Sentimentos da mulher frente a gestação de alto risco / Sentimientos de la mujer frente al embarazo de alto riesgo / Women's feelings facing High-Risk pregnancy

Resumo Introdução: A gestação configura-se como um acontecimento único e memorável para a vida de uma mulher. A gravidez de alto risco é uma experiência estressante em razão dos riscos a que estão submetidos a mãe e o bebê e devido às mudanças que afetam negativamente o seu equilíbrio emocional. Objetivo: Identificar os sentimentos vivenciados pela gestante frente à gravidez de alto risco. Método: Descritivo e exploratório com abordagem qualitativa, com amostra por conveniência composta por mulheres com gestação de alto risco, selecionadas de acordo com a disponibilidade do serviço de internamento, até a saturação das entrevistas. A coleta dos dados foi realizada em um período de dois meses através de entrevistas guiadas por um roteiro. Os dados foram analisados por meio da técnica de análise de conteúdo segundo Minayo. Resultados: Fizeram parte 37 mulheres. Os resultados foram oeganizados nas categorias: Como se deu o diagnóstico de alto risco; Sentimentos ao descobrir que a gestação é/era de risco; Sentimentos em relação ao apoio familiar acerca da gestação de alto risco. Os sentimentos relatados pelas gestantes e puérperas que conviveram com a gravidez de alto risco, deixam evidentes os impactos que este evento traz não somente na saúde física sobretudo para a emocional, deixando as gestantes fragilizadas. Conclusão: Assim, o estudo nos permitiu perceber que os sentimentos vivenciados nesse processo podem interfir na vida dessas mulheres, e de forma negativa. Mas, que apesar dessa situação, estas expressam sentimentos ambíguos, pois mesmo com o risco gestacional, muitas mostram-se felizes pela dádiva de ser mãe.

Resumen Introducción: El embarazo se considera un evento único y memorable en la vida de una mujer. El embarazo de alto riesgo es una experiencia estresante debido a los riesgos a los que están expuestas tanto la madre como su bebé y a los cambios que afectan negativamente su equilibrio emocional. Objetivo: Identificar los sentimientos experimentados por las mujeres embarazadas frente a un embarazo de alto riesgo. Metodología: Descriptivo y exploratorio con enfoque cualitativo, con una muestra a conveniencia compuesta por mujeres con embarazos de alto riesgo, seleccionadas según la disponibilidad del servicio de hospitalización, hasta la saturación de las entrevistas. La recopilación de datos se llevó a cabo durante un período de dos meses a través de entrevistas guiadas. Los datos fueron analizados utilizando la técnica de análisis de contenido según Minayo. Resultados: Participaron 37 mujeres y los resultados se organizaron en las siguientes categorías: cómo se realizó el diagnóstico de alto riesgo; sentimientos al descubrir que el embarazo era de riesgo; sentimientos con respecto al apoyo familiar en relación con el embarazo de alto riesgo. Los sentimientos relatados por las mujeres embarazadas y posparto que vivieron un embarazo de alto riesgo evidencian los impactos que tiene este evento no solo en la salud física sino, especialmente, en el bienestar emocional, pues deja a las mujeres embarazadas en un estado de vulnerabilidad. Conclusión: El estudio nos permitió darnos cuenta de que los sentimientos experimentados en este proceso pueden interferir en la vida de estas mujeres de manera negativa. Sin embargo, a pesar de esta situación, muchas de ellas expresan sentimientos ambiguos, porque, incluso con el riesgo gestacional, están agradecidas por el regalo de la maternidad.

Abstract Introduction: Pregnancy is considered a unique and memorable event in a woman's life. High-risk pregnancy is a stressful experience due to the risks to which the mother and the baby are exposed, and due to the changes that negatively affect their emotional balance. Objective: To identify the feelings experienced by pregnant women facing high-risk pregnancy. Method: Descriptive and exploratory, employing a qualitative approach, the study featured a convenience sample of women with high-risk pregnancies, selected based on inpatient service availability, until interview saturation was achieved. Data collection was conducted over a two-month period through scripted interviews. Data analysis was performed utilizing Minayo's content analysis technique. Results: Thirty-seven women participated in the study. The results were categorized as follows: How the high-risk diagnosis was determined; Feelings upon discovering the pregnancy was high-risk; Feelings regarding family support regarding the high-risk pregnancy. The feelings reported by pregnant and postpartum women who experienced high-risk pregnancies clearly reveal the impacts this event has, not only on physical health, but especially on emotional well-being, leaving the pregnant women in a vulnerable state. Conclusion: The study allowed us to realize that the feelings experienced in this process can negatively interfere in the lives of these women. However, despite this situation, many of them express mixed feelings, because even with the gestational risk, they are grateful for the gift of motherhood.

Antenatal depression among pregnant mothers in Afghanistan: A cross-sectional study.

BACKGROUND: Approximately one in five pregnant women experience antenatal depression globally. The purpose of the present study was to estimate the prevalence of antenatal depression and explore its relationship between various demographic variables, recent sexual engagement, and recent adverse life events among pregnant Afghan women. METHODS: A cross-sectional survey study was carried out between January, 2023 and April 2023 among 460 women aged 15-45 years who were recruited using convenience sampling from Herat province (Afghanistan). Logistic regression models were utilized to explore the relationship between antenatal depression and socio-demographic characteristics among the participants. RESULTS: The prevalence of antenatal depression symptoms was 78.5%. Multiple regression analysis indicated that antenatal depression was significantly associated with (i) being aged 30-45 years (AOR: 4.216, 95% CI: 1.868-9.515, p = .001), (ii) being of low economic status (AOR:2.102, 95% CI: 1.051-4.202, p = .036), (iii) not being employed (AOR: 2.445, 95% CI:1.189-5.025, p = .015), (iv) not having had sex during the past seven days (AOR: 2.335, 95% CI: 1.427-3.822, p = .001), and (v) not experiencing a traumatic event during the past month (AOR:0.263, 95% CI: 0.139-0.495, p < .001). CONCLUSION: The present study provides insight into the factors associated with the high prevalence of antenatal depression among pregnant Afghan women (e.g., demographic variables, recent adverse life events, and recent sexual engagement). It highlights the urgency of addressing antenatal depression in Afghanistan and provides a foundation for future research and interventions aimed at improving the mental health and well-being of pregnant women in the Afghan context.

More than Cramps in Scrubs: Exploring Dysmenorrhea among Women Healthcare Workers.

Though understudied, dysmenorrhea, a painful cramping sensation occurring near and during menses, is the most prevalent gynecological disorder among women of reproductive age, affecting 50-90% of the global population. Contributing factors of this disorder include poor medical assessment, lack of consciousness, gender bias, moderate to high levels of stress, and depression and anxiety. Among school students and healthcare trainees, dysmenorrhea contributes to short-term absenteeism, lower productivity, creativity, and job performance. Among medical trainees, dysmenorrhea has been found to impact daily activities to a disabling degree in nearly one third of instances, resulting in difficulties in relationships and even self-isolation. Dysmenorrhea further produces substantial global economic losses and higher healthcare costs. To begin to alleviate the extensive issue of dysmenorrhea, we must increase awareness to fully understand its prevalence, risk factors, and potential for effective, affordable, and accessible treatments. Concurrently, our clinical environment must adopt a standard description and assessment tool to prevent, measure, and monitor dysmenorrhea, while on a global scale, we must develop and widely disseminate nationwide labor regulations that address the workforce impact due to the effects of dysmenorrhea.

Prevalence and Associated Factors of Liver Enzyme Abnormalities Among Bangladeshi Women: A Cross-Sectional Study.

Background Liver enzyme abnormalities can indicate underlying liver health issues and are influenced by various factors. This study aimed to investigate the prevalence of liver enzyme abnormalities and their associated factors among nonpregnant and nonlactating (NPNL) women in Bangladesh. Methodology A cross-sectional study was conducted among 251 NPNL Bangladeshi women. Data on demographic, socioeconomic, and health-related variables were collected. Logistic regression analysis was used to determine the association between liver enzyme abnormalities and associated factors. Results The prevalence of liver enzyme abnormalities among participants was determined, with associated factors such as age, body mass index (BMI), monthly income, and food security status examined. Elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were observed in 54 (21.5%) and 47 (18.7%) of participants, respectively, with 116 (46.2%) exhibiting an AST/ALT ratio exceeding 1.00. Food insecurity was significantly associated with a higher prevalence of elevated ALT levels (24.4% vs. 8.7%, P = 0.02), as well as low monthly income (18.8%, 14.7% vs. 36.7%, P < 0.01) and higher BMI (11% vs. 27.7% and 25.6%, P = 0.02). Similar trends were observed for AST levels. Moreover, participants with a higher BMI exhibited significantly higher rates of at least one abnormal liver function enzyme (15.9% vs. 34.9%, P = 0.01). Logistic regression analysis revealed a significant association between abnormal liver enzyme levels and certain demographic and socioeconomic factors, specifically BMI and age. Conclusions This study provides insights into the prevalence of liver enzyme abnormalities and their associated factors among NPNL Bangladeshi women. The findings underscore the importance of addressing factors such as BMI and age in mitigating liver health issues in this population. Further research and targeted interventions are warranted to address these concerns effectively.

Laparoscopic-Assisted Vaginal Hysterectomy With Dense Bladder Adhesions and Absent Cervix: A Case Report With a Descriptive Video of the Entire Procedure.

Hysterectomy is one of the most frequently performed surgical procedures in the United States. Hysterectomy for benign gynecological reasons can be performed through several approaches: abdominal, laparoscopic, laparoscopically assisted vaginal, robotic-assisted, and vaginal natural orifice hysterectomy. The choice of approach is strongly influenced by factors such as previous procedures, safety, and recovery process. Currently, vaginal hysterectomy, laparoscopic-assisted vaginal hysterectomy (LAVH), assisted vaginal hysterectomy, and robotic-assisted vaginal hysterectomy are considered minimally invasive approaches with multiple benefits to the patient such as less trauma, shorter operative time, and shorter postoperative period. However, in patients with pelvic adhesions, adhesions within the abdominal cavity, especially omental adhesions to the abdominal wall, and adhesions between the uterus and the bladder caused by multiple cesarian sections or prior surgery on the cervix, these minimally invasive approaches are problematic. In this report, we describe in detail our approach to LAVH in a patient with severe abdominal adhesions and an absent cervix. We believe that our approach is safe and relatively fast compared to an open abdominal procedure and, therefore, it may help gynecologic surgeons-in-training nationwide.

Development and Validation of a Risk Prediction Model for Female Stress Urinary Incontinence in Rural Fujian, China.

Purpose: With China's rapidly aging population and the rising proportion of obese people, an increase in the number of women suffering from urinary incontinence (UI) is to be expected. In order to identify high-risk groups before leakage occurs, we aimed to develop and validate a model to predict the risk of stress UI (SUI) in rural women. Patients and methods: This study included women aged 20-70 years in rural Fujian who participated in an epidemiologic survey of female UI conducted between June and October 2022. Subsequently the data was randomly divided into training and validation sets in a ratio of 7:3. Univariate and multivariate logistic regression analyses were used to identify independent risk factors as well as to further construct a nomogram for risk prediction. Finally, concordance index (C-index), calibration curve and decision curve analysis were applied to evaluate the performance of the predictive models. Results: A total of 5290 rural females were enrolled, of whom 771 (14.6%) had SUI. Age, body mass index (BMI), postmenopausal status, number of vaginal deliveries, vaginal delivery of large infant, constipation and family history of pelvic organ prolapse (POP) and SUI were included in the nomogram. C-index of this prediction model for the training and validation sets was 0.835 (95% confidence interval [CI] = 0.818-0.851) and 0.829 (95% CI = 0.796-0.858), respectively, and the calibration curves and decision analysis curves for both the training and validation sets showed that the model was well-calibrated and had a positive net benefit. Conclusion: This model accurately estimated the SUI risk of rural women in Fujian, which may serve as an effective primary screening tool for the early identification of SUI risk and provide a basis for further implementation of individualized early intervention. Moreover, the model is concise and intuitive, which makes it more operational for rural women with scarce medical resources.

Women's Health: Coming of Age on 2024.

The focus of the life and work of an obstetrics and gynaecological specialist is improving women's health, hence it is imperative that this issue be addressed in the Journal of Obstetrics and Gynaecology of India while we are still fresh with our memories of the "International women's day" celebration. The multidimensional impact of health and well-being of women has now been realised not only in the medical field but also in the realms of socioeconomic development. Governments all over the world are now paying special attention towards improving infrastructure, policymaking and implementation strategies to uplift the quality of healthcare for women and children, which  are now also important components of the Sustainable Development Goals. It is heartening to see worldwide interdisciplinary collaboration and coordination to achieve this vital goal and include every aspect of women's healthcare through the "lifecycle" approach and "holistic care" protocols.

COVID-19 vaccine acceptance among pregnant women: a multicentre cross-sectional survey in Port Harcourt, Nigeria.

Introduction: effective COVID-19 vaccines for the prevention of severe illness have been available for more than one year now. This study was carried out to ascertain vaccine hesitancy and its associations among pregnant women receiving antenatal care in Port Harcourt, a large cosmopolitan town in Nigeria. Methods: we conducted a cross-sectional online survey over 2 months among consenting pregnant women receiving antenatal care in the 3 largest obstetric service centers in Port Harcourt to evaluate COVID-19 vaccine hesitancy and its associations. Results: the prevalence of vaccine hesitancy was 669 (72.2%). Of the respondents, 27 (2.9%) had been infected or had a close family member infected with SARS-CoV-2, and 897 (96.8%) of them had heard of the COVID-19 vaccine; however, only 133 (14.4%) had been vaccinated against COVID-19. The safety of the mother in 260 (32.8%) and the safety of the unborn baby in 114 (14.4%) of the respondents were the reasons for vaccine hesitancy. A small proportion of women 7(0.9%) were hesitant on religious grounds. Tertiary education, use of childhood immunization for previous infants delivered, and availability of COVID-19 vaccine in the antenatal clinic at no cost to the women, were statistically significant predictors of vaccine uptake among the respondents. Conclusion: the prevalence of vaccine hesitancy among pregnant women in Port Harcourt was 72.2%. Higher academic achievement and availability of the COVID-19 vaccine in the antenatal clinic were predictors of vaccine uptake, while reasons for hesitancy were mostly due to safety concerns for the mother and unborn baby.

Feasibility and acceptability of sexually transmitted infection screening during antenatal care of women in Dhaka, Bangladesh.

BACKGROUND: Sexually transmitted infections (STIs) are a major public health concern worldwide. Untreated STIs may have serious sequelae, particularly in pregnant women. The objective of this study was to assess the feasibility and acceptability of screening and treating common STIs in women during pregnancy in Bangladesh. METHODS: Women were enrolled from four maternity clinics/hospitals serving the lower-middle class population in Dhaka, Bangladesh. The participants were interviewed, and vaginal swab samples were collected by clinical staff. Specimens were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and high-risk Human Papilloma Viruses (HPVs) using GeneXpert (Cepheid, Sunnyvale, California). Women were informed of their test results and were provided treatment for curable infections. A test of cure was performed. RESULTS: Out of 1157 pregnant women approached, 1000 (86.4%) participated. Ninety-one percent women learned of their test results on the same day of testing. Out of the 996 valid results, 7 (0.7%) tested positive for Chlamydia trachomatis and 1 (0.1%) for Trichomonas vaginalis. There were no gonorrhoea cases. Out of the 971 women with valid results for high-risk HPVs, 46 (4.7%) tested positive. CONCLUSIONS: Screening women for STIs during antenatal care was highly feasible and well-accepted in Bangladesh. While the prevalence of common curable STIs was very low, hrHPV infection prevalence was moderately high. Our findings support period monitoring of STIs and continued prevention efforts for cervical cancer in Bangladesh.

Hostile Masculinity, Male Peer Support for Violence, and Problematic Anger: Linking Childhood Abuse to Men's Partner Violence Perpetration.

Child abuse and masculinity have been linked to intimate partner violence (IPV) perpetration. However, there is a lack of work examining multiple aspects of masculinity as links between early abuse experiences and men's IPV perpetration. Grounded in notions of gendered power and patriarchy, this study aimed to examine hostile masculinity, male peer support for violence against women, and problematic anger as aspects of masculinity connecting childhood victimization and men's violence against women. Structural equation modeling results demonstrated that childhood adversity was indirectly related to IPV perpetration via the proposed factors. However, various patterns emerged based on the type of childhood abuse experienced. Practice-based implications are offered.

Regulatory emotional self-efficacy and self-compassion mediate anxiety, depression, body image distress and subjective well-being in women with polycystic ovary syndrome: A cross-sectional study.

AIMS: This study aims to investigate the mediating role of regulatory emotional self-efficacy and self-compassion in the relationship among anxiety, depression, body image distress and subjective well-being among women with polycystic ovary syndrome. DESIGN: A cross-sectional study. METHODS: The study recruited 510 women with polycystic ovary syndrome from a tertiary hospital affiliated with a university in Hunan Province, China. The study employed several tools to collect data, including the Generalized Anxiety Scale, the Patient Health Questionnaire-9, the Body Image States Scale, the Self-Compassion Scale, the Regulatory Emotional Self-Efficacy Scale and the Index of Well-being questionnaire. Data analysis was carried out using descriptive analysis, spearman correlation analysis, ordinary least squares regression and bootstrapping. RESULTS: The study's findings indicate that regulatory emotional self-efficacy and self-compassion both act as mediators in the connection between anxiety, depression, body image distress and subjective well-being among women with polycystic ovary syndrome. CONCLUSION: The study emphasizes the significance of regulatory emotional self-efficacy and self-compassion in promoting well-being among women with polycystic ovary syndrome. It also implies that interventions targeted at enhancing these factors could potentially enhance the subjective well-being of women affected by PCOS. IMPACT: Our study's primary contribution is to underscore the crucial mediating roles of regulatory emotional self-efficacy and self-compassion in the relationship among anxiety, depression, body image distress and subjective well-being. Our study indicates that clinical practitioners should prioritize improving the regulatory emotional self-efficacy and self-compassion of women with polycystic ovary syndrome, reducing their anxiety, depression and body image distress and improving their subjective well-being. REPORTING METHOD: This study was reported according to the Standards for Reporting Qualitative Research (SRQR). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution outside of participation in the actual study for purposes of data collection.

Altered coordination between sleep timing and cortisol profiles in night working female hospital employees.

BACKGROUND: Cortisol typically peaks in the morning after waking up and declines throughout the day, reaching its lowest levels during nighttime sleep. Shift work can cause misalignment between cortisol levels and sleep-wake timing. We analyzed this misalignment in female shift workers focusing on the timing and extent of these changes. METHODS: We conducted a cross-sectional study involving 68 shift workers (aged 37 ± 10 years) and 21 non-shift workers (aged 45 ± 10 years) from a hospital. Shift workers were monitored through two day shifts and three night shifts, whereas non-shift workers were monitored during two day shifts. Each participant collected six to eight saliva samples (depending on their shift type) and provided sleep timing information, which was recorded via polysomnography and sleep diaries. Generalized additive mixed models were used to estimate shift-specific differences in cortisol smooth curves. Summary measures calculated for the cortisol smooth curves included cortisol awakening response, peak-to-bed slope, and total output. RESULTS: Between shift workers and non-shift workers, we observed similar diurnal cortisol profiles with a steep negative diurnal slope during day shifts. In shift workers on night shifts, a flattened U-shaped cortisol profile after the post-awakening maximum was observed, with a peak-to-bed slope close to zero. When comparing night to day shifts in the group of shift workers, mean cortisol levels were lower between 42 and 56 minutes and 1.8-11.9 hours after waking up, and higher between 14.9 and 22 hours after waking up. CONCLUSION: Our findings indicate altered cortisol profiles in female hospital employees on night shifts. Specifically, cortisol levels were lower at night when higher levels would typically be necessary for work activities, and higher at bedtime after a night shift, when levels should normally be low.

An Age-Progression Intervention for Smoking Cessation: A Pilot Study Investigating the Influence of Two Sets of Instructions on Intervention Efficacy.

BACKGROUND: Research on age-progression facial morphing interventions for smoking cessation has not investigated the effect of different instructions for intervention delivery. The objective of this pilot study was to investigate the influence of two instruction types used to deliver the intervention on efficacy of the intervention. METHOD: Women were recruited and randomly allocated to an age-progression intervention session with (i) neutral instructions; (ii) instructions designed to reassure; or (iii) a condition that controlled for participant engagement ("control"). The conditions were delivered in a one-time procedure, after which primary (quitting intentions) and secondary (cigarettes/week, quit attempts) outcomes were measured immediately post-intervention, and at 1 and 3 months. RESULTS: Seventy-two women (M = 25.7; SD = 0.9) were recruited and randomly allocated to condition (Neutral n = 27, Reassuring n = 22, Control n = 23). Quitting intentions were higher in the Reassuring versus Control arm (3 months post-intervention, F = 4.37, p = 0.016, 95% CI [0.231, 2.539], eta2 = 0.11); quit attempts were greater in the two intervention arms (58%) versus Control (1-month post-intervention, 15%) (χ2 = 9.83, p < 0.05, OR 1.00 [0.28, 3.63]). CONCLUSIONS: Findings highlight the importance of optimising instructions to enhance intervention efficacy. TRIAL REGISTRATION: clinicaltrials.gov Record: NCT03749382.

How to Evaluate Reports of Intimate Partner Violence? Examining Interpartner Agreement in a Forensic Sample of Different-Sex Couples Where Men are Accused of Intimate Partner Violence.

Research about interpartner agreement on intimate partner violence (IPV) is mainly based on community and clinical samples, with forensic or court-related samples being overlooked. This study assesses interpartner agreement on IPV reports based on the Revised Conflict Tactic Scales, aiming to explore if the proxy method would be reliable in a court-related setting. The study sample comprised 62 different-sex couples identified in the Portuguese judicial system due to an IPV-related crime perpetrated by men. Agreement was assessed based on different indexes: percent agreement and Gwet's AC1 for occurrence, and Tau-b and intraclass correlations for frequency. Men's and women's perpetration were considered. Results showed that interpartner agreement on IPV occurrence (ranging from poor-to-very good) tended to be higher and more consistent among indexes than agreement on IPV frequency (ranging from non-existent to strong). This study highlights the need to collect both partners' reports in court-related settings.

Health-related quality of life in reproductive-age women on antiretroviral therapy: a cross sectional study in Ethiopia.

OBJECTIVES: While numerous studies have explored the impact of gender on Health-Related Quality of Life (HRQOL), there is a lack of evidence specifically among reproductive-age women undergoing Antiretroviral Therapy (ART). Therefore, this study aims to investigate HRQOL and its associated factors among reproductive-age women receiving ART at Hiwot Fana Comprehensive Specialized Hospital in Eastern Ethiopia. METHODS: A cross-sectional study included 418 women of ART. The World Health Organization quality of Life Questionnaire (WHOQOL-HIV BREF) was used to assess HRQOL. Binary logistic regression was used to determine the factors that could predict HRQOL. RESULTS: The study found that the median age of the participants was 37 years, and the overall percentage of women with good HRQOL was 40.7%. Women who stayed on ART for more than 6 years had higher odds of overall good HRQOL (AOR 6.73, 95% CI 3.31-13.71) compared to those with a duration of 6 years or less. Besides, women having no child (AOR 25.03, 95% CI 4.93-127.06), one child (AOR 18.60, 95% CI 3.95-87.65), two children (AOR 12.89, 95% CI 3.66-45.37) and three children (AOR 3.77, 95% CI 1.06-13.34) had higher odds of overall good HRQOL compared to those with four/more children. CONCLUSIONS: The study found that the majority of women on ART had poor HRQOL. Factors such as longer duration of taking ART, higher CD4+ cell count, disclosure of HIV status, and receiving care from adherence support teams were associated with better quality of life. Thus, strengthening adherence support teams, promoting safe disclosure of HIV status, and providing comprehensive support for HIV-positive women are required to improve their overall HRQOL.

Identity development in multicultural context: Multidimensional self exploration approaches employed by Modern Orthodox women.

The aim of this study is to examine identity development of Modern Orthodox women as they pursue their studies within a multicultural and multi-faith environment. Content analysis was used to analyze the final papers of undergraduate religious female students in Israel (N = 47) who participated in a semester-long dialogue course for Jewish students. The findings revealed three salient themes, suggesting that women's self-exploration developed noticeably within a rich multicultural context: (a) participants engaged in self-reflection by drawing comparisons between themselves and Arab students, leading to an exploration of their religious beliefs and group affiliations; (b) participants embraced their individuality within a multicultural context while balancing their religious duties; and (c) participants critically examined the status of Orthodox women in society, particularly within the family context. These findings highlight the process of identity exploration among Modern Orthodox women, complicated by intersections of religion, gender, and culture. In doing so, this study contributes to the understanding of identity development in multicultural societies.

Temporal trends in the prevalence and death of ischemic heart disease in women of childbearing age from 1990 to 2019: a multilevel analysis based on the Global Burden of Disease Study 2019.

Background: Our objective is to describe the current prevalence and death of ischemic heart disease (IHD) in women of childbearing age (WCBA) at the global, regional, and national levels and to analyze its temporal trends from 1990 to 2019. Methods: WCBA was defined as women aged 15-49 years. Estimates and 95% Uncertainty Intervals (UI) of IHD prevalence and death numbers for seven age groups were extracted from the 2019 Global Burden of Disease Study. The age-standardized prevalence and death rate (ASPR and ASDR) of IHD in WCBA was estimated using the direct age-standardization method. Joinpoint regression analysis was used to calculate average annual percent change (AAPC) to represent the temporal trends from 1990 to 2019. Results: Between 1990 and 2019, the global ASPR of IHD experienced a 3.21% increase, culminating in 367.21 (95% UI, 295.74-430.16) cases per 100,000 individuals. Conversely, the ASDR decreased to 11.11 (95% UI, 10.10-12.30) per 100,000 individuals. In 2019, among the five sociodemographic index (SDI) regions, the highest ASPR was observed in the high-middle SDI region, whereas the highest ASDR was found in the low-middle SDI region. Regionally, the Caribbean reported the highest ASPR (563.11 per 100,000 individuals; 95% UI, 493.13-643.03), and Oceania reported the highest ASDR (20.20 per 100,000 individuals; 95% UI, 13.01-31.03). At the national level, Trinidad and Tobago exhibited the highest ASPR (730.15 per 100,000 individuals; 95% UI, 633.96-840.13), and the Solomon Islands had the highest ASDR (77.77 per 100,000 individuals; 95% UI, 47.80-121.19). Importantly, over the past three decades, the global ASPR has seen a significant increase [AAPC = 0.11%, 95% Confidence Interval (CI): 0.09-0.13; P < 0.001], while the ASDR has demonstrated a significant decreasing trend (AAPC = -0.86%, 95% CI: -1.11 to -0.61; P < 0.001). Air pollution, tobacco use, high systolic blood pressure, elevated body mass index, dietary risks, and high LDL cholesterol have been identified as the leading six risk factors for IHD-related deaths among WCBA in 2019. Conclusions: Despite the significant decline in the global ASDR for IHD among WCBA over the last thirty years, the ASPR continues to escalate. We need to remain vigilant about the increased burden of IHD in WCBA. It calls for aggressive prevention strategies, rigorous control of risk factors, and the enhancement of healthcare coverage to mitigate the disease burden of IHD among WCBA in forthcoming years.

Gender and kidney transplantation.

Kidney transplantation provides the best form of kidney replacement therapy with improvement in quality of life and longevity. However, disparity exists in its availability, utilisation and outcomes, not only due to donor availability or financial constraints but also arising from the influence of biological sex and its sociocultural attribute i.e., Gender. Women make up the majority of kidney donors but are less likely to be counselled regarding transpantation, be waitlisted or receive living/deceased donor kidney. Biological differences also contribute to differences in kidney transplantation among the sexes. Women are more likely to be sensitised owing to pregnancy, especially in multiparous individuals, complicating donor compatibility. A heightened immune system in women, evidenced by more autoimmune illnesses, increases the risk of allograft rejection and loss. Differences in the pharmacokinetics of transplant drugs owing to biological variances could also contribute to variability in outcomes. Transgender medicine is also increasingly becoming a relevant topic of study, providing greater challenges in the form of hormonal manipulations and anatomic changes. It is thus important to determine and study transplantation and its nuances in this backdrop to be able to provide relevant sex and gender-specific interventions and design better practices for optimum kidney transplant utilisation and outcomes.

Relationship between depression and sex steroid hormone among women with epilepsy.

Introduction: Sex steroid hormones are emerging significant biomarkers of depression among Women with Epilepsy (WWE) with promising prognostic potential and therapeutic end point. Therefore, the study is aimed at exploring the association between sex steroids hormones, Anti-seizure Medication (ASM) and depression among WWE. Methodology: A baseline questionnaire was used to obtain socio-demographics and clinical characteristic from one hundred and twelve (112) WWE and 50 age matched healthy control. The diagnosis of epilepsy and Electroencephalography (EEG) description was based on 2017 International League Against Epilepsy (ILAE) criteria. Blood samples were collected from cases and control during Luteal Phase (LP) and Follicular Phase (FP). The Zung Self-Rating Depression Scale (ZSRDS) was used to assess depression. Result: The prevalence of depression among WWE is 18.8%, with a significant difference between the level of formal education (p0.000), age (p0.000), and mean ZSRDS (p0.000) among cases and control. There is a statistical difference in hormonal levels between cases and control with regards to higher testosterone [3.28 ± 9.99 vs. 0.31 ± 0.30; p0.037], lower FP prolactin [16.37 ± 20.14 vs. 17.20 ± 7.44; p0.778], and lower LP prolactin [15.74 ± 18.22 vs. 17.67 ± 7.27; p0.473]. Testosterone (p0.024), FP Follicle Stimulating Hormone (FSH) (p0.009), FP Estradiol (p0.006), LP FSH (p0.031), LP Progesterone (p0.023), and LP Prolactin (p0.000) were associated with depression. However, only prolactin (p0.042) and testosterone (p0.000) predicts depression among WWE. Conclusion: There was higher mean depression score, lower prolactin and higher testosterone level among cases compared to control. Furthermore, there was lower prolactin and higher testosterone level in Carbamazepine (CBZ) group compared to Levetiracetam (LEV) groups.

Evaluation of women's aging influence on sperm passage inside the fallopian tube using 3D dynamic mechanical modeling.

The fallopian tubes play an important role in human fertility by facilitating the spermatozoa passage to the oocyte as well as later actively facilitating the fertilized oocyte transportation to the uterus cavity. The fallopian tubes undergo changes involving biological, physical, and morphological processes due to women aging, which may impair fertility. Here, we have modelled fallopian tubes of women at different ages and evaluated the chances of normal and pathological sperm cells reaching the fertilization site, the ampulla. By utilizing a unique combination of simulative tools, we implemented dynamic three-dimensional (3D) detailed geometrical models of many normal and pathological sperm cells swimming together in 3D geometrical models of three fallopian tubes associated with different women's age groups. By tracking the sperm cell swim, we found that for all age groups, the number of normal sperm cells in the ampulla is the largest, compared with the pathological sperm cells. On the other hand, the number of normal sperm cells in the fertilization site decreases due to the morphological and mechanical changes that occur in the fallopian tube with age. Moreover, in older ages, the normal sperm cells swim with lower velocities and for shorter distances inside the ampulla toward the ovary. Thus, the changes that the human fallopian tube undergoes due to women's aging have a significant influence on the human sperm cell motility. Our model of sperm cell motility through the fallopian tube in relation to the woman's age morphological changes provides a new scope for the investigation and treatment of diseases and infertility cases associated with aging, as well as a potential personalized medicine tool for evaluating the chances of a natural fertilization per specific features of a man's sperm and a woman's reproductive system.