Objective:Artificial insemination by husband (AIH) and artificial insemination by donor (AID) are core assisted reproductive techniques for infertile couples; however, few head-to-head comparative prediction models exist for their pregnancy outcomes. This study aimed to compare clinical population characteristics, construct independent pregnancy outcome prediction nomogram models for AIH and AID patients, identify differential independent predictive factors, and evaluate model discrimination performance. Material and Methods:This single-center retrospective observational cohort study enrolled 11651 AIH cycles and 3064 AID cycles from 2015 to 2025. All baseline demographic, clinical, treatment and laboratory parameters were collected and compared between groups. Binary univariate logistic regression was used to screen candidate predictors; variables with P<0.05 were included in multivariate forward stepwise logistic regression to identify independent predictive factors, visualized via forest plots. Visual nomogram prediction models were built using R software. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were adopted to preliminarily assess model predictive ability. Employs the within-cohort bootstrap method for validation. Results:Baseline profiles and pregnancy rates differed significantly between groups (P<0.05). Seven independent predictors were identified for AIH and three for AID. For AIH, advancing female age (OR=0.97, 95% CI:0.95~0.99), prolonged infertility duration (OR=0.96, 95% CI:0.93~0.98) and more treatment cycles (OR=0.92, 95% CI:0.86~0.98) reduced pregnancy probability, while thicker endometrium (OR=1.03, 95% CI:1.00~1.07), optimized ovulation induction (OR=1.27, 95% CI:1.13~1.42), unexplained infertility (OR=1.37, 95% CI:1.23~1.53) and double insemination (OR=1.18, 95% CI:1.06~1.32) elevated pregnancy odds (all P<0.05). For AID, longer infertility duration (OR=0.95, 95% CI:0.91~0.99) and repeated cycles (OR=0.88, 95% CI:0.82~0.95) impaired pregnancy, yet double insemination markedly improved outcomes (OR=4.75, 95% CI:2.78~8.10, P<0.05). The AIH and AID nomogram achieved AUC of 0.577 (95% CI:0.56~0.59) and 0.582 (95% CI:0.56~0.60) separately (P<0.05). Internal validation revealed acceptable calibration of the model, though its discriminative performance remained modest in both AID and AIH cohorts. Conclusion:Ovarian status and baseline fertility profiles differed substantially between the AIH and AID groups. The two nomogram models only demonstrated limited discrimination ability for predicting clinical pregnancy.
Background:Comparative epidemiological evidence on Ebola virus disease (EVD) and Zika virus disease (ZVD) in women of childbearing age (WCBA) is limited, hindering understanding of their mother-to-child transmission (MTCT) potential and maternal-neonatal protection. This study aimed to compare EVD and ZVD epidemiology in WCBA, assess sex-specific differences, and examine the association between ZVD incidence and live births to inform maternal-neonatal protection and disease control. Methods:Data on incidence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of EVD and ZVD (2011-2023) among WCBA and other populations were extracted from the Global Burden of Disease 2023 study. Cumulative cases, age-standardised incidence rates (ASIRs), and mortality-to-incidence ratios (MIRs) were calculated. Sex-specific differences and correlations between ZVD ASIRs and live births were assessed. Results:During 2012-2022, WCBA generally experienced higher cumulative and annual EVD incidence than males aged 15-49 years in Sub-Saharan Africa; higher ZVD incidences were also observed among WCBA in Latin America and Caribbean, although no differences were significant. In main-endemic super-regions, EVD exhibited low incidence but extremely high fatality (MIR 0.39-0.70) in WCBA, with DALYs primarily driven by YLLs; whereas ZVD showed high incidence but low fatality (MIR 1.92 × 10-6-9.45 × 10-6), with DALYs mainly driven by YLDs. Two EVD outbreaks occurred amid low endemicity in Sub-Saharan Africa, while a ZVD outbreak occurred in 2016 during persistent endemicity in Latin America and Caribbean. ZVD ASIRs in WCBA were strongly correlated with corresponding live births in Latin America and Caribbean, Brazil (2011-2022), and constitute countries/territories and Brazilian states in 2016. Conclusion:Strengthened EVD monitoring in Sub-Saharan Africa and a Latin America-Caribbean-centred strategy for ZVD prevention targeting WCBA may improve maternal-neonatal protection and control of neglected tropical diseases with MTCT potential.
Objective:To examine the expression and clinical implications of the mitochondrial ribosomal protein S5 (MRPS5) gene in uterine corpus endometrial carcinoma (UCEC) using bioinformatics tools. Methods:A comprehensive analysis was performed utilizing databases such as SANGERBOX, XIANTAO BIOINFORMATICS TOOL, UALCAN, and STRING. Expression levels of MRPS5 in UCEC were validated through Western blotting (WB) and real-time quantitative PCR (RT-qPCR) to determine its clinical relevance. Results:MRPS5 expression was significantly elevated in UCEC patients (n=546) compared to normal tissues (n=35), P<0.05. WB analysis showed increased MRPS5 protein levels in three endometrial carcinoma cell lines: (RL95-2, 3.36), (HEC-1-B, 3.78), (Ishikawa, 7.39), relative to normal endometrial cells (12Z, 0.94), P<0.05. RT-qPCR revealed significantly higher MRPS5 mRNA levels in these cell lines compared to normal endometrial cells (P<0.0001). In UCEC, high MRPS5 expression was significantly associated with clinical characteristics such as stage, race, nodal weight, age, histological subtype, TP53 mutations, and promoter methylation (P<0.05). Additionally, MRPS5 protein expression in UCEC was linked to alterations in the WNT pathway, mTOR pathway, NRF2 pathway, RTK pathway, chromatin modifier alterations, and MYC/MYCN alterations. Survival analysis showed that high MRPS5 expression levels were significantly associated with decreased overall survival (OS) in UCEC (P<0.05). Conclusion:MRPS5 gene is highly expressed in most cases of UCEC, and is correlated with disease onset, progression, and adverse prognosis, suggesting its potential as a valuable biomarker for diagnosis, treatment, and prognosis of UCEC.
Purpose:Antenatal depression is common and under-recognized, yet few individualized tools exist to support its identification in obstetric practice in low- and middle-income countries. We estimated the prevalence of a positive antenatal depression screen among third-trimester pregnant women in southern Vietnam and developed and internally validated a psychosocial nomogram for the concurrent probability of a positive screen. Patients and Methods:Within a prospective study at Long Khanh Regional General Hospital (July 2025 to May 2026), 968 women at 28 weeks of gestation or later were screened with a Vietnamese-language version of the Edinburgh Postnatal Depression Scale (EPDS; positive screen defined as a score ≥13). Sociodemographic, obstetric, marital, family, and social variables were recorded at the same visit, so predictors and outcome were measured concurrently (a diagnostic rather than a prognostic model). Candidate predictors with p<0.25 in univariable logistic regression entered a multivariable model reduced by backward elimination (p<0.05). Results:The prevalence of a positive screen was 16.5% (160/968; 95% CI 14.3-19.0). Six variables were retained in the final model: an adverse family event (adjusted odds ratio [aOR] 5.25), marital conflict (aOR 3.64), a family history of depression (aOR 2.76), neighbourhood or workplace conflict (aOR 2.48), work-related pressure (aOR 2.22), and a lack of psychosocial support (aOR 1.77). Apparent discrimination was good (area under the curve 0.807, 95% CI 0.769-0.847) and fell to an optimism-corrected 0.782 after bootstrapping the full procedure; the optimism-corrected calibration slope was 0.88 and calibration-in-the-large was near zero. On decision curve analysis the nomogram gave a higher net benefit than screening all women at threshold probabilities above about 10%. Conclusion:About one in six third-trimester women screened positive for depressive symptoms. A nomogram based on six readily recorded psychosocial variables showed good apparent and promising internally validated performance and may support psychosocial risk stratification where universal formal screening is difficult.
Rnda I AshgarNursing Department, Jazan University, Jazan, Saudi ArabiaCorrespondence: Rnda I Ashgar, Nursing department, Jazan University, Jazan, Saudi Arabia, Tel +966500181647, Email Rndaashgar@gmail.comBackground: Middle-aged women in Saudi Arabia are navigating a significant period of life transition during the rapid socioeconomic shift driven by the Saudi Vision 2030. Evidence indicates that chronic diseases are associated with poor quality of life (QoL), whereas competing employment and family responsibilities may further influence well-being. Psychosocial resources, including life satisfaction, family role satisfaction, and social support, are important predictors of QoL. Although clinical research often focuses on the physiological changes during this stage, the hierarchical influence of sociodemographic, health-related, and psychosocial factors on their QoL remains underexplored. This study aimed to identify the incremental predictors of QoL among middle-aged Saudi women using a hierarchical regression analysis.Methods: This cross-sectional study included 310 Saudi women aged 40– 65 years recruited through online convenience sampling. A three-block hierarchical multiple regression analysis was performed to examine the incremental variance explained by the predictors.Results: The hierarchical regression analysis showed that predictors of QoL were multilayered and progressively significant. In the initial step, employment status emerged as a significant positive predictor, although it explained only 1.4% of the variance. The addition of health-related factors in the second step significantly increased the explained variance to 5.6%, identifying the presence of at least one chronic condition as a substantial negative predictor. The final psychosocial block, including self-satisfaction, life satisfaction, family role satisfaction, and social support, contributed to the most dramatic incremental increase, with the full model explaining 43% of the total variance in QoL (R2=0.43, F=22.42, p< 0.001).Conclusion: Psychosocial variables demonstrated the strongest association with QoL and accounted for the largest incremental increase in explained variance. These findings underscore the necessity for nursing and public health interventions to transition toward a holistic, patient-centered model that prioritizes psychosocial factors.Keywords: quality of life, middle-aged women, Saudi Arabia, hierarchical regression, social support, chronic disease, vision 2030
Aman Golani,1 Soumi Ray21School of Computer Science Engineering and Information Systems, Vellore Institute of Technology, Vellore, Tamil Nadu, India; 2Department of Industrial Design, Vellore Institute of Technology, Vellore, Tamil Nadu, IndiaCorrespondence: Soumi Ray, Department of Industrial Design, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India, Tel +91 97580 53137, Email soumi.ray@vit.ac.inBackground: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age and is associated with infertility, obesity, insulin resistance, and elevated long-term to cardiovascular risk. Traditional diagnostics rely on biochemical examinations and pelvic ultrasonography imaging. These are resource-intensive, operator-dependent, and frequently inaccessible in low-resource settings. Given the pronounced heterogeneity of PCOS phenotypes, traditional single-modality diagnostics frequently fail, necessitating a shift toward multimodal diagnostic approaches.Objective: To critically evaluate the diagnostic efficacy and clinical applicability of non-invasive and minimally invasive diagnostic approaches for PCOS, encompassing artificial intelligence (AI) and machine learning (ML) methods, ultrasonographic imaging, hormonal profiling, clinical and biochemical markers, and insulin resistance indicators.Methods: A structured narrative review was conducted using Publish or Perish (Version 8.17.4863.9118) across PubMed and Google Scholar. Studies published between 2014 and 2025 in English-language peer-reviewed journals were considered eligible if they focused on PCOS detection or diagnosis and reported at least one non-invasive or minimally invasive diagnostic modality. After deduplication, 62 papers were selected from 1,110 retrieved. A PRISMA flow diagram is included to document the selection process transparently; this review does not claim formal systematic review compliance.Results: AI-based diagnostic models have reported high accuracy in experimental settings for both image-based and data-driven PCOS detection. While specific architectures exceed 90% accuracy offering viable pathways for low-resource screening, real-world deployment remains constrained by a lack of dataset standardization. Automatic segmentation of ultrasound images has the potential to reduce inter-operator variability in antral follicle counting. Hormonal profiling, centred on LH/FSH ratio, anti-Müllerian hormone, and androgen panels, remains foundational, while emerging molecular, metabolomic, and metabolic biomarkers offer complementary phenotypic precision.Conclusion: The evidence projects a diagnostic shift toward reproducible, multimodal, and phenotype-sensitive PCOS detection. Integration of AI-based pipelines when integrated with imaging morphology, hormonal data, and metabolic markers offers significant opportunities for equitable, early-stage identification across diverse healthcare settings. These findings support the development of accessible, scalable screening tools to reduce diagnostic delay and improve women’s reproductive and metabolic health outcomes globally, though standardised external validation and equity-centered design remain critical priorities.Keywords: polycystic ovary syndrome, artificial intelligence, hormonal profiling, anti-Müllerian hormone, insulin resistance, microRNA
Samar M Alotaibi,1 Asrar S Almutairi,2 Rayhanah R Almutairi,2 Anwar N AlKhunaizi,3 Areej G Al-Otaibi,4 Hatice Bulut,5 Turki S Alqurashi61Maternal and Child Health Nursing Department, College of Nursing, Shaqra University, Al Dawadmi, Saudi Arabia; 2Community and Psychiatric Mental Health Nursing Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 3Maternal and Child Health Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia; 4Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia; 5Division of Obstetrics and Gynaecologic Nursing, Department of Nursing, Faculty of Health Science, Süleyman Demirel University, Isparta, Turkey; 6Department of Social Work, Al-Lith University College, Umm Al-Qura University, Mecca, Saudi ArabiaCorrespondence: Samar M Alotaibi, Maternal and Child Health Nursing Department, College of Nursing, Shaqra University, Al Dawadmi, Saudi Arabia, Email Samar_m@su.edu.saPurpose: To gain an in-depth understanding of Saudi women’s experiences of traumatic childbirth that occurred at any point within the previous five years.Methods: A qualitative study using Interpretative Phenomenological Analysis, an idiographic approach supporting in-depth exploration of lived experience. Fifteen women who had experienced traumatic childbirth occurring at any point within the previous five years were recruited through social media and publicly accessible locations frequented by women. Semi-structured interviews were conducted between January and March 2026. The data were analysed following the steps of Interpretative Phenomenological Analysis to explore women’s lived experiences in depth.Results: Three experiential themes were identified: Experiencing distressing childbirth; living with the emotional aftermath; and the lasting impact of birth trauma on motherhood. These findings highlight the substantial impact of traumatic birth on women’s lives and suggest enduring psychological and relational consequences, particularly when care is perceived as dismissive.Conclusion: There is a need for maternity care to be delivered in a respectful, woman-centred, and supportive manner to reduce the occurrence and impact of traumatic birth experiences. Insight into women’s birth experiences can inform the development of interventions to prevent birth trauma and reduce its consequences within the Saudi healthcare system.Keywords: birth trauma, traumatic childbirth, qualitative study, maternal health, postpartum mental health
Alihan Tigli,1 Yakup Baykus,1 Rulin Deniz,1 Muhammet Bora Uzuner,2 Sefer Ustebay,3 Nazli Sener,1 Yasemin Ercan Degirmenci,1 Guzide Ece Akinci,4 Erdem Gürkan,5 Oğuzhan Karakoç,5 Engin Korkmazer,6 Mustafa Ata Aydin,7 Esra Demirocak,8 Suleyman Aydin81Department of Obstetrics and Gynecology, Faculty of Medicine, Bandırma Onyedi Eylül University, Bandırma, Turkey; 2Department of Anatomy, Faculty of Medicine, Bandırma Onyedi Eylül University, Bandırma, Turkey; 3Department of Pediatrics, Faculty of Medicine, Bandırma Onyedi Eylül University, Bandirma, Turkey; 4Gynecology and Obstetrics Clinic, Şehit Prof. Dr İlhan Varank Sancaktepe Training and Research Hospital, Istanbul, Turkey; 5Gynecology and Obstetrics Clinic, Bandırma Training and Research Hospital, Bandirma, Turkey; 6Department of Obstetrics and Gynecology, Private Practice, Bursa, Turkey; 7School of Medicine, Clinical Sciences, Gazi University, Ankara, Turkey; 8Department of Medical Biochemistry, Faculty of Medicine, Fırat University, Elazig, TurkeyCorrespondence: Suleyman Aydin, Department of Medical Biochemistry, Faculty of Medicine, Fırat University, Elazig, Turkey, Email saydin1@hotmail.comPurpose: This study aimed to investigate the relationship between metabolic indices and Polyendocrine Metabolic Ovarian Syndrome (PMOS) in normal-weight women and to evaluate their individual and combined discriminatory performance.Patients and Methods: This retrospective case-control study included 86 normal-weight women (BMI < 25 kg/m2) with PMOS and 88 healthy controls. Electronic medical records were used to calculate the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Triglyceride–Glucose (TyG) index, Atherogenic Index of Plasma (AIP), and Metabolic Score for Insulin Resistance (METS-IR). Receiver operating characteristic (ROC) curve analysis was used to assess discriminatory performance, and optimal cut-off values were determined using the Youden index. Combined analyses were performed according to concordant classification of the component indices relative to their respective cut-off values.Results: Fasting glucose, fasting insulin, triglyceride levels, HOMA-IR, TyG, AIP, and METS-IR were significantly higher in women with PMOS (p< 0.05). Among individual indices, TyG showed the highest discriminatory performance (AUC=0.775; 95% CI: 0.706– 0.843). HOMA-IR and AIP demonstrated moderate discriminatory performance, whereas METS-IR showed lower performance. Among the combined assessments, HOMA-IR and TyG yielded an AUC of 0.830 (95% CI: 0.747– 0.913), with 80.8% sensitivity and 85.2% specificity.Conclusion: Metabolic indices, particularly TyG, may be useful for identifying metabolic abnormalities in normal-weight women with PMOS. Combined assessment of complementary metabolic indices may provide additional information for metabolic risk evaluation. These findings support further investigation of such indices as practical tools for metabolic assessment and risk stratification, rather than as independent diagnostic criteria for PMOS.Keywords: insulin resistance, atherogenic index of plasma, METS-IR, PCOS, rotterdam criteria, triglyceride-glucose index
Xiaoshuang Du,1 Jinbao Zhu21Obstetrics Medical Center, Weifang Brain Hospital, Weifang City, Shandong Province, People’s Republic of China; 2Department of Anesthesiology, Weifang Brain Hospital, Weifang City, Shandong Province, People’s Republic of ChinaCorrespondence: Jinbao Zhu, Department of Anesthesiology, Weifang Brain Hospital, No. 553, Dongfeng West Street, Weicheng District, Weifang City, Shandong Province, 261000, People’s Republic of China, Email 13031666702@163.comPurpose: To investigate the mechanism of action of propofol in early-onset preeclampsia (EOPE).Patients and Methods: Integrated transcriptomics and network approaches were employed to screen disease targets, drug targets, and differentially expressed genes from the GSE74341 training set (7 EOPE, 5 controls) and GSE44711 validation set (8 EOPE, 8 controls). Signature genes were further selected using machine learning algorithms (LASSO, SVM, Boruta). Immune infiltration levels were evaluated via ssGSEA and their correlations with signature genes were analyzed. Molecular docking validation of binding affinity was performed using CB-DOCK2. The expression patterns of signature genes in EOPE patients were ultimately confirmed using RT-qPCR in a clinical cohort of 36 EOPE patients and 36 healthy pregnant women.Results: Nineteen potential intersection targets of propofol intervention in the EOPE were identified. Machine learning analysis further pinpointed three signature genes (CASP1, FLT1, and CD68). Expression validation and ROC curve analysis confirmed their significant dysregulation, with area under the curve (AUC) values of 1.000, 1.000, and 0.886 in the training set and 0.891, 0.844, and 0.875 in the validation set, respectively, indicating good diagnostic performance. Immunoinfiltration analysis revealed significant alterations in 12 immune cell subsets in EOPE samples, which were closely associated with 3 signature genes. Molecular docking showed negative binding energies (from − 5.0 to − 5.8 kcal/mol), suggesting that propofol can spontaneously bind to all core targets with weak‑to‑moderate affinity, and the binding energy with CD68 was the lowest (– 5.8 kcal/mol). RT-qPCR validation in the clinical cohort confirmed that the expression patterns of the three signature genes were consistent with the bioinformatics predictions.Conclusion: This study identifies CASP1, FLT1, and CD68 as potential targets through which propofol may modulate EOPE-related pathways. Further mechanistic and in vivo validation studies are required.Keywords: transcriptomics, network analysis, molecular docking, early-onset preeclampsia, propofol
Li Binxia,1,* Yin Lina,1,* Lv Xingxing,2 Yuan Yufan11Department of Nursing, The Fourth Hospital of Shijiazhuang/Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, People’s Republic of China; 2Department of Obstetrical, The Fourth Hospital of Shijiazhuang/Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Li Binxia, Department of Nursing, The Fourth Hospital of Shijiazhuang/Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, Hebei, 050033, People’s Republic of China, Email xiaobinbin1985@126.comObjective: To analyze the key drivers influencing the service experience of inpatients in obstetrics and gynecology specialty hospitals, thereby providing a reference for further enhancing the inpatient service experience.Methods: From April to October 2025, a questionnaire survey on inpatient service experience was conducted among 405 inpatients at a tertiary Grade A obstetrics and gynecology specialty hospital. Using the Sklearn package in Python 3.13.3 software, the random forest algorithm was applied to calculate the importance of each questionnaire item. A data-driven importance matrix was constructed based on patients’ evaluation scores to conduct key driver analysis. The random forest model exhibited favorable predictive performance (R2=0.783), allowing for the objective derivation of feature importance to replace traditional subjective importance ratings.Results: A total of 365 valid questionnaires were collected, with an effective response rate of 90.12%. The overall score of the inpatient service experience was (3.84 ± 0.18). Through IPA, the 20 experience elements were categorized into four quadrants: 3 items in the urgent improvement zone (pain management, discharge health guidance, meal quality), 4 items in the key strength zone, 2 items in the secondary improvement zone, and 11 items in the maintenance zone.Conclusion: Admission/discharge procedures and information, pain management, and meal quality are key drivers of the service experience in obstetrics and gynecology specialty hospitals. The driving logic of patient experience can be summarized as a "three-tier pyramid” model: environmental cleanliness forms the foundation, doctor-patient communication constitutes the middle layer, and pain management, discharge guidance, and meal quality represent the apex.Keywords: inpatients, patient experience, service experience, importance-performance analysis, critical factors, hospital management
Mahad Ibrahim Ali,1,2 Jama Mohamed,1 Soheir H Ahmed3,41Faculty of Statistics and Data Science, University of Hargeisa, Hargeisa, Somalia; 2Quality Assurance and Institutional Transformation Directorate, University of Hargeisa, Hargeisa, Somalia; 3School of Graduate Studies, University of Hargeisa, Hargeisa, Somalia; 4College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, SomaliaCorrespondence: Mahad Ibrahim Ali, Email mahad.ibraahim481@gmail.comBackground: Underweight, overweight and obesity are a critical public health issues among Somali women. Understanding the factors associated with these conditions is important for informing health policies and interventions.Objective: This study aims to investigate the prevalence and associated factors of underweight, overweight and obesity among Somali women using Somali Health and Demographic Survey 2020.Methods: The study used cross-sectional secondary data analysis from Somali Health and Demographic Survey 2020, a nationally representative survey with 14,460 women were included in the analysis. Women were categorized based on body mass index as underweight (18.49 kg/m2), normal-weight (18.50– 24.99 kg/m2), overweight (25.00– 29.99 kg/m2) and obese (≥ 30 kg/m2). Sixteen factors, including socio-demographic, economic, and household factors, were analyzed. Stata version 17.0 was used for data analysis. We applied multilevel binary logistic regression to assess associations.Results: The prevalence of a normal BMI (46%), while 13.62% were underweight, 30.53% were overweight, and 9.84% were obese. Underweight was associated with not watching TV (AOR = 1.318, 95% CI: 1.060– 1.639), never being married (AOR = 2.130, 95% CI: 1.671– 2.715), and being a non-head household member (AOR = 1.718, 95% CI: 1.323– 2.232). Overweight and obesity were associated with higher wealth (AOR = 2.867, 95% CI: 2.289– 3.591), increasing age (AOR = 4.008, 95% CI: 2.805– 5.728). Lower odds of overweight and obesity were seen in never-married women (AOR = 0.319, 95% CI: 0.239– 0.424).Conclusion: Findings indicate that underweight, overweight and obesity were prevalent among Somali women, with economic and social disparities playing a crucial role in the prevalence of obesity. Targeted interventions are needed to address under nutrition among economically disadvantaged women and prevent the rising trend of obesity in urban and wealthier populations.Keywords: underweight, overweight, obese, socio-demographic factors, Somali health and demographic survey, Somali women
Xiaoyan Lu, Shanshan NiDepartment of Obstetrics, Beilun People’s Hospital, Ningbo, Zhejiang, 31580, People’s Republic of ChinaCorrespondence: Shanshan Ni, Department of Obstetrics, Beilun People’s Hospital, No. 1288 East Lushan Road, Ningbo, Zhejiang, 31580, People’s Republic of China, Email 15267853568@163.comPurpose: This study utilized 1990– 2019 data from the Global Burden of Disease (GBD) 2019 study to comprehensively evaluate global and regional temporal trends of endometriosis burden.Patients and Methods: Age-standardized incidence rates (ASIR) and disability-adjusted life year (DALY) rates were extracted from GBD 2019. Using the DisMod-MR 2.1 modeling framework, we analyzed three-decade trends across 204 countries and territories.Results: Globally, endometriosis presented opposing trends in age-standardized incidence rate (ASIR) and age-standardized DALY rate from 1990 to 2019. The global age-standardized DALY rate declined markedly, with an EAPC of − 0.82, while the ASIR rose steadily (EAPC = 0.46). Stratified by Socio-Demographic Index (SDI), high-SDI regions witnessed the most prominent growth in ASIR, with an EAPC of 0.54. Among the 21 GBD geographic regions, High-income North America had the fastest ASIR growth (EAPC = 0.65). Eastern Europe was the only region with rising age-standardized DALY rates (EAPC = 0.16). Oceania bore the world’s largest overall endometriosis burden, with the highest ASIR and age-standardized DALY rates globally. At the national level, New Zealand had the highest disease burden, whereas San Marino and Sweden showed the steepest increases in incidence rates.Conclusion: These findings reveal persistent global growth in endometriosis incidence coupled with stark interregional disparities. The paradox of rising incidence alongside declining disability warrants further investigation, particularly given Oceania’s disproportionately high burden despite its advanced SDI status.Keywords: endometriosis, incidence, disability adjusted life year, socio-demographic index, adult
Background:Postpartum hemorrhage (PPH) remains one of the leading global causes of maternal morbidity and mortality. To date, however, comprehensive long-term epidemiological trends and standardized future projections of PPH burden stratified by socioeconomic level have not been sufficiently characterized. This study aimed to systematically analyze the global, regional, and socioeconomic-stratified burden of PPH from 1990 to 2021, and forecast epidemiological trends through 2040, to provide evidence for targeted global maternal health interventions. Methods:Based on publicly available aggregated data from the 2021 Global Burden of Disease Study (GBD 2021), this secondary ecological analysis estimated the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year rate (ASDR) across 204 countries and territories. We calculated temporal trend inflection points and annual percentage changes (APC) using Joinpoint regression, and applied optimized autoregressive integrated moving average (ARIMA) models to project future trajectories of PPH burden through 2040. The slope index of inequality (SII) and concentration index (CI) were used to quantify absolute and relative socioeconomic disparities in PPH burden. Results:Globally, the age-standardized incidence rate (ASIR) of PPH decreased steadily from 495.93 per 100,000 population in 1990 to 358.57 per 100,000 population in 2021, with an estimated annual percentage change (EAPC) of -0.83%. Stratified by socio-demographic index (SDI), low-SDI regions had the highest PPH burden in 2021 (ASIR: 740.01 per 100,000 population), while high-SDI regions maintained the lowest burden (ASIR: 192.76 per 100,000 population). Exploratory ARIMA projections indicate that if current trends continue, global PPH morbidity measured by ASIR and age-standardized prevalence rate (ASPR) will likely show an upward trend by 2040. This increasing trend is mainly driven by epidemiological transitions in middle-SDI regions, while global PPH mortality is projected to continue declining. However, these projections carry considerable uncertainty, especially for longer forecasting horizons, and should be interpreted as exploratory "what-if" scenarios rather than deterministic predictions. Over the past three decades, absolute socioeconomic inequalities in PPH burden have narrowed, while relative disparities increased slightly, with women aged 25-29 years identified as the highest-risk population globally. Conclusion:Over the past three decades, the global burden of postpartum hemorrhage (PPH) has decreased notably. However, distinct socioeconomic and regional disparities persist: low-SDI regions still face severe mortality risks linked to PPH, while middle-SDI regions are grappling with new morbidity challenges driven by population aging and changing obstetric risk profiles. To address global maternal health inequities, stratified, context-adaptive public health strategies tailored to each region's unique socioeconomic and epidemiological characteristics are needed. Given the inherent uncertainties of the ARIMA modeling approach, all forecast results should be interpreted with caution.
Background:Breast cancer and thyroid cancer are common malignancies in Chinese women. The incidence and mortality rates of both cancers are increasing, seriously endangering the health of Chinese women. The association between these two diseases has drawn attention, yet research focusing on their comorbidity remains relatively limited. Methods:We conducted a secondary analysis of data collected from a study that examined the health status of 17,086 women aged 25-55 years who underwent physical examinations at a tertiary hospital in China. Results:The results showed that nearly half of the women had comorbidities. Age, BMI, hypertension, diabetes, uterine fibroids, lung disease, liver disease and kidney disease differed among the three groups of women, ie, those without thyroid or breast disease, those with a single thyroid/breast disease, and those with thyroid-breast comorbidity (all P < 0.05). Hypertension (OR = 1.434, 95% CI: 1.063-1.934), overweight or obesity (OR = 1.472, 95% CI: 1.211-1.788), kidney disease (OR = 1.424, 95% CI: 1.161-1.747), and uterine fibroids (OR = 2.542, 95% CI: 1.879-3.439) were associated factors for thyroid-breast comorbidity in women. Conclusion:Based on the comorbidity characteristics of thyroid and breast diseases, this study aims to integrate thyroid disease and breast disease, dissect the current status of comorbidity in the Chinese female population, and further explore associated factors to provide more accurate and systematic countermeasures for improving women's health.
Background:High-grade squamous intraepithelial lesion (HSIL) is a precancerous condition of the cervix. Identifying risk factors associated with HSIL and understanding their potential mechanisms may inform prevention strategies. This study aimed to investigate the associations of genetically predicted gene expression and circulating metabolites with HSIL risk using Mendelian randomization (MR). Methods:We performed two-sample MR analysis to evaluate the associations of genetically predicted gene expression (eQTLGen consortium, N=31,684) and circulating metabolites (genome-wide association study [GWAS], N=8,299) with HSIL risk (FinnGen R12, N=293,218; 8,291 cases). Mediation analysis was conducted to explore whether metabolites might mediate the associations between genes and HSIL. Sensitivity analyses, including Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO), leave-one-out, and colocalization, were performed to assess the robustness of the findings. All GWAS data used in this study were derived from European-ancestry populations. Results:Eleven genes showed significant associations with HSIL after false discovery rate (FDR) correction (q<0.05), including VWA7, PAX8, GUSBP1, IKZF3, PAX8-AS1, NFKBIL1 (interpret with caution due to an influential single nucleotide polymorphism [SNP]), ERBB2, COL11A2, SKIV2L, TCF19, and PGAP3. Eleven circulating metabolites were also significantly associated with HSIL. Mediation analysis suggested that two phospholipid metabolites (GCST90200685 and GCST90200692) might mediate a small proportion of the total protective association of COL11A2 with HSIL (1.46% and 1.45%, respectively), indicating that the protective association of COL11A2 is largely independent of these circulating metabolites. Colocalization analysis showed strong evidence of shared causal variants for eight genes (PP.H4>0.98), while COL11A2 showed weak evidence of colocalization (PP.H4=1.58×10-15). Functional enrichment analysis indicated that COL11A2-related genes were enriched in extracellular matrix (ECM)-receptor interaction and PI3K-Akt signaling pathways. Conclusion:This MR study identified 11 genes and 11 circulating metabolites associated with HSIL risk. Among these, COL11A2 showed a protective association that appeared to be largely independent of circulating phospholipid metabolites, suggesting potential local mechanisms. These findings provide genetic and metabolic clues for future studies on HSIL etiology.
Introduction:To assess global osteoarthritis (OA) burden trends (1990-2021) in adults ≥55 years by joint type, sex, age, and SDI. Material and Methods:Using Global Burden of Disease (GBD) 2021 data from 204 countries, we analyzed Estimated Annual Percentage Change (EAPC) in age-Standardized Incidence (ASIR) and DALY rates via Joinpoint regression, stratified for knee, hip, hand, and other OA. Results:Global OA burden increased steadily. Overall EAPC was 0.21 (ASIR) and 0.33 (DALY). Knee OA had the highest burden (ASIR: 1045.52; DALY: 592.26/100,000), while hand OA grew fastest (ASIR EAPC: 0.43; DALY EAPC: 0.49). Women bore higher burden (ASIR: 1813.94 vs. men: 1354.57/100,000; DALY: 1262.98 vs. 891.58/100,000) with faster increases (EAPC 0.24 vs. 0.19). Incidence peaked at 55-59 years among participants aged ≥55 years included in this study (1800.1 per 100,000); DALY peaked at ≥90 years (1589.7/100,000). High-SDI regions had highest burden (ASIR: 1873.28; DALY: 1277.17/100,000), but middle-SDI regions showed fastest growth (ASIR EAPC: 0.40; DALY EAPC: 0.56), notably in Southeast Asia (ASIR EAPC: 0.46; DALY EAPC: 0.63), East Asia (0.43; 0.64), and South Asia (0.36; 0.57). Conclusion:OA burden rises globally, with knee OA dominant but hand OA accelerating. Women and older adults face disproportionate impacts. Rapid growth in middle-SDI Asian regions underscores an urgent need for tailored interventions in modernizing aging populations. These findings highlight that joint-site, gender, age and socioeconomic stratifications should be fully integrated into global OA prevention frameworks. Developed regions should focus on long-term disability management for the oldest elderly, while emerging Asian economies require early screening and lifestyle modification strategies targeting middle-aged women and manual workers, which can effectively curb the future surge of OA-related disability.
Objective:To develop and validate a simple and practical scoring system based on O-RADS ultrasound features for distinguishing benign from malignant ovarian cystic lesions. Methods:This multi-institutional retrospective study included women with ovarian cystic lesions who underwent pelvic ultrasound and had either histopathological confirmation or at least 2 years of imaging follow-up. Participants were randomized into training (70%, n=1715) and internal validation (30%, n=711) sets, with an external validation set (n=278) from another center. Univariate and multivariate logistic regression identified independent O-RADS predictors of malignancy, which were assigned weights to construct a scoring system. Performance was validated internally and externally, and compared with O-RADS. Inter-observer agreement was assessed between two junior sonographers and two senior sonographers. Results:Seven independent predictors were identified: maximum diameter ≥10 cm (score 2), solid component (2), irregular internal wall (2), color score 3-4 (2), ascites (2), >3 papillary projections (1), and acoustic shadowing (-2), with an optimal cutoff value of 4 points. In the training set, the scoring system achieved an AUC of 0.973, sensitivity of 95.3%, and specificity of 92.5%, compared to O-RADS (AUC of 0.954, sensitivity of 97.3%, specificity of 86.7%). The scoring system maintained stable performance in internal validation (AUC of 0.968, sensitivity of 93.8%, specificity of 91.8%) and external validation (AUC of 0.964, sensitivity of 93.0%, specificity of 90.2%). Inter-observer agreement was excellent among all sonographers (κ=0.80, p<0.001), as well as between junior (κ=0.82) and senior (κ=0.79) sonographers. Conclusion:The O-RADS-based scoring system demonstrated excellent and stable diagnostic performance, potentially offering a simple and practical tool for clinical practice; however, prospective multicenter validation in diverse populations is warranted before widespread adoption.
Ping Yang,1,* Si Chen,2,* Qiuyun Li,1 Yuzhen Zhang,1 Changjie Li,1 Wenjuan Xu,1 Haihua Yu,1 Lili Zhang21Department of Obstetrics and Gynecology, Beijing You’an Hospital, Affiliated to Capital Medical University, Beijing, 100069, People’s Republic of China; 2Beijing You’an Hospital, Affiliated to Capital Medical University, Beijing, 100069, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lili Zhang, Beijing You’an Hospital, Affiliated to Capital Medical University, No. 8, Xizhoutiao, You’anmenwai, Fengtai District, Beijing, 100069, People’s Republic of China, Tel +86 13716162977, Email zhanglyliy@163.comObjective: This study aimed to evaluate the effectiveness of the Information–Knowledge–Attitude–Practice (IKAP) model in breastfeeding management for pregnant women with high hepatitis B virus (HBV) DNA loads (≥ 2 × 105 IU/mL).Methods: A prospective quasi-experimental study enrolled 136 eligible women between January 2023 and October 2023. Based on compliance, 68 who received the full IKAP-based intervention were assigned to the experimental group, and 68 who received routine health education served as controls. The experimental group received systematic, individualised IKAP-model education from the second trimester through 12 months postpartum, progressing through information, knowledge, attitude and practice stages. The control group received routine education (eg, prenatal classes, outpatient consultations). Primary outcomes (exclusive breastfeeding rate and self-efficacy at 42 days postpartum) and neonatal HBV transmission blockade outcomes at 7– 8 months were compared.Results: The exclusive breastfeeding rate at 42 days was significantly higher in the intervention group (85.29%) than in the control group (67.65%) (absolute risk difference = 17.64%, relative risk = 1.26, p < 0.05). Postpartum breastfeeding self-efficacy scores were also significantly higher in the intervention group (38.2 ± 4. 1 vs 32.5 ± 5.3; mean difference = 5.7, p < 0.05). Neonatal breastfeeding initiation success was 100% in both groups (p > 0.05).Conclusion: The phased IKAP model demonstrated superior outcomes compared with conventional education, safely increasing exclusive breastfeeding rates by approximately 17% and enhancing feeding confidence in high-risk mothers. Despite limitations, such as a non-randomised, single-centre design, it provides an effective and scalable framework for real-world application in supporting this special population.Keywords: Hepatitis B virus, viral load, breastfeeding, patient education as topic
Hongjing Chen,1 Qiang Gu,2 Linyu Qian,1 Fang Wang31Department of Obstetrics, Affiliated Maternity and Child Healthcare Hospital of Nantong University, Nantong City, Jiangsu Province, People’s Republic of China; 2Department of Breast Surgery, Affiliated Maternity and Child Healthcare Hospital of Nantong University, Nantong City, Jiangsu Province, People’s Republic of China; 3Department of Emergency, Affiliated Maternity and Child Healthcare Hospital of Nantong University, Nantong City, Jiangsu Province, People’s Republic of ChinaCorrespondence: Qiang Gu, Department of Breast Surgery, Affiliated Maternity and Child Healthcare Hospital of Nantong University, No. 399, Shiji Avenue, Nantong City, Jiangsu Province, People’s Republic of China, Email Guqiang828@126.comObjective: To investigate the correlation between the degree of placental calcification, umbilical artery hemodynamic parameters, and delivery outcomes in patients with gestational diabetes mellitus (GDM).Methods: A total of 190 GDM patients admitted to our hospital were retrospectively selected as the research subjects; gestational weeks ranged from 28 to 42. According to the placental calcification degree detected by ultrasound before delivery, they were divided into Grade 0 (n=62), Grade I (n=58), Grade II (n=45), and Grade III (n=25). Clinical data of all subjects were collected, and the umbilical artery hemodynamic parameters [systolic peak velocity/end-diastolic velocity (S/D), resistance index (RI), pulsatility index (PI)] and delivery outcome-related indicators were compared among groups. Spearman rank correlation analysis was used to explore the correlation between placental calcification degree and umbilical artery hemodynamic parameters. Multivariate Logistic regression analysis was used to screen independent risk factors for adverse delivery outcomes in patients with GDM.Results: There were significant differences in umbilical artery S/D, RI and PI among patients with different placental calcification degrees (F=108.75, 82.73, 158.20, all P< 0.001). Spearman rank correlation analysis showed that placental calcification degree was positively correlated with umbilical artery S/D, RI and PI in patients with GDM (r=0.760, 0.730, 0.817, all P< 0.001). There were statistically significant differences in cesarean section rate, preterm delivery rate, fetal distress rate and macrosomia rate among groups (χ2=42.984, 16.052, 47.556, 11.798, all P< 0.001). Multivariate Logistic regression analysis showed that Grade II placental calcification, Grade III placental calcification, and umbilical artery S/D ≥ 3.0 were independent risk factors for adverse delivery outcomes in patients with GDM.Conclusion: Placental calcification degree was closely correlated with umbilical artery hemodynamic parameters in patients with GDM. Grade II and Grade III placental calcification and umbilical artery S/D ≥ 3.0 could all affect the occurrence of adverse delivery outcomes in patients with GDM.Keywords: gestational diabetes mellitus, placental calcification, umbilical artery hemodynamics, delivery outcomes, correlation
