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1.
Mil Med ; 189(Supplement_3): 832-841, 2024 Aug 19.
Article in English | MEDLINE | ID: mdl-39160871

ABSTRACT

INTRODUCTION: As female active duty populations increase in all military environments, it is critical that women's health be addressed in a comprehensive manner. The study's results will be utilized to assist Navy health care leaders in addressing female force readiness policies, treatment gaps, and training specific to women's mental health. MATERIALS AND METHODS: In total, 212 active duty participants were recruited from the Navy's mental health specialties. The survey was hosted on the U.S. Government's MAX.gov survey website and received Institutional Review Board and Survey Review Board approval per Navy and Defense Health Agency requirements. Participants recorded their experiences with various patient presentations using Likert scale assessments, indicated their comfort in prescribing medication to patients with 11 distinct presenting concerns, and responded to six questions regarding their training and clinical experience in the field of women's mental health. RESULTS: Differences were noted for provider gender, treatment setting, patient sex, provider rank, and years of independent practice. Female providers were more likely than males to report that their female patients presented with 15 of the 21 measured issues. Providers located at MTFs were significantly more likely than providers in operational billets to report female patients presenting with certain conditions and reported being more comfortable prescribing medication. Eighty percent of respondents authorized to prescribe medicine rated themselves as very or extremely comfortable prescribing medications to their patients for all specified conditions except two: women who are breastfeeding and women who are pregnant. Senior officers reported the most comfort prescribing medication to women who are planning to become pregnant and women who have experienced perinatal loss. Only a minority of providers (20%, female; 33%, males) reported receiving women's mental health education during their training. Of those who did receive training, it was limited to post-partum and pregnancy. Most participants (93%) agreed that women's mental health should be incorporated into training programs for military providers. CONCLUSIONS: This exploratory study highlights that provider variables impact assessment and treatment of and for patients. The study highlights the interplay of gender, treatment setting, experiences, and level of comfort are associated with provider assessment of presenting concerns. The authors hope this study will help in prioritizing women's mental health practices, mental health training, and research, and in informing policy and decision-making.


Subject(s)
Mental Health Services , Military Personnel , Humans , Female , Adult , Military Personnel/psychology , Military Personnel/statistics & numerical data , Surveys and Questionnaires , Mental Health Services/statistics & numerical data , Mental Health Services/standards , Male , United States , Middle Aged , Women's Health/statistics & numerical data , Health Knowledge, Attitudes, Practice
2.
PLoS One ; 19(8): e0305992, 2024.
Article in English | MEDLINE | ID: mdl-39121172

ABSTRACT

OBJECTIVES: Violence against women is a widespread public health concern with severe effects to women's sexual and reproductive health, including higher risks for miscarriage or stillbirth, unintended pregnancy and induced abortion. This study examined the association between women exposure to physical violence, psychological violence and sexual and reproductive health outcomes (contraceptive use, miscarriage or stillbirth and abortion) in Germany. METHODS: This study used a cross-sectional research design to analyze data on violence against women and sexual and reproductive health (SRH) outcomes collected through the German Health Interview and Examination Survey for Adults, Wave 1, between 2008 and 2011 (n = 3149 women, aged 18-64 years). Multivariable logistic regression models were used to assess the association between experiences of violence among women and the presence of sexual and reproductive health outcomes, considering the influence of socio-demographic and health-related factors (age, marital status, socioeconomic status, social support, number of children, alcohol consumption, health status, chronic conditions). RESULTS: Three associations remained significant (p<0.05) in fully-adjusted models: (i) exposure to physical violence by a parent or caregiver and birth control pill utilization (aOR, adjusted Odds Ratio, 95% CI: 1.36, 1.02-1.81) (ii) exposure to physical violence since the age of 16 and miscarriage or stillbirth (aOR, 95%CI: 1.89, 1.17-3.04); and (iii) exposure to psychological violence by a parent or caregiver and abortion (aOR, 95%CI: 1.87, 1.30-2.70). CONCLUSIONS: The results suggest that adult German women who experienced physical or psychological violence since the age of 16, including violence perpetrated by a parent or caregiver, were more likely to report miscarriage or stillbirth and abortion. Direct assessment of violence experiences against women should be conducted by healthcare professionals in clinical encounters, particularly by obstetrics and gynaecological specialists, for the prevention of women´s adverse sexual and reproductive health outcomes. Furthermore, violence should be treated as a major public health concern and addressed through a multisectoral approach, involving the healthcare and educational sectors, researchers and relevant policymakers.


Subject(s)
Reproductive Health , Humans , Female , Adult , Germany/epidemiology , Adolescent , Middle Aged , Reproductive Health/statistics & numerical data , Young Adult , Cross-Sectional Studies , Pregnancy , Sexual Health , Abortion, Spontaneous/epidemiology , Health Surveys , Abortion, Induced/psychology , Abortion, Induced/statistics & numerical data , Women's Health/statistics & numerical data , Stillbirth/epidemiology
3.
Am J Prev Med ; 67(3): 389-396, 2024 09.
Article in English | MEDLINE | ID: mdl-38796029

ABSTRACT

INTRODUCTION: Women's physical activity levels vary throughout adulthood. However, the associations between trajectories of physical activity and health outcomes have been little studied. The aim of this study was to examine the associations of physical activity trajectories with incident diabetes, hypertension, obesity, depression, and physical disability in mid-aged women. METHODS: Data were from the 1946-51 cohort of the Australian Longitudinal Study on Women's Health (n=11,611). Mailed surveys at 3-year intervals from 1998 (age 47-52) to 2019 (age 68-73) were used to collect data on physical activity and each outcome. The analyses were conducted in 2023/24. Physical activity trajectories from age 47-61 (2-4 time-points) were identified using group-based trajectory modeling. Cox regression models with time-varying covariates were used to examine the associations of physical activity trajectories with adverse health outcomes onset from ages 56-73 (2-5 time-points). RESULTS: Trajectories of physical activity were labeled as Low (59.7% of participants), Declining (5.9%), Increasing (26.3%), and High (8.1%). The median of 9-year overall physical activity (MET.minutes/week) was 450 in the Low, 1324 in the Declining, 1399 in the Increasing, and 2323 in the High group. Compared with the Low group, the risks of diabetes, obesity and physical disability were lower in the Increasing and High groups, and the risk of depression was lower in the High group. Conversely, the risk of obesity was higher in the Declining group. CONCLUSIONS: Targeting mid-aged women with declining physical activity for prevention programs could enhance health in later life.


Subject(s)
Depression , Exercise , Obesity , Humans , Female , Middle Aged , Australia/epidemiology , Longitudinal Studies , Aged , Chronic Disease/epidemiology , Obesity/epidemiology , Depression/epidemiology , Women's Health/statistics & numerical data , Hypertension/epidemiology , Diabetes Mellitus/epidemiology , Surveys and Questionnaires
4.
PLoS One ; 19(5): e0302820, 2024.
Article in English | MEDLINE | ID: mdl-38820266

ABSTRACT

BACKGROUND: The Women's Health Needs Study (WHNS) collected information on the health characteristics, needs, and experiences, including female genital mutilation (FGM) experiences, attitudes, and beliefs, of women aged 18 to 49 years who were born, or whose mothers were born, in a country where FGM is prevalent living in the US. The purpose of this paper is to describe the WHNS design, methods, strengths and limitations, as well as select demographic and health-related characteristics of participants. METHODS: We conducted a cross-sectional survey from November 2020 -June 2021 in four US metropolitan areas, using a hybrid venue-based sampling (VBS) and respondent-driven sampling (RDS) approach to identify women for recruitment. RESULTS: Of 1,132 participants, 395 were recruited via VBS and 737 RDS. Most were born, or their mothers were born, in either a West African country (Burkina Faso, Guinea, Mali, Mauritania, Sierra Leone, The Gambia) (39.0%) or Ethiopia (30.7%). More than a third were aged 30-39 years (37.5%) with a majority who immigrated at ages ≥13 years (86.6%) and had lived in the United States for ≥5 years (68.9%). Medicaid was the top health insurer (52.5%), followed by private health insurance (30.5%); 17% of participants had no insurance. Nearly half of women reported 1-2 healthcare visits within the past 12 months (47.7%). One in seven did not get needed health care due to cost (14.8%). Over half have ever used contraception (52.1%) to delay or avoid pregnancy and 76.9% had their last pelvic and/or Papanicolaou (pap) exam within the past 3 years. More than half experienced FGM (55.0%). Nearly all women believed that FGM should be stopped (92.0%). CONCLUSION: The VBS/RDS approach enabled recruitment of a diverse study population. WHNS advances research related to the health characteristics, needs, and experiences of women living in the US from countries where FGM is prevalent.


Subject(s)
Circumcision, Female , Women's Health , Humans , Female , Circumcision, Female/statistics & numerical data , Circumcision, Female/psychology , Adult , United States , Middle Aged , Adolescent , Cross-Sectional Studies , Young Adult , Women's Health/statistics & numerical data , Prevalence , Health Knowledge, Attitudes, Practice , Surveys and Questionnaires
5.
Dtsch Arztebl Int ; 121(12): 401-406, 2024 Jun 14.
Article in English | MEDLINE | ID: mdl-38616556

ABSTRACT

BACKGROUND: Cardiovascular diseases due to arteriosclerosis are the most common causes of death and disability in both men and women. Hypercholesterolemia, a treatable risk factor, is often detected after a delay in women, and then inadequately treated. It is, therefore, important to know the sex-specific aspects of cholesterol metabolism and to address them specifically. METHODS: We conducted a selective literature search in PubMed with particular attention to current guidelines. RESULTS: In the population as a whole, the age-associated rise in serum cholesterol levels occurs approximately 10 years later in women than in men. Women are exposed to a higher cholesterol load than men at the beginning of their lives, and especially after menopause. This is correlated with a later, but nonetheless clinically relevant rise in the incidence of myocardial infarction in older women. Because women's LDL cholesterol and lipoprotein(a) levels rise after menopause, their lipid profiles should be re-evaluated at this time. Moreover, conditions that are specific to women such as polycystic ovary syndrome, contraception, and especially the phases of life-such as planning to become pregnant, pregnancy, and breastfeeding-need to be considered for both diagnostic and therapeutic purposes. Sex-specific differences and cholesterolassociated risks are particularly pronounced in women with familial hypercholesterolemia (prevalence 1:250). CONCLUSION: Lowering high cholesterol levels, especially in postmenopausal women, may prevent the development of cardiovascular diseases.


Subject(s)
Cholesterol , Hypercholesterolemia , Humans , Female , Hypercholesterolemia/blood , Hypercholesterolemia/epidemiology , Cholesterol/blood , Cholesterol/metabolism , Women's Health/statistics & numerical data , Risk Factors , Sex Distribution , Cardiovascular Diseases/blood , Cardiovascular Diseases/metabolism , Male
6.
Article in German | MEDLINE | ID: mdl-38662021

ABSTRACT

BACKGROUND: Women live longer than men, but they spend more life years with health-impairment. This article examines the extent to which this gender paradox can be explained by two factors: the "mortality effect," which results from the higher life expectancy of women, and "differential item functioning" (DIF), which refers to gender differences in reporting behavior. METHODS: Impaired life expectancy at age 50 is calculated for the health indicators general health, limitations, and chronic morbidity using the Sullivan method. Data on health prevalence are obtained from the 2012 survey "Gesundheit in Deutschland aktuell" (GEDA), data on mortality is taken from the Human Mortality Database. The gender difference in impaired life expectancy is decomposed into the mortality effect and the health effect. The latter is finally adjusted for DIF effects on the basis of vignettes from the 2004 SHARE survey. RESULTS: The gender paradox can be resolved not only partially but completely for all three health indicators considered by the mortality effect and DIF. After taking these two factors into account, the gender difference in impaired life expectancy reverses from higher values for women to higher values for men. DISCUSSION: The causes of the gender paradox are highly complex and the differences between women and men in total and impaired life expectancy are not necessarily going into contradictory directions. The extent of women's higher impaired life expectancy depends decisively on the underlying health indicator and is largely explained by the mortality effect.


Subject(s)
Life Expectancy , Humans , Life Expectancy/trends , Female , Male , Germany/epidemiology , Middle Aged , Sex Distribution , Aged , Aged, 80 and over , Mortality/trends , Women's Health/statistics & numerical data , Health Status Disparities , Chronic Disease/epidemiology , Chronic Disease/mortality , Risk Factors
10.
Eat Behav ; 50: 101748, 2023 08.
Article in English | MEDLINE | ID: mdl-37253297

ABSTRACT

Evidence suggests social media use is strongly linked to disordered eating (e.g., binge eating and dietary restraint) among adolescent and young adult women, in part because it promotes engagement in social comparison (the tendency to evaluate one's own standing or ability by comparing it to another's). Yet no study has examined the impact of social media use and comparison on disordered eating among middle-aged women. Participants (N = 347), ages 40-63, completed an online survey about their social media use, social comparison, and disordered eating (bulimic symptoms, dietary restraint, and broad eating pathology). Results indicated that 89 % (n = 310) of middle-aged women used social media in the past year. Most participants (n = 260; 75 %) used Facebook, and at least a quarter used Instagram or Pinterest. Approximately 65 % (n = 225) used social media at least daily. Controlling for age and body mass index, social media-specific social comparison was positively associated with bulimic symptoms, dietary restriction, and broad eating pathology (all ps < 0.001). Multiple regression models evaluating frequency of social media use and social media-specific social comparison together revealed that social comparison explained a significant amount of unique variance in bulimic symptoms, dietary restriction, and broad eating pathology (all ps < 0.001) above and beyond frequency of social media use. Instagram explained a significant proportion of variance of dietary restraint compared to other social media platforms (p = .001). Findings suggest a large percentage of middle-aged women frequently engage with some type of social media. Further, social media-specific social comparison, rather than frequency of social media use, may be driving disordered eating in this age group of women.


Subject(s)
Body Image , Diet, Reducing , Feeding and Eating Disorders , Social Media , Adult , Female , Humans , Middle Aged , Body Mass Index , Bulimia/epidemiology , Diet, Reducing/statistics & numerical data , Feeding and Eating Disorders/epidemiology , Feeding and Eating Disorders/etiology , Mothers , Photic Stimulation , Social Media/statistics & numerical data , Social Values , Surveys and Questionnaires , Women's Health/statistics & numerical data
13.
Esc. Anna Nery Rev. Enferm ; 27: e20220288, 2023. tab
Article in Portuguese | LILACS, BDENF - Nursing | ID: biblio-1506223

ABSTRACT

Resumo Objetivo Estimar a frequência e os fatores associados à violência sexual contra mulheres no Espírito Santo. Métodos Estudo transversal realizado a partir de dados notificados entre 2011 e 2018 no Sistema de Informação de Agravos de Notificação. A análise multivariada foi conduzida por meio da regressão de Poisson, com variância robusta. Resultados A frequência de violência sexual foi de 15,6%, sendo maior a ocorrência em crianças; pessoas sem deficiências e/ou transtornos; residentes em área urbana; com agressor único, desconhecido, do sexo masculino e sem suspeita de uso de álcool. A residência foi o local de maior ocorrência e o caráter de repetição esteve presente. Conclusão e implicações para a prática A violência sexual contra mulheres apresentou alta frequência no estado. Os resultados reforçam a associação desse agravo com características da vítima, do agressor e do evento, evidenciando a vulnerabilidade das crianças e o espaço doméstico como um cenário de grande frequência desse agravo.


Resumen Objetivo Estimar la frecuencia y los factores asociados con la violencia sexual contra la mujer en Espírito Santo. Métodos Estudio transversal realizado a partir de datos notificados entre 2011 y 2018 en el Sistema de Información de Enfermedades de Declaración Obligatoria. El análisis multivariado se realizó mediante regresión de Poisson, con varianza robusta. Resultados La frecuencia de violencia sexual fue del 15,6%. La prevalencia fue mayor en niñas; personas sin discapacidades y/o trastornos; residentes en áreas urbanas; con un único agresor, desconocido, del género masculino y sin sospecha de consumo de alcohol. La residencia fue el lugar de mayor ocurrencia y el carácter de repetición estuvo presente. Conclusión e implicaciones para la práctica La violencia sexual contra las mujeres fue altamente prevalente en el estado. Los resultados refuerzan la asociación de esa condición con las características de la víctima, del agresor y del evento, evidenciando la vulnerabilidad de las niñas y el espacio doméstico como escenario de alta frecuencia de esa condición.


Abstract Objective To estimate the frequency and factors associated with sexual violence against women in Espírito Santo. Methods Cross-sectional study based on data reported between 2011 and 2018 in the Notifiable Diseases Information System. Multivariate analysis was conducted using Poisson regression, with robust variance. Results The frequency of sexual violence was 15.6%, being the prevalence higher among children; people without disabilities and/or disorders; urban areas residents; with a sole, male, unknown aggressor and without suspicion of alcohol use. The residence was the place with the highest occurrence and the character of repetition was present. Conclusion and implications for practice Sexual violence against women was highly prevalent in the state. The results reinforce the association of this condition with the characteristics of the victim, the aggressor and the event, evidencing the vulnerability of children and the domestic space as a scenario of high frequency of this harm.


Subject(s)
Humans , Female , Child , Adolescent , Adult , Middle Aged , Young Adult , Sex Offenses/statistics & numerical data , Women's Health/statistics & numerical data , Notification/statistics & numerical data , Violence Against Women , Socioeconomic Factors , Child Abuse, Sexual/statistics & numerical data
15.
Asian Pac J Cancer Prev ; 23(2): 475-783, 2022 Feb 01.
Article in English | MEDLINE | ID: mdl-35225459

ABSTRACT

BACKGROUND: Although it is known that cancer mortality rate varies depending on occupations in Japan, differences in female cancer mortality rate depending on occupational classes have not been analyzed using the Vital Statistics in Japan. In this study, we analyzed the Vital Statistics data in Japan from 1995 to 2015, and revealed differences in cancer mortality rate depending on occupational classes among Japanese women. METHODS: The Vital Statistics data by occupations from 1995 to 2015 were obtained from the "Report of Vital Statistics : Occupational and Industrial Aspects" in Japan, and data on mortality for cancer in all sites, colorectal cancer, liver cancer, gallbladder and extrahepatic bile duct cancer, pancreatic cancer, lung cancer, breast cancer, and uterine cancer were used. We classified main occupation categories into non-manual workers and manual workers, and calculated age-standardized mortality rate for each of the occupational class, year, age group, and type of cancer and its annual percent change. RESULTS: Age-standardized mortality rates for non-manual workers (222.0 per 100,000 persons in 1995 and 143.8 per 100,000 persons in 2015) were higher in cancer in all sites than those for manual workers (127.6 per 100,000 persons in 1995 and 103.7 per 100,000 persons in 2015) throughout the years. However, age-standardized mortality rates showed a significant decreasing trend between 1995 and 2015 for non-manual workers, and the absolute value of annual percent change was higher in non-manual workers than in manual workers. As a result, a difference in age-standardized mortality rates for cancer in all sites between the two types of occupational classes decreased throughout the years. CONCLUSION: A further study investigating differences in physical or behavioral characteristics of female non-manual and manual workers is needed in order to understand the key factors for the higher cancer mortality rate in non-manual workers.


Subject(s)
Mortality/trends , Neoplasms/mortality , Occupational Diseases/mortality , Occupations/statistics & numerical data , Adult , Female , Humans , Japan/epidemiology , Middle Aged , Occupational Health/statistics & numerical data , Occupations/classification , Women's Health/statistics & numerical data
16.
Am J Prev Med ; 62(4): 548-557, 2022 04.
Article in English | MEDLINE | ID: mdl-35135719

ABSTRACT

INTRODUCTION: High and increasing levels of pregnancy-related mortality and morbidity in the U.S. indicate that the underlying health status of reproductive-aged women may be far from optimal, yet few studies have examined mortality trends and disparities exclusively among this population. METHODS: All-cause and cause-specific mortality data for 1999-2019 were obtained from the Centers for Disease Control and Prevention WONDER Underlying Cause of Death database. Levels and trends in mortality between 1999 and 2019 for women aged 15-44 years stratified by age, race/ethnicity, and state were examined. Given the urgent need to address pregnancy-related health disparities, the correlation between all-cause and pregnancy-related mortality rates across states for the years 2015-2019 was also examined. RESULTS: Age-adjusted, all-cause mortality rates among women aged 15-44 years improved between 2003 and 2011 but worsened between 2011 and 2019. The recent increase in mortality among this age group was not driven solely by increases in external causes of death. Patterns differed by age, race/ethnicity, and geography, with non-Hispanic American Indian and Alaskan Native women having 2.3 and non-Hispanic Black women having 1.4 times the risk of all-cause mortality in 2019 compared with that of non-Hispanic White women. Age-adjusted all-cause mortality rates and pregnancy-related mortality rates were strongly correlated at the state level (r=0.75). CONCLUSIONS: Increasing mortality among reproductive-aged women has substantial implications for maternal, women's, and children's health. Given the high correlation between pregnancy-related mortality and all-cause mortality at the state level, addressing the structural factors that shape mortality risks may have the greatest likelihood of improving women's health outcomes across the life course.


Subject(s)
Health Status Disparities , Mortality , Women's Health , Adolescent , Adult , Age Distribution , Centers for Disease Control and Prevention, U.S. , Ethnicity/statistics & numerical data , Female , Humans , Mortality/ethnology , Mortality/trends , Pregnancy , United States/epidemiology , Women's Health/ethnology , Women's Health/statistics & numerical data , Young Adult
17.
BMC Cancer ; 22(1): 69, 2022 Jan 16.
Article in English | MEDLINE | ID: mdl-35033023

ABSTRACT

BACKGROUND: The Predicting Risk of Cancer at Screening (PROCAS) study provided women who were eligible for breast cancer screening in Greater Manchester (United Kingdom) with their 10-year risk of breast cancer, i.e., low (≤1.5%), average (1.5-4.99%), moderate (5.-7.99%) or high (≥8%). The aim of this study is to explore which factors were associated with women's uptake of screening and prevention recommendations. Additionally, we evaluated women's organisational preferences regarding tailored screening. METHODS: A total of 325 women with a self-reported low (n = 60), average (n = 125), moderate (n = 80), or high (n = 60) risk completed a two-part web-based survey. The first part contained questions about personal characteristics. For the second part women were asked about uptake of early detection and preventive behaviours after breast cancer risk communication. Additional questions were posed to explore preferences regarding the organisation of risk-stratified screening and prevention. We performed exploratory univariable and multivariable regression analyses to assess which factors were associated with uptake of primary and secondary breast cancer preventive behaviours, stratified by breast cancer risk. Organisational preferences are presented using descriptive statistics. RESULTS: Self-reported breast cancer risk predicted uptake of (a) supplemental screening and breast self-examination, (b) risk-reducing medication and (c) preventive lifestyle behaviours. Further predictors were (a) having a first degree relative with breast cancer, (b) higher age, and (c) higher body mass index (BMI). Women's organisational preferences for tailored screening emphasised a desire for more intensive screening for women at increased risk by further shortening the screening interval and moving the starting age forward. CONCLUSIONS: Breast cancer risk communication predicts the uptake of key tailored primary and secondary preventive behaviours. Effective communication of breast cancer risk information is essential to optimise the population-wide impact of tailored screening.


Subject(s)
Breast Neoplasms/prevention & control , Early Detection of Cancer/psychology , Patient Acceptance of Health Care/psychology , Women's Health/statistics & numerical data , Adult , Breast Self-Examination/psychology , Female , Health Behavior , Humans , Middle Aged , Risk Assessment , United Kingdom
18.
JAMA Netw Open ; 5(1): e2143730, 2022 01 04.
Article in English | MEDLINE | ID: mdl-35029663

ABSTRACT

Importance: Meta-analyses have reported conflicting data on the safety of hormonal contraception, but the quality of evidence for the associations between hormonal contraceptive use and adverse health outcomes has not been quantified in aggregate. Objective: To grade the evidence from meta-analyses of randomized clinical trials (RCTs) and cohort studies that assessed the associations between hormonal contraceptive use and adverse health outcomes among women. Data Sources: MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched from database inception to August 2020. Search terms included hormonal contraception, contraceptive agents, progesterone, desogestrel, norethindrone, megestrol, algestone, norprogesterones, and levonorgestrel combined with terms such as systematic review or meta-analysis. Evidence Review: The methodological quality of each meta-analysis was graded using the Assessment of Multiple Systematic Reviews, version 2, which rated quality as critically low, low, moderate, or high. The Grading of Recommendation, Assessment, Development and Evaluations approach was used to assess the certainty of evidence in meta-analyses of RCTs, with evidence graded as very low, low, moderate, or high. Evidence of associations from meta-analyses of cohort studies was ranked according to established criteria as nonsignificant, weak, suggestive, highly suggestive, or convincing. Results: A total of 2996 records were screened; of those, 310 full-text articles were assessed for eligibility, and 58 articles (13 meta-analyses of RCTs and 45 meta-analyses of cohort studies) were selected for evidence synthesis. Sixty associations were described in meta-analyses of RCTs, and 96 associations were described in meta-analyses of cohort studies. Among meta-analyses of RCTs, 14 of the 60 associations were nominally statistically significant (P ≤ .05); no associations between hormonal contraceptive use and adverse outcomes were supported by high-quality evidence. The association between the use of a levonorgestrel-releasing intrauterine system and reductions in endometrial polyps associated with tamoxifen use (odds ratio [OR], 0.22; 95% CI, 0.13-0.38) was graded as having high-quality evidence, and this evidence ranking was retained in the subgroup analysis. Among meta-analyses of cohort studies, 40 of the 96 associations were nominally statistically significant; however, no associations between hormonal contraceptive use and adverse outcomes were supported by convincing evidence in the primary and subgroup analyses. The risk of venous thromboembolism among those using vs not using oral contraception (OR, 2.42; 95% CI, 1.76-3.32) was initially supported by highly suggestive evidence, but this evidence was downgraded to weak in the sensitivity analysis. Conclusions And Relevance: The results of this umbrella review supported preexisting understandings of the risks and benefits associated with hormonal contraceptive use. Overall, the associations between hormonal contraceptive use and cardiovascular risk, cancer risk, and other major adverse health outcomes were not supported by high-quality evidence.


Subject(s)
Contraceptive Agents, Hormonal/adverse effects , Drug-Related Side Effects and Adverse Reactions/epidemiology , Long Term Adverse Effects/epidemiology , Women's Health/statistics & numerical data , Adult , Cohort Studies , Drug-Related Side Effects and Adverse Reactions/etiology , Female , Humans , Long Term Adverse Effects/chemically induced , Meta-Analysis as Topic , Pregnancy , Randomized Controlled Trials as Topic , Systematic Reviews as Topic
19.
PLoS One ; 17(1): e0262643, 2022.
Article in English | MEDLINE | ID: mdl-35085326

ABSTRACT

In low- and middle-income countries, poor autonomy prevents women from making financial decisions, which may impact their access to improved sanitation facilities. Inadequate access to improved sanitation disproportionately affects women's and children's health and wellbeing. Although socio-cultural factors are known contributors to gender inequity, social beliefs that potentially motivate or dissuade women from making sanitation-related household decisions are not well understood. These beliefs may vary across settlement types. To empower more women to make sanitation-related decisions, the relevant socio-cultural norms and underlying social beliefs need to be addressed. In this mixed methods study, we explored women's role in sanitation-related decision making in three settlement types, urban slums, peri-urban, and rural communities in Bihar. Trained qualitative researchers conducted six focus group discussions with women of two age groups: 18-30 years old, and 45-65 years old to understand the norm-focused factors around women's role in getting a toilet for their household. Using insights generated from these group discussions, we developed and conducted a theory-driven survey in 2528 randomly selected participants, to assess the social beliefs regarding women making toilet construction decisions in these communities. Overall, 45% of the respondents reported making joint decisions to build toilets that involved both men and women household members. More women exclusively led this decision-making process in peri-urban (26%) and rural areas (35%) compared to urban slums (12%). Social beliefs that men commonly led household decisions to build toilets were negatively associated with women's participation in decision making in urban slums (adjusted prevalence ratio, aPR: 0.53, 95% CI: 0.42, 0.68). Qualitative insights highlighted normative expectations to take joint decisions with elders, especially in joint family settings. Surrounding norms that limited women's physical mobility and access to peers undermined their confidence in making large financial decisions involved in toilet construction. Women were more likely to be involved in sanitation decisions in peri-urban and rural contexts. Women's involvement in such decisions was perceived as widely acceptable. This highlights the opportunity to increase women's participation in sanitation decision making, particularly in urban contexts. As more women get involved in decisions to build toilets, highlighting this norm may encourage gender-equitable engagement in sanitation-related decisions in low-resource settings.


Subject(s)
Focus Groups/statistics & numerical data , Women's Health/statistics & numerical data , Adolescent , Adult , Aged , Bathroom Equipment/statistics & numerical data , Decision Making , Family Characteristics , Female , Gender Identity , Gender Role , Health Services/statistics & numerical data , Humans , Income/statistics & numerical data , India , Middle Aged , Poverty Areas , Qualitative Research , Rural Population/statistics & numerical data , Sanitation/statistics & numerical data , Young Adult
20.
Cancer Control ; 29: 10732748211068634, 2022.
Article in English | MEDLINE | ID: mdl-35012377

ABSTRACT

BACKGROUND: Invasive cervix uteri cancer is the fourth most common malignancy in women globally. This study investigates the incidence and trends of cervix uteri cancer in Lebanon, a country in the Middle East, and compares these rates to regional and global ones. METHODS: Data on cervix uteri were obtained from the Lebanese national cancer registry for the currently available years 2005 to 2016. The calculated age-standardized incidence and age-specific rates were expressed as per 100,000 population. RESULTS: From 2005 to 2016, cervix uteri cancer was the tenth most common cancer among women. Its age-standardized incidence rate fluctuated narrowly between 3.5 and 5.7 per 100,000, with the lowest rate in 2013 and the highest rate in 2012. The age-specific incidence rate had 2 peaks, the highest peak at age group 70-74 years and the second at age group 50-59 years. The annual percent change (+.05%) showed a non-statistically significant trend of increase. The age-standardized incidence rate of cervix uteri cancer in Lebanon was comparable to that of the Western Asia region that has the lowest incidence rate worldwide. The rate was intermediate as compared to other countries in the Middle East and North Africa Region and relatively similar to the ones in Australia, North America, and some Western European countries. CONCLUSION: The incidence rates of invasive cervix uteri are low in Lebanon. This could be attributed to the low prevalence of human papilloma virus infection and other sexually transmitted infections among Lebanese women, and the opportunistic screening practices. It is important to adopt a comprehensive approach to decrease the potential burden of cervix uteri, especially with the rising patterns of risky sexual behaviors. This includes improving awareness, enhancing access to preventive services, developing clinical guidelines, and training health care providers on these guidelines.


Subject(s)
Global Health/statistics & numerical data , Uterine Cervical Neoplasms/epidemiology , Women's Health/statistics & numerical data , Adult , Aged , Female , Humans , Incidence , Lebanon/epidemiology , Middle Aged , Prevalence , Risk Factors , Uterine Cervical Neoplasms/etiology
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