Qualitative Study to Explore the Occupational and Reproductive Health Challenges among Women Tobacco Farm Laborers in Mysore District, India.

Tobacco farm laborers are primarily women and children working for very low wages. The aim of this study was to explore occupational and reproductive health challenges faced by women tobacco farm laborers in Mysore District, India. We conducted interviews and six focus group discussions among 41 women tobacco farm laborers. Codes and themes were generated based on deductive and inductive approaches using the socioecological model. Participants reported symptoms of green tobacco sickness including headaches, back pain, gastric problems, weakness, and allergies during menstruation, pre-natal, and post-natal periods. Participants had poor awareness about the health effects of tobacco farming, and there were gender inequalities in wages and the use of personal protective equipment. Participants received support from family and community health workers during their pregnancy and post-natal period. Women reported wanting maternity benefits from the tobacco board, as well as monetary support and nutritional supplements. There is a need for health education about the environmental dangers of tobacco among farm laborers, and more supportive policies for women farmworkers during pregnancy and post-natal periods.

Action framework for reproductive health promotion: Analysis of contemporary French public policies using a critical lexicometric approach and a transgender perspective / Cadre d'action de promotion de la santé reproductive : analyse critique lexicométrique et trans des politiques publiques françaises contemporaines.

INTRODUCTION: In France, since 2017 the law has allowed people to change the gender marker on their civil status documents without having undergone medical treatment and sterilization surgery. However, no legislative framework has been provided to ensure their right to family, leaving those who wish to become parents in a space of social, political, and legal uncertainty that is inconsistent with international and human rights. In parallel, France has developed an arsenal of health strategies that constrain actors working in the field. PURPOSE OF THE RESEARCH: This study examines the possibilities available to public health actors for promoting reproductive health in the absence of legislation and in the context of political and legislative adversity. To this end, it relies on a participatory, critical, and lexicometric analysis of national strategies for sexual and reproductive health and parenthood support. RESULTS: Governance strategies make no mention of parentality among transgender people. Sexual and reproductive health policies focus on tackling sexually transmitted infections, on health pathways, and on violence and discrimination. The analysis also highlights a lack of awareness on this topic. CONCLUSIONS: Shortcomings in the legislative framework and public health strategies raise ethical questions about the promotion of reproductive health and the potentially non-inclusive approach of actors in the field. These issues force communities to carry out actions outside the scope of ordinary regulations, and they highlight the political positioning of the public-health field in France.

Introduction: Depuis 2017, la loi française a mis fin à la nécessité d'intervention médicale et de stérilisation des personnes faisant modifier leur sexe administratif à l'état civil. Pour autant, aucun cadre législatif n'a été prévu pour garantir leur droit à la famille, ancrant leurs projets parentaux dans un aléa social, politique et juridique contraire aux droits humains et internationaux. Parallèlement, l'État français s'est doté d'un arsenal de stratégies de santé contraignant la place et le rôle des actrices et acteurs de terrain. But de l'étude: Cette étude interroge les possibilités des actrices et acteurs de santé publique à promouvoir la santé reproductive des personnes en l'absence de toute législation et dans un contexte d'adversité politique et législative. Pour cela, elle s'appuie sur une analyse participative, critique et lexicométrique des stratégies nationales de santé sexuelle et reproductive et de soutien à la parentalité. Résultats: La parentalité des personnes trans est absente des stratégies de gouvernance. Les politiques de santé sexuelle et reproductive se centrent autour de la lutte contre les infections sexuellement transmissibles, les parcours de santé et les discriminations et violences. L'analyse fait également ressortir la méconnaissance de cet enjeu. Conclusions: Les manquements du cadre législatif et des stratégies de santé publique interrogent les possibilités éthiques pour les actrices et acteurs de terrain de promouvoir la santé reproductive de manière non inclusive. Ce constat condamne les communautés à mener des actions en dehors du droit commun et pose la question de la place politique du champ de la santé publique en France.

Beyond the reproductive tract: gut microbiome and its influence on gynecological health.

PURPOSE OF REVIEW: The analysis of microbiome in association with female health is today a "hot topic" with the main focus on microbes in the female reproductive tract. Nevertheless, recent studies are providing novel information of the possible influence of the gut microbiome on gynecological health outcomes, especially as we start to understand that the gut microbiome is an extended endocrine organ influencing female hormonal levels. This review summarizes the current knowledge of the gut microbes in association with gynecological health. RECENT FINDINGS: The gut microbiome has been associated with endometriosis, polycystic ovary syndrome, gynecological cancers, and infertility, although there is a lack of consistency and consensus among studies due to different study designs and protocols used, and the studies in general are underpowered. SUMMARY: The interconnection between the gut microbiome and reproductive health is complex and further research is warranted. The current knowledge in the field emphasizes the link between the microbiome and gynecological health outcomes, with high potential for novel diagnostic and treatment tools via modulation of the microenvironment.

Correlates of sexual and reproductive health service utilization among older adults in China: Findings from the sexual well-being (SWELL) study.

BACKGROUND: Sexual and reproductive health (SRH) is critical to the overall health of older adults. We assessed the utilization of SRH services and its correlates among older adults in China. METHODS: We recruited community-dwelling adults aged 50 and above in five Chinese cities between June 2020 and December 2022. In this study SRH services included reproductive health examination, cervical cancer screening, and sexual life counselling. Logistic regression was used to assess correlates of SRH services utilization. RESULTS: A total of 3001 older adults (1819 men and 1182 women) were enrolled. Among them, 11.4 % (343/3001) of participants received a reproductive health examination, 35.4 % (418/1182) of female participants received cervical cancer screening, and 30.1 % (401/1332) of sexually active participants sought help for their sexual lives. Older men with an annual income of USD 7500 or more (aOR = 3.21, 95%CI: 1.39-7.44), two or more chronic conditions (2.38, 1.39-4.08), and reproductive health problems (2.01, 1.18-3.43) were more likely to receive a urological examination. For older women, individuals who were younger (aged 50-59 years: 5.18, 2.84-9.43; aged 60-69 years: 2.67, 1.49-4.79), lived in an urban area (1.88, 1.31-2.71), were employed (1.73, 1.21-2.47), had two or more chronic conditions (2.04, 1.37-3.05), were sexually active (1.72, 1.15-2.58) and talked about sex (1.69, 1.21-2.36) were more likely to receive a gynecological examination. CONCLUSION: SRH services utilization among older adults was low, with urological examination among older men particularly low. SRH messages and services tailored for older adults are needed to enhance their utilization of SRH services.

Impact of DEHP exposure on female reproductive health: Insights into uterine effects.

Several endocrine disrupting compounds released from plastics, including polyfluoroalkyl substances, bisphenols, flame retardants, phthalates and others, are of great concern to human health due to their high toxicity. This review discusses the effects of di-(2-ethylhexyl) phthalate (DEHP), the most common member of the phthalate family, on female reproduction. In vitro and in vivo studies link DEHP exposure to impaired hypothalamic-pituitary-ovarian s (HPO) axis function, alteration of steroid-hormone levels and dysregulation of their receptors, and changes in uterine morphophysiology. In addition, high urinary DEPH levels have been associated with several reproductive disorders in women, including endometriosis, fibromyoma, fetal growth restriction and pregnancy loss. These data suggest that DEHP may be involved in the pathophysiology of various female reproductive diseases. Therefore, exposure to these compounds should be considered a concern in clinician surveillance practices for women at reproductive age and should be regulated to protect their health and that of their progeny.

Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe.

A retrospective facility-based costing study was undertaken to estimate the comparative cost per visit of five integrated sexual and reproductive health and HIV (human immuno-deficiency virus) services (provider perspective) within five clinic sites. These five clinics were part of four service delivery models: Non-governmental-organisation (NGO) directly managed model (Chitungwiza and New Africa House sites), NGO partner managed site (Mutare site), private-public-partnership (PPP) model (Chitungwiza Profam Clinic), and NGO directly managed outreach (operating from New Africa House site. In addition client cost exit interviews (client perspective) were conducted among 856 female clients exiting integrated services at three of the sites. Our costing approach involved first a facility bottom-up costing exercise (February to April 2015), conducted to quantify and value each resource input required to provide individual SRH and HIV services. Secondly overhead financial expenditures were allocated top-down from central office to sites and then respective integrated service based on pre-defined allocation factors derived from both the site facility observations and programme data for the prior 12 months. Costs were assessed in 2015 United States dollars (USD). Costs were assessed for HIV testing and counselling, screening and treatment of sexually transmitted infections, tuberculosis screening with smear microscopy, family planning, and cervical cancer screening and treatment employing visual inspection with acetic acid and cervicography and cryotherapy. Variability in costs per visit was evident across the models being highest for cervical cancer screening and cryotherapy (range: US$6.98-US$49.66). HIV testing and counselling showed least variability (range; US$10.96-US$16.28). In general the PPP model offered integrated services at the lowest unit costs whereas the partner managed site was highest. Significant client costs remain despite availability of integrated sexual and reproductive health and HIV services free of charge in our Zimbabwe study setting. Situating services closer to communities, incentives, transport reimbursements, reducing waiting times and co-location of sexual and reproductive health and HIV services may help minimise impact of client costs.

Sexual and Reproductive Health Care after Gonadotoxic Treatment in Females at a Tertiary Pediatric Hospital.

STUDY OBJECTIVES: Recommendations from the Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancer emphasize the importance of reproductive health care, yet little is known regarding adherence to these recommendations and non-fertility-related sexual and reproductive health (SRH) outcomes. METHODS: Follow-up of outcomes on the basis of the COG-LTFU guidelines was assessed in female patients who underwent fertility preservation consultation before gonadotoxic therapy between 2016 and 2022 at a single institution and were at least 6 months from treatment completion. RESULTS: We included 140 patients, with a mean time of 2.7 years from treatment completion. Eighty-six patients were 12 years old or older, of whom sexual activity was recorded in 59 (68.7%), and 12 of 31 (38.7%) sexually active patients underwent sexual function assessment. The 57 (66.3%) patients at high risk of premature ovarian insufficiency (POI) at diagnosis were more likely than minimal-risk counterparts (29, 33.7%) to have abnormal uterine bleeding (42.1% vs 17.2%, P = .03), to be diagnosed with POI (29.8% vs 0%, P = .01), and to have sexual activity recorded (77.2% vs 51.7%, P = .03). Of 17 patients with POI, 82.4% were on hormone replacement therapy, and 58.8% had undergone bone mineral density testing. CONCLUSION: This study adds to the limited literature regarding non-fertility-related SRH outcomes after gonadotoxic therapy and illustrates opportunities to improve adherence to the COG-LTFU guidelines. Increased attention to SRH guidelines may increase detection and treatment of SRH conditions, improving the health and quality of life of female cancer survivors.

The effect of red blood cell disorders on male fertility and reproductive health.

Male infertility is defined as a failure to conceive after 12 months of unprotected intercourse owing to suspected male reproductive factors. Non-malignant red blood cell disorders are systemic conditions that have been associated with male infertility with varying severity and strength of evidence. Hereditary haemoglobinopathies and bone marrow failure syndromes have been associated with hypothalamic-pituitary-gonadal axis dysfunction, hypogonadism, and abnormal sperm parameters. Bone marrow transplantation is a potential cure for these conditions, but exposes patients to potentially gonadotoxic chemotherapy and/or radiation that could further impair fertility. Iron imbalance might also reduce male fertility. Thus, disorders of hereditary iron overload can cause iron deposition in tissues that might result in hypogonadism and impaired spermatogenesis, whereas severe iron deficiency can propagate anaemias that decrease gonadotropin release and sperm counts. Reproductive urologists should be included in the comprehensive care of patients with red blood cell disorders, especially when gonadotoxic treatments are being considered, to ensure fertility concerns are appropriately evaluated and managed.

Implications of lifestyle factors on male reproductive health.

In recent decades, there has been a substantial decline in sperm quality in humans, with lifestyle factors playing a major role in this trend. There are several lifestyle factors which are contributing to male infertility. This review, however, discusses factors such as obesity, diet/nutrition, psychological stress, radiation exposure, cigarette smoking, and alcohol use with reference to male infertility. Sperm count, motility, morphology and sperm DNA may be adversely affected by lifestyle factors, which may also affect the endocrine regulation of reproductive function. The decline in male fertility has a significant impact on fertility rates, and the resulting implications for the human population make this a serious public health concern in the twenty-first century. Thus, lifestyle interventions through a specific framework of educational, environmental, nutritional/physical exercise, and psychological support coupled with the use of nutritional antioxidants supplements can help couples achieve better health and well-being and improve their fertility prospects or increase their chances of conception.

Lineamientos técnicos para la atención preconcepcional y alto riesgo reproductivo / Technical guidelines for preconceptional care and high reproductive risk

La Ley Nacer Con Cariño para un parto respetado y un cuidado cariñoso y sensible para el Recién Nacido, tiene por objeto garantizar y proteger los derechos de la mujer desde el periodo preconcepcional, embarazo, parto y puerperio, así como los derechos de los niños y niñas desde la concepción, gestación, durante el nacimiento y la etapa de recién nacido, a través del establecimiento de los principios y normas generales para la organización y funcionamiento del Sistema Nacional Integrado de Salud. La atención preconcepcional comprendida en el marco de la ley, deberá considerar un derecho con enfoque holístico, en donde las acciones desarrolladas provengan de la mejor evidencia científica disponible. La salud materna y la salud neonatal están estrechamente vinculadas, por ello se hace importante generar lineamientos que establezcan disposiciones necesarias para la atención integral en salud desde la preconcepción hasta la finalización del embarazo

The Law Born With Care for a respected birth and a caring and sensitive care for the newborn, aims to guarantee and protect the rights of women from the preconception period, pregnancy, delivery and puerperio, as well as the rights of children from conception, gestation, birth and newborn, through the establishment of general principles and rules for the organization and operation of the National Integrated Health System. Preconceptional attention within the framework of the law should consider a right with a holistic approach, where the actions developed come from the best available scientific evidence. Maternal health and neonatal health are closely linked, so it is important to generate guidelines that establish necessary provisions for comprehensive health care from preconception to the end of pregnancy

Estrategias usadas en la atención de la salud sexual de poblaciones rurales de bajos ingresos / Strategies Used in Sexual Health Care for Low-Income Rural Populations / Estratégias utilizadas na atenção à saúde sexual de populações rurais de baixa renda

Introducción: en la ejecución de políticas públicas de salud sexual, resultan cruciales las estrategias utiliza-das en la construcción de la relación agente de salud-usuario. En la literatura son pocos los artículos que exploran las estrategias que utilizan los agentes de salud para interactuar con pobladores rurales al abor-dar estas problemáticas. Este artículo se propone describir y comprender las estrategias que utilizan los agentes de salud en la atención de la salud sexual y reproductiva de pobladores rurales de bajos ingresos. Para ello, se conceptualiza la relación médico-paciente como una interfaz social, es decir, como un espacio de articulación entre los mundos de sentido de los actores involucrados. Materiales y métodos: se desarrolló un estudio de carácter exploratorio-descriptivo de tipo transversal. Se realizaron 21 entrevistas semiestruc-turadas a agentes del sistema de salud, y su análisis se hizo desde un enfoque cualitativo. Resultados: los agentes de salud utilizan un amplio repertorio de estrategias para abordar la salud sexual de los pobladores rurales. Se identificaron y caracterizaron dos tipos de estrategias (dialógicas y monológicas), con sus respectivos subtipos. Conclusión: el estudio visibiliza las estrategias dialógicas como modo alternativo de relación médico-paciente, en contraste con estrategias tradicionales, de tipo monológico. Además, contribuye a la formación de los agentes de salud, y en la conformación de los equipos que abordan la salud sexual y reproductiva en contextos rurales

Introduction: The strategies used for constructing health agent-user relationship are crucial for exe-cuting public policies on sexual health. In the literature, few articles explore the strategies used by health agents to interact with rural residents when addressing these problems. We aimed to describe and understand these strategies used by health agents for sexual health care in low-income rural resi-dents. To achieve this, the doctor­patient relationship is assumed to be a social interface and a space of articulation between the worlds of meaning of the actors involved. Materials and methods: An explor-atory, descriptive, and cross-sectional study was developed. Overall, 21 semistructured interviews were conducted with health agents, and the results were qualitatively analyzed. Results: Health agents use a wide repertoire of strategies to address the sexual health of rural residents. Two types of strategies (dia-logical and monological) and their respective subtypes were identified and characterized. Conclusion:Dialogic strategies are an alternative to the doctor­patient relationship and are contradictory to the traditional monological strategies. They impact the training of health agents and the formation of teams that address sexual and reproductive health in rural settings

Introdução: na execução das políticas públicas de saúde sexual, as estratégias utilizadas na construção da relação agente de saúde-usuário são cruciais. Na literatura são escassos os artigos que exploram as estratégias utilizadas pelos agentes de saúde para interagir com os moradores rurais na abordagem desses problemas. Este estudo se propõe a descrever e compreender as estratégias utilizadas pelos agen-tes de saúde na atenção à saúde sexual e reprodutiva de moradores rurais de baixa renda. Para isso, a relação médico-paciente é conceituada como interface social, ou seja, como espaço de articulação entre os mundos de sentido dos atores envolvidos. Materiais e métodos: foi desenvolvido um estudo transver-sal exploratório-descritivo. Foram realizadas 21 entrevistas semiestruturadas com agentes do sistema de saúde e sua análise foi feita a partir de uma abordagem qualitativa. Resultados: os agentes de saúde utilizam um amplo repertório de estratégias para abordar a saúde sexual dos residentes rurais. Dois tipos de estratégias (dialógicas e monológicas) foram identificadas e caracterizadas, com seus respecti-vos subtipos. Conclusão: este estudo torna visíveis as estratégias dialógicas como modo alternativo de relação médico-paciente, em contraste com as estratégias tradicionais de tipo monológico. Além disso, contribui para a formação de agentes de saúde e na formação de equipes que abordem saúde sexual e reprodutiva em contextos rurais.

Women's Awareness of Reproductive Health.

Background and Objectives: reproductive disorders are a serious global concern in medical, social, and demographic contexts. According to estimates, approximately 10-15% of couples around the world suffer from infertility. Numerous studies have shown that modifiable lifestyle factors, such as a high-fat diet, a postponed decision to start a family, tobacco smoking, alcohol consumption, risky sexual behavior, psychiatric diseases, and chronic stress, have a negative influence on the fertility of women. The main goal of this study is to assess the knowledge of women about reproductive health, infertility risk factors, and causes of infertility and to determine whether the level of this knowledge varies based on sociodemographic variables. Materials and Methods: a survey was conducted among 111 patients who anonymously filled in a questionnaire comprising questions regarding fertility and its deficiencies. The results were analyzed using the Chi-square test and Fisher's test. Results: the survey results indicated that women had a good or very good level of knowledge of the causes of infertility. The obtained test results were statistically significant (p < 0.05), but the studied group did not possess sufficient knowledge of the symptoms characterizing the diseases related to limited fertility (p > 0.05). The level of knowledge on the diagnosis of infertility did not depend on the age of the examined people, their educational level, or personal experience in this field (p > 0.05). The results also revealed that the awareness of women on reproductive health was poor. The studied women had a low level of knowledge of infertility risk factors, and their knowledge did not correlate with age, educational level, or personal experiences. Conclusions: information on the aspects of reproductive health should be widely disseminated through public educational campaigns, aimed at correcting erroneous convictions among women about the risk factors for infertility and assisting them in improving fertility.

Emerging Role of Eruca sativa Mill. in Male Reproductive Health.

A growing interest has been drawn to the use of traditional medicinal plants for the treatment of human diseases and, in particular, infertility and reproductive toxicity associated with environmental factors. The Mediterranean basin area is a recognized source of plant species with therapeutic interest. In this frame, Eruca sativa (ES) is an annual edible plant and a member of the Brassicaceae family. A relatively large number of studies, focusing on the biological effects of the extract from the leaves of ES on in vitro and in vivo models of disease, have been published in recent years. The present narrative review aims to analyze the phytochemical constituents, traditional uses, possible pharmacological activities, and recognized effects of ES on male reproductive outcomes. Available investigations have revealed the presence of a number of compounds with antioxidant properties, such as polyphenols, glucosinolates, flavonoids, and carotenoids in extracts from ES. Based on the chemical and pharmacological characteristics of the aforementioned compounds, we show that ES has possible preventive properties and therapeutic uses, especially in the functional derangements of the male reproductive system.

Increasing Rates of Human Papillomavirus Catch-Up Vaccination at a Sexual and Reproductive Health Clinic: A Quality Improvement Project.

INTRODUCTION: Catch-up human papillomavirus (HPV) vaccination of adults aged 19 to 26 who were not vaccinated as children or adolescents may decrease rates of HPV-associated cancer. The purpose of this project was to increase uptake of catch-up HPV vaccination at a sexual and reproductive health clinic through the implementation of a multicomponent, systems-based intervention. PROCESS: Catch-up vaccination rates were recorded at an intervention health clinic and a comparison health clinic. A comparative, interrupted time series design was used to compare rates of catch-up vaccination pre- and postintervention. Electronic health record prompts, in-clinic education, and scheduling of a next visit at the current visit were implemented. Data were analyzed using descriptive statistics, t tests, and regression analysis. OUTCOMES: The proportion of all patients aged 19 to 26 who received an HPV vaccination rose at the intervention health clinic from 0.76% preintervention to 4.42% postintervention. At the intervention clinic there was a nonsignificant increase (4.47 minutes) in average daily patient cycle times between the pre- and postintervention periods (t(13) = 1.895, P = .075). DISCUSSION: Rates of catch-up HPV vaccination increased significantly following the multicomponent, systems-based intervention. Further iteration of the quality improvement process should examine the sustainability of the interventions and the effects of the intervention on vaccine series completion.

Endocrine disruptors: Unravelling the link between chemical exposure and Women's reproductive health.

An Endocrine Disrupting Chemical (EDC) is any compound that disrupts the function of the endocrine system in humans and is ubiquitous in the environment either as a result of natural events or through anthropogenic activities. Bisphenol A, phthalates, parabens, pesticides, triclosan, polychlorinated biphenyls, and heavy metals, which are frequently found in the pharmaceutical, cosmetic, and packaging sectors, are some of the major sources of EDC pollutants. EDCs have been identified to have a deteriorating effect on the female reproductive system, as evidenced by the increasing number of reproductive disorders such as endometriosis, uterine fibroids, polycystic ovary syndrome, premature ovarian failure, menstrual irregularity, menarche, and infertility. Studying EDCs in relation to women's health is essential for understanding the complex interactions between environmental factors and health outcomes. It enables the development of strategies to mitigate risks, protect reproductive and overall health, and inform public policy decisions to safeguard women's well-being. Healthcare professionals must know the possible dangers of EDC exposure and ask about environmental exposures while evaluating patients. This may result in more precise diagnosis and personalized treatment regimens. This review summarises the existing understanding of prevalent EDCs that impact women's health and involvement in female reproductive dysfunction and underscores the need for more research. Further insights on potential mechanisms of action of EDCs on female has been emphasized in the article. We also discuss the role of nutritional intervention in reducing the effect of EDCs on women's reproductive health. EDC pollution can be further reduced by adhering to strict regulations prohibiting the release of estrogenic substances into the environment.

How a "Something Else" Response Option for Sexual Identity Affects National Survey Estimates of Associations Between Sexual Identity, Reproductive Health, and Substance Use.

This randomized experiment tested whether the inclusion of a "something else" response option for a question about sexual identity in a national health survey would significantly moderate estimated differences between sexual identity subgroups in terms of various health outcomes, including substance use and reproductive health. We conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (NSFG; 2015-2019), where two large national half-samples were randomly assigned to receive one of two different versions of a question about sexual identity (a four-category version that included a "something else" response option or a three-category version omitting this option). We focused on national estimates of differences between subgroups defined by sexual identity. Multivariable models indicated that the estimated subgroup differences changed in a statistically significant fashion when using the four-category version of the sexual identity question for several measures, including 16% of male measures (household size, past-year cigarette use, and past-year illicit drug use) and 15% of female measures (wanting a/another child, ever had a sexually transmitted disease, and past-year marijuana use). The absence of a "something else" response option for questions about sexual identity in national health surveys may cause respondents to select options that do not accurately describe their identities, and this can have a significant effect on national estimates of differences between sexual identity subgroups in terms of selected health outcomes.

Effects of long-term proton pump inhibitor use on sexual hormones and sexual and reproductive health in female patients.

PURPOSE: Proton pump inhibitors (PPIs) are widely used to treat a range of gastrointestinal diseases around the world. Long-term use of PPIs has been associated to a variety of undesirable effects. Although short-term therapy has been shown to have little or no effect on endocrine hormone in women, however, its long-term safety has received little attention. We aimed at evaluating long-term use of PPIs and its effects on female reproductive hormones as well as related clinical consequences. METHODS: A cross-sectional study was conducted in two outpatient gastroenterology clinics in the province of Khyber Pakhtunkhwa. This study included female patients who had been using PPIs on a regular basis for 3 months or more. RESULTS: In total of 101 participants, patients with sexual complaints have significantly altered levels of prolactin (p = 0.05), estrogen (p < 0.001) and progesterone (p = 0.001) than patient without sexual complaints. The frequency of amenorrhea (p < 0.001), cyclic disturbances (p < 0.001), breast augmentation (p = 0.001) and painful breast (p = 0.004) were statistically significant in patients with raised serum prolactin values. Serum values of Sex hormone binding globulin SHBG (p < 0.001), estradiol (p = 0.002) and total testosterone (p < 0.001) were significantly altered between normal prolactin and hyperprolactinemic patients. CONCLUSION: These findings suggest that long-term PPI use may cause endocrine hormone disturbances leading to sexual difficulties in women.

Global impacts of COVID-19 pandemic on sexual and reproductive health services: An international comparative study on primary care from the INTRePID Consortium.

OBJECTIVE: To understand how the COVID-19 pandemic has impacted sexual and reproductive health (SRH) visits. DESIGN: An ecological study comparing SRH services volume in different countries before and after the onset of the COVID-19 pandemic. SETTING: Seven countries from the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID) across four continents. POPULATION: Over 3.8 million SRH visits to primary care physicians in Australia, China, Canada, Norway, Singapore, Sweden and the USA. METHODS: Difference in average SRH monthly visits before and during the pandemic, with negative binomial regression modelling to compare predicted and observed number of visits during the pandemic for SRH visits. MAIN OUTCOME MEASURES: Monthly number of visits to primary care physicians from 2018 to 2021. RESULTS: During the pandemic, the average volume of monthly SRH visits increased in Canada (15.6%, 99% CI 8.1-23.0%) where virtual care was pronounced. China, Singapore, Sweden and the USA experienced a decline (-56.5%, 99% CI -74.5 to -38.5%; -22.7%, 99% CI -38.8 to -6.5%; -19.4%, 99% CI -28.3 to -10.6%; and -22.7%, 99% CI -38.8 to -6.5%, respectively); while Australia and Norway showed insignificant changes (6.5%, 99% CI -0.7 to -13.8% and 1.7%, 99% CI -6.4 to -9.8%). The countries that maintained (Australia, Norway) or surpassed (Canada) pre-pandemic visit rates had the greatest use of virtual care. CONCLUSIONS: In-person SRH visits to primary care decreased during the pandemic. Virtual care seemed to counterbalance that decline. Although cervical cancer screening appeared insensitive to virtual care, strategies such as incorporating self-collected samples for HPV testing may provide a solution in a future pandemic.

Maternal pre-pregnancy BMI and reproductive health in adult sons: a study in the Danish National Birth Cohort.

STUDY QUESTION: Is maternal pre-pregnancy BMI associated with semen quality, testes volume, and reproductive hormone levels in sons? SUMMARY ANSWER: Maternal pre-pregnancy BMI was associated with an altered reproductive hormone profile in young adult sons, characterized by higher levels of oestradiol, LH, and free androgen index (FAI) and lower levels of sex hormone-binding globulin (SHBG) in sons born of mothers with pre-pregnancy overweight and obesity. WHAT IS KNOWN ALREADY: Evidence suggests that maternal pre-pregnancy BMI may influence reproductive health later in life. Only one pilot study has investigated the association between maternal pre-pregnancy BMI and reproductive health outcomes in sons, suggesting that a high BMI was associated with impaired reproductive function in the adult sons. STUDY DESIGN, SIZE, DURATION: A population-based follow-up study of 1058 young men from the Fetal Programming of Semen Quality (FEPOS) cohort nested within the Danish National Birth Cohort (DNBC), 1998-2019, was carried out. PARTICIPANTS/MATERIALS, SETTING, METHODS: In total, 1058 adult sons (median age 19 years, 2 months), born 1998-2000 by mothers included in the DNBC, participated in FEPOS. At a clinical examination, they provided a semen and blood sample, measured their testes volume, and had height and weight measured. Maternal pre-pregnancy BMI was obtained by self-report in early pregnancy. Semen characteristics, testes volume, and reproductive hormone levels were analysed according to maternal pre-pregnancy BMI categories and as restricted cubic splines using negative binomial and ordinary least square regression models. Mediation analyses examined potential mediation by the sons' birthweight, pubertal timing, fat mass, and BMI. Additional analyses investigated the role of paternal BMI in the potential associations between maternal BMI and reproductive health outcomes. MAIN RESULTS AND THE ROLE OF CHANCE: We found no consistent associations between maternal pre-pregnancy BMI and semen characteristics or testes volume. Sons of mothers with higher pre-pregnancy BMI had higher oestradiol and lower SHBG levels, both in a dose-dependent manner. Sons of mothers with pre-pregnancy obesity (≥30 kg/m2) had higher LH levels and a higher FAI than sons born by mothers with normal pre-pregnancy BMI (18.5-24.9 kg/m2). The mediation analyses suggested that the effect of maternal pre-pregnancy BMI on higher levels of oestrogen, LH, and FAI was partly mediated by the sons' birthweight, in addition to adult fat mass and BMI measured at the clinical examination, whereas most of the effect on lower levels of SHBG was primarily mediated by the sons' own fat mass and BMI. Paternal BMI was not a strong confounder of the associations in this study. LIMITATIONS, REASONS FOR CAUTION: This study was based in a population-based cohort with a low prevalence of overweight and obesity in both mothers and adult sons. Some men (10%) had blood for reproductive hormone assessment drawn in the evening. While several potential confounding factors were accounted for, this study's inherent risk of residual and unmeasured confounding precludes provision of causal estimates. Therefore, caution should be given when interpreting the causal effect of maternal BMI on sons' reproductive health. WIDER IMPLICATIONS OF THE FINDINGS: Given the widespread occurrence of overweight and obesity among pregnant women, it is imperative to thoroughly examine the potential consequences for reproductive hormone levels in adult sons. The potential effects of maternal pre-pregnancy obesity on sons' reproductive hormone profile may potentially be partly avoided by the prevention of overweight and obesity in the sons. STUDY FUNDING/COMPETING INTEREST(S): The project was funded by the Lundbeck Foundation (R170-2014-855), the Capital Region of Denmark, Medical doctor Sofus Carl Emil Friis and spouse Olga Doris Friis's Grant, Axel Muusfeldt's Foundation (2016-491), AP Møller Foundation (16-37), the Health Foundation, Dagmar Marshall's Fond, Aarhus University, Independent Research Fund Denmark (9039-00128B), and the European Union (ERC, BIOSFER, 101071773). Views and opinions expressed are, however, those of the authors only and do not necessarily reflect those of the European Union or the European Research Council. Neither the European Union nor the granting authority can be held responsible. The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.

Episódios de cuidado cotidiano: diálogos sobre raça, maternagem e rede de apoio / Episodes of daily care: dialogues on race, mothering and support network

Este estudo se dedica a pensar os efeitos do racismo e da racialidade enquanto elementos estruturantes do mundo em que vivemos e da saúde sexual e reprodutiva de mulheres negras, seus projetos de vida e exercício de parentalidade. Por meio de uma perspectiva sobre a impossibilidade da justiça, considerando a necessidade de destruição do Mundo como o conhecemos, e iluminando (com luz negra) a perversidade que não é uma falha mas é a característica mesma do projeto racial que está na base das formações sociais modernas, este trabalho dá centralidade à potência dos emaranhados sociais e da coletividade na produção de estratégias de continuidade da vida, dialogando com as noções de rede e sobrevivência coletiva. Seu objetivo é entender os sentidos e práticas das redes de apoio de mulheres racializadas durante o ciclo gravídico puerperal e no exercício de cuidado à prole em contexto de vulnerabilização. Este é um estudo qualitativo de caráter analítico- exploratório cujas fontes de dados foram produções da literatura científica, registros em diário de campo e discursos das mulheres participantes. Os instrumentos da pesquisa foram uma roda de conversa e duas entrevistas individuais de mulheres mães pretas e periféricas; e a análise elaborada a partir da metodologia episódica proposta por Grada Kilomba. Esta autora encontrou nas narrativas de histórias pessoais de mulheres negras, episódios de suas vidas, a possibilidade de reconstruir e recuperar percepções e definições próprias dos sujeitos que as experenciaram e as têm como própria realidade. Os resultados construídos revelam que os sentidos e práticas das redes de apoio das mulheres-mães negras periféricas envolvidas nesse estudo são múltiplos e ambíguos. Ao mesmo tempo em que possibilitam a emancipação da mulher ao papel da mãe que se dedica integralmente aos filhos em detrimento de seus desejos individuais descolados da maternagem, são também moduladores de sua maternagem e reprodutores da opressão imposta por esse modelo socialmente consolidado. O cenário é complexo, há disputas de gênero, poder institucionalizado, mecanismo de manutenção da visão do outro racial como identidade e referência, jogos de poder e conflito geracional, interesses próprios, alianças consanguíneas, relações por aliança, abandono, vida, vitórias, acolhimento, esperança, acordos, negociações, uma miríade de elementos que sustentam a existência destes sujeitos. Suas maternagens são especialmente atravessadas por eventos críticos, mortes materiais e simbólicas, que tornam seu sofrimento cotidiano e determinam que ressignifiquem sua existência diariamente, à medida em que compartilham o cuidado de seus filhos com seus pares.

This study is dedicated to thinking about the effects of racism and raciality as structuring elements of the world we live in as well as of black women's sexual and reproductive health, their life projects and parenting. Through a perspective on the impossibility of justice, considering the need to destroy the world as we know it, and by shedding (black) light on the perversity that is not a failure but the very characteristic of the racial project that underpins modern social formations, this work focuses on the power of social entanglements and collectivity in the production of strategies for the continuity of life, engaging with the notions of networks and collective survival. It aims to understand the meanings and practices of racialized women's support networks during the pregnancy-puerperium cycle and when caring for their offspring in a context of vulnerability. This is a qualitative study of an analytical-exploratory type and its data sources were scientific literature, field diary entries and the speeches of the participating women. The research instruments were a conversation circle and two individual interviews with black women who are mothers from a peripheral region, and the analysis was based on the episodic methodology proposed by Grada Kilomba. This author found in the narratives of black women's personal stories, episodes from their lives, the possibility of reconstructing and retrieving the perceptions and definitions of the subjects who experienced them and have them as their own reality. The results show that the meanings and practices of support networks of the black women who are mothers in the periphery and were involved in this study are multiple and ambiguous. At the same time as they make it possible for women to emancipate themselves from the role of mothers who dedicate themselves entirely to their children, in detriment to their individual desires detached from mothering, they are also modulators of their mothering and reproducers of the oppression imposed by this socially consolidated model. The scenario is complex, there are gender disputes, institutionalized power, a mechanism for maintaining the view of the racial other as an identity and reference, power games and generational conflict, self-interest, consanguineous alliances, alliance relations, abandonment, life, victories, acceptance, hope, agreements, negotiations, a myriad of elements that sustain the existence of these subjects. Their mothering is especially crossed by critical events, material and symbolic deaths, which make their suffering a daily occurrence and determine that they resignify their existence on a regular basis, as they share the care of their children with their peers.