RESUMEN
Kisspeptin and neurokinin B (NKB) play a key role in several physiological processes including in puberty, adult reproductive function including the menstrual cycle, as well as mediating the symptoms of menopause. Infundibular kisspeptin neurons, which coexpress NKB, regulate the activity of gonadotropin-releasing hormone (GnRH) neurons and thus the physiological pulsatile secretion of GnRH from the hypothalamus. Outside of their hypothalamic reproductive roles, these peptides are implicated in several physiological functions including sexual behavior and attraction, placental function, and bone health. Over the last two decades, research findings have considerably enhanced our understanding of the physiological regulation of the hypothalamic-pituitary-gonadal (HPG) axis and identified potential therapeutic applications. For example, recognition of the role of kisspeptin as the natural inductor of ovulation has led to research investigating its use as a safer, more physiological trigger of oocyte maturation in in vitro fertilization (IVF) treatment. Moreover, the key role of NKB in the pathophysiology of menopausal hot flashes has led to the development of pharmacological antagonism of this pathway. Indeed, fezolinetant, a neurokinin 3 receptor antagonist, has recently received Food and Drug Administration (FDA) approval for clinical use to treat menopausal vasomotor symptoms. Here, we discuss the roles of kisspeptin and NKB in human physiology, including in the regulation of puberty, menstrual cyclicity, reproductive behavior, pregnancy, menopause, and bone homeostasis. We describe how perturbations of these key physiological processes can result in disease states and consider how kisspeptin and NKB could be exploited diagnostically as well as therapeutically to treat reproductive disorders.
Asunto(s)
Kisspeptinas , Neuroquinina B , Salud Reproductiva , Humanos , Kisspeptinas/metabolismo , Neuroquinina B/metabolismo , Neuroquinina B/fisiología , Animales , Femenino , Reproducción/fisiologíaRESUMEN
Medical and surgical advancements of the past 70 years have resulted in a remarkable shift in the natural history of congenital heart disease (CHD) such that survival to adulthood is expected for >90% of children born with congenital heart defects, including those with complex CHD. There are now more adults than children living with CHD, a majority of them are female. As significant strides have been made in the management of adult patients with CHD, there has been an evolving understanding of the important role inherent sex-specific differences play in impacting long-term outcomes for females with CHD including differences in sexual and reproductive health, risk and incidence of acquired cardiovascular disease, and health surveillance. Notably, care for the female CHD patient is a continuum that is not isolated to discrete stages but cumulative of health exposures and experiences over a lifetime. This review aims to provide a brief overview of the current understanding of the unique health needs and considerations for females with CHD over their lifetime for both the pediatric and adult provider to help identify opportunities for care optimization, continue to raise awareness of the necessity of lifelong care and advocate for the critical need of research that prospectively evaluates pregnancy and other health-related exposures on long-term quality of life and survival for females with CHD.
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Cardiopatías Congénitas , Humanos , Cardiopatías Congénitas/terapia , Femenino , Embarazo , Calidad de Vida , Adulto , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/tendencias , Salud ReproductivaRESUMEN
The widespread use of polyethylene terephthalate (PET) in food and beverage packaging raises concerns about its potential health effects, particularly when PET-derived nanoplastics (PET-NPs) are released into the environment. This study investigates the reproductive toxicity of PET-NPs in male mice. Mice were exposed to PET-NPs at doses of 0.1 mg/day and 0.5 mg/day for 28 days, and the testes index, sperm count, sperm morphology, Reactive Oxygen Species (ROS) production, DNA integrity, histopathology, and spermatogenesis were evaluated. PET-NP exposure resulted in a significant decrease in sperm concentration and an increase in abnormal spermatozoa-particularly blunt-headed sperm and sperm with neck and tail anomalies- and elevated ROS levels in testicular tissue in a dose-dependent manner (p < 0.05). Additionally, PET-NPs induced DNA strand breaks, as demonstrated by the COMET assay (p < 0.05). Histopathological analysis revealed disorganization of the germinal epithelium, vacuolization, reduced sperm density, and increased interstitial spaces, accompanied by a significant decline in spermatogenic activity, as assessed by Johnsen scoring. These findings strongly suggest that the observed adverse effects on male reproductive health, including sperm abnormalities, DNA damage, and impaired spermatogenesis, are primarily driven by ROS-induced oxidative stress. The observed changes provide clear evidence of the adverse effects of subchronic exposure to PET nanoplastics on male reproductive health, highlighting the inherent risks associated with nanoplastic exposure and offering crucial insights for public health awareness and regulatory considerations.
Asunto(s)
Tereftalatos Polietilenos , Especies Reactivas de Oxígeno , Recuento de Espermatozoides , Espermatogénesis , Espermatozoides , Testículo , Animales , Masculino , Tereftalatos Polietilenos/toxicidad , Ratones , Testículo/efectos de los fármacos , Testículo/patología , Testículo/metabolismo , Espermatogénesis/efectos de los fármacos , Especies Reactivas de Oxígeno/metabolismo , Espermatozoides/efectos de los fármacos , Espermatozoides/patología , Salud Reproductiva , Daño del ADN/efectos de los fármacos , Microplásticos/toxicidad , Relación Dosis-Respuesta a Droga , Nanopartículas/toxicidadRESUMEN
Transgender and gender diverse (TGD) persons face considerable challenges accessing sexual and reproductive health care (SRHC), often resulting in poor health outcomes when compared to cisgender persons. Aetiological research predominantly explains these health disparities through a single axis explanation reducing them to factors related to gender identity. Yet, a one-dimensional representation of TGD persons fails to recognize the multiple experiences of systemic oppression that may contribute to poor sexual and reproductive health (SRH) experiences and outcomes. This scoping review was conducted to locate, analyse and synthesise contemporary scientific research exploring TGD persons' experiences with SRHC services, from an intersectional perspective. Searches were conducted in PsycINFO, APA Psychinfo, Ovid MEDLINE®, SCOPUS, and CINAHL. Studies were included if they were in English, conducted in OECD countries, published between 2012 to 2022 in peer-reviewed journals, based upon empirical research, involving human participants and presenting disaggregated data for TGD populations. To be included, studies also had to contain TGD individuals who had accessed SRHC services and data that pertained to forms of oppression, disadvantage, social determinants of health or aspects of identity that intersected with their gender identities. 1290 records were identified and entered into Endnote software X9, with 413 removed before screening. A total of 877 records were screened by the author and a research assistant independently who examined titles and abstracts and selected 27 for in-depth analysis. Included studies were uploaded to NVivo 12 and subjected to in-depth review, coding, and synthesis using descriptive statistics and thematic analysis. The review found that efforts to understand TGD persons' experiences of multiple marginalisation in SRHC settings are hampered by methodological challenges relating to adopted sampling techniques, measures used, the use of small and non-representative samples, and geographic location. The review found multiple intersecting systems of oppression including cissexism, heterosexism, racism, classism, geographical disadvantage and ageism, that challenged TGD persons' access to quality care within SRHC settings. Best practices were identified including affirming, person-centred care, collaboration, trauma-informed care and leveraging informal support networks, which provide hope for improved service provision and design.
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Servicios de Salud Reproductiva , Personas Transgénero , Humanos , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , Servicios de Salud Reproductiva/estadística & datos numéricos , Masculino , Femenino , Accesibilidad a los Servicios de Salud/normas , Minorías Sexuales y de Género/estadística & datos numéricos , Minorías Sexuales y de Género/psicología , Disparidades en Atención de Salud , Salud SexualAsunto(s)
Fertilización In Vitro , Servicios de Salud Reproductiva , Investigadores , Humanos , Alabama , Miedo , Fertilización In Vitro/legislación & jurisprudencia , Fertilización In Vitro/tendencias , Médicos/psicología , Investigadores/psicología , Útero , Servicios de Salud Reproductiva/legislación & jurisprudencia , Servicios de Salud Reproductiva/tendenciasRESUMEN
BACKGROUND: Women who experience intimate partner violence (IPV) are likely to experience reduced sexual and reproductive health (SRH). This paper aims to describe the prevalence of IPV and family planning use, and explore how IPV intersects with SRH among young Kiribati women; including met and unmet need for family planning, and use of contraception. METHODS: Data for this paper were drawn from the Kiribati Social Development Indicator Survey [1], conducted in 2018-2019. Chi-square tests for independence were conducted, with 95% confidence intervals to identify the strength of association. Associations were considered statistically significant at p < .05. RESULTS: Of the n = 3,106 women who had been intimately partnered or sexually active in the last year, 20% had unmet need for either spacing or limiting, the greatest unmet need being observed in women aged 15-24 years (28.8%). Half (51%) of ever-partnered Kiribati women experienced physical IPV from an ex/partner in their lifetime, one quarter experienced sexual IPV (24%) and 46% psychological IPV. Women aged 15-24 years reported higher rates of physical and/or sexual IPV over their lifetime and within the last year. Women who had experienced IPV from their partner in the last 12 months were significantly less likely to show unmet need for spacing or limiting (46.5%) than women who had not experienced any IPV (53.5%) and were more likely to be using a modern method of contraception (31%) than women who had not experienced IPV (26%). Women who experienced lifetime IPV were more also more likely to report met need for family planning. CONCLUSIONS: This study shows women in Kiribati experience elevated rates of IPV and unmet need for family planning. Inclusion of young women (including single women) and rural women, especially women living with IPV must be prioritised as an international goal if the SRH needs are to be met for all. In order to overcome the difficulties faced by young women, women in remote areas and those experiencing IPV, health-care providers would benefit from further training and information on the issues around IPV.
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Violencia de Pareja , Salud Reproductiva , Salud Sexual , Humanos , Femenino , Violencia de Pareja/estadística & datos numéricos , Violencia de Pareja/psicología , Adolescente , Adulto Joven , Adulto , Salud Reproductiva/estadística & datos numéricos , Salud Sexual/estadística & datos numéricos , Micronesia/epidemiología , Servicios de Planificación Familiar/estadística & datos numéricos , Prevalencia , Conducta Anticonceptiva/estadística & datos numéricos , Conducta Anticonceptiva/psicología , Conducta Sexual/estadística & datos numéricos , Conducta Sexual/psicologíaRESUMEN
The vaginal tract of cis-gender women of reproductive age is inhabited by communities of bacteria generally dominated by one of four Lactobacillus species. These bacteria are important for the reproductive health of women and favor better outcomes, including fertility, pregnancy leading to term and protection against infections. Past studies have focused on the role of carbohydrates in the balance of vaginal communities, and the role of fatty acids has been underestimated. However, small- to long-chain fatty acids present few properties that, in combination with sugar metabolism, affect the outcomes of the health or disease within the vaginal communities. Herein, we explore the origins of fatty acids in the vaginal tract as well as their roles in the bacterial life cycle in this environment. We also detail the putative impact of vaginal FAs on S. aureus, one of the etiologic agents of aerobic vaginitis. Finally, we discuss their potential for prevention or therapy in women of reproductive age.
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Ácidos Grasos , Salud Reproductiva , Vagina , Femenino , Humanos , Ácidos Grasos/metabolismo , Vagina/microbiología , Vagina/metabolismo , Staphylococcus aureus , Lactobacillus , EmbarazoRESUMEN
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that can significantly affect reproductive health. This study aims to assess reproductive health metrics among SLE patients in Indian settings to compare fertility rates and the impact of the disease on pregnancy with data from the general population. The independent, prospective, multicenter, observational study collected data from SLE patients at seven centres in India through a database created by the Indian Rheumatology Association. Data were gathered using structured proformas validated by experts. The final analysis included women aged > 15 years (total cohort), after excluding male subjects and those with inadequate data. Participants were categorized into married and unmarried cohorts, and various reproductive health metrics were analyzed pre- and post-disease. The total cohort included 631 subjects with an average age at recruitment of 36.46 ± 12.31 years, and mean age at menarche of 13.74 ± 1.44 years. The total cohort had an average of 1.8 pregnancies per woman, with an abortion rate of 0.35. The married cohort showed a pregnancy wastage ratio of 201.43. The cumulative fertility rate noted for the married cohort was 1.40, while for the total cohort was 1.04. Significant differences in pregnancy outcomes were observed before and after the onset of SLE, with pregnancies declining from 703 to 136 (P < 0.0001). A significant increase in pregnancy complications, including pregnancy-induced hypertension, small for gestational age, and pre-eclampsia, was noted before and after disease onset (P < 0.0001). Central nervous system and skin involvement also became more prevalent post-disease (P = 0.046 and P = 0.040, respectively). The study highlights the significant impact of SLE on pregnancy, both before and after disease onset, noting reduced pregnancies and live births, along with increased rates of pregnancy loss, stillbirths, and abortions. Complications such as hypertension and pre-eclampsia were more common after disease onset. These findings emphasize the need for targeted healthcare strategies and collaborative efforts to improve reproductive outcomes in patients with SLE.
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Lupus Eritematoso Sistémico , Complicaciones del Embarazo , Salud Reproductiva , Humanos , Lupus Eritematoso Sistémico/epidemiología , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/fisiopatología , Femenino , Embarazo , Adulto , Estudios Prospectivos , India/epidemiología , Complicaciones del Embarazo/epidemiología , Adulto Joven , Resultado del Embarazo/epidemiología , Persona de Mediana Edad , Fertilidad , Índice de Embarazo , Aborto Espontáneo/epidemiología , Aborto Espontáneo/etiologíaRESUMEN
INTRODUCTION: The utilization of sexual and reproductive health (SRH) services by males globally is significantly low despite their considerable sexual and reproductive health needs. This study aimed to understand the factors that influence the utilization of male sexual and reproductive health SRH services. METHODS: We used an explanatory sequential mixed methods research design, with qualitative description to explore the perceptions of males (15-49years) on the utilization of male SRH services in Anambra State, Nigeria. In October 2021, 56 males participated in seven focus group discussions conducted across seven communities. The data were analysed by thematic analysis. A composite narrative was used to report the results. RESULTS: Males in both urban and rural areas of Anambra State preferred informal health facilities; male-focused health facilities and male health workers. The participants perceived services as costly; and criticized healthcare workers' attitudes. Some rural areas had inadequate SRH facilities, staff and commodities. The participants exhibited varying levels of SRH awareness. CONCLUSION: To improve male SRH service utilization, clinics should be more male-centric and cost-effective. Healthcare providers require retraining to offer patient-centered care. Additionally, ward development committees should advocate for better staffing and the availability of SRH commodities.
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Grupos Focales , Investigación Cualitativa , Servicios de Salud Reproductiva , Humanos , Masculino , Nigeria , Adulto , Servicios de Salud Reproductiva/estadística & datos numéricos , Persona de Mediana Edad , Adolescente , Adulto Joven , Aceptación de la Atención de Salud/estadística & datos numéricos , Población Rural/estadística & datos numéricosRESUMEN
BACKGROUND: Research examining young people's healthcare-seeking behaviors in Sub-Saharan Africa has largely focused on university or out-of-school youth who are sexually active and/or HIV-positive. Healthcare-seeking behavior in younger adolescents has been less well studied even though it is during secondary school years that the majority of adolescents become sexually active. There is limited evidence to guide strategies that schools, health facilities, and social service agencies use to encourage adolescents to utilize sexual and reproductive health resources prior to sexual debut. METHODS: This study used cross-sectional data collected in 2021 during school hours from eleven secondary schools in the Northwest District of Botswana. Adolescents ages 14-19 years completed surveys using hand-held tablets. Descriptive statistics were run for all variables; bivariate analyses examined their association with skipped visits. Logistic regression identified correlates of forgone visits. The outcome variable of interest was whether a respondent had ever forgone a visit to a health clinic for sexual and reproductive health information or services. RESULTS: 553 adolescents, provided information used for analysis. One fifth of respondents had had sexual intercourse (21%). Most had not been tested for HIV (54%), did not know their HIV status (60%), or had not had an STI other than HIV (92%). Teachers (31%) and female family members (31%) were the most frequently consulted sources on bodily changes during adolescence. In the bivariate analysis, age, gender, sexual experience, HIV testing, awareness of HIV status, and having had an STI were significantly associated with forgone visits. At the multivariate level, younger respondents and those who had never been tested for HIV or had an STI had lower odds of forgone visits compared to their older peers and those who had been tested or had an STI. The most common reasons for forgoing visits reflected perceptions that nurses were unfriendly and did not believe adolescents should have sex. Students identified logistical barriers, including not knowing where to go, long distances to services, and limited operating hours. CONCLUSIONS: While logistical barriers might be easily addressed, perceived barriers, including negative staff attitudes and behaviors towards adolescents, require concerted and collaborative efforts by educators, health professionals, and policy makers to change.
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Aceptación de la Atención de Salud , Conducta Sexual , Humanos , Adolescente , Estudios Transversales , Botswana , Femenino , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Adulto Joven , Conducta Sexual/estadística & datos numéricos , Servicios de Salud Reproductiva/estadística & datos numéricos , Conducta del Adolescente/psicología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Adolescents in Sub-Saharan Africa (SSA) face significant health and social challenges related to sexual and reproductive health (SRH), including unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STI). Barriers to information and services are compounded by lack of access to appropriate information, fear of being judged, health provider attitudes and contextual factors such as culture, religion, poverty, and illiteracy. Facility-based service delivery models for adolescents offer a structured environment and provide an opportunity to deliver such information and services. The review critically examined how well these models meet the SRH needs of adolescents in SSA. METHODS: A systematic search was conducted using five databases: Web of Science, MEDLINE, Scopus, PubMed, and Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to maintain transparency and completeness. Covidence software was used for screening and data extraction, and NVIVO 12 PRO was used to manage the analysis. A narrative synthesis using Thomas and Harden's thematic analysis was used to identify themes. RESULTS: The search yielded 14,415 articles, and 20 papers met the inclusion criteria and were included in this review. From the findings, adolescents expressed the need for comprehensive SRH information, adolescent-friendly facilities, parental and male involvement, and respectful healthcare providers. Three facility-based adolescent-friendly SRH delivery models are used in SSA: Stand-alone clinics, Youth-friendly corners, and Integrated/mainstreamed models. Adolescent-friendly interventions, friendly staff, and accessibility were reported as facilitators to services meeting the needs of adolescents and promoting positive experiences. However, several barriers were identified: negative attitudes of health workers, financial constraints, transportation challenges, waiting time, intimidating environments, and lack of confidentiality pose a challenge to the effectiveness of the model. CONCLUSION: Facility-based SRH service delivery models can improve access to information and services when complemented with community-based interventions, adolescent-friendly providers, and assurance of service accessibility. However, significant gaps, such as healthcare providers' negative attitudes and behaviours, concerns about privacy and confidentiality, financial constraints, and transportation challenges, limit their effectiveness. These findings call for expanding out-of-facility services, adopting mHealth solutions, enhancing provider training, strengthening confidentiality, and reducing financial barriers to ensure equitable and effective access to services.
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Servicios de Salud Reproductiva , Humanos , Adolescente , África del Sur del Sahara , Servicios de Salud Reproductiva/organización & administración , Investigación Cualitativa , Femenino , Salud Sexual , Accesibilidad a los Servicios de Salud , Masculino , Salud Reproductiva , EmbarazoRESUMEN
BACKGROUND: A culturally sensitive sexual and reproductive health (SRH) information communication intervention which is effective can improve SRH information communication (IC) between parents and their adolescents. This facilitates adolescents' informed SRH decisions to optimise positive SRH outcomes. AIM: The aim of this article was to integrate the findings from a systematic review and a qualitative study on sexual and reproductive health information communication and the considerations to make in adapting an effective parent-adolescent SRH information communication intervention from the systematic review findings. METHODS: Explanatory sequential Mixed Methods Research was used; first, a quantitative Systematic Review was conducted in lower-and-middle-income countries, utilising Joanna Briggs Institute (JBI) software for reviews. The systematic review findings were then explained, utilizing an exploratory qualitative design in the second phase of the study. A purposive sample of ten parent-adolescent pairs was selected from Asante Akyem North Municipality of Ghana and all participants were interviewed individually. The sample was based on the demographics highlighted in the systematic review. A semi-structured interview guide was developed from the findings of the systematic review. RESULTS: The results confirmed that effective SRH information communication interventions are associated with parent-adolescent SRH information communication skills. SRH communication is also influenced by the SRH information parents and adolescents have and the personal and social motivation to communicate the information. The method of intervention delivery, the experts involved, and the place of delivery were also identified as important issues to consider in adapting and implementing an intervention. CONCLUSION: The study has provided information on the components of a culturally sensitive SRH information communication intervention. The contextual information gathered, which explained the systematic review findings, will be helpful in the adaptation of SRH information communication intervention.
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Comunicación , Padres , Salud Reproductiva , Salud Sexual , Humanos , Adolescente , Ghana , Femenino , Masculino , Padres/psicología , Adulto , Relaciones Padres-Hijo , Educación Sexual , Conducta Sexual , Conocimientos, Actitudes y Práctica en Salud , Comunicación en Salud/métodosRESUMEN
BACKGROUND: Globally, adolescent health remains a public health priority given that adolescents often face unique vulnerabilities to health issues like mental disorders, substance abuse, and sexual health risks. In developing countries like Ghana, primary healthcare facilities (PHCs) are often the first point of contact for addressing these issues. However, there is a lack of literature examining the capacity of PHCs to address adolescent sexual and reproductive health (ASRH) issues. This study aims to fill this gap in the literature by assessing the availability and readiness of ASRH services within Ghana's PHCs. METHODS: The study utilized a multi-stage sampling approach to select 67 PHCs across four districts in the Greater Accra region, reflecting Ghana's broad demographic diversity. We employed the WHO's Services Availability and Readiness Assessment (SARA) tool to measure the availability and readiness of ASRH services. This framework focused on key domains including service availability and readiness, assessing aspects such as HIV testing, family planning, and availability of contraceptives and necessary staff training. Data analysis was conducted using Stata version 17.0, analysing frequencies and percentages to capture the extent of service provision across the selected facilities. RESULTS: The study highlighted significant disparities in the availability and readiness of essential ASRH services (HIV services, family planning, contraceptive pills, IUCD provisions, and male condoms) across selected districts and facility types. In Shai Osudoku, 65% of facilities offered a full range of selected ASRH services, the highest among the districts, whereas Ningo Prampram had the lowest at just 16%. In terms of facility types, 57% of CHPS facilities, 59% of health centres, and 44% of clinics provided all the selected ASRH services. Urban areas reported a 51% provision rate of these services, slightly less than the 54% observed in rural areas. Additionally, readiness disparities were evident: only 21% of urban facilities had adequate service guidelines compared to 29% in rural areas, and a higher percentage of rural facilities (46%) had trained staff, compared to 23% in urban areas. CONCLUSION: This study examined the availability and readiness of ASRH services in PHCs across the Greater Accra region, revealing significant disparities by location and facility type. Particularly, rural and public facilities demonstrated a higher availability of ASRH services compared to urban and private facilities. These findings suggest an uneven distribution of resources and highlight a potential urban underutilization of public health services. Moreover, the study identified a critical lack of service guidelines and trained staff across many facilities, emphasizing the need for enhanced training and resource allocation to improve service readiness. Targeted interventions are necessary to elevate the quality and accessibility of ASRH services, ensuring equitable health care delivery across all regions. Future research should expand to other regions to validate these findings and inform nationwide health strategies.
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Accesibilidad a los Servicios de Salud , Atención Primaria de Salud , Servicios de Salud Reproductiva , Salud Reproductiva , Salud Sexual , Humanos , Ghana , Adolescente , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Femenino , Masculino , Servicios de Salud Reproductiva/estadística & datos numéricos , Servicios de Salud Reproductiva/normas , Servicios de Salud del Adolescente/estadística & datos numéricos , Servicios de Salud del Adolescente/normas , Instituciones de Salud/estadística & datos numéricos , Instituciones de Salud/normasRESUMEN
BACKGROUND: Refugee women's reproductive health (RH) outcomes have been impacted by several factors, including experiencing war, lack of access to healthcare, and possible gender-based violence. After resettlement, low health literacy, financial difficulties, cultural and linguistic barriers, and unfamiliarity with the healthcare system also add to the preexisting barriers. Although several efforts have focused on health education and improving health literacy among refugee women, there has not been a validated tool to measure the effectiveness of these trainings and their possible impact. This study aims to adapt a culturally and linguistically appropriate survey that helps address this gap. METHODS: We conducted a literature review to identify the existing tools and identified possible domains and items supporting RH literacy measures. The identified items were collected and adapted as a single scale with three domains: (a) general health literacy, measured with HLS-EU-Q6, (b) digital health literacy, measured with eHEALS, and (c) reproductive health literacy, measured through a composite of the Cervical Cancer Literacy Assessment Tool (C-CLAT) and the Refugee Reproductive Health Network (ReproNet) postpartum literacy scale. After content validity and face validity of the adapted scale, it was translated into Dari, Arabic, and Pashto and was administered to participants of RH literacy training sessions. RESULTS: A total of 67 Dari, 53 Arabic, and 64 Pashto-speaking refugee women completed the survey. The mean scores obtained between the three language groups were similar in the domains of digital health literacy and reproductive health literacy (p > 0.05), whereas the scores for general health literacy were not (p > 0.05). The inter-item reliability score for the domains of general health literacy, digital health literacy and RH literacy across all three language groups was above α = 0.7. CONCLUSION: This scale addresses the need for validated tools to measure reproductive health literacy. It has the promise to provide a tool for assessing the effectiveness of health interventions on health literacy. Future applications can utilize this scale to investigate the differences in health literacy in refugee populations speaking Dari, Pashto, and Arabic.
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Alfabetización en Salud , Refugiados , Salud Reproductiva , Humanos , Femenino , Salud Reproductiva/educación , Adulto , Encuestas y Cuestionarios , Persona de Mediana Edad , Adulto Joven , Conocimientos, Actitudes y Práctica en SaludRESUMEN
BACKGROUND: Interventions towards ending intimate partner violence (IPV) and female sexual and reproductive health and rights (SRHR) violation are more successful when the prevalence amongst females, and awareness level of these rights amongst males and females are known. This fosters a compounding holistic impact on women's health and wellbeing throughout the rest of their lives. OBJECTIVE: This study assessed the prevalence of IPV and SRHR violation amongst females and the awareness of IPV and female SRHR amongst males and females in the Fako Division, Cameroon. METHODS: A cross-sectional community-based quantitative study design was used to collect data from participants in Limbe and Buea health districts of the Fako Division. Participants were selected through a multistage sampling technique. A structured questionnaire was used to collect data on IPV from 860 female participants and on the awareness of SRHR from 1487 male and female participants. The data was analyzed in SPSS version 26. Factors associated with the number of IPV experienced by females and awareness of IPV and SRHR were identified using poison and logistic regression models respectively. Awareness of IPV and SRHR among males and females was compared using a Chi squared test. p < 0.05 was considered statistically significant. RESULTS: Of the 860 females surveyed, 818 (95.1%) and 556 (64.7%) have experienced at least one form of IPV and SRHR violation respectively. Factors independently associated with the number of times IPV was experienced included being an internally displaced person (p = 0.004, IRR = 1.38), unskilled (p = 0.001, IRR = 1.48), divorced (p < 0.001, IRR = 3.09), widowed (p < 0.001, IRR = 0.08) and earning a lower income (p = 0.003, IRR = 0.72). In addition to having a lower level of education, the associated factors were similar to the prevalence of SRHR violation experienced. Both males (85.5%, 83%) and females (85%, 87%) had a high awareness level of IPV and female SRHR. Amongst the factors associated with IPV awareness, level of education was significant in both females and males (p = 0.015, 0.038 respectively) and having a skilled job was significant (p = 0.003) with female SRHR awareness. CONCLUSION: This study showed that though both males and females have a high awareness level of IPV and SRHR, the prevalence of IPV and SRHR violation amongst females is still very high. Male-directed education aimed at promoting behaviour change that fosters respect of women's rights, changes harmful social norms and engages men as champions of female SRHR and ending IPV will likely decrease the prevalence of IPV and female SRHR violation.
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Conocimientos, Actitudes y Práctica en Salud , Violencia de Pareja , Salud Reproductiva , Humanos , Femenino , Camerún/epidemiología , Violencia de Pareja/estadística & datos numéricos , Adulto , Estudios Transversales , Prevalencia , Masculino , Adulto Joven , Persona de Mediana Edad , Salud Sexual , Adolescente , Derechos Sexuales y Reproductivos , Encuestas y CuestionariosRESUMEN
BACKGROUND: The COVID-19 pandemic and associated lockdowns altered social interactions and the health and education context of Malawian youth. It is important to understand the repercussions of the pandemic on the wellbeing of youth so that policymakers can better mitigate negative outcomes and address future pandemic needs. METHODS: This study used qualitative data from an evaluation of the "Secondary Education Expansion for Development" project to assess how COVID-19 impacted the education and sexual and reproductive health outcomes of youth in Malawi. Focus group discussions and key informant interviews were conducted in rural and urban areas with primary and secondary school students, their caregivers and teachers, and community leaders, providing insights on how the pandemic impacted them. RESULTS: Both male and female students lost motivation to continue their learning during the COVID-19 related school closures and teacher strikes. Participants reported that some female students became pregnant, married early, and sometimes engaged in sex work to make ends meet. There were also reports of increased financial barriers to sending children to school when they reopened, and there were reports of lower grades and poorer quality of teaching post-school closures. CONCLUSIONS: The findings highlight the need for community- and policy-level strategies to mitigate interruptions to students' schooling and protect them from outcomes like pregnancy and early marriage that could further hinder their education.
Asunto(s)
COVID-19 , Investigación Cualitativa , Salud Reproductiva , Instituciones Académicas , Salud Sexual , Estudiantes , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Femenino , Malaui/epidemiología , Masculino , Adolescente , Estudiantes/psicología , Conducta Sexual/psicología , SARS-CoV-2 , Grupos Focales , Embarazo , Pandemias , Adulto Joven , Educación SexualRESUMEN
BACKGROUND: Stigma surrounding women's sexual and reproductive health (SRH) often prevents them from seeking essential care. In South Korea, unmarried women face strong cultural taboos, increasing their risk for conditions such as pelvic inflammatory disease, infertility, and cervical cancer. While many unmarried women turn to web-based communities for support, these spaces frequently expose them to microaggressions, further discouraging their access to health care and worsening their health risks. OBJECTIVE: We aimed to encourage a safe space for seeking support on the culturally taboo topic of SRH by counteracting and reducing web-based microaggressions. We sought to make these last-resort safe spaces supportive by reducing and preventing microaggressions, fostering coping strategies, and educating rather than solely punishing perpetrators. METHODS: We conducted co-design sessions with 14 unmarried Korean women. In the first co-design session, we introduced the term microaggression and collaborated with participants to create base design components aimed at countering and preventing microaggressions. In the second co-design session, participants initially viewed examples of microaggression comments, then designed using the provided base design templates inspired by their suggestions from the first session and finally designed for a scenario where they would be seeking support. We analyzed co-design session transcripts using inductive and deductive methods. RESULTS: Our analysis revealed 6 goals addressing coping strategies, educational approaches, and cultural characteristics shaping participants' designs. Reflective coping strategies were supported through designs that numerically indicate positive support and provide holistic views of diverse perspectives, helping participants reassess provocative situations with cognitive clarity. Suppressive coping strategies were fostered by encouraging less-emotional responses, empowering participants to address microaggressions logically without self-blame. Educational approaches emphasized fostering shared awareness of microaggressions and providing respectful education for perpetrators about the harm their words can cause. Participants suggested counterspeech mechanisms, including rephrasing suggestions and public educational resources, to balance education with freedom of expression. They also proposed that forum-approved experts guide discussions to ensure accurate, empathetic responses and support users in addressing nuanced situations effectively. Cultural characteristics heavily influenced these goals. Participants noted the nebulous nature of microaggressions, their reluctance to burden their social support network, and societal perceptions of women as overly emotional-all of which shaped their desire for designs that enhance logical justification. For example, participants preferred tools such as expert-led discussions and comprehensive perspectives to rationalize their experiences while reducing stigma. CONCLUSIONS: Our work advocates for prioritizing educational and explanatory approaches over punitive detection and deletion measures to create supportive web-based spaces for individuals discussing stigmatized SRH. By integrating culturally informed coping strategies, counter speech mechanisms, and educational designs, these tools empower microaggression targets and allies while fostering reflection and behavior change among perpetrators. Our work provides a first step toward counteracting microaggressions and ultimately encouraging women to seek the needed SRH care.
Asunto(s)
Adaptación Psicológica , Salud Reproductiva , Humanos , Femenino , República de Corea , Adulto , Internet , Salud Sexual/educación , Adulto Joven , Habilidades de AfrontamientoRESUMEN
BACKGROUND: Telemedicine is an important way to fill in the access gap to in-person health care services during challenging times like pandemics. OBJECTIVE: This study aimed to investigate the role that telemedicine played during the COVID-19 pandemic by multicountry comparison of the use of telemedicine prior to and during the pandemic. METHODS: This study analyzes data from the second wave of the International Sexual Health and Reproductive Health study. This included data collected between April 2021 and July 2022 in 8 countries, including Armenia (n=296), Egypt (n=889), Germany (n=138), Moldova (n=311), Nigeria (n=205), Portugal (n=951), Singapore (n=13), and Spain (n=54). This study covered sociodemographics, sexual and reproductive health (SRH), and telemedicine use. Descriptive statistics and multilevel modeling were used to assess the factors influencing the use of telemedicine. RESULTS: Overall, 2857 participants were recruited. Approximately 57.6% (n=1646) of participants had never used telemedicine prior to COVID-19 measures, while 45.9% (n=1311) of participants required health care but reported not using telemedicine services following the introduction of COVID-19 measures. In high-income countries, the most common mode reported was audio-based telemedicine services, with 283 (71.8%) and 417 (73.5%) participants doing so before and during COVID-19, respectively. This was followed by text-based telemedicine services, with 152 (38.6%) and 173 (30.5%) participants doing so before and during COVID-19, respectively. In low- to middle-income countries, many participants also reported using audio-based telemedicine services, with 288 (35.3%) and 237 (40.8%) participants doing so before and during COVID-19, respectively. This was followed by chat-based telemedicine services, with 265 (32.4%) and 217 (37.3%) participants doing so before and during COVID-19, respectively. Multilevel modeling revealed that those who were older (adjusted odds ratio [aOR] 0.99, 95% CI 0.99-1.00) and were in countries with a higher gross domestic product per capita (aOR 0.99, 95% CI 0.98-1.00) were less likely to have ever used telemedicine. Participants who were of male sex assigned at birth (aOR 0.79, 95% CI 0.65-0.96) were less likely to use telemedicine during the pandemic. Participants who perceived that they were worse off financially were more likely to have switched to telemedicine during COVID-19 (aOR 1.39, 95% CI 1.02-1.89) and were more likely to report having a poor or fair experience of telemedicine services (aOR 1.75, 95% CI 1.34-2.29). When sexual orientation was included in the model, nonheterosexual individuals were more likely to ever use telemedicine prior to COVID-19 (aOR 1.35, 95% CI 1.08-1.69), more likely to have used telemedicine during COVID-19 (aOR 1.58, 95% CI 1.24-2.02), and more likely to have switched to telemedicine during COVID-19 (aOR 1.55, 95% CI 1.09-2.21). CONCLUSIONS: Telemedicine played a key role in addressing health care needs during the COVID-19 pandemic. Age, sex, economic status, and sexual orientation influenced its use.
Asunto(s)
COVID-19 , Pandemias , Salud Reproductiva , Salud Sexual , Telemedicina , Humanos , COVID-19/epidemiología , Telemedicina/estadística & datos numéricos , Estudios Transversales , Femenino , Adulto , Masculino , Salud Reproductiva/estadística & datos numéricos , Persona de Mediana Edad , Adulto Joven , SARS-CoV-2 , AdolescenteRESUMEN
BACKGROUND: Mobile health apps often require the collection of identifiable information. Subsequently, this places users at significant risk of privacy breaches when the data are misused or not adequately stored and secured. These issues are especially concerning for users of reproductive health apps in the United States as protection of sensitive user information is affected by shifting governmental regulations such as the overruling of Roe v Wade and varying state-level abortion laws. Limited studies have analyzed the data privacy policies of these apps and considered the safety issues associated with a lack of user transparency and protection. OBJECTIVE: This study aimed to evaluate popular reproductive health apps, assess their individual privacy policies, analyze federal and state data privacy laws governing these apps in the United States and the European Union (EU), and recommend best practices for users and app developers to ensure user data safety. METHODS: In total, 4 popular reproductive health apps-Clue, Flo, Period Tracker by GP Apps, and Stardust-as identified from multiple web sources were selected through convenience sampling. This selection ensured equal representation of apps based in the United States and the EU, facilitating a comparative analysis of data safety practices under differing privacy laws. A qualitative content analysis of the apps and a review of the literature on data use policies, governmental data privacy regulations, and best practices for mobile app data privacy were conducted between January 2023 and July 2023. The apps were downloaded and systematically evaluated using the Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective (THESIS) evaluation tool to assess their privacy and security practices. RESULTS: The overall privacy and security scores for the EU-based apps, Clue and Flo, were both 3.5 of 5. In contrast, the US-based apps, Period Tracker by GP Apps and Stardust, received scores of 2 and 4.5, respectively. Major concerns regarding privacy and data security primarily involved the apps' use of IP address tracking and the involvement of third parties for advertising and marketing purposes, as well as the potential misuse of data. CONCLUSIONS: Currently, user expectations for data privacy in reproductive health apps are not being met. Despite stricter privacy policies, particularly with state-specific adaptations, apps must be transparent about data storage and third-party sharing even if just for marketing or analytical purposes. Given the sensitivity of reproductive health data and recent state restrictions on abortion, apps should minimize data collection, exceed encryption and anonymization standards, and reduce IP address tracking to better protect users.
Asunto(s)
Seguridad Computacional , Confidencialidad , Internet , Aplicaciones Móviles , Políticas , Servicios de Salud Reproductiva , Aplicaciones Móviles/legislación & jurisprudencia , Aplicaciones Móviles/normas , Aplicaciones Móviles/estadística & datos numéricos , Investigación Cualitativa , Servicios de Salud Reproductiva/legislación & jurisprudencia , Servicios de Salud Reproductiva/normas , Servicios de Salud Reproductiva/estadística & datos numéricos , Confidencialidad/legislación & jurisprudencia , Confidencialidad/normas , Internet/legislación & jurisprudencia , Internet/normas , Internet/estadística & datos numéricos , Seguridad Computacional/legislación & jurisprudencia , Seguridad Computacional/normas , Seguridad Computacional/estadística & datos numéricos , Unión Europea , Regulación Gubernamental , Benchmarking , Interfaz Usuario-Computador , Estados Unidos , Europa (Continente)RESUMEN
In this study, male Sprague-Dawley (SD) rats were exposed to bisphenol S (BPS) at environmentally relevant concentrations to investigate its reproductive toxicity and evaluate its effects on the gut-blood-testicular axis. After 28 days of exposure to BPS (0.05 and 20â¯mg/kg), the results showed a reduction in weight gain and the induction of reproductive toxicity in male rats, including decreased sperm parameters, lower sperm viability, and increased abnormal sperm density and mortality. These observations were made by counting with a hemocytometer under the optical microscope. 16S rRNA and untargeted metabolomic elucidated potential impacts on the gut-blood-testicular axis: BPS impaired the physical barrier, evoked inflammation, and resulted in dysbiosis of the gut microbiota. Additionally, BPS altered serum metabolites, including phosphatidic acid and diacylglycerol, which are involved in Fc gamma R-mediated phagocytosis and linked to inflammation. Furthermore, histopathological analysis, western blot (WB), enzyme-linked immunosorbent assay (ELISA), and immunofluorescence results showed that exposure to BPS led to testicular damage, inflammation, activation of the p38 and ERK MAPK pathways, and disruption of the blood-testis barrier (BTB). Collectively, these findings indicate that BPS impair the intestinal health, disrupt gut microbiome, and ultimately lead to reproductive dysfunction through the gut-blood-testicular axis.