Unmasking the Mystery of Renal Neoplasm in a Perimenopausal Woman: A Case Report.

Mixed epithelial and stromal tumor (MEST) is a benign, complex, and rarely encountered renal neoplasm. This case involves a 46-year-old perimenopausal woman who presented with symptoms, such as abdominal pain, burning sensation during urination, increased urinary frequency, and hesitancy. Computed tomography (CT) urography revealed an exophytic, heterogeneously hyperdense mass originating from the interpolar and lower pole parenchyma of the left kidney, suggesting a neoplastic origin. Due to concerns about malignancy and the presence of local symptoms, a laparoscopic-assisted left radical nephrectomy was performed. Histopathological examination of the excised tissue revealed a biphasic neoplasm consisting of epithelial and stromal elements. The epithelial component exhibited cysts and glands of variable sizes, lined by columnar cells and surrounded by stromal tissue. The diagnosis of MESTs of the kidney was established and confirmed through immunohistochemistry. This unique type of benign kidney tumor can be effectively managed through conservative surgery and is associated with a favorable prognosis.

Women's experiences of childbirth during the COVID-19 pandemic in Lithuania.

INTRODUCTION: Childbirth experiences depend on environmental factors, the provision of qualified medical and non-medical care, and the woman's psychological well-being. Stress experienced during pregnancy and childbirth affects a woman's psychological well-being. The aim of this study was to determine the care of women who gave birth during the COVID-19 pandemic in Lithuania. METHODS: This qualitative study used an interview method to reveal women's childbirth experiences during and before the pandemic in Lithuania. The data obtained during the interview were analyzed using qualitative content analysis. Interviews were taken from 15 women who gave birth at least twice, i.e. the first time until March 2020 (but not earlier than March 2019) and gave birth again during the COVID-19 pandemic (March 2020 - January 2021). RESULTS: A total of 15 women participanted in the interviews. The experience of childbirth before the COVID-19 pandemic was seen as largely positive by women, but childbirth during the COVID-19 pandemic was mentioned as more complex and negative because of the challenges posed by the pandemic, but easier for other reasons not affected by the pandemic. The results of our study show that a higher proportion of women were satisfied with delivery care in hospitals, were happy, and praised the work of midwives and other staff, which mainly contributed to a positive experience. CONCLUSIONS: The COVID-19 pandemic posed particular challenges to women's childbirth experiences, and not enough attention was paid to mental health. The stress that was exacerbated during the pandemic period had a profound impact on the pregnant woman in Lithuania.

Empowering Self-Care: Caring Things in Alice Dunbar-Nelson's 1890s "New Woman" Short Fiction.

Alice Dunbar-Nelson is mostly remembered as a poet, activist, and ex-wife of Paul Laurence Dunbar. Her volume The Goodness of St. Rocque and Other Stories (1899) has been largely overshadowed as a result. Yet, the collection contains a portfolio of heroines analogous and contemporaneous to the famed New Woman figure of the fin de siècle. In this article, I consider Dunbar-Nelson's heroines in light of their New Woman-esque agency and autonomy as they find remedies and power in objects and materials steeped in New Orleans's cultural heritage. Ceded neither social nor political self-governance nor domestic comfort, this article reads these transcendental, metaphysical objects as sources of self-care. With close analysis of "The Goodness of St. Rocque," "Tony's Wife," and "Little Miss Sophie," I argue that Dunbar-Nelson's protagonists exert influence over their lives, specifically in the negotiation of romantic relationships, through voodoo charms, Catholic candles, tarot cards, sewing machines, and knitting needles. Covering courtship, break-ups, and unhappy marriages, I demonstrate the ways in which these empowering spiritual objects respond to health concerns, including malnutrition and domestic violence, in turn, situating them as alternatives to patriarchal and historically racist medical institutions. Valorizing the cultural milieu of New Orleans and the customs of the Caribbean and European heritage, and thereby conveying Dunbar-Nelson's resistance to white and male supremacist ideologies in late-nineteenth-century Southern America, the article ultimately assesses the parallels with (predominantly white) New Woman fiction, through shared themes of fraught heterosexual dynamics and women's declining health.

Do we want to know the enormity of women's severe menstrual disorders and chronic pelvic pain?

OBJECTIVE: The purpose of this paper is to call for a nationwide study to assess the prevalence and incidence of women health problems related to menstrual disorders and severe pelvic pain. RATIONALE: The exact prevalence and incidence of endometriosis, adenomyosis, severe painful menstrual disorders, and of severe chronic pelvic pain are unknown. These issues severely impact women's quality of life and represent huge costs for our societies. Using adapted questionnaires, recent progresses in diagnosis and increased fundings announced by politicians, we can and should change this situation by performing a nationwide study to assess prevalence and incidence of these women problems in the French general population. The huge, anticipated costs of this study do appear quite reasonable when accounting for the enormous costs and societal consequences of endometriosis, menstrual disorders and severe pelvic pain. CONCLUSION: These long-awaited data will improve our understanding of the causes, consequences, and natural history of endometriosis. These data will allow women to better understand that pain is not always related to endometriosis, thus preventing unjustified fears. Physicians will be able to adapt and improve medical managements, particularly the diagnosis. Politicians will have the tools to improve women's health and gender equality.

Sleep disturbances in late pregnancy: associations with induction of labor.

PURPOSE: Sleep disturbances, which are common during pregnancy, may compromise labor. Nevertheless, little is known about associations between sleep disturbances and the likelihood of ending up induction of labor (IOL). Accordingly, we aimed to evaluate the connections between sleep disturbances during pregnancy and IOL. METHODS: Altogether 1778 women from the FinnBrain Birth Cohort Study with gestation weeks over 37 + 6 were enrolled in the study. The women were divided into IOL (n = 331) and spontaneous onset of labor (SOL, n = 1447) groups. Sleep disturbances in late pregnancy were evaluated using the Basic Nordic Sleep Questionnaire. Logistic regression analyses were conducted with adjustments for age, body mass index, parity, smoking, and depressive symptoms. RESULTS: Sleep disturbances were frequent in both IOL and SOL groups. In the IOL group 43.0% and in the SOL group 39.0% had poor general sleep quality (P = 0.186). Nocturnal awakenings occurred most commonly, in 94.0% and 93.9%, respectively (P = 0.653). In the IOL group, more women (22.7%) were habitual snorers than in the SOL group (17.0%, P = 0.017), however, the difference lost the statistical significance in adjusted analysis (P = 0.848). Women in the IOL group were more likely to be short sleepers (< 7 h) compared to those in the SOL group (20.2% and 15.4%, respectively, P = 0.034) with no difference after adjustment (P = 0.133). The two groups showed no differences in sleep loss (P = 0.252). CONCLUSIONS: Deterioration in sleep quality was noticeable in pregnant women, but it was unconnected with IOL. As the frequency of IOL is increasing, more research for related risk factors is needed.

Use of Machine Learning for Early Detection of Maternal Cardiovascular Conditions: Retrospective Study Using Electronic Health Record Data.

BACKGROUND: Cardiovascular conditions (eg, cardiac and coronary conditions, hypertensive disorders of pregnancy, and cardiomyopathies) were the leading cause of maternal mortality between 2017 and 2019. The United States has the highest maternal mortality rate of any high-income nation, disproportionately impacting those who identify as non-Hispanic Black or Hispanic. Novel clinical approaches to the detection and diagnosis of cardiovascular conditions are therefore imperative. Emerging research is demonstrating that machine learning (ML) is a promising tool for detecting patients at increased risk for hypertensive disorders during pregnancy. However, additional studies are required to determine how integrating ML and big data, such as electronic health records (EHRs), can improve the identification of obstetric patients at higher risk of cardiovascular conditions. OBJECTIVE: This study aimed to evaluate the capability and timing of a proprietary ML algorithm, Healthy Outcomes for all Pregnancy Experiences-Cardiovascular-Risk Assessment Technology (HOPE-CAT), to detect maternal-related cardiovascular conditions and outcomes. METHODS: Retrospective data from the EHRs of a large health care system were investigated by HOPE-CAT in a virtual server environment. Deidentification of EHR data and standardization enabled HOPE-CAT to analyze data without pre-existing biases. The ML algorithm assessed risk factors selected by clinical experts in cardio-obstetrics, and the algorithm was iteratively trained using relevant literature and current standards of risk identification. After refinement of the algorithm's learned risk factors, risk profiles were generated for every patient including a designation of standard versus high risk. The profiles were individually paired with clinical outcomes pertaining to cardiovascular pregnancy conditions and complications, wherein a delta was calculated between the date of the risk profile and the actual diagnosis or intervention in the EHR. RESULTS: In total, 604 pregnancies resulting in birth had records or diagnoses that could be compared against the risk profile; the majority of patients identified as Black (n=482, 79.8%) and aged between 21 and 34 years (n=509, 84.4%). Preeclampsia (n=547, 90.6%) was the most common condition, followed by thromboembolism (n=16, 2.7%) and acute kidney disease or failure (n=13, 2.2%). The average delta was 56.8 (SD 69.7) days between the identification of risk factors by HOPE-CAT and the first date of diagnosis or intervention of a related condition reported in the EHR. HOPE-CAT showed the strongest performance in early risk detection of myocardial infarction at a delta of 65.7 (SD 81.4) days. CONCLUSIONS: This study provides additional evidence to support ML in obstetrical patients to enhance the early detection of cardiovascular conditions during pregnancy. ML can synthesize multiday patient presentations to enhance provider decision-making and potentially reduce maternal health disparities.

A qualitative study on the health system-related needs in women survivors of rape.

BACKGROUND: Rape, as an adverse incidence, leads to irreparable complications and consequences in women. Provision of health services to women survivors of rape requires catering for their real needs and identifying current deficits as well as barriers. The present study aimed to explore health system-related needs in women survivors of rape. METHODS: In the present qualitative study, the participants consisted of 39 individuals, including 19 women survivors of rape and 20 individuals with work experience in providing services to women survivors of rape. The participants were selected using the purposive sampling method with a maximum variation in Isfahan, Iran. Data were collected through in-depth interviews as well as field notes and were concurrently analyzed via conventional qualitative content analysis method. RESULTS: After analyzing the interviews, the health system-related needs of women survivors of rape were classified into two main categories: 1- The need for efficient medical care services with three sub-categories, namely "receiving services with respect for privacy and confidentiality", "non-judgmental behavior and approach", and "the need to receive empathy and the feeling of not being alone", and 2- The need for desirable conditions and structure to provide services with two sub-categories, namely "the need to receive comprehensive and integrated services", and "establishing specialized centers for providing services to survivors". CONCLUSIONS: Overall, explaining and highlighting the health system-related needs of women survivors of rape could provide a suitable basis for policy-making and planning according to their real needs. Receiving continuous services in separate centers with confidentiality and empathy could reduce the worries and concerns of women survivors of rape and help improve their health.

Petersen's Hernia in a Pregnant Woman Following Roux-en-Y Gastric Bypass Surgery: The Importance of Emergency Surgical Treatment.

Roux-en-Y gastric bypass (RYGB) patients are at risk of creating potential spaces for possible internal hernias during the procedure. During pregnancy, the pregnant uterus elevates the bowel, increasing intra-abdominal pressure. Cases reported to date have described mild abdominal pain and no evidence of peritoneal irritation, with inconclusive ultrasound and MRI findings for diagnosis of Petersen's hernia. We present the case of a 42-year-old female patient with a history of RYGB eight years earlier without complications, with a pregnancy of 34 weeks of gestation. Symptomatology began with colicky abdominal pain in the epigastric, with irradiation to the right upper quadrant. On physical examination, revealed a painful abdomen on the median and deep palpation in the epigastric and right upper quadrant, the rest of the studies were inconclusive. As there was no improvement of the symptoms in 12 hours, an emergency diagnostic laparoscopy was performed, finding a strangulated Petersen's hernia requiring resection, with the closure of the gastric pouch, intestinal anastomosis, and Stamm gastrostomy with closure of the mesenteric gap. Therefore, a pregnant patient presenting with upper quadrant abdominal pain with a history of RYGB, even one with normal labs and imaging, should be assumed to have an internal hernia until proven otherwise. The emergency surgical approach is associated with early resolution and prevents its progression with catastrophic results.

Association between decision-making during pregnancy and woman-centred care among Tanzanian pregnant women: A cross-sectional survey.

BACKGROUND: Many women in Tanzania lack autonomy in decision-making for their pregnancy and childbirth. Woman-centred care (WCC) seeks to provide each woman with the appropriate information that promotes participation and highlights their informed decision-making. Thus, decision-making has been proposed as an essential determinant of WCC. This study aimed to assess the association between decision-making and WCC among Tanzanian pregnant women. METHODS: We conducted a cross-sectional study among 710 pregnant women in Tanzania. The 23-item Woman-Centred Care English version questionnaire was used to assess how women perceived the care provided by midwives. Participants were categorized into two decision-making groups: decision-making for the birthing place by pregnant women themselves and by others. The pre-defined cut-off point of the top 20 percentile was used to indicate a high level of WCC. Binary logistic regression models were used to determine the association between decision-making and WCC. RESULTS: The median score (interquartile range) of WCC was 97 (92-103) points when decisions were made by pregnant women, compared to 92 (88-96) points when decisions were made by others (p<0.001). There was a significant association between decision-maker and WCC in both unadjusted (p<0.001) and multivariable-adjusted (p=0.006) analyses. The unadjusted odds were approximately 5 times higher in the pregnant women decision-making group (OR: 4.80, 95% CI: 2.74-8.43) and 3 times higher (OR:2.90, 95% CI: 1.36-6.07) after the adjustment for covariates. We observed no significant interaction between decision-making and parity on the level of WCC (p for interaction=0.52). CONCLUSION: Pregnant women who made decisions for the birthing place had a higher likelihood of having a high level of WCC compared with their counterparts. Our findings suggest that women should be empowered to be involved in decision-making to increase their satisfaction with the care provided by healthcare providers and foster a positive childbirth experience.

Network analysis of posttraumatic stress and posttraumatic growth symptoms among women in subsequent pregnancies following pregnancy loss.

BACKGROUND: Pregnant women who have undergone pregnancy loss often display both posttraumatic stress (PTS) and posttraumatic growth (PTG). However, the precise relationship and structure of symptomatic levels of PTS and PTG have not been well understood. This study aimed to assess the associations between PTS and PTG symptoms in women during subsequent pregnancies following a previous pregnancy loss. METHODS: A total of 406 pregnant women with a history of pregnancy loss were included in this study. The Impact of Events Scale-6 (IES-6) and the Posttraumatic Growth Inventory Short Form (PTGI-SF) were used to assess symptoms of PTS and PTG, respectively. The Graphical Gaussian Model was employed to estimate the network model. Central symptoms and bridge symptoms were identified based on "expected influence" and "bridge expected influence" indices, respectively. The stability and accuracy of the network were examined using the case-dropping procedure and nonparametric bootstrapped procedure. RESULTS: The network analysis identified PTG3 ("Ability to do better things") as the most central symptom, followed by PTS3 ("Avoidance of thoughts") and PTG6 ("New path for life") in the sample. Additionally, PTS3 ("Avoidance of thoughts") and PTG9 ("Perception of greater personal strength") were bridge symptoms linking PTS and PTG clusters. The network structure was robust in stability and accuracy tests. CONCLUSIONS: Interventions targeting the central symptoms identified, along with key bridge symptoms, have the potential to alleviate the severity of PTS experienced by women with a history of pregnancy loss and promote their personal growth.

Síntomas depresivos en una muestra de mujeres con hipotiroidismo subclínico y su relación con los cloratos del agua del grifo / Depressive symptoms in a sample of women with subclinical hypothyroidism and their relationship to chlorates in tap water

Introducción: en el hipotiroidismo subclínico pueden aparecer síntomas depresivos y su presencia suele facilitar la instauración de un tratamiento de reemplazo; sin embargo, estudios recientes no han encontrado una asociación entre ambos. Por otra parte, la función tiroidea puede verse afectada por disruptores endocrinos y, algunos de ellos, como los cloratos, pueden encontrarse en el agua que bebemos. Objetivos: conocer si el tipo de consumo de agua puede influir en la aparición de síntomas depresivos en pacientes con hipotiroidismo subclínico. Métodos: participaron 96 mujeres con hipotiroidismo subclínico, sin tratamiento tiroideo, de un área de salud de España. Estudiamos, entre otras variables, la presencia de síntomas depresivos, el tipo de consumo de agua (grifo/embotellada o manantial) y el nivel de cloratos en el agua del grifo. Resultados: el 41,7 % (40) de las mujeres presentaban síntomas depresivos y estos se relacionaban con el consumo de agua del grifo (p = 0,001), resultando este un predictor confiable (OR: 27,79; p = 0,007). El nivel de cloratos en el agua del grifo era de 250 µg/L, valor situado en el límite máximo permitido por la ley. Conclusiones: en mujeres con hipotiroidismo subclínico, la exposición crónica a cloratos en el agua, en niveles autorizados por la ley, podría favorecer la inhibición del transporte de yodo y la aparición de síntomas depresivos. Sería interesante comprobar esta hipótesis, así como su posible efecto sobre otros perfiles poblacionales.(AU)

Introduction: depressive symptoms may develop in subclinical hypothyroidism and their presence usually facilitates recognition and the establishment of replacement treatment; however, recent studies have found no association between the two. Besides, thyroid function can be affected by endocrine disruptors and some of them, such as chlorates, can be found in the water we drink. Objectives: to know if the type of water consumed may influence the development of depressive symptoms in patients with subclinical hypothyroidism. Methods: 96 women with subclinical hypothyroidism, without thyroid treatment, were enrolled. We studied, among other variables, the presence of depressive symptoms, type of water consumption (tap, bottled or spring) and the level of chlorates in the tap water. Results: 41.7 % (40) of women presented depressive symptoms and these were related to the consumption of tap water (p = 0.001), resulting in a reliable predictor (OR, 27.79; p = 0.007). Chlorate level in the tap water was 250 μg/L, a value within the maximum limit allowed by law. Conclusions: chronic exposure to chlorates in water, in women with subclinical hypo-thyroidism, at levels authorized by law, could favor the inhibition of iodine transport and the appearance of depressive symptoms. It would be interesting to test this hypothesis as well as its possible effect on other population profiles.(AU)

Cluster Headache Presenting As Sinonasal Pathology in a Young Adult: A Diagnostic Odyssey.

Cluster headache is a debilitating primary headache disorder marked by severe, unilateral pain often accompanied by autonomic symptoms. We describe the case of a 20-year-old student who presented with excruciating peri-orbital pain localized to the right side, accompanied by ipsilateral nasal obstruction, a nasal spur, and a deviated nasal septum (DNS). The initial clinical picture strongly suggested sinonasal pathology, leading to investigations and treatments aimed at this presumed diagnosis. However, as the patient's symptoms persisted and evolved over time, with episodes of recurrent and intense pain associated with ipsilateral tearing, rhinorrhea, and ptosis, further evaluation was pursued. A comprehensive assessment, including detailed headache characteristics, neurological examination, and neuroimaging, ultimately revealed the diagnosis of cluster headache. This case emphasizes the diagnostic challenges associated with atypical presentations of cluster headaches, the importance of a meticulous clinical evaluation, and the need for early recognition to provide timely and effective interventions for these severely affected individuals.

Unveiling the Strong Black Woman Schema-Evolution and Impact: A Systematic Review.

The Strong Black Woman (SBW) schema is described as a statue of unrelenting strength, resilience, and self-sufficiency, serving as a shield of protection and cultural adaptation to suppress and control manifestations of racial and gender oppression. Stemming from superwoman syndrome, a conceptual model exploring the multifactorial roles women hold and their impact, the SBW extends beyond gender roles to the sociopolitical context of the Black woman's lived experience. Endorsement of the SBW posits risk for health disparities including stress, anxiety, depression, and obesity. This review was conducted to explore the SBW schema and experiences of Black women who endorse it, to delineate how Black women describe themselves in relation to the SBW persona, and to inform further inquiry, nursing practice, and clinical approaches to improving health outcomes of this population. A systematic review of qualitative studies was conducted with a literature search from CINAHL, APA PsycINFO, MEDLINE, PubMed, and SocINDEX databases yielding seven relevant papers for this analysis. Studies using the superwoman schema and the SBW schema with participants who identified as Black women were included in the review. Consistent with the SBW phenomenon, many participants described examples and consequences of being an SBW. While most women identified with SBW, not all endorsed the persona entirely, challenging its ideal and reinforcing positive self-care. Themes include (a) Strength by nature, not choice, (b) Suppressed emotion, (c) Success over everything, and (d) Prioritizing others over self. Additional emerging themes are also included. Black women increasingly recognize the negative impacts of the SBW schema, pinpointing how their internal feelings manifest in their external world. The conceptual framework itself is an anomaly, incongruently impacting both the mental and physical health of Black women, further contributing to the long-term health and sociopolitical disparities that Black women experience. Simply acknowledging and understanding these experiences by healthcare practitioners are not enough to prevent or eliminate the risks involved with the endorsement of the SBW schema but rather intentionally addressing these as a contributing social determinant of health that predisposes them to long-term chronic conditions.

'Robbed out of mind': Reflections on Alzheimer's and gendered subjectivity in select Indian literary narratives.

Neurological degeneration is a potent signifier molding older lives, divesting them of 'personhood' and making them a 'target of care'. This article delineates the depictions of Alzheimer's and its associated losses in select Indian literary narratives- Jalsobi: In the Shadow of Light (2018) and Girl in White Cotton (2019) and seeks to understand how 'ageing into disability' for older women has severe implications that marginalize their embodied existence, foisting a symbolic death. Through the fictional accounts, the article explores two primary threads of consideration - how the 'selfhood' gets eroded/reclaimed while experiencing cognitive impairment and how the shift from the patient-centric to the person-centric approach alters the relational care dynamics in the Indian context. It also attempts to situate the conception and representation of age-induced cognitive loss within the framework of critical disability studies, which understates the reductionist biomedical perspective and fosters an alternative, inclusive, and empathetic understanding of dysfunctionality.

What is 'physiological birth'? A scoping review of the perspectives of women and care providers.

PROBLEM: Physiological birth was defined by the World Health Organization in 1997, however, clinical practices in childbirth have changed considerably since this time. BACKGROUND: Ambiguous terms in healthcare such as 'physiological birth' may cause confusion amongst care providers and consumers. AIM: To identify what is known about physiological birth, and how perceptions of physiological birth manifest in current literature. METHODS: This review followed the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR checklist. Four databases were searched using keywords relating to physiological birth. Relevant studies were identified using agreed criteria, and data were extracted and synthesised. RESULTS: A total of 24 studies met the inclusion criteria for this review. Three connected factors were identified: (1) Physiological birth in a risk-averse system, (2) Dominant voices in birth, and (3) Lack of exposure to physiological birth. No unified universal definition of physiological birth was identified in the literature. DISCUSSION: 'Physiological birth' as a term lacks consistency. A risk-averse healthcare system could be a barrier to physiological birth. Dominant voices in the birthing space can dictate the way birth occurs. Lack of exposure to physiological birth may diminish the acquisition and maintenance of important skills and knowledge among care providers. Recognising the factors important to women could lead to a positive birth experience. CONCLUSION: Excluding a woman's subjective experience from health professionals' understanding of physiological birth increases the likelihood of risk management being the paramount objective in clinical decision-making. We propose it is timely to align clinical understanding of physiological birth with midwifery's woman-centred professional philosophy.

Consanguineous Marriages and the Perception of Wife-Beating Justification in Pakistan: An Application of Fairlie Decomposition Analysis.

Pakistan has a significant occurrence of both consanguineous marriages and intimate partner violence (IPV), which may be interlinked. The practice of consanguineous marriages could potentially influence women to rationalize and accept instances of IPV. Such attitudes perpetuate a culture of violence against women, creating difficulties for victims to reject or escape from it. Pakistan has high prevalence rate of consanguineous marriages and IPV. However, no research has been done to explain the difference in acceptance of IPV between women in consanguineous and non-consanguineous marriages. This study used Pakistan Demographic and Health Survey data and applied association tests, logistic regression, and the Fairlie decomposition analysis. The Fairlie decomposition helps us identify the relative contribution of different socioeconomic factors in the inequalities in IPV between the two types of marriages. Five dimensions of wife-beating justification are used as outcome variables. Age, education, and empowerment of women, husband education, woman witness parental violence, region, place of residence, and household wealth status are used as independent variables. The logistic regression results indicated that women in consanguineous marriages of younger age and who witnessed parental violence are more likely to justify wife-beating than those who belong to wealthy households and enjoy more empowerment. Compared to the Punjab province, women residing in Sindh and Baluchistan are less likely and in the Khyber Pakhtunkhwa province are more likely to justify wife-beating. The Fairlie decomposition analysis shows that household wealth status, woman education, and empowerment are the main contributors in explaining the gap between the wife-beating justification of the two groups. The IPV gap can be reduced up to 77% if the distribution of women in different wealth quantiles of the consanguineous marriage group is identical to the non-consanguineous marriage group. Furthermore, woman education level is the second highest contributor. Consanguineous marriages are a prevalent cultural practice in Pakistan and are associated with several negative health and social outcomes. Addressing this issue requires a sustained and comprehensive effort by the government, civil society, and international partners, with a particular focus on women from poor households with less education.

Associations between arterial health and sexual function in women aged 60-64 years.

INTRODUCTION: Female sexual dysfunction is very common, but its determinants remain under-investigated. Vasculogenic impairments are suggested to be related to female sexual dysfunction, but previous literature regarding the association is scarce. This study aims to study the association between arterial health and female sexual function in women in their 60s. MATERIAL AND METHODS: The sample for this cross-sectional study comprised 117 women (aged 60-64 years) who participated in the Finnish Retirement and Aging study. Arterial health was measured according to the participants' pulse wave velocity, ankle-brachial index, blood pressure, and pulse pressure. Sexual function was measured using the Female Sexual Function Index, which resulted in a total score and six sub-scores. Associations were examined using multivariable regression analyses, which were adjusted for age, relationship happiness, systemic menopausal hormone therapy and/or local estrogen, smoking, alcohol risk use, body mass index, and depressive symptoms. RESULTS: Higher diastolic blood pressure was associated with a higher total Female Sexual Function Index score (ß = 0.24, 95% confidence interval [CI] 0.07-0.41) and with higher desire (ß = 0.02, 95% CI 0.01-0.04), arousal (ß = 0.04, 95% CI 0.01-0.08), lubrication (ß = 0.04, 95% CI 0.002-0.08), satisfaction (ß = 0.03, 95% CI 0.003-0.05), and pain (ß = 0.06, 95% CI 0.02-0.10) sub-scores. Also, higher ankle-brachial index was associated with higher satisfaction sub-score (ß = 2.10, 95% CI 0.44-3.73) and lower pulse pressure was associated with higher orgasm sub-score (ß = 0.03, 95% CI 0.0002-0.06). Other associations between ankle-brachial index and Female Sexual Function Index scores were statistically insignificant, but considering the magnitude the findings may imply clinical significance. Systolic blood pressure and pulse wave velocity were not associated with sexual function. CONCLUSIONS: This study suggested a plausible association between higher diastolic blood pressure and female sexual function, but considering clinical significance our findings suggest an association between higher ankle-brachial index and good sexual function in women in their 60s.

Women's sexual health improvement: sexual quality of life and pelvic floor muscle assessment in asymptomatic women.

Introduction: Problems related to the quality of sexual life in gynecological practice are usually neglected. This study aimed to highlight the significance of this area of concern and evaluate the usefulness of tools, such as patient-reported outcomes (PROs) and pelvic floor examination, to improve women's sexual wellbeing and to identify predictors of poor quality of sexual life during the well-woman annual visit. Methods: A cross-sectional study was designed to examine 300 healthy women to determine whether the sexual quality of life (SQOL) questionnaire (on electronic devices) and pelvic floor muscle assessment (the vulva, anus, muscles, and periurethral (VAMP) protocol) of asymptomatic women during the annual bimanual examination (BME) help differentiate patients who would benefit from discussing sexual problems with a gynecologist. Dyspareunia was an exclusion criterion. Results: The majority of subjects experienced high sexual wellbeing (82.0% with SQOL score of ≥84), with a mean of 85.7 points. SQOL scores were lower for psychiatric disorders or symptoms (37.0% of subjects), although they did not correlate with age, BMI, parity, contraception use, history of vulvovaginal symptoms, neurosurgical/orthopedic problems, and rectal, bowel, or bladder symptoms. Patients with dyspareunia (16.0% of participants, although they denied it during the face-to-face consultation) had a 3.6 times higher prevalence of low or moderate quality of sexual life. The VAMP protocol score was low in asymptomatic women, 33.0% met positive criteria (VAMP+, NRS ≥3) for pelvic floor dysfunction (overactivity), although at borderline levels. VAMP+ was positively correlated with chronic pain and genitourinary symptoms, but neither with dyspareunia nor incontinence, and was unrelated to the SQOL score (p = 0.151). Conclusion: Women's sexual health is a global health priority. Finding a way to start a discussion with an asymptomatic patient is crucial to increasing patients' interest in disclosing a sexual health problem to be resolved. PROs or simple questions about sexual wellbeing direct the discussion mainly toward the at-risk group for sexual deterioration: those with mental health problems and women with dyspareunia. Dyspareunia is considered a predictor of decreased quality of sexual life, a major sexual disorder that should not be overlooked. Gynecological consultation should resolve concerns, identify the problem, and refer for professional sexual care if still needed.

Influential Social Determinants of Adherence to Preventive and Health Promotion Activities during Pregnancy and the First Year of Life: Systematic Review.

Effective monitoring throughout pregnancy and the first year of life is a crucial factor in achieving lower rates of maternal and infant mortality. Currently, research on socioeconomic factors that influence the lack of adherence to preventive and control measures during pregnancy and the first year of life is limited. The objective of this review is to examine the available evidence on social determinants that influence participation in health promotion and preventive activities throughout the pregnancy journey and in infants during their first year of life. We performed a systematic review of the literature searching in the major scientific databases (PubMed, Scopus, EMBASE, WOS, and Cochrane Library) for articles from February 2017 to May 2023 containing information on health inequities that impact participation in health promotion and preventive measures from pregnancy through the first year of an infant's life. A total of 12 studies were selected; these studies were performed in ten different countries on five different continents. The selected studies cover preventive measures during maternal care, vaccination, and immunization during pregnancy and the first year of life, newborn screening, and follow-up of the first 12 months of life. The social factors associated with low adherence to health promotion activities during pregnancy and the first year of life include education, income, ethnicity, place of residence, and family characteristics. Despite the diverse geographical distribution, it is observed that there are common social factors linked to a decrease in the adherence to preventive measures during pregnancy and in the early years of life.

Mental Health and Body Image and the Reduction of Excess Body Weight in Woman (Polish Sample).

In recent years, excessive body weight has become one of the most serious psychological, biological and social problems. According to forecasts by the World Health Organization, obesity and overweight will continue to increase among both adults and children in the coming years. Poland ranks sixth in Europe in this respect. In 2021, almost 58% of Poles had above-average body weight (overweight or obesity). In Poland, 29% of women are overweight, and 21% of women are obese. Body dissatisfaction, depression, and anxiety disorder are indicated as consequences of high BMI in women. Reducing excess body weight improves psychosocial functioning and changes body assessment. The most lasting effects of weight reduction are achieved by a properly selected diet combined with increased physical activity. This results in a change in lifestyle, changes in the levels of metabolic indicators, and changes in one's body image and mental health. Objective: Our objective was to assess changes in body image and mental health among Polish women and their dependence on the weight reduction method used (type of diet and physical activity). Comparative studies involving 122 women were conducted. These women were selected from 1000 volunteers based on BMI criteria. The effects of diet therapy were compared with the effects of diet therapy combined with physical activity. Research tools: The GHQ-12 scale was used to measure mental health, and the Body Esteem Scale was used to measure body image. The study lasted four years. The results showed changes in body image, general mental health index, and BMI in women who dieted and in those who dieted and exercised. In women using a diet combined with physical activity, greater positive changes in mental condition and stronger positive changes in body image, namely in the assessment of satisfaction with sexual attractiveness, physical condition, and body weight control, were observed compared to women using diet therapy alone.