive. Objectives This study redefines co-located IPV/SV centers (e.g., Family Justice Centers) as complex health interventions and applies the form and function matrix advanced within the field of implementation science. Design The current study uses cross-sectional data collected as part of a larger formative evaluation testing protocols for an implementation study and outcome evaluation. Methods A researcher-developed adaptive fidelity survey was administered to agency leaders from six co-located IPV/SV centers to determine the core functions and adaptable forms of co-located service models along with the necessary infrastructural support. Univariate statistics and a descriptive content analysis approach were used to analyze the survey data. Results Survey findings showed that there are core services, partners, infrastructure, and processes that many or most respondents believed to be essential to the functioning of the co-located center. However, respondents also believed that implementation of these elements could vary without diminishing the effectiveness of the model. Conclusions Findings highlight that there are many ways to accomplish the same function, which underscores the need for a flexible and adaptive measurement approach to capturing fidelity in function and variation in form. This study adds to the research on limitations of fidelity assessment for complex health interventions and suggests focusing on the hypothesized relationships between structural elements of the model and intermediary outcomes.
Background Severe injuries and illnesses during an athlete’s active career can lead to career interruption or retirement, and are associated with negative body image and decreased quality of life (QoL). However, the relationship between body image and QoL in retired female athletes with such medical histories remains unclear. Although support for athletes’ health has recently increased, post-retirement support remains insufficient. Objectives This study examined whether body appreciation, defined as respect for, acceptance of, and gratitude toward one’s body, mediates the association between injury/illness history and QoL among retired female athletes. Design A cross-sectional survey was conducted among 750 retired Japanese female athletes to assess their injury/illness histories (yes/no), QoL, and body appreciation. Methods QoL was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and body appreciation was measured using the Body Appreciation Scale-2. First, correlation analyses were performed for the study variables. Subsequently, mediation analyses examined whether body appreciation (M) mediated the relationship between injury/illness history (X) and the WHOQOL-BREF total score, the four domain scores, and the overall QoL (general health) score (Y). Results Among 750 retired female athletes, 38.7% reported an injury/illness. Injury/illness history showed a small negative correlation with body appreciation ( r = -.09), whereas body appreciation correlated with total QoL ( r = .74) and QoL domains ( r = .55 to .71). The mediation model indicated a significant indirect association with total QoL via body appreciation (B = -0.081, 95% CI [-0.145, -0.017]), with similar indirect associations observed for the QoL domains. Conclusion The findings suggest history may be indirectly associated with post-retirement QoL through body appreciation, rather than being directly related to QoL alone. These results highlight the potential importance of fostering body appreciation to support the lifelong health of female athletes.
Background The prevalence of obesity has increased alarmingly over the last decades in the United Arab Emirates (UAE). Bariatric surgery (BS) is a more effective approach to losing weight than dieting in morbidly obese women. Perinatal depression is a well-known risk to maternal and neonatal health across the globe. Objectives To determine whether bariatric surgery predicts depression among pregnant women in this descriptive cross-sectional study. Design A descriptive cross-sectional survey study conducted in a major pediatric and maternity hospital in Abu Dhabi, UAE. Methods Forty-one pregnant women with a history of BS who attended a major pediatric and maternity hospital in Abu Dhabi, UAE, between July 2021 and November 2022 were recruited for the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen the participants for depression symptoms. An analysis of sociodemographic variables and depression scores was performed. Categorical variables were compared using chi-square tests. Continuous variables were compared using independent t-tests, and skewed data using the Mann-Whitney test. The ethical approval of the study was obtained from the Research and Ethics Committee of the hospital (No. RP DAE/2021/102) on 15 June 2021. Written informed consent was obtained from all participants prior to their enrollment in the study. Results Depression was present in 46.3% of the participants, among whom 2.7% were experiencing severe depression. The analysis of the EPDS scores between the Roux-en-Y bypass (RYGB) and sleeve gastrectomy (SG) groups indicates a higher EPDS score in the SG group compared to the RYGB group ( U = 220.000; p = 0.015). There were no significant differences in the proportions of participants across the different sociodemographic characteristics based on depression score classification. Conclusions The prevalence of depression was high among pregnant women with a history of bariatric surgery. Although the results were based on a small sample, the results of this study indicate the risk of depression is higher in pregnant women who had had sleeve gastrectomy bariatric surgery.
Background While the global prevalence and consequences of child marriage are well documented, limited qualitative research has examined its lived impacts in conflict-affected Yemen, particularly from the perspectives of girls and communities. Moreover, little attention has been paid to local forms of resistance, agency, and the enabling conditions that support change in fragile and protracted conflict settings. Objectives This study aimed to explore the emotional, social and physical costs of child marriage, examine girls’ and communities’ resistance strategies including reflection, regret, and hope and identify enabling structures and supportive environments that can facilitate efforts to end child marriage in Yemen. Design A qualitative study using focus group discussions. Methods A total of 97 participants were included through purposive sampling, comprising married and unmarried adolescent girls, young women, and adult community members. Sixteen focus group discussions were conducted between September and December 2024 using semi-structured guides tailored to each participant group across three Yemeni governorates (Marib, Sana’a, and Taiz). Data were analyzed using thematic analysis. Results Participants described early marriage as producing interconnected emotional, social, health, and educational harms that reshape girls’ life trajectories. Married girls reported psychological distress, restricted mobility, premature domestic responsibilities, maternal health risks, and the loss of educational opportunities. Despite these constraints, girls and community members articulated forms of reflection, negotiation, and aspiration that challenged the inevitability of early marriage. Family support, community awareness, and institutional environments were identified as critical factors shaping girls’ ability to delay or resist child marriage. Conclusion Child marriage in Yemen produces cumulative and gendered harms that undermine girls’ wellbeing and life trajectories. While conflict intensifies these harms, girls, families, and communities actively negotiate, resist, and reimagine alternatives within constrained environments. Strengthening girls’ education, legal enforcement, community-based support, and access to health and social services is essential to advancing girls’ agency and addressing child marriage in fragile settings.
Background High-quality preconception care can optimise health and wellbeing and reduce adverse maternal and infant outcomes. Larger-bodied preconception women are more likely to experience weight stigma and discrimination in healthcare due to their body size, and thus receive lower-quality care. General Practitioners (GPs) are key healthcare providers in preconception care, yet there is a limited understanding on their perspectives caring for larger-bodied preconception women. Objectives To better understand the experiences and viewpoints of GPs’ caring for larger-bodied preconception women. Design Descriptive qualitative study design using thematic analysis. Methods Semi-structed interviews with GPs (N = 15) who provided preconception care in Australia were conducted online via Zoom. Participants were purposively recruited via word of mouth, emailing digital flyers to GP clinics, and posting information on social media platforms. Interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted and themes were continuously refined through collaborative discussions with the research team. Results Three overarching themes were identified: 1) narratives and assumptions about larger-bodied preconception women, with a focus on how these can prevail throughout general practice and contribute to weight stigmatising interactions with preconception women; 2) factors influencing GPs’ approaches to caring for larger-bodied women, highlighting how approaches to care are impacted by external factors within healthcare; and 3) challenges to providing non-stigmatising care to larger-bodied preconception women, emphasising that significant effort is required to contest common assumptions and narratives associated with higher body weight. Conclusion Findings demonstrated that whilst GPs have a strong desire to provide high-quality preconception care to all women, the pervasiveness of weight stigma in healthcare can impact the care they provide. Supporting GPs to provide non-stigmatising care to larger-bodied preconception women is urgently warranted to improve health outcomes for all women equitably.
Background Women with ADHD and autism experience elevated rates of premenstrual problems, yet no direct comparisons between these conditions exist in adults. Objectives This study examined premenstrual dysphoric disorder (PMDD) prevalence, symptoms, and impairment across ADHD, autism, and neurotypical women. Design Cross-sectional data from 199 women aged 20-40 without hormonal contraceptive use were analyzed across two samples. Methods Participants included 89 with ADHD, 39 with autism, and 71 controls. Premenstrual symptoms were assessed using the Premenstrual Symptoms Screening Tool (PSST), alongside measures of ADHD characteristics, autism traits, and sensory hypersensitivity. Results Both ADHD and autistic women showed significantly elevated provisional PMDD rates according to the PSST screening instrument compared to controls, with no significant difference between neurodivergent groups. Dimensional analyses revealed positive associations between premenstrual symptoms and neurodiverse traits, particularly inattention, hyperactivity-impulsivity, and social skills difficulties. The impact of premenstrual problems was similarly associated with these traits across diagnostic groups. Contrary to hypotheses, sensory hypersensitivity was not independently associated with premenstrual symptoms after controlling for ADHD and autism characteristics. Conclusions Premenstrual problems constitute a significant burden for both ADHD and autistic women, with dimensional associations suggesting that individuals with more severe neurodivergent traits face heightened risk. Yet our findings also demonstrate that prevalence estimates are only as reliable as the recruitment strategies behind them. Advancing this field requires both greater clinical attention to menstrual cycle-related difficulties in neurodivergent populations and recruitment strategies that yield dependable estimates.
Background Peripartum cardiomyopathy (PPCM) is a rare, potentially life threatening condition with nonspecific heart failure symptoms, often leading to delayed diagnosis. Large language models (LLMs) may support differential diagnosis suggestion. Objectives To assess whether commonly available LLMs can suggest PPCM and differential diagnoses based on typical symptoms. Design Comparative evaluation of three LLMs using standardized clinical scenarios. Methods ChatGPT (GPT-5), Gemini (2.5 Flash), and Claude (Sonnet 4.5) were queried with prompts describing a 34-year-old woman with PPCM-related symptoms, with and without postpartum context. Responses were analyzed for PPCM and key differential diagnoses recommended by the European Society of Cardiology. Results ChatGPT and Claude consistently identified PPCM. Gemini suggested PPCM mainly when dyspnea or edema were present and required postpartum context when palpitations were reported. Claude listed the most differential diagnoses. Conclusion LLMs are a valuable tool among differential diagnosis suggestion but performance varies and cannot replace clinical judgment.
Background The liberalisation of abortion law does not necessarily translate into quality services. The South African Choice on Termination of Pregnancy Act includes the requirement of non-mandatory and non-directive pre-abortion counselling. However, pre-abortion counselling in public abortion clinics is often directive, coercive and, at times, anti-abortion. Objectives : We reflect on our attempts to ensure that the legislative requirement of “non-directive” pre-abortion counselling is realised in public termination of pregnancy clinics through the nurses’ participation in an in-service abortion counselling certificate course (ACCC) based on person-centred and reproductive justice principles. Design : We adopted a qualitative exploratory transfer of training research design, with a goals-focused approach. Methods Using stratified purposive sampling, we interviewed eleven (of the 29) nurses who participated in the course about their current consultation/counselling practices and experiences. We analysed the data using template analysis, with the outcomes of the ACCC as a priori themes, supplemented by themes emerging in the analytical process. Results : Participants emphasised that their practice is now person-centred and non-directive. Non-judgmentalism, active listening, empathy, and facilitating autonomous decision-making were all listed as attributes they now bring to their pre-abortion interactions with users. These declarations were, however, interwoven with reference to contraceptive coercion and discomfort with “repeat” abortions. Providers also mentioned several institutional and systems challenges that undermined person-centred care. Conclusion : In-service training focused on non-directive, person-centred counselling, such as the ACCC, while necessary, is not sufficient to ensure that legislative or policy requirements for non-directiveness will be met. Two key elements need addressing in addition to person-centred in-service training: (1) gendered understandings of women as always having the agency to prevent pregnancies, as well as primarily responsible for contraceptive use; and (2) structural inadequacies that work against person-centredness and non-directiveness in these encounters.
