Efeito do tônus do corpo perineal nas disfunçõessexuais em mulheres jovens nulíparas / Effect of perineal body tone on sexual dysfunctionsin young nulliparous women

Objetivo: avaliar o tônus do corpo perineal em mulheres jovens nulíparas e correlacionar com as funções sexuais e a presença de disfunção sexual. Método: foi realizado um estudo descritivo, observacional, transversal utilizando uma amostra de conveniência incluindo mulheres adultas jovens nulíparas. A avaliação das participantes consistiu na aplicação dos questionários socioclínico, Pelvic Organ Prolaps / Urinary Incontinence Sexual Questionnaire (PISQ-12), Female Sexual Function Index (FSFI) e exame físico do tônus do corpo perineal. Os dados foram analisados pelo programa Statistical Package for the Social Sciences (SPSS®), versão 23, adotando um nível de significância de 5%. Resultados: participaram 77 mulheres jovens nulíparas (21,68 ± 2,94 anos), destas 77, 92% apresentavam vida sexual ativa e 66,03% tônus normal do corpo perineal. Dentre as alterações tônicas, o aumento do tônus predominou (33,76%). Houve alta prevalência de disfunção sexual (87,01%) pelo FSFI (23,38 ± 7,21) com maior queixa de dispareunia. Mulheres com tônus aumentado apresentaram maior disfunção sexual em relação a desejo e estímulo subjetivo (p=0,04), à excitação (p=0,01), satisfação (p=0,04) e dor ou a desconforto (p=0,03). Houve correlação inversa entre a presença de aumento do tônus e os domínios FSFI desejo e estímulo subjetivo (R= - 0,56) e excitação (R= - 0,34) e correlação direta para dor ou desconforto (R= 0,30). Conclusão: o aumento do tônus do corpo perineal piora a função sexual de mulheres jovens nulíparas.

Sexual Function Index (FSFI) and physical examination of the tone of the perineal body. The data were analyzed using the Statistical Package for the Social Sciences (SPSS®), version 23, adopting a significance level of 5%. Results: 77 young nulliparous women (21.68 ± 2.94 years) participated, of which 77, 92% had an active sexual life and 66.03% had normal tone of the perineal body. Among the tonic changes, increased tone predominated (33.76%). There was a high prevalence of sexual dysfunction (87.01%) according to the FSFI (23.38 ± 7.21) with greater complaints of dyspareunia. Women with increased tone had greater sexual dysfunction in relation to desire and subjective stimulation (p=0.04), excitement (p=0.01), satisfaction (p=0.04) and pain or discomfort (p=0.03). There was an inverse correlation between the presence of increased tone and the FSFI domains desire and subjective stimulus (R= - 0.56) and excitement (R= - 0.34) and a direct correlation for pain or discomfort (R= 0.30). Conclusion: increased perineal body tone worsens sexual function in young nulliparous women.

Representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada / Social representations of reproductive planning among women with unplanned pregnancies / Representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado

Objetivo: conhecer as representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada na Estratégia Saúde da Família. Método: estudo qualitativo, orientado pela Teoria das Representações Sociais, realizado com 15 gestantes, entre abril e maio de 2019. Utilizou-se a entrevista semiestruturada. Os dados foram organizados por meio do Discurso do Sujeito Coletivo, com auxílio do software DSCsoft©. Protocolo de pesquisa aprovado pelo Comitê de Ética em Pesquisa. Resultados: as representações sociais das mulheres em gravidez não planejada evidenciadas pelo Discurso do Sujeito Coletivo foram representadas por oito ideias centrais, a saber: "eu não me preveni, nem ele", "nós nos prevenimos", "eu comprava", "pegava no posto", "construir uma família", "ter esse acesso", "estou por fora" e "eu sei que é disponível". Conclusão: as representações sociais nos discursos das mulheres em gravidez não planejada estavam pautadas no desconhecimento acerca do planejamento reprodutivo, dos anticoncepcionais disponíveis e seu uso correto.

Objective: to understand the social representations of reproductive planning among women with unplanned pregnancies in the Family Health Strategy. Method: qualitative study, guided by the Theory of Social Representations, carried out with 15 pregnant women between April and May 2019. Semi-structured interviews were used. The data was organized using the Discourse of the Collective Subject, with the aid of DSCsoft© software. Research protocol approved by the Research Ethics Committee. Results: the social representations of women with unplanned pregnancies as evidenced by the Collective Subject Discourse were represented by eight central ideas, namely: "I didn't prevent myself, nor did he", "we prevented ourselves", "I would buy it", "I would get it at the health center", "build a family", "have this access", "I am not aware" and "I know it is available". Conclusion: the social representations in the women's speeches about unplanned pregnancies were based on a lack of knowledge about reproductive planning, the contraceptives available and their correct use.

Objetivo: conocer las representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado en la Estrategia Salud de la Familia. Método: estudio cualitativo, basado en la Teoría de las Representaciones Sociales, realizado con 15 mujeres embarazadas, entre abril y mayo de 2019. Se utilizaron entrevistas semiestructuradas. Los datos fueron organizados mediante el Discurso del Sujeto Colectivo, con ayuda del software DSCsoft©. El protocolo de investigación fue aprobado por el Comité de Ética en Investigación. Resultados: las representaciones sociales de las mujeres con embarazo no planificado reveladas por el Discurso del Sujeto Colectivo fueron representadas por ocho ideas centrales, a saber: "yo no me cuidé y él tampoco", "nos cuidamos", "yo los compraba", "los buscaba en el centro de salud", "construir una familia", "tener acceso", "no participo" y "sé que está disponible". Conclusión: las representaciones sociales en los discursos de las mujeres con embarazo no planificado se basaron en la falta de conocimiento sobre la planificación reproductiva, en los anticonceptivos disponibles y su uso correcto.

Prescribing Information: Elizabeth B. Connell, the Pill, and the (Woman) Patient's Peace of Mind.

Throughout the 1970s and 1980s, commercialized reproductive technologies experienced a reputational crisis as news about the hormonal birth control pill's possible side effects reportedly caused 18-30% of women to stop taking it. While secondary literature has followed patients' and legislatures' actions, few histories have focused on physicians' responses. How did physicians manage this public crisis of confidence? This article contributes to existing literature through a backstage look at the work of Elizabeth B. Connell (1925-2018), whose wide-ranging career in medicine, academia, government, industry consulting, and popular writing embroiled her at the center of these controversies. To counter critique from legislatures and consumer reformers, Connell became a mediator for medicine in the public sphere, dispensing select information and arguing for limits on others - for the patient's sake. If legislative inquiry's primary havoc was unleashing information, Connell would help the profession moderate it. Because Connell was a woman doctor whom health feminists who were her contemporaries denied was a feminist doctor, the existing scholarship has occluded her. This article reconstructs the contributions of this important and flawed doctor, illuminating how she contorted herself to suit her various public messages, constrained by her conflicting, dual identities as woman and doctor.

Survey of Medical Trainees Indicates a Need for Increased Access to Obstetrics and Gynecology Care.

INTRODUCTION: Given the higher rates of infertility and complicated pregnancies among female physicians, we identified a need to assess access to obstetrics and gynecology (OBGYN) care for medical trainees. We hypothesized that medical students and residents are not up-to-date on routine OBGYN care.  Methods: We administered an optional, anonymous survey to all medical students and residents at Albany Medical College (Albany, NY, USA) who self-identified as having a uterus to assess their access to gynecologic care in November 2022. Data collected included demographic information, care-seeking practices, reproductive health screening history, contraception use, and menstrual cycle irregularities.  Results: A total of 184 trainees responded to the survey; 71% were medical students and 29% were residents. Around 11% of respondents had never seen an OBGYN provider. About 45% of respondents had not seen a provider in the last year, 20% had not seen a provider in the last three years, and 37% had not seen a provider since beginning their training. Of the trainees, 26% were not up to date on recommended cervical cancer screening; 35% indicated they had irregular menses; and 50% had not received sexually transmitted infection (STI) testing in the last year. Older age was associated with a lower rate of STI testing. Age and trainee type were both associated with having ever seen an OBGYN provider; both older participants and residents were more likely than younger participants and medical students to have answered 'yes.' Race was also associated with having ever seen an OBGYN provider.  Conclusions: Trainees accessed OBGYN care at lower-than-expected rates. There is an opportunity to improve access to OBGYN care for these trainees, which should be recommended to improve reproductive health in this group.

Assessment of the Validity and Quality of Polycystic Ovarian Syndrome (PCOS) Screening Tools Available for Women Globally: A Systematic Review.

Background: This systematic review has the following aims: (1) to identify measurement tools used globally by healthcare providers to diagnose PCOS in women at elevated risk; (2) to assess the comprehensiveness of these tools regarding mental health and chronic pain; (3) to list strategies for validating, disseminating, and implementing these tools; and (4) to provide future recommendations for experts in healthcare settings. Methods: This review utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the Arksey and O'Malley York methodology. Studies were sourced from the PubMed, Embase, and Cochrane Library databases, with inclusion criteria focusing on peer-reviewed articles addressing PCOS diagnosis and associated comorbidities. Data extraction and analysis followed the Joanna Briggs Institute (JBI) recommendations. Results: A total of 63 studies met the inclusion criteria. Findings indicate that current screening tools for PCOS often lack comprehensive integration of mental health and chronic pain assessments. Tools like the PCOSQ and its updated version, PCOSQ-50, inadequately address pain-related symptoms, highlighting a gap in holistic patient evaluation. This review identified significant associations between PCOS and mental health disorders, including anxiety and depression, emphasizing the need for mental health screenings as part of PCOS management. Conclusions: There is a critical need for validated PCOS screening tools that encompass both physical and psychological aspects of the condition. Educating healthcare providers on the cultural and social determinants influencing PCOS can improve diagnosis and patient outcomes. Future research should focus on developing holistic screening tools and culturally relevant educational resources, aiming to enhance the overall quality of life for women with PCOS.

Using Planned and Unplanned Adaptation to Implement Universal Alcohol Screening and Brief Intervention to Prevent Alcohol-Exposed Pregnancies in Four Primary Care Health Systems.

BACKGROUND: The United States Preventive Services Task Force recommends annual alcohol screening and brief behavioral intervention (alcohol SBI) with general adult and pregnant populations. Implementation of alcohol SBI in primary care has encountered numerous barriers to adapting procedures and infrastructure to support its routine delivery. This collection of case studies describes the implementation strategies used by 4 academic health system teams that were funded by the Centers for Disease Control and Prevention to implement alcohol SBI within healthcare systems to prevent alcohol-exposed pregnancies. METHODS: We used constructs from the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to describe planned and unplanned adaptations to implementation strategies, and the SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix to identify key questions, challenges, and recommendations for improving alcohol SBI implementation. Participating systems were 2 regional affiliates of a national reproductive healthcare organization, an integrated non-profit healthcare system, and an urban medical center and its affiliated network of community health centers. RESULTS: Planned adaptations included expanding the target population for brief interventions to include patients drinking at low levels who could become pregnant, modifying workflows and systems to support routine screening, and customizing training content and logistics. Unplanned adaptations included varying site recruitment and pre-implementation awareness-building strategies to enhance local receptivity of systems with decentralized management, and pivoting from in-person to virtual training during the COVID-19 pandemic. Fewer unplanned adaptations were observed for health systems with centralized management structures and practice teams that were fully engaged in implementation planning, training, roll-out, and problem-solving. CONCLUSIONS: Unplanned adaptations were observed across the 4 cases and emphasized the importance of flexible, adaptive designs when implementing evidence-based practice in dynamic settings. Participation of the health system in planning, including decisions to modify electronic health records and workflows, supported adapting to unplanned circumstances to achieve implementation goals.

Breast cancer and cardiovascular health.

Modern cancer therapies greatly improve clinical outcomes for both early and advanced breast cancer patients. However, these advances have raised concerns about potential short- and long-term toxicities, including cardiovascular toxicities. Therefore, understanding the common risk factors and underlying pathophysiological mechanisms contributing to cardiovascular toxicity is essential to ensure best breast cancer outcomes. While cardio-oncology has emerged as a sub-speciality to address these challenges, it is essential that all cardiologists recognize and understand the cardiovascular consequences of cancer therapy. This review aims to provide a comprehensive overview of the potential adverse cardiovascular effects associated with modern breast cancer therapies. A preventive, diagnostic, and therapeutic workflow to minimize the impact of cardiovascular toxicity on patient outcomes is presented. Key aspects of this workflow include regular monitoring of cardiovascular function, early detection and management of cancer therapy-related cardiovascular toxicities, and optimization of cardiovascular risk factor control. By highlighting the gaps in knowledge in some areas, this review aims to emphasize the critical role of cardio-oncology research in ensuring the holistic well-being of patients with breast cancer.

Cross-cultural study on the uses of traditional herbal medicine to treat various women's health issues in Northeast India.

BACKGROUND: This cross-cultural study conducted in the diverse regions of Assam, Meghalaya, and Manipur sheds light on the common utilization of five specific medicinal plants among indigenous communities residing in these areas. OBJECTIVES: The main focus of this study is to document and compare the traditional medicinal plant used and the knowledge and practices related to women's health issues in different cultures; to identify commonalities and differences in the use of medicinal plants across cultures and various medicinal plants used traditionally by the indigenous communities to treat women's health problems according to their indigenous name, scientific name. MATERIALS AND METHODS: The study used a survey method and a pre-structured interview schedule through one-on-one interactive communication and field observation. The authors collected data from three different states, i.e., Assam (Karbi Anglong district & Udalguri district), Meghalaya (East Khasi Hills district), and Manipur (Senapati district) by personally meeting and interacting with traditional herbal medicinal practitioners. For this study, 10 practitioners from each area of study were interviewed. During the data collection process, the vernacular name of the medicinal plant, methods of preparation, mode of application, and probable dosage were compiled and documented involving practitioners belonging to four different communities, i.e, Bodo, Karbi, Khasi, and Poumai Naga of the selected states. RESULTS: A total of 39 plant species were meticulously collected and documented across the Karbi Anglong district and Udalguri district in Assam, East Khasi Hills district in Meghalaya, and Senapati district in Manipur. Turmeric (Curcuma longa), ginger (Zingiber officinale), gooseberry (Emblica officinalis), papaya (Carica papaya), and passion fruit (Passiflora edulis) have emerged as common medicinal resources within these communities. Poaceae, represented by 5 species, emerged as the dominant family among the collected plants, highlighting the diversity and significance of these botanical remedies. Zingiber officinale Roscoe " has the highest usage report of 18 with an RFC (Relative frequency citation) of 0.45. CONCLUSION: The study's findings reveal a rich repository of traditional herbal knowledge in the northeast regions of India. Notably, the indigenous communities of these regions use plant resources to cure a wide range of ailments. This study emphasizes the necessity of documenting, preserving, and transmitting traditional herbal medicinal knowledge for both cultural and practical reasons. It also provides vital insights into the importance of cross-cultural study in promoting different cultures, the richness of traditional medicinal knowledge by engaging with diverse cultures and demonstrates the possibilities for incorporating traditional medicine into modern healthcare systems, particularly in treating women's health issues across these culturally diverse regions.

Empowering Women's Health: Examining the Impact of Human Papillomavirus (HPV) Vaccination on Cervical Cancer Treatment and Beyond.

This study aims to identify the change in the health status of women, particularly in cervical cancer treatment through HPV vaccination. Thus, the research aims to measure the reduction in the incidence of cervical cancer in vaccinated women and evaluate the impact of HPV vaccination on the overall health and well-being of women treated for cervical cancer. The paper uses a research approach that involves reviewing the literature, analysing epidemiological data, and assessing the impact of the vaccination program. Major observations suggest that many developed countries' campaigns have reduced cervical cancer and enhanced treatment. Further, the study also addresses some additional effects of the intervention, both health-related with an emphasis on the decrease in healthcare costs and an enhancement of the quality of life among women, and social with a focus on the changes in women's status as a result of vaccination. The research also focusses on the community and economic points of view on HPV vaccination programs, its problems and opportunities regarding socio-economic factors, cultural disparities, and healthcare systems. This study implies that working on those barriers by implementing effective interventions, increasing awareness, and demanding relevant changes in policies could improve vaccination levels as well as outcomes. Hence, this research supports HPV vaccination as vital to the future health status of women. Through the use of survey data and the adoption of a public health perspective, the study can fill existing gaps in the literature on preventive interventions and cervical malignancies and consequently contribute to the enhancement of women's health, particularly in developing countries.

Prunes May Blunt Adverse Effects of Oral Contraceptives on Bone Health in Young Adult Women: A Randomized Clinical Trial.

Background: Oral contraceptives (OCs) may promote bone loss, thereby leading to suboptimal bone health later in life. Research is needed to determine whether dietary interventions can blunt OC-related bone loss; prune consumption, shown to be effective in improving bone density in previous studies, could provide a safe and inexpensive solution. Objectives: The purpose of this study was to determine whether 12 mo of consuming 50 g of prunes daily would prevent bone loss or increase bone accrual in young (18-25 y) OC users. Methods: Ninety women were randomly assigned to a control group not using OCs (non-OC), an OC group not consuming prunes (OC), and an OC group consuming 50 g prunes daily (OC+P) for 12 mo. Bone mineral density (BMD) was measured at baseline and after 12 mo via dual-energy X-ray absorptiometry (at all sites) and peripheral quantitative computed tomography (at tibia). Blood samples were collected at baseline and after 6 and 12 mo to assess biomarkers. Results: There were no significant differences between groups for dietary intake, physical activity, serum tartrate-resistant acid phosphatase-5b, or bone alkaline phosphatase concentrations. Baseline serum C-reactive protein and vitamin D concentrations were higher (P < 0.001) for OC and OC+P groups than those in the non-OC group. Serum parathyroid hormone was higher for non-OC group than OC group at both baseline (P = 0.049) and final (P = 0.032). BMD measured by dual-energy X-ray absorptiometry at all sites did not change among groups. Ultradistal radius BMD increased over time (P < 0.05) within non-OC and OC+P groups. Trabecular density of the distal tibia as measured by peripheral quantitative computed tomography decreased from baseline to 12 mo within the OC group only (P = 0.016). Conclusions: OC use tended to promote minor negative effects on bone and consuming prunes tended to provide a potential protective effect on trabecular density of the distal tibia and ultradistal radius.This trial was registered at www.clinicaltrials.gov as NCT04785131.

Combination non-targeted and sGRP78-targeted nanoparticle drug delivery outperforms either component to treat metastatic ovarian cancer.

Metastatic ovarian cancer (MOC) is highly deadly, due in part to the limited efficacy of standard-of-care chemotherapies to metastatic tumors and non-adherent cancer cells. Here, we demonstrated the effectiveness of a combination therapy of GRP78-targeted (TNPGRP78pep) and non-targeted (NP) nanoparticles to deliver a novel DM1-prodrug to MOC in a syngeneic mouse model. Cell surface-GRP78 is overexpressed in MOC, making GRP78 an optimal target for selective delivery of nanoparticles to MOC. The NP + TNPGRP78pep combination treatment reduced tumor burden by 15-fold, compared to untreated control. Increased T cell and macrophage levels in treated groups also suggested antitumor immune system involvement. The NP and TNPGRP78pep components functioned synergistically through two proposed mechanisms of action. The TNPGRP78pep targeted non-adherent cancer cells in the peritoneal cavity, preventing the formation of new solid tumors, while the NP passively targeted existing solid tumor sites, providing a sustained release of the drug to the tumor microenvironment.

Prevalence of stress urinary incontinence symptoms and their impact on the quality of life of Palestinian women: the first large cross-sectional study among the general population.

BACKGROUND: Little studies were conducted to assess the prevalence of stress urinary incontinence among Palestinian women. This study was conducted to determine the prevalence of stress urinary incontinence symptoms, their impact on the quality of life, and the risk factors that were associated with stress incontinence symptoms among Palestinian women. METHODS: This study was conducted in a cross-sectional design from 2023 to 2024. The data were collected through an interviewer-administered questionnaire. The questionnaire collected the demographic and health characteristics of the women. Additionally, the questionnaire also contained the PRAFAB questionnaire (PRAFAB-Q). Moreover, the questionnaire included the Assessment of Quality of Life (AQoL)-8D scale. RESULTS: Data were collected from 386 Palestinian women (response rate = 85.8%). The mean age of women in this study was 37.1 ± 14.7 years. In this study, 104 (26.9%) reported stress urinary incontinence symptoms. Of the women, 102 (26.4%) reported urinary leakage during coughing, 100 (25.9%) reported urinary leakage during sneezing, and 94 (24.4%) reported urinary leakage during laughing. The women who had a family history of stress incontinence were 2.5-fold (95% CI: 1.2-5.2) more likely to have stress incontinence symptoms compared to the women who did not have a family history of stress incontinence. Similarly, the women who were overweight/obese were 2.0-fold (95% CI: 1.1-3.7) more likely to have stress incontinence symptoms compared to the women who were underweight or had a normal weight. PRAFAB-Q scores were predicted by place of residence, family history of stress incontinence, and being recruited from a hospital. CONCLUSION: The study reported a high prevalence of stress urinary incontinence and identified the risk factors that were associated with stress incontinence symptoms among Palestinian women. The findings showed that the intensity of stress urinary incontinence symptoms was associated with deteriorated quality of life of the affected women. These findings could be used by urologists, gynecologists, obstetricians, and other healthcare providers caring for women to design ways to reduce the burden of stress urinary incontinence among Palestinian women and improve their quality of life.

Clinical characteristics and long-term prognosis of female patients with acute coronary syndrome.

Background: Cardiovascular disease has traditionally been studied predominantly in men, but understanding its manifestations in women is crucial for effective management. This study aims to evaluate the long-term prognosis of female patients with acute coronary syndrome (ACS) within a tertiary hospital setting in Spain. Methods: Retrospective observational study based on a cohort of consecutive hospitalized patients with ACS from January 2009 to December 2014. Data on demographics, risk factors, treatment, and outcomes were collected, with a median follow-up of 9.2 years. Results: Women with ACS, constituting 27.3% of 2,330 patients, were older and had a higher prevalence of cardiovascular risk factors such as obesity, hypertension, and diabetes mellitus compared to men. They presented with more non-ST-segment elevation myocardial infarction and underwent less coronary angiography. Female patients were also less likely to be treated with acetylsalicylic acid, a second antiplatelet drug, or statins. Despite initial higher mortality rates [hazard ratio (HR) 1.30; 95% confidence interval (CI) 1.13-1.49; p < 0.001], female patients exhibited a more favorable long-term prognosis after adjustments (adjusted HR 0.82; 95% CI 0.71-0.96; p = 0.014), even in the subgroup analysis excluding patients with unstable angina. Conclusions: Women with ACS are more comorbid, but after adjustments, female sex appears to be a protective factor that confers a better long-term prognosis.

Unravelling the nexus of microfinance and women's non-communicable disease (NCD) health outcomes in Sri Lanka: An exploratory study.

ABSTRACTNon-communicable diseases (NCDs) are a major contributor to the global burden of disease, increasingly impacting low-income and marginalised populations in low- and middle-income countries such as Sri Lanka. Microfinance could be a potential approach to target NCDs. Using an ethnographic approach with thematic analysis, this study explored the nexus between microfinance and NCD outcomes. In-depth interviews were conducted with 29 micro-loan borrowing women across 15 field sites within Puttalam district in Sri Lanka. The findings revealed that perceived increases in income from microfinance loans contributed to enhanced household health savings ability, enabling the purchase of medicines bought out-of-pocket and from privately owned pharmacies, and spending for NCD-relevant health emergencies and health-related transportation. Additionally, perceived income increases also influenced the behavioural risks, including the spending and consumption of food, and physical activity levels, both positively and negatively. The microfinance networks also influenced women's perceived social support, psychological stress and coping mechanisms, and health information transmission, positively and negatively. The findings from this study provide important insights on how financial inclusion programs such as microfinance influence the health determinants and outcomes relevant to NCDs. This can help address ways to target both NCDs and inequities of socioeconomically disadvantaged and marginalised populations, particularly women.

Breast Cancer Risk Assessment Tool (BCRAT) and long-term breast cancer mortality in the Women's Health Initiative.

BACKGROUND: While the Breast Cancer Risk Assessment Tool (BCRAT) predicts breast cancer incidence, the model's performance, re-purposed to predict breast cancer mortality, is uncertain. Therefore, we examined whether the BCRAT model predicts breast cancer mortality in postmenopausal women in the Women's Health Initiative (WHI). METHODS: BCRAT 5-year breast cancer incidence risk estimates were calculated for 145,408 women (aged 50-79 years) enrolled in the WHI at 40 US clinical centers to examine associations of BCRAT risk groups (< 1%, 1-< 3%, ≥ 3%) with breast cancer mortality using Cox proportional regression modeling in all participants and in those with incident breast cancer. RESULTS: Women with BCRAT ≥ 3% risk, compared to women with BCRAT < 1% risk, were older (age 70-79 years: 38.3% versus 5.3%), less commonly Black (1.1% versus 40.2%), and had stronger breast cancer family history. With 20-years follow-up, considering all participants, with 8,849 breast cancers and 1,076 breast cancer deaths, breast cancer mortality in BCRAT group ≥ 3% was not higher versus BCRAT group < 1% (Hazard Ratio [HR] 1.06 95% Confidence Interval [CI] 0.80-1.40): percent without 20-year breast cancer mortality; 99.4% [group < 1%] and 98.8% [group ≥ 3%]. Considering women with incident breast cancer, breast cancer mortality was also not higher in BCRAT group ≥ 3% versus BCRAT group < 1% (HR 1.07 95% CI 0.79-1.45). CONCLUSIONS: The BCRAT model, at ≥ 3% 5-year incidence risk (US guideline threshold for chemoprevention), does not identify women with higher breast cancer mortality risk, with implications for breast cancer prevention strategies.

Black college women's preventive health behaviors: Applications of a Black Feminist-Womanist research paradigm.

OBJECTIVE: The researchers applied Lindsay-Dennis' Black Feminist-Womanist research paradigm to Andersen's Behavioral Model for Health Service Use to guide initial research about Black American women's preventive health behaviors. METHODS: This article highlights this application, using interpretive phenomenological analysis for qualitative questions assessing how 40 Black college women define health and their experiences in health care. This was part of a larger convergent parallel mixed-methods approach in a 2022 cross-sectional online survey. RESULTS: Participants defined health as a concept involving health literacy, physical and mental health, and being free from health conditions or disease. Regarding health-related lived experiences, negative experiences were more frequently reported than positive experiences. However, many participants reported both positive and negative health care related experiences. Predisposing, enabling, and need factors were all present in qualitative responses. CONCLUSIONS: This article highlights the fit of a Black Feminist-Womanist research paradigm to Andersen's model to better understand Black women's health experiences and illustrates ways that medical mistrust, health literacy, and past experiences with health care can influence health service use. Areas for future research on barriers and facilitators to preventive care and implications for reducing health disparities are also discussed.

The experiences and psychological impact of living with premenstrual disorders: a systematic review and thematic synthesis.

Introduction: As the psychological impact and decreased quality of life experienced by women living with a Premenstrual Disorder (PMD) has been reported in the literature, the aim of this systematic review and thematic synthesis was to explore a) their experiences and the psychological impact of PMDs, specifically Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD), and b) their perceived support needs. Method: Six databases were searched for publications reporting on qualitative studies, since the database inception. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. Results: Seventeen papers reporting on 479 women met the inclusion criteria: ten focused on PMS, six on PMDD and one on PMS and PMDD combined. Two main PMD themes were identified: 1) controlled by PMDs, which had three subthemes, and 2) a women and life left broken, with five subthemes. Conclusion: Women's accounts revealed that experiences of PMDs were intense, life changing and life-controlling. Women were left holding the responsibility of understanding and managing their own condition, whilst advocating for themselves in a healthcare setting in which their condition has been little understood. Consequently, women developed coping strategies to lead a functional life, and experienced changes to their sense of self. Clinical recommendations included the need for professionals working with women in crisis, to assess for PMDs and signpost towards specialist services.

Psychological needs, self-efficacy, motivation, and resistance training outcomes in a 16-week barbell training program for adults.

Background: Despite extensive research on the relationship between psychological factors and aerobic training, there remains a gap in understanding these relationships within resistance training (RT), particularly barbell-based RT. This study aimed to examine the associations between basic psychological needs, behavioral regulation, self-efficacy, and a longitudinal barbell-based RT program for adults. Methods: Forty-three adults (M age = 45.09 ± 10.72) were recruited from the Competitive Edge resistance training program at a medical fitness center in Northwest Montana. The study followed an 18-week schedule: 8 weeks of training, 1 week of active recovery, and 8 additional weeks of training. Results: The results reveal several significant findings. First, the basic psychological need for competence significantly increased from baseline (M = 5.06) to post-program (M = 5.30), (p = 0.017). Second, the composite score of the BREQ-3 significantly predicting muscular strength improvements in the deadlift (ß = 3.64, p = 0.039). Third, both mastery (p = 0.021) and resilience (p = 0.007) self-efficacy subscales increased from baseline to post-program. Fourth, exploratory analyses indicated that the reasons to exercise scale predicted increases in muscular endurance with the weight management (ß = 10.016, p = 0.046) and solitude (ß = 6.792, p = 0.037) subscales. Conclusion: These findings highlight the importance of psychological factors in predicting strength outcomes and muscular endurance, suggesting that psychological interventions may complement physical training to maximize benefits. This research contributes valuable insights into how psychological factors influence training outcomes, potentially guiding future interventions and program designs to better support strength development and endurance in resistance training contexts.

Caring for Women in an Active War Zone.

Emergency nursing in Gaza's war zone presents innumerable challenges when caring for female patients in a depleted health care system. Negative health outcomes specifically impact women of all ages due to lack of access to menstrual products, prenatal and primary care, private bathrooms, medication, essential nutrition, and clean water. The massive destruction of infrastructure and consequent internal displacement of millions has led to a rise in infectious diseases. The few remaining functional hospitals depend heavily on foreign medical delegations for supplies, which results in a lack of standardized treatment for women's health complaints. Emergency departments must also navigate overcrowding, lack of basic supplies and specialists, and prioritization of daily mass casualty incidents from nearby explosions. These obstacles make treatment, discharge teaching, and follow-up care for women's health difficult to implement. Despite these arduous circumstances, Gazan health care professionals find innovative solutions to improve outcomes and reduce harm while honoring the cultural and religious preferences of their female patients.