Background:Endometriosis is a chronic, estrogen-dependent inflammatory condition affecting approximately 10% of women of reproductive age and manifesting with pelvic pain, dysmenorrhea, dyspareunia, fatigue, and infertility. First-line treatment in most patients is hormonal therapy, and among the available options, contraceptives are frequently used. Short-acting contraceptives (SACs) have been employed off-label to manage endometriosis-related symptoms, yet comparative evidence regarding optimal formulations and regimens remains limited. This narrative review, part of the Agnodice Project, aims to synthesize recent evidence on the SAC formulation-specific effectiveness for endometriosis management, and to provide evidence-based practical considerations for endometriosis management. Methods:A literature search of systematic reviews and/or meta-analyses providing data on non-contraceptive clinical benefits of SAC versus other SAC or SAC vs placebo or no treatment, including the period from 2014 to 2024, was conducted. Information was extracted as individual items related to endometriosis. Results:Of 86 studies included in the Agnodice Project, 10 systematic reviews and meta-analyses specifically addressed endometriosis, yielding 21 comparative items with significant differences. SACs effectively reduced dysmenorrhea, chronic pelvic pain, and post-operative endometrioma recurrence, among others. Continuous regimens consistently outperformed cyclic schedules for pain control and quality of life. Among formulations, desogestrel monotherapy was superior across multiple outcomes in women with endometriosis. Furthermore, we present practical, expert considerations based on the synthesized evidence. Conclusions:SACs represent valuable first-line therapeutic options for endometriosis symptom management, with continuous regimens providing optimal symptom control and recurrence prevention. Formulation selection should be individualized based on symptom profile, safety profile, comorbidities, estrogen tolerance, and patient preference.
Objective: Maternal vaccination rates are low in the United States. Understanding barriers to vaccination for pregnant women from the provider’s perspective can help better address these issues. This exploratory study assesses participating prenatal health care providers’ beliefs and perspectives regarding maternal vaccination for Tdap, flu, COVID-19, and respiratory syncytial virus (RSV) vaccines. Methods: This qualitative study included 24 virtual in-depth interviews with prenatal health care providers (12 physicians, 12 certified nurse midwives) working in rural and urban areas. Thematic analysis was conducted to identify perceived barriers and challenges to prenatal care, provider perceptions and recommendations on Tdap, flu, COVID-19, and RSV vaccines, vaccination resources shared with pregnant women, and vaccine administration practices. Results: Most providers reported pregnant women were receptive to vaccination when benefits and risks of prenatal vaccination were explained. Rural providers identified barriers to care that included limited transportation, lack of access to health care, and language barriers. Findings also indicate prenatal health care providers can foster trust, engage in two-way conversations, and navigate patients’ cultural influences when addressing vaccination challenges. Conclusion: Provider communication about maternal vaccination should be grounded in an evidence-based, participatory approach. Building trust, recognizing and addressing cultural barriers and access challenges are key to identifying practical steps to support access to and uptake of maternal vaccinations.
Background: Postmenopausal women with a sedentary lifestyle and lower physical activity have a worse metabolic profile. Additionally, there is no consensus on the cut-off points to classify sedentary behavior (SED) and movement. Objective: To analyze the association between SED and cardiovascular risk indicators and the association between reclassifying SED as light physical activity (LPA) and body and truncal fat, glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and leptin. Methods: This cross-sectional study assessed SED and LPA via accelerometry in 89 postmenopausal women. We classified SED and LPA using Vanhelst and Freedson’s cutoff points. We evaluated body composition, truncal fat, glucose, insulin, HOMA-IR, and leptin levels. Associations were analyzed through linear and logistic regression models, adjusting for confounders. Results: In this study of postmenopausal women with overweight or obesity, higher SED time (0.40 counts per minute [CPM]) was positively associated with adiposity and metabolic markers. Each 10% increase in SED time was associated with a 0.8% higher total body fat (ß = 0.8; 95% Confidende Interval (CI): 0.1, 1.5) and a 1.3 kg higher truncal fat mass (ß = 1.3; 95% CI: 0.4, 2.3), while women in the highest SED tertile showed higher insulin and leptin levels. Conversely, higher LPA was inversely associated with trunk fat (ß = 1.0; 95% CI: −1.8, −0.2) and leptin (ß = 3.0 µg/ML; 95% CI: −5.5,−0.5); 95% CI: −1.8, −0.2), particularly using a > 40 CPM threshold. Conclusions: SED is a risk factor for metabolic disorders and increased body fat among postmenopausal women, whereas LPA may be protective, even at low intensities.
Purpose:Folic acid is essential for preventing neural tube defects and for normal fetal development. This study aims to evaluate the rate and trends of folic acid intake among women completing the questionnaire to enroll in the preconception care program and examine its role as a potential indicator associated with modifiable biomedical, behavioral, and social health risk factors. Methods:This is a cross-sectional study. A total of 42,730 women seeking to enroll in preconception care program of Seoul City, Korea, between Nov. 2017 and Dec. 2023. Folic acid intake among women planning pregnancy and modifiable risk factors, including biomedical, behavioral, and social risks, were obtained from an organized questionnaire on online. We exclude cases having incomplete data for analysis. Results:The proportion of participants taking folic acid is 35.1% (15,003/42,730).Factors associated with greater folic acid use included advanced maternal age, higher body mass index, greater gravidity, previous spontaneous abortion, previous artificial abortion, regular exercise, and higher family income. Conversely, factors associated with less folic acid use included depression, insomnia, bulimia, social drinking, positive screening for risky drinking, cigarette smoking, unmarried status, and white-collar employment. Conclusions:Our study found that folic acid intake during the preconception period remains low at 35.1%. Annual trends show the modest improvement but remain insufficient. And preconception folic acid intake was significantly associated with greater or lesser likelihoods of several modifiable biomedical, behavioral, and social risk factors. Therefore, folic acid use may serve as a surrogate marker of health awareness and engagement in preconception care. Future studies should assess folic acid as a marker of preconception care effectiveness.
Introduction:Worldwide, lowering maternal mortality is a top priority. While significant efforts have been made to address direct obstetric complications, indirect causes such as pre-existing medical conditions that are aggravated by pregnancy remain a major cause of mortality but are often unrecognized. Understanding indirect maternal mortality prevalence and patterns is crucial for creating focused interventions. Methods:Data were explored from the Global Burden of Disease (GBD) study 2021. Maternal mortality ratio (MMR), maternal mortality rate (MM Rate), disability-adjusted life years (DALYs), and years of life lost (YLLs) were extracted and analyzed. Age-standardized rates and estimated annual percentage change were calculated to evaluate temporal trends. Data visualization and trend analysis were conducted using GBD Compare, Cause of Death Visualization, and GBD Foresight Visualization tools. Microsoft Excel was used for additional data organization and statistical summarization. Result:The analysis revealed a global declining trend in indirect maternal mortality, as measured by the MM Rate, MMR, DALYs, and YLLs. The MM Rate decreased from 3.59 (95% uncertainty interval [UI]: 3.11, 4.14) per 100,000 women of reproductive age in 1980 to 0.97 (95% UI: 0.83, 1.13) in 2021, while the MMR declined from 31.49 (95% UI: 27.23, 36.24) to 14.67 (95% UI: 12.64, 17.07) per 100,000 live births over the same period. Indirect maternal deaths and DALYs were most prominent among women aged 25-29 and 30-34 years. The death rates in these age groups were 1.3 and 1.28 per 100,000 women, respectively, with corresponding DALY rates of 81.87 (95% UI: 70.2, 96.15) and 73.89 (95% UI: 63.03, 85.58). Conclusion:This analysis demonstrates a significant global decline in indirect maternal mortality from 1980 to 2021, reflected in reductions in the MMR, MM Rate, DALYs, and YLLs. Although global maternal mortality has declined, substantial variation continues across countries and regions, with the highest burden in low- and middle-income countries. Notably, some high-income countries have experienced increases since 1980. This signals a global health concern that demands urgent attention.
Sex and gender influence disease mechanisms and outcomes, yet their integration into medical curricula remains limited. Faculty knowledge and confidence are essential for effective incorporation. This study assessed baseline sex- and gender-specific health (SGSH) knowledge, attitudes, and comfort among medical school educators and delivered a multi-format faculty development intervention. A survey adapted from prior SGSH assessments was distributed to medical school block leaders before the intervention, measuring SGSH knowledge, comfort differentiating sex and gender, awareness of SGSH resources, and readiness to integrate SGSH content. The intervention included virtual and in-person grand rounds, distribution of How Sex and Gender Impact Clinical Practice , and a screening of Ms. Diagnosed . Of the 103 invited to participate, 68 educators (66% response rate) completed the baseline survey. Forty percent reported no prior SGSH training, and only 13.2% felt very comfortable with SGSH concepts. Although 94.1% correctly identified gender as a social construct and sex assignment at birth, 22% remained uncomfortable distinguishing the two. More than 80% were neutral or uncomfortable identifying SGSH resources. Comfort with curriculum integration varied: 45.6% felt comfortable, 32.4% neutral, and 22.1% uncomfortable, with differences observed across specialties. These findings reveal significant gaps in medical educators’ SGSH knowledge and comfort regardless of experience, with SGSH content narrowly confined to reproductive health topics. Simply providing resources is insufficient; educators need structured guidance on integration. By outlining baseline gaps and an intervention model, this study offers a framework for institutions seeking to enhance SGSH integration through interactive, longitudinal, multi-format faculty development approaches.
Background: While rates of alcohol use disorder (AUD) have been rising faster among women than among men, women remain less likely than men to receive any treatment. The present study examined acceptability and usability of digital cognitive behavioral therapy computer based training for cognitive behavioral therapy (CBT4CBT) by sex and explored within-sex associations between study condition and AUD outcomes in a nontreatment-seeking sample. Methods: Exploratory analyses used data from a clinical trial of CBT4CBT for AUD among an online sample of people with lifetime AUD who were not receiving AUD treatment ( N = 160 total; females: n = 83 cognitive behavioral therapy [CBT], n = 26 contro [Co]; males: n = 39 CBT, n = 12 Co). Study assessments were administered at baseline, postintervention, and 1-month follow-up and included self-reported alcohol use, recovery, and acceptability measures. Sex differences and within-sex comparisons were assessed using t -tests, chi-square tests, Fisher exact tests, and sex-stratified random-effects regressions. Results: Female participants were 44.3 (standard deviation [SD] = 15.8) years of age, and the majority were White (73.4%). Male participants were 38.8 (SD = 15.1) years of age and were primarily White (47.1%) or Black (43.1%). The percentage of participants with heavy drinking days was lower in the CBT4CBT group among female participants at postintervention and among male participants at the 1-month follow-up. Random-effects regressions indicated a significant intervention effect on the percentage of drinking days among female participants. CBT4CBT acceptability and usability were high across sexes, barring a few exceptions specifically among female participants. Conclusions: Both male and female participants experienced significant intervention effects. Acceptability data and within-sex associations between study condition and outcomes identified potential areas for improving online alcohol interventions for women.
Background:Gender disparities in physicians' employment and leadership remain a persistent challenge in Japan, and regional variation has been less well examined. We investigated sex differences in employment type, senior leadership representation, and parental leave uptake among physicians in Shizuoka Prefecture, Japan, a microcosm of the country in demographic and socioeconomic structure. Methods:We analyzed records for 4809 physicians from 80 medical institutions in Shizuoka Prefecture (2023). Employment type (full-time vs. part-time), sex distribution in senior positions (administrator, vice director, and department/section chief), and parental leave uptake (2021-2023) were assessed. Sex differences and regional comparisons were evaluated using chi-square tests and odds ratios with 95% confidence intervals. Trends in parental leave uptake were examined using the Cochran-Armitage trend test. Results:Part-time employment did not differ significantly between women (24.0%) and men (26.6%) (p = 0.123). The Eastern region showed higher part-time employment for both sexes than the Central and Western regions (all p < 0.001). Women were less represented in senior positions (all p < 0.001). Male physicians' parental leave uptake increased significantly from 2021 to 2023 (p = 0.0098), whereas female uptake remained stable. Conclusions:Gender disparities among physicians in Shizuoka Prefecture appear to be shaped by regional and institutional factors, underscoring the need for region-specific strategies and workplace reforms. These disparities included substantially higher part-time employment in the Eastern region for both sexes, persistent male dominance in senior leadership, and increasing parental leave uptake among male physicians.
Objective: Menopause-related symptoms are an important occupational health concern; however, despite experiencing such symptoms, many women delay seeking medical attention due to work-related demands or other reasons. We evaluated the effects of the gynecologist-delivered brief health behavior counseling approach on menopausal symptoms and work productivity among untreated perimenopausal working women. Methods: In this prospective interventional study, 55 perimenopausal employees with menopausal symptoms completed baseline questionnaires and received a gynecologist-delivered counseling session. Follow-up assessments were conducted 1 month later. Menopausal symptoms were assessed using the Simplified Menopausal Index (SMI), and work productivity was evaluated using the World Health Organization Health and Work Performance Questionnaire (WHO-HPQ). Outcomes were analyzed both overall and according to baseline symptom severity (SMI <51 vs. ≥51). Results: Total SMI scores showed an overall trend toward improvement after the intervention, with significant reductions observed among participants with baseline SMI ≥51. Improvements in WHO-HPQ absolute presenteeism scores were also observed. Baseline SMI and WHO-HPQ scores were not significantly correlated. Changes in menopausal symptoms were positively associated with changes in work productivity. No significant differences were observed between in-person and web-based counseling delivery. Conclusions: Gynecologist-delivered brief health behavior counseling improved menopausal symptoms and work productivity among untreated symptomatic perimenopausal working women. Introducing such a gynecologist-led intervention into workplace-based menopause care may help prevent women from leaving the workforce due to menopausal symptoms.
Background: The Dobbs v. Jackson Supreme Court decision overturned Roe v. Wade and federal abortion protections, resulting in nearly half of U.S. states banning or significantly restricting abortion. Qualitative data are needed to understand how abortion restrictions influence pregnancy perceptions and experiences. Objectives: This study describes pregnancy perceptions and experiences before and after Dobbs , across states with abortion restrictions and protections, and across individual-level differences in income and age. Design and Methods: We conducted in-depth interviews with people during pregnancy ( n = 31, 28 pre- Dobbs ) and a subset of those individuals again during the postpregnancy period ( n = 14, all post- Dobbs ) from October 2021 to August 2023. All interviews were recorded, transcribed, concept mapped, and coded using MAXQDA 2022. We also conducted across-group comparisons by state abortion policy, income, and age. Results: Before Dobbs , participants described how abortion accessibility was already compromised in some states. After abortion was banned in restrictive states, participants described feeling dehumanized, criminalized, that their reproductive autonomy was constrained, and that pregnancy carried real risks to their lives. In protective states, participants were grateful they had abortion access but lacked awareness and knowledge about abortion access in other states. Participants explained that Dobbs and abortion restrictions are harming perinatal wellbeing, even for wanted pregnancies. Group comparisons demonstrated that lower income and younger people described greater impacts related to abortion availability. Conclusion: Post- Dobbs abortion restrictions are negatively impacting the mental and physical well-being of pregnant people, even those with wanted pregnancies. Dobbs could exacerbate existing health inequities for younger and lower-income people.
Background:Adverse childhood experiences (ACEs) are prevalent and have long-term effects on regulation, stress, and health. Given the heightened physiological and psychological vulnerability of pregnancy, early life adversity may increase susceptibility to traumatic stress during crisis, such as the COVID-19 pandemic. Objective:To evaluate associations between maternal ACE exposure and prenatal pandemic-related traumatic stress (PTS) measured by symptom count and domains. Methods:This secondary analysis included baseline data collected from a longitudinal cohort of 424 pregnant individuals receiving prenatal care in Kaiser Permanente Northern California between August 2020 and April 2021. ACEs were measured with the Adverse Childhood Experiences Questionnaire and dichotomized ≥3 versus <3 exposures, and by type (abuse, neglect, household dysfunction, violence in home). PTS was evaluated using the 9-item PTS Scale, capturing intrusion, avoidance, arousal, and dissociation. Linear and log-binomial regression models estimated associations between ACEs and PTS, adjusting for covariates. Results:Participants with ≥3 ACEs reported more traumatic stress symptoms (mean difference [MD]: 1.1; 95% confidence interval [CI]: 0.6,1.7) and significantly higher PTS scores (MD: 3.5; 95% CI: 2.0,5.0). After adjustment, higher ACE exposure was associated with elevated intrusion (risk ratio [RR]: 2.03; 95% CI: 1.34-3.07) and dissociation (RR: 1.54; 95% CI: 1.26-1.88) symptoms. Abuse, neglect, and household dysfunction were independently associated with higher total prenatal PTS scores; abuse and neglect were associated with increased dissociative symptoms, and household dysfunction was associated with higher intrusion and arousal symptoms. Conclusions:Higher ACE exposure was associated with increased prenatal PTS, with distinct risk patterns across ACE domains. Findings underscore the importance of trauma-informed, ACE-aware prenatal care models, especially during public health emergencies.
Background: Preterm birth (PTB) is the leading cause of neonatal death and a major contributor to under-five mortality. Women's awareness, knowledge, and ability to recall PTB-related themes are essential for prevention and care but remain understudied in Europe.Objectives: To describe self-appraised awareness of PTB, PTB themes recalled from discussions with health care professionals (HCPs), perception of personal PTB risk, and recognition-based knowledge score.Materials and Methods: We conducted a cross-sectional, web-based survey of pregnant women at 12-32 weeks' gestation in five European countries. Analyses were stratified by country and by PTB risk.Results: The analytic sample comprised 247 women, of whom 111 (44.9%; 95% confidence interval [CI], 38.9-51.2) were classified as at higher PTB risk. Among these, 35.1% (95% CI, 26.9-44.4) did not recognize their higher PTB risk in the current pregnancy despite a previous PTB. Differences in awareness were observed between countries, with no differences across PTB risk strata. Recall of PTB themes discussed with HCPs and the recognition-based knowledge score were low and did not differ across PTB risk strata. Topic-specific shortfalls in recall and recognition were identified.Conclusions: A disconnect emerged between feeling informed and retaining actionable knowledge. HCPs should reserve time with women to deliver education using evidence-based techniques (e.g., teach-back) to build, maintain, and reinforce recall of PTB knowledge so that women are not only aware but also active participants in prevention, monitoring, and care.
Introduction: Perinatal women need continuous, individualized, accessible care, which traditional models often fail to provide. Chatbots can offer education, symptom tracking, and psychological support, but evidence is fragmented and requires systematic synthesis to assess effectiveness. Aim: To understand the current studies on the application of chatbots in the perinatal period and to explore their contributions, limitations, and future directions in this field. Methods: Relevant studies were systematically identified through a comprehensive search of major databases, including PubMed, Scopus, Web of Science, Embase, CINAHL, Joanna Briggs Institute, Cochrane Library, CNKI, SinoMed, VIP, and WanFang, covering all records up to June 2025. Two independent researchers screened and evaluated the retrieved citations, and data were extracted in a structured format to maintain methodological rigor and inter-reviewer consistency. Results: A total of 17 studies were included in this review, which indicated that chatbots offer a range of functionalities: optimizing follow-up and revisit processes, monitoring health status, providing psychological and counseling support, offering educational resources, and serving as interactive tools. Most of the included studies demonstrated that chatbots offer beneficial effects, including disease monitoring, enhanced parenting self-efficacy, mental health support, facilitation of role adaptation, improved health literacy and health behaviors, and increased user engagement and satisfaction. Conclusion: Most of the included studies indicate that chatbots have a positive impact on pregnancy and postpartum care outcomes. However, the majority of these studies remain in the preliminary stages, and further validation of chatbot effectiveness in this context is still needed through large-scale, multicenter, randomized controlled trials. Impact: Deepening knowledge of perinatal chatbots’ uses and limits enables targeted digital health strategies to improve care quality and maternal, neonatal, and family experiences. Patient and Public Contribution: Chatbot could be a potentially valuable tool in perinatal care to enhance health education, psychological support, and communication between care providers and women.
Background and Objective: Herpes zoster (HZ), also known as shingles, is caused by reactivation of the latent varicella-zoster virus. HZ commonly manifests as a painful rash but may lead to more severe complications. An estimated 1 million cases of HZ occur annually in the United States, with adults aged ≥50 years, women, and individuals living with certain underlying conditions at increased risk compared with the general population. This narrative review aims to support the provision of comprehensive HZ-preventive care to female patients through consolidating evidence on risk factors for HZ and current prevention practices. Risk Factors for HZ: Evidence shows that women are at an increased risk of developing HZ and related complications. A variety of risk factors may contribute to this increased risk among women. Some are specific to women, including certain cancers. Other risk factors include chronic conditions and immune diseases with increased prevalence among women, such as rheumatoid arthritis and systemic lupus erythematosus. HZ Prevention Practices: Gaps in HZ prevention persist, including in recombinant zoster vaccine uptake and disparities in vaccination uptake by race and ethnicity. Various methods have been proposed that aim to address gaps in prevention, including approaching vaccination outside of the traditional primary care setting and considering the educational and resource needs of women’s health providers. Guidelines and resources from the Centers for Disease Control and Prevention and medical societies are among the tools available to primary care providers and specialists in the women’s health space, such as obstetricians/gynecologists and oncologists, to support the incorporation of HZ-preventive care into clinicians’ practices.
Background: Cannabis is one of the most common substances used during pregnancy. This study examined motivation to quit cannabis use among pregnant women enrolled in a randomized controlled trial of a technology-delivered brief motivational intervention targeting sexually transmitted infection (STI) risk behaviors, including substance use. Methods: Secondary analyses used data from a clinical trial among pregnant adults who screened positive for STI risk behavior ( e.g., sexual behavior and alcohol/drug use risk during pregnancy). Four subscales (autonomous, introjected, external, and amotivation) from the Treatment Self-Regulation Questionnaire assessed motivation for not using cannabis and the timeline follow-back assessed cannabis use at baseline, 2-month, and 6-month follow-up during pregnancy. Mixed logistic regression and negative binomial regression investigated the relationship between motivation and cannabis use (Y/N) and cannabis use days, respectively, with a generalized estimating equations approach after adjusting for age and marital status. Results: Of 176 participants (mean age: 30.2 [standard deviation = 5.0]; 26% Black), n = 62 (35.2%) reported cannabis use during pregnancy. Participants with cannabis use during pregnancy were more likely to be younger, Black, and have lower socioeconomic status than those with no cannabis use. Higher autonomous, introjected, and amotivation scores were associated with lower odds of cannabis use ( p = 0.0003, p = 0.0033, p = 0.0307, respectively). Higher autonomous, introjected, and external regulation scores were associated with fewer average cannabis use days ( p = 0.0013, p = 0.0035, p = 0.005, respectively). Conclusions: Higher levels of motivation are associated with less cannabis use during pregnancy. Given psychosocial barriers to treatment, these findings may support delivery of brief technology-delivered motivational interventions to reduce prenatal cannabis use.
Objective:To evaluate the efficacy of Fenavari, a novel formulation of standardized Asparagus racemosus and Trigonella foenum-graecum, in alleviating menopausal symptoms in women. Methods:This multicenter, randomized, double-blind, placebo-controlled, three-arm, parallel-group study enrolled women aged 40-60 years with menopausal symptoms. A total of 150 participants were randomized (1:1:1) to receive Fenavari 300 mg, Fenavari 500 mg, or placebo once daily for 84 days. Menopausal symptoms were assessed using the Menopause Rating Scale (MRS), sleep using the Pittsburgh Sleep Quality Index, mood using the Profile of Mood States, and anxiety using the Beck Anxiety Inventory at baseline and Days 14, 28, 56, and 84. Hormonal parameters (serum estradiol, progesterone, and follicle-stimulating hormone [FSH]) were measured at baseline and on Days 56 and 84. Safety and laboratory assessments were conducted throughout the study. Results:A total of 138 participants completed the study. Both Fenavari 300 mg and 500 mg significantly reduced MRS total scores from Day 14 through Day 84 compared with placebo (Fenavari 300 mg: -8.26 ± 0.46, p < 0.0001; Fenavari 500 mg: -10.40 ± 0.40, p < 0.0001; placebo: -4.09 ± 0.47). Somatic and psychological symptoms improved significantly by Day 84 in both treatment groups, with earlier and greater effects observed in the 500 mg group. Urogenital symptoms showed significant improvement by Day 84 in both groups. Both doses of Fenavari significantly reduced hot flashes and night sweats by Day 84. Significant improvements were also observed in anxiety, sleep quality, and mood by Day 84. Serum estradiol increased significantly with corresponding reductions in FSH by Day 84 compared with placebo. Both doses were well-tolerated with no safety concerns reported. Conclusion:Fenavari significantly improved menopausal symptoms across somatic, psychological, and vasomotor domains from Day 14 onward, and improved sleep, anxiety, and mood along with favorable hormonal changes and good tolerability, supporting its potential as a safe nonhormonal option for menopause management.
Background: Despite a plethora of previous research on experiences of discrimination and physical health outcomes, there has been less attention to sex/gender differences, although some research suggests a greater stress-related biological and behavioral impact on women. Methods: Five databases were reviewed up to May 2023 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We included studies that examined self-reported experiences of discrimination and physical health outcomes among adults (aged 18+) in the United States if results were either stratified by sex/gender or tested a sex/gender-by-discrimination interaction term. Results: A total of 3,397 articles were extracted, and 50 met the inclusion criteria, including 3 articles found through an external search. Ten studies reported that the measure of association between discrimination and physical health outcomes was greater among women, 7 reported a greater association among men, 21 reported homogenous associations, and 12 studies reported that the associations varied by sex/gender across multiple outcome measures or in more complex modeling analyses ( e.g., additional moderators, mediation analysis). Conclusion: Discrimination and physical health outcomes vary by sex/gender, irrespective of race/ethnicity. There are some limitations and methodological issues that were found in the literature. These considerations should be reconciled in future research for more streamlined and consistent analyses and reporting. We further provide recommendations on analyzing and interpreting sex/gender differences in future research. Future studies should also examine sex/gender differences between experiences of discrimination and mental health outcomes.
Introduction: Placenta accreta spectrum (PAS) represents a significant contributor to maternal mortality, primarily as a result of severe postpartum hemorrhage. The most prominent risk factors associated with PAS are the placenta previa and a history of cesarean delivery. Nevertheless, a normal location of placenta does not exclude PAS, although this is underreported. Case Report: We report a G3P2L0 female who was booked with us since her first trimester and had two previous cesarean deliveries, but with no live issue. During her elective lower segment cesarean section at term with all routine preparations, the placenta did not separate with the routine prophylactic dose of oxytocin, even though placenta was placed fundally. Non-separation of the placenta with a well-contracted uterus led us to consider manual removal of the placenta; however, no plane of cleavage was felt or seen, raising a suspicion of the placenta accreta syndrome. As we were at a secondary care setup without any ICU and blood bank facility, given no postpartum hemorrhage, a decision to leave the placenta in situ was taken, and the patient was shifted to a tertiary care setup for observation. She underwent an emergency hysterectomy at the referral center. Conclusion: In non-previa PAS cases, guidelines for management, tools for early suspicion and management when encountered as a surprise, and research toward its pathogenesis have a long way to go. Conservative management, particularly in uterine body PAS and resource-limited settings, with leaving the placenta in situ, should be strongly considered.
Objectives:This study aimed to evaluate the implementation of a structured anamnesis tool designed to standardize contraceptive counseling, the VALORA checklist, and to assess health care professionals' (HCPs) characteristics, and user characteristics, checklist satisfaction, ease of use, and preferred formats following training. Study Design:This observational pilot study included two online surveys completed by 30 HCPs (gynecologists and primary care physicians) across Spain before and after training on the VALORA checklist. The surveys collected data on professional characteristics, aggregated user profiles, checklist use, satisfaction, and perceptions. Comparative analyses assessed changes in checklist implementation and item-level evaluation. Results:Before training, checklists were reportedly used in a mean of 54.3% of consultations, increasing to 78.2% post training (median 65% vs. 92.5%; p = 0.031). The improvement in assessing family history of thrombosis (median 100 [50-100] vs. 100 [80-100]; p = 0.005) was statistically significant. Other items with lower baseline implementation, such as liver disease and cholelithiasis, also showed numerical improvement. After training, 60% of HCPs incorporated the VALORA checklist into routine practice, and overall satisfaction was high (86.7% very or totally satisfied). Ease of use was rated positively by 96.7% of HCPs, with 70% preferring an interactive digital format and expressing interest in automated risk assessment and contraceptive recommendations. Conclusions:Training on the VALORA checklist increased the use of structured anamnesis during oral contraceptive counseling and improved the evaluation of underassessed risk factors. High satisfaction and a preference for digital integration suggest the potential for broader adoption. Future studies should explore long-term adherence, user-level outcomes, and digital implementation to optimize safe, individualized contraceptive care.
