Does transdermal testosterone treatment improve fertility-related quality of life (QOL) in women with diminished ovarian reserve (DOR)? Transdermal testosterone for 9 weeks at a dose of 5.5 mg per day did not result in improved fertility-related QOL compared with placebo in women with DOR. Reduced QOL is prevalent in women with infertility, many of whom have DOR. Several studies have shown a correlation between DOR and lower testosterone levels, and testosterone is frequently prescribed to women with DOR undergoing fertility treatment. Some studies have reported that testosterone therapy may improve wellbeing in pre- and post-menopausal women, though others have found no benefit. There are no studies evaluating the effect of testosterone on QOL in women undergoing fertility treatment. Pre-planned secondary analysis of a double-blind placebo-controlled randomized controlled trial that included 288 participants recruited between April 2015 and August 2022. Of these, 213 completed QOL surveys both before and after treatment and were eligible for inclusion in this analysis. Participants were women aged 18-43 years with DOR according to the Bologna criteria and planning to undergo IVF treatment at one of eight fertility clinics in Spain, Belgium, and Denmark. Participants were randomized to 5.5 mg of transdermal testosterone per day as 1% gel (n = 106) or an identical placebo (n = 107), applied for a median of 60 days prior to commencing ovarian stimulation. QOL was assessed using the FertiQoL instrument prior to commencing the intervention, and at the completion of the intervention but prior to commencing ovarian stimulation. QOL scores were compared using a one-way ANCOVA adjusted for age, BMI, parity, history of IVF treatment, and baseline FertiQoL scores. There were no significant differences in baseline characteristics between the testosterone (n = 106) and placebo (n = 107) groups. After adjustment, testosterone showed no benefit over placebo for the Total FertiQoL score (F(1,204)=0.07, P = 0.79), the Core and Treatment scores, nor for any of the included FertiQoL subscales. Total testosterone levels were higher in the testosterone group than the placebo group at the end of the treatment (3.2 ± 2.7 nmol/l vs 0.6 ± 0.4 nmol/l, P < 0.001). QOL was a secondary outcome in this trial, and participants were not recruited based on a low QOL. Considering the available evidence, including the current study, premenopausal women are unlikely to benefit from testosterone treatment with regard to wellbeing and QOL. This study provides further evidence that testosterone should not be seen as a treatment for low wellbeing or QOL. The study was supported by unrestricted grants and support from Besins Healthcare, Roche Diagnostics, and Ferring Pharmaceuticals. The study medication and placebo were provided by Besins Healthcare. Funders had no access to patient data and had no role in the interpretation of the data, nor in the writing or approval of the final manuscript. The researchers were independent of the funders and had full access to all the data in the study. S.J.L. has received honoraria from Merck, Organon, and Hologic, consulting fees from Merck, and travel support from Merck, Organon, Besins Healthcare, and Ferring Pharmaceuticals. S.R.D. has received grants from NHMRC Australia, MS Australia, MRFF Australia, the Australian Heart Foundation, and Lawley Pharmaceuticals, consulting fees from Besins Healthcare, Astellas, and Abbott, honoraria from Theramex, Astellas, and Bayer, travel support from Astellas, and drugs/placebo from Lawley Pharmaceuticals for clinical trials; she is an Executive Board Member of the Australian Academy of Health and Medical Sciences. C.B. has received honoraria from Ferring Pharmaceuticals, IBSA, Organon, Merck A/S, and Abbott. A.G. has received honoraria from Lab Seid and travel support from Merck Serono. P.H. has received honoraria from Merck, IBSA, Gedeon Richter, and Besins Healthcare. L.D.L.F. has received consulting fees from Gedeon Richter, Ferring Pharmaceuticals, and Organon, travel support (personal and to institution) from Gedeon Richter, Ferring Pharmaceuticals, IBSA, Merck, Organon, and Theramex, and educational support (to institution) from Gedeon Richter and Merck. A.P. has received grants from Gedeon Richter, Ferring Pharmaceuticals, and Merck A/S, consulting fees from Gedeon Richter and Ferring Pharmaceuticals, honoraria from Ferring Pharmaceuticals, Gedeon Richter, Merck A/S, Abbott, and Organon, and travel support from Gedeon Richter. D.S. has received grants from Organon, Ferring Pharmaceuticals, Besins Healthcare, Gedeon Richter, and Vitrolife, honoraria from Organon, Ferring Pharmaceuticals, Besins Healthcare, Gedeon Richter, and Merck, travel support from Organon, Ferring Pharmaceuticals, Besins Healthcare, Gedeon Richter, and Merck, and is President of the Belgian Society for Reproductive Medicine. N.P.P. has received grants from Merck Serono, Ferring Pharmaceuticals, Theramex, Organon, Besins Healthcare, and Gedeon Richter, consulting fees from Merck Serono, Besins Healthcare, Organon, IBSA, FertilAI, and Alife, and honoraria from Merck Serono, Theramex, IBSA, Ferring Pharmaceuticals, Organon, Roche Diagnostics, and Besins Healthcare. S.G.M., F.M., and F.F. have no interests to declare. NCT02418572 (ClinicalTrials.gov).
South African women are vulnerable to HIV acquisition during the postpartum period which can result in perinatal transmission via breastfeeding; many male partners do not know their HIV status. Biomedical approaches to preventing HIV for postpartum women include pre-exposure prophylaxis (PrEP) and antiretroviral treatment for male partners with HIV. Gaps in implementation include low uptake of PrEP among postpartum women and infrequent testing of men who may be motivated to test for HIV to protect the health of their infant. We will conduct a randomised pilot trial in KwaZulu-Natal (KZN) Province, South Africa among postpartum women and their male partners. The study will pilot a combination intervention consisting of cognitive behavioural strategies (including communication skills training, motivational interviewing and problem-solving) to promote H IV self-testing (HIVST) for P artners and P rEP uptake for HIV-uninfected P ost p artum Women, the 'H4P' intervention. The study aims to determine the feasibility, acceptability and preliminary effectiveness of the H4P intervention. We will enrol 60 HIV-uninfected women, aged 18 years and older, in their third trimester of pregnancy and reporting a partner whose HIV-serostatus is unknown. Sixty male partners will also be eligible to enrol. Enrolled women will receive three oral HIVST kits to distribute to their male partners and standard of care information on HIVST and PrEP. Women randomised to the intervention arm will receive additional counselling and reproductive health-centred HIVST information for the male partner, including information about why HIV testing is important during their partners' postpartum period. To evaluate feasibility, we will calculate screening-to-enrolment ratios for women and men, the number of women who distribute HIVST kits to their male partners and the number of men who test. Acceptability will be evaluated using the Client Satisfaction Questionnaire and qualitative interviews. Effectiveness will be assessed at 3 months by measuring the proportion of women initiating PrEP via self-report and urine tenofovir measurements or receipt of injectable PrEP and the proportion of men who test positive who link to HIV care. Qualitative interviews will explore perceptions of the intervention. Ethics approval for this study was obtained from the Human Research Ethics Committee at The University of the Witwatersrand, Johannesburg, South Africa (Reference number: 250612) and the Institutional Review Boards at Massachusetts General Brigham (2025P002271, Boston, Massachusetts, USA) and the University of Alabama at Birmingham (300015167, Birmingham, Alabama, USA) in the USA. Site support and approvals were obtained from the health facility and the KwaZulu-Natal Provincial Department of Health. Results will be disseminated through peer-reviewed manuscripts, reports and both local and international presentations. NCT07194902.
Exposure to parental depression is a risk factor for offspring mental illness. To examine the association between the timing of exposure to parental depression, from pregnancy to young adulthood, and adult offspring mental health. This prospective longitudinal cohort study of adult offspring aged 22 to 27 years in the Avon Longitudinal Study of Parents and Children, a British birth cohort, was conducted from September 1990 to July 2020. Data were analyzed from March 2024 to January 2026. Parental depressive symptoms were assessed repeatedly using the Edinburgh Postnatal Depression Scale (score range, 0 to 30, with higher scores indicating more severe depressive symptoms) beginning in pregnancy through offspring age of 21 years. The main outcomes were offspring symptoms of depression at age 27 years, anxiety at age 25 years, psychotic disorders at age 24 years, and alcohol use disorder (AUD) at age 22 years. Covariates included socioeconomic status and maternal-offspring polygenic risk for multiple psychiatric disorders. A total of 5329 adult offspring (3276 females [61.5%]) provided at least 1 outcome measure, which included 3795 participants providing symptoms of depression (mean [SD] age, 27.8 [0.5] years), 3505 participants providing symptoms of anxiety (mean [SD] age, 25.3 [0.6] years), 3342 participants with assessments for psychotic disorders (mean [SD] age, 24.5 [0.8] years), and 3392 participants reporting on symptoms of AUD (mean [SD] age, 22.9 [0.5] years). Cumulative exposure to parental depression across all time points was associated with increased odds of offspring depression (maternal: AOR, 2.36 [95% CI, 1.91-2.92]; paternal: AOR, 2.13 [95% CI, 1.60-2.83]) and anxiety (maternal: AOR, 2.58 [95% CI, 2.06-3.23]; paternal: AOR, 1.98 [95% CI, 1.49-2.63]). Only maternal depression was associated with increased odds of psychosis symptoms (maternal: AOR, 1.90 [95% CI, 1.27-2.82]; paternal: AOR, 1.63 [95% CI, 0.95-2.80]). There were no statistically significant associations with AUD. Significant associations between maternal depression and adult offspring depression were observed from 32 weeks' gestation (AOR, 1.08 [95% CI, 1.01-1.15]) to age 18 years (AOR, 1.08 [95% CI, 1.01-1.16]). Maternal depression from the 8-month postnatal period (AOR, 1.06 [95% CI, 1.01-1.11]) onward (aged 21 years: AOR, 1.13 [95% CI, 1.02-1.24]) was associated with offspring anxiety symptoms. Paternal depression was significantly associated with offspring depression from mid-childhood (AOR, 1.08 [95% CI, 1.01-1.15]) onward (aged 21 years: AOR, 1.22 [95% CI, 1.04-1.43]), with similar associations between paternal depression and offspring anxiety from mid-childhood (aged 5 years: AOR, 1.11 [95% CI, 1.03-1.18]) onward (aged 21 years: AOR, 1.22 [95% CI, 1.04-1.43]). Only maternal prenatal depression at 32 weeks' gestation was associated with offspring psychotic symptoms (AOR, 1.20 [95% CI, 1.03-1.41]). In this cohort study, analyses of 2 decades of data found distinct temporal associations between maternal and paternal depression and offspring psychiatric symptoms, and pregnancy was found to be a sensitive period in the association between maternal depression and offspring psychotic experiences. The findings suggest a substantial role of timing for specifying the association between parental depression and psychiatric outcomes in young adults and emphasize the need to support parental mental health from pregnancy onward.
BACKGROUND: The purpose of this study is to investigate the downstream effects of anti-abortion legislation on the practice of obstetrics and gynecology in urban Texas. METHODS: We conducted semi-structured interviews until saturation with eleven obstetricians/gynecologists (OBGYNs) to explore the effects of Texas’s abortion laws. Analysis consisted of inductive and deductive approaches. RESULTS: We identified three main themes regarding the downstream effects of Texas abortion laws: the conflicting role of colleagues as a support system and a source of frustration and distrust for OBGYNs, the lowered standard of care for those with a desired pregnancy, and concerns that anti-abortion legislation will decrease the quality and quantity of OBGYNs in Texas. Interwoven across these themes is a sense of medical confusion and burnout caused by the vaguely worded statutes. CONCLUSIONS: Abortion laws affect providers and patients far beyond the accessibility and availability of elective abortion. Texas anti-abortion legislation is vaguely written, resulting in institutional confusion and delays, provider burnout, and compromised care for women experiencing pregnancy, including pregnancy loss or other complications. This is at least partially due to disagreement and distrust between colleagues, particularly in regard to care provided in situations where the law is unclear. Finally, participants fear that anti-abortion laws will negatively affect the training and availability of OBGYNs statewide, threatening future reproductive care and rights. We interviewed 11 Texas obstetrician/ gynecologists (OBGYNs) to explore how anti-abortion laws affect their medical practice and overall wellbeing. Participants described three main issues: • Providers feel torn between relying on colleagues for support and feeling frustrated or distrustful of them. • People with wanted pregnancies receive lower quality medical care as doctors hesitate to perform life-saving procedures. • Providers worry that these laws will drive doctors away from Texas or discourage new ones from training there, making it harder for patients to get care in the future. Overall, anti-abortion laws create confusion, delays, and stress for medical providers, which might cause burnout. Texas’s anti-abortion laws create an environment of medical uncertainty, professional strain, and worse patient care. They restrict abortion and hurt the practice of obstetrics and gynecology more broadly, with possible long-term effects for both providers and patients in the state. Based on this paper, we suggest that healthcare organizations and medical training programs provide better support for OBGYNs to navigate the legal and medical landscape in Texas and other states with anti-abortion legislation.
Sexual health literacy is critical for young people to make informed decisions and access sexual and reproductive health services. In Türkiye, factors such as social stigma, lack of information, and cultural taboos and structural barriers may negatively affect young people's sexual and reproductive health service-seeking behaviors. The aim of this study is to determine the levels of sexual health literacy and sexual and reproductive health service seeking among Turkish youth, identify the factors affecting these levels, and to examine the relationship between sexual health literacy and service-seeking behavior. The cross-sectional descriptive study was completed with 512 young people aged 18-30 years in Türkiye using an online survey distributed via social media platforms. Data were collected using the Sexual Health Literacy Scale and the Sexual and Reproductive Health Service Seeking Scale. Descriptive statistics, t-test, one-way ANOVA, Pearson correlation, and linear regression analyses were used in the analysis of the data. Participants' sexual health literacy was found to be at a moderate level (50.09 ± 9.23), while service seeking was above moderate (37.62 ± 9.87). A positive relationship was found between sexual health literacy and service seeking (p < 0.05). According to regression analysis, sexual health literacy level and history of unwanted pregnancy were factors predicting service seeking (R²=0.125, F = 7.983, p < 0.001). The level of sexual health literacy was found to be associated with gender, income level, family type, parents' education level, receipt of sexual health education, active sexual life, contraceptive use, unwanted pregnancy, and sexually transmitted disease history. The level of service seeking was influenced by marital status, family type, parental education, sexual activity, sexually transmitted disease diagnosis, unwanted pregnancy, and the need for emergency contraception. Main barriers to service seeking were embarrassment (35%), not prioritizing sexual health (22.1%), minimizing the problem (21.5%), and lack of information (18%). This study shows that limited sexual health literacy may restrict Turkish youth's access to sexual and reproductive health services. Strengthening sexual health education, improving access to reliable online information, and fostering youth-friendly health services including guidance by nurses are essential. These measures can ensure equitable, inclusive, and effective sexual and reproductive health care.
Maternal nutrition is increasingly recognized as a modulator of offspring skeletal development. While genetics has long been considered the primary determinant of craniofacial morphology, emerging evidence suggests that prenatal and early postnatal dietary exposures also influence facial morphology. However, how maternal diet differentially affects male and female craniofacial structures remains unclear. This study aimed to examine the effects of a maternal high-fat, high-sugar (HFHS) diet on craniofacial and dental morphology in first- (F1) and second- (F2) generation adult mice. Female mice were fed a HFHS diet for 6 weeks before mating and throughout pregnancy and lactation. F1 offspring were weaned to a standard chow diet, and a subset of female F1 offspring were bred to produce F2 offspring, also maintained on chow. Craniofacial skeletal and dental structures of adult F1 and F2 mice at 1-year of age were assessed using micro-computed tomography for linear and geometric morphometrics. HFHS diet exposure significantly reduced midfacial and mandibular length in F1 females, and these effects persisted in F2 females. In males, cranial and mandibular morphology were not affected. Tooth size was reduced in both sexes of F1 offspring but not in F2. Maternal HFHS diet induces jaw-specific changes in offspring craniofacial morphology, with subtle skeletal differences observed in females across both generations. By contrast, dental effects did not persist beyond one generation. These findings highlight the potential for maternal dietary habits to exert both immediate and transgenerational influences on offspring facial form that may persist into adulthood.
BACKGROUND: Although abortion is a frequent event in women’s reproductive life and abortion-related complications have negative consequences for women’s health and wellbeing, little is known about the quality of abortion care. To improve the quality, women’s experience of care and satisfaction, need to be further standardized and studied. This study aims to assess experience and satisfaction with post-abortion care in Africa, and Latin America and the Caribbean (LAC). METHODS: We performed a secondary analysis from the World Health Organization Multi-Country Survey on Abortion. This analysis uses data from women with abortion-related complications who completed the exit survey in the form of an audio computer-assisted self-interview. Using construct validity, exploratory factor analysis and internal consistency coefficients we developed scales based on 12 items on experience of care and on 5 items on satisfaction. We performed logistic regression analyses to gain a better understanding of which clinical and sociodemographic characteristics were associated with poor experience of care and poor satisfaction. RESULTS: Three thousand one hundred seventy-eight women were included (299 from LAC and 2879 from Africa). Most women (85.1%) had mild or moderate abortion-related complications. The mean total score on experience of care was 2.96 (± 2.43), with a possible score range from 0 to 12. The mean total score regarding satisfaction was 1.05 (± 0.96), with a possible score range from 0 to 5. Women with no education were more likely to have poor experience of care compared to women with primary/secondary education. Women with no running water at home, with no adequacy of household income for personal needs, with no ability to save money and who did not earn their own money were more likely to have poor experience of care and poor satisfaction. Women treated in facilities with better capability to provide postabortion care were less likely to have poor satisfaction. CONCLUSIONS: Socioeconomically vulnerable women reported worse experiences and satisfaction with post-abortion care. Facilities with better capabilities improved satisfaction. Utilizing and implementing standardized scales and scores is essential for enhancing post-abortion experience of care improving care quality, and informing effective health policies and practices.
Explore Spanish-preferring participants' experiences with and perceptions of communication of genomic results through professional medical interpreters via multiple modes in the Clinical Sequencing Evidence-Generating Research consortium. In this cross-site analysis, we described self-reported data from Spanish-preferring participants (n = 334) who completed a survey after genomic results sessions conducted with a professional medical interpreter present regarding their understanding of results, perceptions of results communication quality, perceived cultural concordance, and satisfaction with and perceptions of interpretation across interpreter modes (in-person, video, phone). Overall, most respondents who had a Spanish interpreter present during their genomic results session reported: understanding the genomic results 'quite a bit' or 'extremely' well (68%), satisfaction with the language interpretation provided (94%), perceiving good quality interpretation (96%), and that the interpreter and clinical team worked well together (98%). Regarding cultural concordance, most respondents reported feeling equal respect (94%), cultural understanding (91%), ease (82%), and personal connection (67%) with both the interpreter and the clinical team. Across all interpreter modes, respondents' satisfaction and perceived quality of genomic results communication and of Spanish interpretation were high, and their perceived cultural concordance with interpreters and clinicians was similar. In open-ended responses, the factors most frequently described as influencing respondents' perceptions of interpretation centered on interpretation understandability and perceived accuracy, interpreters' kind demeanor and attentiveness to respondents' needs, and challenges with remote technology. From the perspectives of Spanish-preferring patients and parents (of minors) across diverse settings, communication of genomic results through professional medical interpreters using in-person and remote (video and phone) modalities was well-received and involved both information exchange and interpersonal facets. Remote interpretation with professional interpreters can promote quality, culturally-concordant communication in genomic settings. Attentiveness to maintaining call quality in remote sessions, along with providing interpreters of any mode with genetics-specific resources, may help facilitate patient satisfaction.
BACKGROUND: High-quality postnatal care (PNC), including Person-centered postnatal care (PCPNC), is essential to achieving optimal maternal and neonatal outcomes. PCPNC refers to postnatal care that is respectful of and responsive to postpartum women’s preferences, needs, and values. While interest in person-centered care across the reproductive health continuum has increased, there are no validated tools to comprehensively measure PCPNC. This study aimed to develop and validate a tool to comprehensively measure PCPNC that is relevant to the experiences of women in low- and middle-income countries (LMICs). METHODS: The adaptation and validation process included a literature review to define the construct and develop the scale items. This was followed by expert reviews with maternal health experts, healthcare providers, and women with past postnatal care experience to assess content validity. We then conducted cognitive interviews with postpartum women to ensure the questions were relevant, clear, and understandable. We iteratively revised the questions at each stage and surveyed 268 postpartum women (who gave birth within the last six months) in the Upper East Region of Ghana for initial analysis. We then analyzed the data, which informed additional edits to the questions. The final questions were administered in a survey to 1,394 women in Ghana and Kenya who had received postnatal care within 12 weeks postpartum. Psychometric analysis was employed for item reduction and to assess construct and criterion validity, as well as internal consistency reliability. RESULTS: Following iterative factor analysis, we developed a 38-item PCPNC scale. The 38 items load onto one dominant factor, with three factors having eigenvalues greater than one and a Cronbach’s alpha of 0.93. We grouped the items into three conceptual domains, representing the “dignity and respect,” “communication and autonomy,” and “responsive and supportive care” subscales, each of which has a Cronbach’s alpha > 0.7. PCPNC scores are associated with satisfaction with PNC and intent to receive PNC in the same health facility in the future, suggesting good criterion validity. CONCLUSIONS: The PCPNC scale is a valid and reliable tool for measuring respectful and responsive PNC, and will thus facilitate efforts to monitor and improve the experiences of mothers and their babies during PNC.
Environmental health studies frequently measure levels of harmful chemicals in people or personal spaces, and returning those individual levels is an ethical responsibility and important opportunity to teach people about chemical exposures and how to reduce them. We sought to enhance meaningful report-back by quantitatively evaluating a personalized tutorial designed to support environmental health literacy about personal chemical exposures. We developed a novel smartphone-based tutorial that used the Predict-Observe-Explain educational framework to increase understanding of personal results graphs and promote taking actions to lower exposure. We deployed the tutorial as part of report-back in the Illinois Kids Development Study and Chemicals in Our Bodies pregnancy cohorts, and we collected digital analytics on how participants (n = 295) interacted with it. We tested the effect of the tutorial on participants' accuracy at answering four graph-reading questions and examined differences by educational attainment and socioeconomic status. The tutorial prompted participants to select exposure sources that were relevant to them, and we calculated response frequencies of participants' self-reported interest in taking related actions. A total of 92% of participants (n = 270) completed the Predict and Observe phases of the tutorial. Among those participants, 70% (n = 188) correctly answered all four graph-reading questions on their first attempt (without tutorial assistance), and success increased to 96% (n = 258) after the tutorial provided feedback and participants could make a second attempt. Improvement was greatest among participants without a bachelor's degree. Participants who answered the Explain phase (n = 182) expressed high interest in trying new behaviors to reduce exposure. While most participants understood their personal exposure graph without assistance, the tutorial successfully reduced differences in understanding by educational attainment. The tutorial was also effective at creating intentions to adopt health-protective behaviors. Scalable tools like this can support effective report-back in populations with all levels of environmental health literacy. To help people at all educational levels learn about their chemical levels and how to reduce them, we developed a personalized tutorial for use in reporting back results in environmental exposure studies. Before tutorial assistance, participants without a bachelor's degree had lower understanding of their personal results graphs. Tutorial assistance successfully reduced differences in understanding between those with and without a bachelor's degree. In addition, the tutorial was effective at creating intentions to adopt health-protective behaviors based on personalized recommendations for each participant. This scalable digital tool supports understanding and action during report-back of chemical exposure results.
Human sexuality is an important aspect of functionality, and many patients believe that it determines their quality of life. Sexual dysfunction can lead to stress, strained relationships, and a decrease in self-esteem. The majority of modern medical treatments for improving female sexual function are associated with significant side effects and high costs. Traditionally, M. communis has been used to treat sexual impotence. Here, we present the protocol of an interventional clinical phase II study to test the hypothesis that vaginal gel containing Myrtus communis extract can improve sexual function in women of reproductive age. In a prospective, randomized, placebo-controlled and highly blind clinical phase II trial, 80 women aged 18--40 years with sexual dysfunction meeting the inclusion criteria will be randomized to an intervention group receiving a vaginal gel containing myrtle leaf extract (n = 38) or an active control group receiving a placebo gel with an identical appearance (n = 38). Randomization will be performed via a permuted block technique with random allocation software. This study will be conducted at the women's clinic of Imam Reza Hospital in Mashhad. Blinded assessments of outcome variables will be conducted twice: before treatment and one month after treatment. The primary outcome measure was sexual function. This randomized controlled clinical trial evaluates the efficacy of the vaginal gel Myrtus communis on the sexual function of married women during reproductive age. The study design presented here fulfills the criteria of a high-quality clinical phase II trial of sexual function. IRCT.behdasht.gov.ir Identifier: IRCT20230723058892N1.
BACKGROUND: Cervical cancer is the fourth most common cancer among women with significant global disparities in disease burden. In lower-resource settings, where routine screening for cervical cancer is uncommon, higher incidence of advanced-stage disease contributes to increased morbidity and mortality. Understanding care delays may inform strategies to decrease overall time to treatment, and could potentially improve outcomes. We sought to characterize the cervical cancer care cascade and identify factors associated with time to care cascade completion within a Ugandan cohort. METHODS: We collected sociodemographic, reproductive health and care journey data from 268 Ugandan women newly diagnosed with cervical cancer at Mulago National Referral Hospital and the Uganda Cancer Institute. We characterized time from symptoms to presentation (patient interval), time from presentation to diagnosis (diagnostic interval) and time from diagnosis to treatment (treatment interval) and estimated the influence of patient, health provider, system, and disease factors on length of each interval using survival analysis. RESULTS: Median patient, diagnostic and treatment intervals were 74 days (IQR 26–238), 83 days (IQR 34–229), and 34 days (IQR 18–58), respectively. Patient interval was prolonged by the belief that symptoms would resolve spontaneously (aHR 0.37, 95% CI 0.24–0.57), confusion about where to seek care (aHR 0.64, 95% CI 0.47–0.88), and utilization of traditional care (aHR 0.70, 95% CI 0.51–0.96). Patient interval facilitators included perceiving symptoms as serious (aHR 2.14, 95% CI 1.43–3.19) and suspecting cancer (aHR 1.82, 95% CI 1.12–2.97). Diagnostic interval delays included symptomatic bleeding (aHR 055, 95% CI 0.35–0.85) and visiting > 2 clinics (aHR 0.69, 95% CI 0.49–0.97); facilitators included early-stage disease (aHR 1.41, 95% CI 1.03–1.95) and direct tertiary care presentation (aHR 2.13, 95% CI 1.20–3.79). Treatment interval delays included anticipating long waits (aHR 0.68, 95% CI 0.46–1.02) and requiring blood transfusions (aHR 0.63, 95% CI 0.37–1.07); no facilitators were identified. CONCLUSIONS: We identified potentially modifiable barriers and facilitators along the cervical cancer care cascade. Interventions targeting these factors may reduce delays, but are unlikely to significantly improve morbidity or mortality given advanced-stage disease at symptom acknowledgement and relatively timely treatment initiation. Expanding cervical cancer screening and vaccination are of utmost importance.
To evaluate whether higher Distressed Communities Index (DCI) scores, as a measure of community-level socioeconomic distress, are associated with worse risk-adjusted postoperative outcomes and healthcare resource utilization after gynecologic surgery. This was a retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Gynecology Collaborative database. Generalized linear mixed-effect models and linear mixed-effect models were used to evaluate the association between DCI scores and surgical outcomes, with institution treated as a random effect and models adjusted for the ACS-NSQIP predicted morbidity percentage. Six ACS-NSQIP Gynecology Collaborative sites in the United States, between January 1, 2018, and June 30, 2023. Adult patients undergoing gynecologic operations during the study period. Patient records, including ZIP Code data, were merged with DCI scores ranging from 0 (low distress) to 100 (high distress), with DCI > 75 identifying distressed communities. No therapeutic interventions were applied. Exposures of interest were community-level distress as measured by DCI. The primary outcome was a composite measure of postoperative morbidity. Secondary outcomes included markers of resource utilization (length of stay, discharge to nursing facility, and hospital readmission) and comparisons of outcomes between oncologic and benign procedures. Patients with DCI > 75 had a higher mean body mass index, greater comorbidity burden, higher ACS-NSQIP predicted morbidity percentage, longer mean length of stay, and higher unadjusted composite postoperative complication rates compared with patients with DCI ≤ 75. In generalized and linear mixed-effect models adjusting for ACS-NSQIP predicted morbidity, DCI (modeled continuously or dichotomized at >75) was not independently associated with postoperative complications (OR 1.06, 95% CI 0.86-1.30, p = .62), discharge destination (OR 0.69, 95% CI 0.38-1.26, p = .23), unplanned readmission (OR 1.15, 95% CI 0.86-1.54, p = .34), or length of stay. By contrast, higher ACS-NSQIP predicted morbidity percentage remained strongly associated with composite complications and hospital length of stay. In our multicenter cohort, DCI showed no independent association with postoperative outcomes in multivariable analysis. Future research should include samples with higher proportions of participants from highly distressed communities, as well as more precise socioeconomic status measures (income, education, neighborhood), since ZIP code-based indicators may lack granularity. Such efforts could enhance individual risk stratification and targeted interventions. Linking clinical and community data is promising, but success requires rigorous harmonization, quality control, and methodological refinement.
More than 20% of perinatal women experience depression, with suicide being a leading cause of maternal death in the United States. Professional societies emphasize the need to identify those at risk of developing perinatal depression to better target preventive care delivery during pregnancy. We evaluated receptivity to a machine learning-based predictive screener designed to identify women in the first trimester of pregnancy who were asymptomatic but were at risk for developing moderate to severe depression symptoms later in pregnancy. Our participants were adult pregnant women with negative first-trimester depression (Patient Health Questionnaire-9) screens at 1 of 4 obstetric practices. Of the 810 women who were clinically eligible, 787 were successfully contacted via their patient portal. Of these, 289 (36.7%) viewed the screener and 255 (88.2%) completed the 6-question predictive screener. In total, 51 (20%) were identified by the screener as being at risk for developing perinatal depression. Participants were asked a series of follow-up questions regarding the acceptability of the predictive screener and desired preventive resources. Chi-square tests were used to compare demographic characteristics, perceived benefits and concerns, and desired resources between those identified as at risk for depression and those who were not. Differences in acceptability ratings between the two risk groups were determined using nonparametric Mann-Whitney U tests. On a 5-point Likert scale of agreement, participants found the screener questions easy to complete (median score 5, IQR 5-5) and felt comfortable sharing their answers with their obstetric care providers (median 5, IQR 4-5). Key perceived benefits of completing the screener included opportunities to seek preventive care (75/255, 29.4%) and to receive education on depression risk (66/255, 25.9%). Primary concerns about knowing one's risk of future depression included worrying about developing depression (90/255, 35.3%) and a lack of prevention opportunities (39/255, 15.3%). Desired preventive resources included counseling (197/255, 77.3%), mind-body interventions (166/255, 65.1%) such as exercise, and prenatal classes or support groups (81/255, 31.8%). Participants found the screener acceptable and felt comfortable receiving it through their patient portal. Specific preventive care options were commonly endorsed, several of which are scalable and evidence based. A minority of participants voiced addressable concerns about knowing their risk of developing depression in the future.
What have been the activities, characteristics, and outcomes of uterus transplantation (UTx) performed worldwide from 2000 through 2024? In 91 UTx cases, 67 involved live donors and 80 of the recipients had Mayer-Rokitansky-Küster-Hauser syndrome, with 12-month graft survival of 74%, enabling pregnancy attempts that yielded 44 healthy singleton deliveries with a live birth rate per embryo transfer of 30.3%. UTx is the only treatment for women with absolute uterine factor infertility who wish to carry a pregnancy. According to a comprehensive report including data up to 2020 on 45 UTx cases, 19 live births occurred (35.8% per embryo transfer) at a mean of 35.3 weeks gestation. Data were extracted from the web-based registry of the International Society of Uterus Transplantation (ISUTx). This registry captures information on donor and recipient characteristics, transplantation procedures, postoperative complications, immunosuppression, complications including rejections, and reproductive outcome. Analyses were undertaken of the 91 transplants performed between 6 April 2000 and 31 December 2024, that were recorded in the registry. Twenty-four medical centers in five continents registered their uterus transplants by entering data from the day of transplantation until 3 months after graft removal. The following variables were assessed: the demographic and laboratory characteristics of donors and recipients, the source of graft (live versus deceased donor), surgical specifics including technique, duration, ischemic times, and post-op complications, immunosuppression, rejection data, pregnancy with live birth(s), and hysterectomy. In 91 uterus transplantations (67 from live donors, 24 from deceased donors), the overall surgical success rate, defined as graft viability by 12 months, was 75%. Most recipients (88%) had Mayer-Rokitansky-Küster-Hauser syndrome, with mothers being the most frequent (64%) live donors. Live donor hysterectomies were performed by laparotomy (54%), robotics (28%), or laparoscopy (18%). Total ischemic time was shorter in live- versus deceased-donor UTx procedures. Rejection episodes that were treated with escalations of immunosuppression were more frequent during months 1-5 (44%) than during months 6-10 (28%) post-UTx. Graft survival during the first 12 months was superior when grafts from premenopausal donors were used as compared to from postmenopausal donors. Forty-four singleton live births (mean gestational length of 34.5 weeks), including eight second births, were reported, with a live birth rate per embryo transfer of 30%. Preeclampsia was the most common pregnancy complication, occurring in 23% of live-birth pregnancies. Major postnatal complications occurred in 11 infants, 9 with respiratory distress syndrome; no major malformations were observed. Data in the registry are self-reported and not subjected to validation. Although the ISUTx registry represents the most comprehensive quality registry of UTx activity in the world, cases from at least four centers are excluded as they were not entered into the registry. Birth outcomes from some registry cases are as yet unknown as these ongoing cases have not yet reached the endpoint of hysterectomy. This study presents the most comprehensive analysis to date of UTx, the only fertility treatment for absolute uterine factor infertility. The registry serves as the prime source for quality assessment and process improvement in UTx. The establishment and operation of the registry were funded by the Swedish Research Council (2024-03487 to M.B.) and Jane and Dan Olsson Foundation (2024-11 to M.B.). There was no competing interest. Not applicable.
To report the implementation across Fetal Medicine units and the agreement between first and second trimester referral scans in the identification of fetal anomalies in cases referred for the expert assessment of the fetal anatomy in the first trimester following the publication of the national guidelines in Italy. This multicenter, retrospective study aimed to evaluate the implementation and diagnostic performance of first-trimester referral ultrasound (US) in identifying fetal anomalies, following the introduction of national guidelines in Italy. The analysis included singleton pregnancies referred to nine specialized Fetal Medicine centers between 11+0 and 13+6 weeks' gestation due to increased risk for structural anomalies. Risk was defined as either a nuchal translucency (NT) measurement ≥ 3.5 mm or suspicion of a structural anomaly at initial screening. Only cases undergoing referral US within the specified gestational window were included. Diagnostic accuracy was assessed by comparing findings from first-trimester referral US with those from follow-up referral US performed either at 14-16 weeks or at 19-21 weeks. Out of 344 referred cases, 322 (93.6%) underwent first-trimester referral US within the appropriate timeframe. After excluding miscarriages and terminations, 136 cases were evaluated again at 19-21 weeks and 207 at 14-16 weeks. The agreement between the 11+0-13+6 week and 19-21 week scans was 85.3%, with a sensitivity of 82.0%, specificity of 88.0%, positive predictive value (PPV) of 84.7%, and negative predictive value (NPV) of 85.7%. Agreement between the early and 14-16 week scans was 91.3%, with sensitivity, specificity, PPV, and NPV of 90.7%, 92.1%, 93.9%, and 88.2%, respectively. The study demonstrates successful implementation of national first-trimester referral US guidelines in Italy. When performed by experienced operators using a standardized protocol, first-trimester anatomy assessment is feasible and provides high diagnostic accuracy, enabling early detection of structural fetal anomalies.
To compare gestational age (GA) dating models for pregnancies conceived via assisted reproductive technology (ART), assess whether 14 or 15 days more accurately reflects the median follicular-phase duration in ART pregnancies and evaluate whether the gestational timelines of ART pregnancies are comparable with that of spontaneously conceived pregnancies. We employed population data from the Medical Birth Registry of Norway (2015-2021), including 163 544 children conceived spontaneously, 2067 conceived via fresh embryo transfer (ET) and 2080 conceived via frozen ET. Among ART pregnancies, we compared two GA dating methods: a population-based ultrasound model (GAUS) and an ART-based formula based on the known oocyte fertilization date. Statistical agreement was evaluated by calculating individual pairwise differences in GA estimates. Bias and precision in the estimated date of delivery (EDD) were assessed by constructing cumulative birth distribution (Kaplan-Meier) curves for fresh and frozen ET pregnancies separately, employing time-to-event analysis to account for nonspontaneous births. The absolute individual GA differences between ultrasound and ART-based dating, considering a 14-day median follicular-phase duration, were ≤ 1 day for 969/2067 (46.9%) fresh ET pregnancies and for 874/2080 (42.0%) frozen ET pregnancies. An approximate systematic difference of 1 day was observed, which we corrected by employing a 15-day median follicular-phase duration in the ART-based formula (GAART,15). There was a median pairwise difference between GAUS and GAART,15 of -0.4 (95% CI, -0.5 to -0.3) days in fresh ET pregnancies and -0.2 (95% CI, -0.4 to -0.1) days in frozen ET pregnancies. Both models demonstrated equivalent precision in the EDD. Measured using the ultrasound model, frozen ET pregnancies had a median pregnancy duration of 286.1 (95% CI, 285.5-286.7) days, which was 3.2 (95% CI, 2.4-3.9) days longer than that in fresh ET pregnancies, and 2.6 (95% CI, 2.0-3.2) days longer than that in spontaneously conceived pregnancies. We found close statistical agreement between ultrasound and ART-based dating models for both GA and EDD. However, 15 (not 14) days of follicular-phase duration should be utilized in the ART-based formula to avoid systematic bias in ART-based GA estimates. Fresh and frozen ET pregnancies had different birth distributions and median pregnancy durations, underscoring that they are not comparable with spontaneously conceived pregnancies and they should be evaluated separately. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Eating disorders (EDs) are frequently underdiagnosed in transgender and gender-diverse (TGD) adults. Many existing ED screeners were developed in cisgender, White, female samples and may miss symptom patterns relevant to TGD adults. This study evaluated internal consistency and screening accuracy of the Brief Assessment of Stress and Eating (BASE), a 10-item ED screener, in a national sample of TGD adults. Participants were 2098 TGD adults (57.5% gender diverse; 28.5% transgender men; 14.0% transgender women) enrolled in The PRIDE Study, a U.S.-based longitudinal cohort. Participants completed the BASE and SCOFF and were identified for elevated ED risk using a DSM-5-aligned Eating Disorder Diagnostic Scale algorithm. We examined internal consistency and classification accuracy using receiver operating characteristic and precision-recall curves, and compared BASE and SCOFF performance overall and by gender subgroup. The BASE showed good internal consistency (ordinal α = 0.80). In the full sample, the BASE outperformed the SCOFF (AUC = 0.803 vs. 0.764, p = .0003), with a similar pattern among transgender men (AUC = 0.793 vs. 0.730). Among transgender women and gender-diverse adults, AUCs did not differ significantly between the BASE and SCOFF. Cut-scores based on Youden's J (7.5-8.5) produced balanced sensitivity (0.68-0.75) and specificity (0.70-0.77), whereas more liberal cut-scores (5-6) increased sensitivity (>0.85) with reduced specificity. The BASE is a psychometrically sound and low-burden screener for elevated ED risk in TGD adults. Its broader symptom coverage and comparable performance across TGD subgroups support use in primary care and gender-affirming services to improve identification of probable EDs.
Objective: To investigate the quality of life (QoL) and its influencing factors in patients with early-stage endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) undergoing fertility-sparing treatment. Methods: A total of 134 patients with EC or AEH who received fertility-sparing treatment at Peking Union Medical College Hospital between August 2023 and December 2024 were enrolled. Patients were divided into two treatment groups: those receiving gonadotropin-releasing hormone agonist (GnRHa) combined with aromatase inhibitors, and those receiving high-dose oral progestins. During treatment, diagnostic curettage or hysteroscopy was performed every 3 months, and treatment was discontinued upon assessment of complete response (CR). According to treatment duration (time to achieve CR), patients were categorized into the 3-month group (n=79), 6-month group (n=40), and ≥9-month group (n=15). The Functional Assessment of Cancer Therapy-General (FACT-G) version 4 was used to quantitatively assess QoL during treatment; questionnaires were administered every 3 months, and all 134 patients completed the survey at baseline and at 3, 6, and 9 months of treatment. Multivariate linear regression analysis was used to analyzed the influencing factors of QoL. Results: Among the 134 patients, 61 (45.5%) had AEH and 73 (54.5%) had EC; 71 patients (53.0%) received GnRHa combined with aromatase inhibitors, and 63 (47.0%) received high-dose oral progestins. QoL assessment showed that FACT-G scores gradually increased from baseline in the 3-month and 6-month groups, indicating improvement in QoL as treatment progressed; whereas the median FACT-G scores in the ≥9-month group remained below 80 throughout treatment, indicating relatively lower QoL. However, there was no statistically significant difference in FACT-G scores at CR among the 3-month, 6-month, and ≥9-month groups (median scores: 82.0, 83.0, and 76.5, respectively; H=1.575, P=0.455). Univariate analysis showed no significant differences in FACT-G scores at CR among patients with different treatment regimens, body mass index (BMI), treatment duration, pathological type, marital status, treatment history, or reproductive history (all P＞0.05). Multivariate analysis showed that FACT-G scores at CR were positively correlated with baseline FACT-G scores (B=0.634, P＜0.001) and negatively correlated with BMI (B=-4.021, P=0.035). No correlation was observed between treatment regimen and QoL. Conclusions: In fertility-sparing treatment, BMI may be a key factor affecting QoL, while long-term treatment may lead to a decline in QoL. Clinical attention should be paid to weight management and psychosocial support. 目的： 探讨接受保留生育功能治疗的早期子宫内膜癌（EC）及不典型子宫内膜增生（AEH）患者的生活质量及其影响因素。 方法： 纳入2023年8月至2024年12月于北京协和医院接受保育治疗的EC及AEH患者134例。患者治疗方式分为促性腺激素释放激素激动剂（GnRHa）联合芳香化酶抑制剂、大剂量口服孕激素2种，治疗期间每3个月进行诊断性刮宫或宫腔镜检查，评估为完全缓解（CR）的停止治疗。按治疗持续时间（获得CR的时间）将患者分为3个月组（n=79）、6个月组（n=40）及≥9个月组（n=15）。采用肿瘤治疗功能评估系统通用模块（FACT-G）第4版对患者治疗过程中的生活质量状况进行量化评估，每3个月对患者开展1次问卷调查，134例患者均在治疗前及治疗3个月时、6个月时、9个月时参与调查。采用多因素线性回归模型分析患者生活质量的影响因素。 结果： 134例患者中，AEH 61例（45.5%），EC 73例（54.5%）；71例（53.0%）接受GnRHa联合芳香化酶抑制剂治疗，63例（47.0%）接受大剂量口服孕激素治疗。生活质量评估结果显示，3个月组和6个月组FACT-G评分较基线逐渐升高，提示生活质量随治疗推进有所改善；而≥9个月组在治疗过程中的中位FACT-G评分均在80分以下，相对更低。但3个月组、6个月组、≥9个月组患者CR时的FACT-G评分差异无统计学意义（中位FACT-G评分分别为82.0、83.0、76.5分；H=1.575，P=0.455）。单因素分析结果显示，不同治疗方式、体质指数（BMI）、治疗时间、病理类型、婚姻状况、治疗史及孕产史的患者，CR时FACT-G评分未见显著差异（均P＞0.05）。多因素分析结果显示，患者CR时FACT-G评分与基线FACT-G评分呈正相关（B=0.634，P＜0.001），与BMI呈负相关（B=-4.021，P=0.035）。未观察到不同治疗方式与患者生活质量的相关性。 结论： 在保育治疗中，BMI可能是影响患者生活质量的关键因素，但长期治疗可能导致生活质量下降，临床应重视体重管理与心理社会支持。.
In utero exposures to certain pathologies during pregnancy increase offspring cardiovascular disease (CVD) risks, and pregnancy complications and CVD risks are higher in twins than in singletons. However, the association between placental abruption and nonfatal incident CVD in twin offspring, and whether the abruption effects are mediated through preterm delivery, is unknown. We used the PACER (Placental Abruption and Cardiovascular Event Risk) offspring cohort, which links births to hospitalizations and mortality records in New Jersey from 1993 to 2020 (28 years of follow-up) and is restricted to twin offspring. In a Cox model, we estimated the counterfactual decomposition of the abruption-CVD association into a natural direct and indirect effect through preterm delivery. Of 116 796 twin births, 2597 (2.2%) were complicated by abruption. The rate of incident CVD was higher among abruption than nonabruption births (1560 versus 577 per 100 000 person-years). Abruption was associated with a 2.47-fold increased risk of CVD in the twin offspring, with similar risks for heart disease and stroke. Results indicated that 40% of the total effect was mediated through preterm delivery <37 weeks; the proportion mediated increased with earlier gestational ages at delivery. These risks persisted after accounting for unmeasured confounding bias. Placental abruption is associated with higher CVD risk in twins through early adulthood, with substantial mediation of effects through preterm delivery. Efforts to optimize obstetric care for pregnant women carrying twins to reduce the risk of abruption may be worthy of consideration. This may translate to public health benefits in reducing CVD in twin offspring.