Objective This study's primary objective was to characterize obstetrical providers' knowledge and utilization of noninvasive prenatal testing (NIPT) for 22q11.2 deletion screening. Study Design A one-time survey was distributed to physicians, nurse practitioners, and midwives. Participants answered 18 multiple-choice questions pertaining to demographic information, clinical use of carrier and NIPT, and knowledge regarding use of NIPT for 22q11.2 deletion syndrome. Responses were descriptively analyzed based on years of clinical experience and provider subspecialty. Results Twenty-two providers responded to the survey: six Obstetrics and Gynecology (OB/GYN) resident physicians, 10 OB/GYN generalist physicians, three Maternal-Fetal Medicine physicians, two nurse practitioners, and one midwife. All resident physicians reported never ordering 22q11.2 deletion NIPT, despite using a Trisomy screening panel, which includes 22q11.2 deletion as an opt out. Conversely, all experienced physicians ( n = 13) reported using expanded panels and screening for 22q11.2 deletion. Only half of our sample who completed the survey ( n = 10) felt adequately informed to counsel patients on screening results and procedures. Conclusion Our findings demonstrate an association between years in practice and the utilization of 22q11.2 deletion NIPT screening. Enhanced educational initiatives beginning during residency are necessary to improve provider knowledge on 22q11.2 deletion screening, information regarding test ordering, and counseling procedures.
Female genital mutilation/cutting (FGM-C) affects more than 230 million women and girls worldwide and carries increased risk of adverse obstetrical outcomes, including obstetrical anal sphincter injury (OASIS). With growing global migration, obstetrical care providers may increasingly encounter individuals affected by FGM-C in historically low-prevalence settings such as the United States. Therefore, it is essential to understand the association between FGM-C and adverse obstetrical outcomes in settings such as the United States to inform evidence-based practice. To estimate the association between FGM-C and OASIS, among inpatient, singleton, vaginal deliveries among people delivering in-hospital in the United States. The secondary objectives were to estimate the association between FGM-C and postpartum hemorrhage and prolonged second stage of labor in this population and the role of episiotomy in mitigating risk of OASIS in this population. We conducted a population-based, retrospective cohort study of pregnant individuals delivering singleton fetuses in the United States using the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) database (2016-2019, inclusive). Exposure and outcome variables were derived using International Classification of Diseases-10 disease and procedure codes. Weighted multivariate logistic regression models were used to estimate the odds ratio (OR) for the association between FGM-C and OASIS and secondary outcomes. During the study period, 2020,780 delivery-related discharges were captured, representing an estimated 10,168,193 singleton vaginal deliveries nationwide using the complex survey design of the NIS. A total of 795 (0.03%) individuals were diagnosed with FGM-C and 39,668 with OASIS (1.4%) during the study period. After adjusting for potential confounders, vaginal deliveries affected by FGM-C had 3.02 times the odds of sustaining OASIS (95% CI: 2.23-4.07), 1.99 times the odds of experiencing postpartum hemorrhage (95% CI: 1.45-2.73), and 2.33 times the odds of a prolonged second stage of labor (95% CI: 1.23-4.39) compared to unaffected individuals. Performance of episiotomy attenuated the risk of OASIS (aOR 1.12, 95% CI: 0.59-2.11). Singleton vaginal deliveries complicated by FGM-C have significantly increased odds of experiencing adverse obstetric outcomes, including OASIS, postpartum hemorrhage, and prolonged second stage of labor. Episiotomy may be protective against OASIS in this population.
BackgroundFor many transgender young adults considering gender affirming hysterectomy, discussions may begin prior to the age of 18. However, the extent of their relevant understanding is unclear.ObjectivesDetermining whether transgender men who started testosterone during adolescence correctly understand their reproductive anatomy and the nature and implications of hysterectomy with or without oophorectomy as well as the extent of their recalled counseling and related beliefs.DesignCross-sectional survey.MethodsAn anonymous REDCap survey, sent both through community message boards and the Prolific survey platform, assessing knowledge of and experiences with reproductive and sexual health care in the context of gender affirming care. Analyses were descriptive.ResultsOf 125 respondents, most had initiated testosterone between age 17 and 18 (n=85,67%). Roughly two-thirds (n=80, 64%) wanted or had had a hysterectomy, but only 48% (n=60) wanted or had had an oophorectomy. The majority correctly identified the purpose of the uterus (n=116, 93%) and ovaries (n=88, 70%) ovaries, as well as their physical relationship to each other (n=103, 82%). Fewer correctly defined a hysterectomy (n=78, 64%). Only a third of our respondents reported ever being counseled about the uterus (n=42, 35%) and the ovaries (n=43, 36%). Roughly one-third recalled counseling about testosterone's effects on the uterus and ovaries, primarily by their testosterone prescriber. Most people were uncertain of their knowledge of surgical requirements, but those who felt confident enough to state beliefs tended to be correct.ConclusionMost respondents who started testosterone prior to 18 had basic knowledge of the function and location of the uterus and ovaries, with less knowledge about gender-affirming surgeries. There is a need for clear guidelines to inform clinical counseling in adolescence, as transgender patients may start thinking about hysterectomy for gender affirmation during adolescence, even if the procedure is not accessible until they reach majority. For many transgender young adults considering removal of their uterus for gender affirmation (hysterectomy), discussions may begin prior to the age of 18. However, the extent of their relevant understanding of these discussions is unclear. This was a survey of transgender men who had started therapy prior to 18 about their knowledge and beliefs regarding their reproductive anatomy and the nature and implications of hysterectomy with or without oophorectomy (removal of ovaries). The majority correctly identified the purpose of the uterus and ovaries, but fewer correctly defined a hysterectomy. Only a third of our respondents stated they had ever been counseled on what the uterus and ovaries were. There is a need for clear guidelines to inform clinical counseling in adolescence as transgender patients may start thinking about hysterectomy for gender affirmation during adolescence even if the procedure is not accessible until they reach majority.
The scope of preimplantation genetic testing for monogenic disorders (PGT-M) in Japan, initially limited to severe childhood-onset diseases, appears to be expanding following the 2022 revision of the Japan Society of Obstetrics and Gynecology's definition of "severity." This study examines the impact of this definitional change on the acceptability of PGT-M by comparing attitudes of Japanese genetic professionals before and after the revision, focusing on three childhood-onset cancer predisposition syndromes: Li-Fraumeni syndrome (LFS), familial adenomatous polyposis (FAP), and neurofibromatosis type 1 (NF1). A two-phase survey was conducted in 2019-2020 and 2024 among clinical genetic specialists supervisors and certified genetic counselors. The survey explored views on PGT-M acceptability, the concept of "selection of life," awareness of the revised severity definition, and background factors influencing opinions. Among 382 respondents, LFS was most frequently judged acceptable for PGT-M, followed by FAP and NF1. Between the two phases, "unacceptable" responses declined, while "neither" increased. Those viewing PGT-M as "selection of life" were more likely to oppose it (r=-.293, p<.01). Genetic professionals in the pediatric field were more likely to consider PGT-M unacceptable (r=-.22, p<.01). These findings suggest that clinical experience, ethical perceptions, and institutional guidelines shape professional attitudes toward PGT-M. These findings have implications for genetic counseling practice and policy discussions surrounding the evolving scope of PGT-M. Ongoing dialogue and education are essential as eligibility criteria and societal values continue to evolve.
To examine whether clinicians' awareness of a recent US Food and Drug Administration (FDA) regulatory communication on menopausal hormone therapy (MHT) was associated with reported changes in clinical practice, counseling priorities, and treatment choices in standardized clinical vignettes. This cross-sectional, web-based survey included 600 practicing obstetricians and gynecologists providing menopause or perimenopause care. A composite Regulatory Awareness Score was created from survey items addressing recognition of the regulatory action, perceived relevance, understanding of its rationale, and appraisal of its correctness and timeliness. The primary outcome was self-reported change in routine clinical approach after the regulatory communication. Multivariable logistic regression was used to examine the association between awareness and reported practice change. Ranked counseling factors were compared across awareness tertiles, and vignette choices were examined using multinomial logistic regression. Regulatory awareness was not independently associated with reporting a change in clinical practice (adjusted odds ratio [aOR]: 0.89; 95% CI: 0.69-1.14; P=0.345). Higher odds of reported change were associated with use of a standard hormone therapy protocol (aOR: 1.50; 95% CI: 1.05-2.14; P=0.024), more favorable perceptions of compounded bioidentical hormone therapy (BHT) (aOR: 1.85; 95% CI: 1.35-2.54; P<0.001), stronger prioritization of patient preference (aOR: 1.21; 95% CI: 1.06-1.38; P=0.004), and higher menopause patient volume (aOR: 1.01; 95% CI: 1.00-1.01; P=0.042). Across awareness tertiles, counseling priorities were broadly similar, with only modest differences for symptom severity. In vignette analyses, higher awareness was associated with lower relative selection of compounded BHT in a context-dependent manner. Regulatory awareness alone did not explain self-reported change in menopausal hormone therapy practice after adjustment for clinician characteristics, protocol use, BHT perceptions, and counseling priorities. BHT perceptions, use of a standard protocol, and patient-preference prioritization showed stronger associations with reported change, whereas awareness was more clearly reflected in vignette-based treatment choices than in global self-reported practice change.
ObjectiveTo characterize interspecialty variation and areas of consensus in the understanding and clinical management of functional hypothalamic amenorrhea among physicians from different clinical specialties in China.MethodsWe conducted a nationwide, cross-sectional questionnaire survey of licensed physicians practicing in reproductive endocrinology, obstetrics and gynecology, and related specialties involved in functional hypothalamic amenorrhea care. The survey was administered anonymously via a national continuing medical education platform affiliated with the Peking Union Medical College Hospital Alliance between 1 November and 30 November 2025.ResultsA total of 2026 questionnaires were included in the final analysis, comprising 112 reproductive endocrinologists (5.5%), 1516 obstetricians-gynecologists (74.8%), and 398 physicians from other specialties (19.6%). Overall, only 62.7% of respondents recognized genetic susceptibility as a contributing factor to functional hypothalamic amenorrhea, and only 43.9% of respondents perceived that functional hypothalamic amenorrhea was generally diagnosed appropriately. Compared with physicians from other specialties, reproductive endocrinologists and obstetricians-gynecologists were significantly more likely to prioritize sex hormone evaluation, pelvic ultrasonography, and assessment of the thyroid and adrenal axes (all p < 0.01), whereas physicians from other specialties more frequently reported emphasizing assessments of energy metabolism (p < 0.01). Among women without fertility intentions, reproductive endocrinologists were more likely to report prioritizing elimination of precipitating factors (p < 0.05) and recommending hormone replacement and bone-targeted therapies (both p < 0.01). For women desiring pregnancy, reproductive endocrinologists were more likely to report recommending ovulation induction (p < 0.01), whereas physicians from other specialties reported greater support for the use of pulsatile gonadotropin-releasing hormone pumps (p < 0.01).ConclusionsVariations were observed in physicians' self-reported diagnostic and management approaches to functional hypothalamic amenorrhea across clinical specialties in China. These findings suggest the importance of promoting multidisciplinary consensus, developing standardized clinical pathways, and strengthening interdisciplinary collaboration to improve the quality of care for women with functional hypothalamic amenorrhea.
The teaching and practical training of future doctors play an important role in the university curriculum. At the Women's Clinic of Saarland University Hospital in Homburg, we developed a five-day block placement concept that focused on learning practical gynecological and obstetric skills rather than simply imparting theoretical knowledge. The student`s satisfaction with the block placement was assessed using a non-standardized questionnaire with the two items "How do you rate your learning outcomes from the placement?" and "The placement increased my interest in gynecology and obstetrics". The assessment was based on a scale of 1 to 6. A total of 205 out of 220 students (93.2%) from the winter semester 2022/2023 participated in the evaluation and completed the questionnaire. 198 students (96.6%) rated the satisfaction with their perceived learning from the block internship as very good (1) or good (2), and 201 students (98%) reported an increase in their interest in the subject area. An overwhelming majority of students rated the practical teaching concept as very good or good, which speaks to the success of this practical teaching format. Nevertheless, the study also has several limitations. For example, only one cohort of medical students was surveyed. Furthermore, when establishing a new teaching concept, there is a risk that participants in an evaluation will not respond objectively, but rather according to the criterion of social desirability. We suggest our practice-oriented block placement concept, which focuses on learning skills relevant to the future medical profession, as a possible curriculum for undergraduate teaching in gynecology and obstetrics, to inspire students for the field.
Hereditary breast and ovarian cancer (HBOC) syndrome, caused by pathogenic variants in BRCA1 or BRCA2, is associated with increased risks of breast, ovarian, pancreatic, and prostate cancers. Although long-term, multi-organ surveillance is recommended, real-world data on its implementation in Japan remain limited. We conducted a web-based cross-sectional survey among 274 individuals registered for a hybrid public lecture at Keio University Hospital in 2024; 121 responded (44.2%). Respondents included HBOC carriers, healthcare professionals, and the general public. Among 66 carriers, 57 were affected and 9 were unaffected. Although the sample size is small, surveillance uptake was high among affected carriers (89.5%). Approximately half of affected carriers undergoing surveillance reported satisfaction, while nearly half underwent surveillance at multiple institutions, suggesting fragmented care. Across all groups including healthcare professionals and the general public, the most acceptable annual cost was less than 50,000 yen. Healthcare professionals identified interdepartmental coordination and shortages of genetic specialists as major challenges. These exploratory findings suggest that affordability, convenience, interdepartmental and interfacility coordination, and the availability of genetic medicine professionals may be important considerations in efforts to develop sustainable HBOC surveillance systems in Japan.
This study investigated the current clinical status, structural barriers, and perceived outcomes of menopausal care provided by gynecologists in Japan, with a specific focus on the management of menopausal disorders among working women. A web-based survey was conducted among 919 gynecologists in December 2025. Participants were categorized by weekly menopausal patient volume (none/minimal, 1-19, or ≥ 20 patients/week). A mixed-methods approach was employed, including adjusted multivariable logistic regression analyses. Most gynecologists (89.4%) encountered patients with decreased work performance, and 29.8% reported managing patients who had resigned owing to menopausal symptoms. Meanwhile, 82.4% of respondents perceived improvements in work performance following treatment. Adjusted multivariable analyses confirmed weekly patient volume as an independent predictor of occupational outcomes and willingness to continue menopausal care. While nearly all gynecologists prescribed hormone replacement therapy and Kampo (Japanese herbal) medicine, the variety of additional treatments increased significantly with patient volume. Furthermore, 66.4% of gynecologists reported that their residency training in menopausal disorders was insufficient. Consultations for menopausal disorders required significantly more time than those for dysmenorrhea, regardless of patient volume. Qualitative analysis identified inadequate reimbursement as the most frequently cited systemic concern. Gynecologists frequently encounter menopause-related work performance impairment but perceive treatment as beneficial. After adjustment for physician characteristics, higher patient volume remained an independent predictor of severe occupational consequences and willingness to continue menopausal care. Addressing time-intensive consultations, insufficient reimbursement, and limited postgraduate education is essential to support working women with menopausal symptoms.
Menstrual distress is a multifactorial health concern influenced by various biological and psychological determinants. Despite growing interest in menstrual health, the interplay between sociodemographic factors, contraceptive history, and pre-existing health conditions in relation to menstrual distress has not been sufficiently elucidated. This study aimed to examine the associations between age, educational background, occupational status, contraceptive history, type of contraceptive used, and the presence of reproductive or psychiatric disorders with menstrual distress levels among women. A cross-sectional analysis was conducted from April to September 2025 among Indonesian women aged 15-49 years. Data were collected via an online survey using validated Indonesian version of the Menstrual Distress Questionnaire (MEDI-Q) to evaluate menstrual distress, including subdomains for Menstrual Symptoms (MS), Menstrual Symptoms Distress (MSD), and Menstrual Specificity Index (MESI). The association between age and menstrual distress was examined using the Pearson correlation coefficient. In addition, non-parametric statistical methods were applied to evaluate the relationships between MEDI-Q scores and other variables of interest using Mann-Whitney U test. A total of 930 participants were included in this study. Our study demonstrates a significant higher score across all domains of the MEDI-Q among younger participants (p < 0.001). Participants with vocational qualifications or higher exhibiting higher MS scores (p = 0.026). Both the MEDI-Q total score and MS were significantly greater in employed participants (p = 0.025 and p = 0.007, respectively) and those with a history of reproductive disease (p = 0.022 and p = 0.021, respectively). Furthermore, participants with a history of psychiatric disease and those who did not used contraceptives showed significantly higher MEDI-Q total, MS, and MSD scores (all p < 0.001). The findings suggest that sociodemographic factors, contraceptive history, and underlying reproductive or psychiatric conditions play a significant role in menstrual distress. These results highlight the need to consider both sociodemographic and health-related factors in research and interventions related to menstrual health.
To evaluate how individuals with different BMI (Body Mass Index) levels respond to the statement "obesity is a disease" in terms of agreement, emotional reactions, and motivation for weight loss. A cross-sectional online survey was conducted in January 2024 among 597 Israeli adults (43.3+16.7 years old), stratified by weight status (normal weight (n = 200), overweight (n = 200), obesity (n = 197)) and gender (females (50.1%), males (49.9%)). Participants reported their level of agreement with the statement "obesity is a disease" their emotional reactions to this statement, and weight-related motivation. Multivariate analyses examined demographic and psychological predictors of agreement. Overall, 47.6% of participants agreed with the disease framing. Agreement was significantly associated with higher BMI, lower religiosity, and poorer self-rated mental health. However, agreement was not associated with greater motivation to lose weight or perceived control over weight. Participants with obesity endorsed more negative emotional responses, to the statement including worry, frustration, helplessness, and pressure versus those with lower weight-status. Positive emotions such as optimism or confidence were not significantly associated with weight status. Framing obesity as a disease is common and more frequently endorsed by individuals with obesity (versus those with lower weight status), yet it does not appear to enhance motivation for weight loss. This framing is also associated with emotional distress, suggesting that such messaging may unintentionally reinforce internalized stigma. Public health communications should consider these nuanced responses and strive to promote messages that are empathetic, non-stigmatizing, and behaviorally supportive.
Oral and maxillofacial surgery (OMFS) faces increasing challenges arising from evolving healthcare demands, rising case complexity, and ongoing workforce recruitment challenges, necessitating the long-term preservation of specialized expertise. Although training pathways are well established, career trajectories among medical students remain highly heterogeneous. This study addresses the structural recruitment challenge in OMFS in Germany. It focuses on the mismatch between presumably strong interest in OMFS among medical students, and key barriers, particularly dual-degree requirements. A cross-sectional, nationwide online survey was distributed by the Young Forum of the German Association of Oral and Maxillofacial Surgery (Junges Forum der DGMKG) across German medical schools to assess factors influencing career decisions for or against OMFS. The questionnaire covered demographic characteristics, career planning, knowledge and practical experience, and perceived stigma related to OMFS. The study included 108 medical students (69% female; mean age 25 years), including 64% clinical students, 25% preclinical students, and 11% students in their final practical year. The primary outcome was self-reported interest in OMFS as a potential specialty choice. Interest was highest for OMFS (25%), followed by pediatrics (16%) and gynecology and obstetrics (12%). Completion of an OMFS internship and higher self-rated OMFS knowledge were independently associated with greater interest in OMFS, with internship completion associated with more than sixfold higher odds of naming OMFS as the preferred specialty (OR 6.65, p = 0.013). Female participants showed lower odds of preferring OMFS in the exploratory multivariable model and were also less willing to pursue a second dental degree (p < 0.001). While perception of training burden did not differ significantly by gender, it varied across training phases. Prior dental education showed a strong bivariate association with OMFS interest (Cramér's V = 0.50). Operative activity and reconstructive surgery emerged as the main motivators, whereas training duration and dual-degree requirement represented the dominant perceived barriers across all training phases. Within this exploratory sample of medical students, OMFS was frequently named as a specialty of interest. However, structural and environmental barriers may contribute to reduced willingness to pursue specialist training. Earlier OMFS exposure and greater specialty-specific knowledge were associated with increased interest, whereas the dual-degree requirement, prolonged training duration, and financial burden were perceived as barriers. These findings highlight the importance of earlier curricular exposure, structured practical experience, and targeted support strategies to improve long-term recruitment in OMFS.
Cervical cancer (CC) is the fourth-most common and lethal cancer in women worldwide, with ~ 23% of cases in Chinese patients. We sought to characterize real-world treatment patterns and decision drivers for locally advanced CC (LACC) in China. We conducted a cross-sectional, 3-phase survey (quantitative development, cognitive, and quantitative interviews) of 360 physicians across 21 cities in China. Primary outcomes included treatment patterns and decision drivers for Chinese patients with LACC. Cancer stage was reported per International Federation of Gynecology and Obstetrics (FIGO) 2018. Respondents were gynecologists (55.6%), radiation oncologists (36.1%), and medical oncologists (8.3%), who reported 67.7% patients had LACC (stage IB3-IVA). Treatment patterns varied by stage: chemoradiotherapy (CRT) alone was used by 18.1%, 42.2%, and 52.1% of respondents for stages IB3-IIA2, IIB, and III-IVA CC, respectively, with surgery-based treatment used by 67.1%, 42.0%, and 26.6% of respondents. Among patients with LACC receiving concurrent CRT, 57.7% received external-beam radiotherapy (EBRT) plus brachytherapy (BT). The most important LACC treatment decision drivers were treatment efficacy (91.7%), CC stage (89.7%), and safety (88.6%). Only 63.9% reported that both EBRT and BT could be performed at their hospitals. Radiotherapy-related issues were reported as the top unmet medical need by 66.4%. There is a significant LACC burden among female patients in China, and deviations from guideline-concordant concurrent CRT. Addressing implementation gaps in concurrent CRT adoption requires improved radiotherapy access, greater multidisciplinary team use, guideline-aligned quality control, enhanced physician and patient education, and improved affordability. Future research should incorporate patient perspectives to improve patient-centered care and outcomes.
Half of the women who develop cervical cancer in the US have never had a cervical cancer screen. Self-sampling is an equivalent technique to the invasive speculum exam. We aim to evaluate the current knowledge, attitudes, and behaviors toward self-sampled primary HPV testing in family medicine. The annual cross-sectional survey of the Council of Academic Family Medicine's general membership included knowledge, attitudes, and beliefs about primary human papillomavirus (HPV) screening using self-sampling. The knowledge questions were based on current guidelines, as defined by the 2024 United States Preventive Services Task Force (USPSTF) 1. The attitude and belief questions were based on the Question-Behavior Theory 2. All surveys were emailed to the membership with up to five weekly reminders to complete. We had a 62% survey response rate with 744 respondents. Regardless of demographic descriptors, all respondents significantly changed their intended behavior regarding offering self-sampling for cervical cancer screening (p < 0.001). Of those with a baseline attitude of not offering self-sampling, 88% changed their response to offer self-sampling at the end of the survey. Baseline knowledge of the advantages of primary HPV screening was lowest among underrepresented minority Hispanic respondents (52% correct, compared to 80% among Whites, p < 0.001). Women respondents were 2.96 times more likely to intend to offer self-sampling for cervical cancer screening than men (OR 2.96 (95% CI: 1.18, 7.44, p<0.05). Based on the Question-Behavior Theory, over 90% of family medicine educators intend to offer women self-sampling for cervical cancer screening.
What is the current lifetime prevalence of infertility in the U.S., and how do U.S. adults view access to in vitro fertilization (IVF) and state-mandated insurance coverage? Cross-sectional data were analyzed from a nationally weighted online survey of 1,000 U.S. adults in November 2024. Survey-weighted descriptive statistics estimated lifetime infertility prevalence and support for the right to access IVF and for state-mandated IVF insurance coverage. Survey-adjusted chi-square tests assessed differences in support across sociodemographic groups. The sample included adults aged 18-87 years (median age 51 years). Lifetime infertility prevalence was 8.9% (95% CI: 7.2-11.0). Most respondents supported IVF access for infertility patients (74.2%; 95% CI: 70.9-77.2), and approximately two-thirds supported state-mandated IVF insurance coverage (64.6%; 95% CI: 61.2-67.7). Support for IVF access varied significantly by age (p = 0.04), education (p < 0.01), income (p < 0.01), race/ethnicity (p = 0.01), political leaning (p < 0.01), and infertility experience (p < 0.01). Lower support was observed among adults ages 18-29 and 30-49, those with lower income or educational attainment, Black respondents, Independents/Independent-leaning respondents, and individuals without personal or secondhand infertility experience. Support for state-mandated IVF insurance coverage varied by education (p < 0.01), income (p < 0.01), political leaning (p < 0.01), and infertility experience (p < 0.01), with the lowest support among respondents with lower income or education, Republican/Republican-leaning respondents, and those without infertility experience. Approximately 1 in 11 U.S. adults has experienced infertility. Although support varied across demographic and political groups, most Americans support IVF access and insurance mandates.
Stressful events during pregnancy are recognized risk factors for adverse birth outcomes, including preterm birth (PTB) and small-for-gestational-age (SGA) infant. Prior studies report mixed findings, often due to small samples, limited stress categorization, and inadequate adjustment for confounders. This study addresses these gaps using a large, nationally representative sample to examine associations between partner-related, traumatic, financial, and emotional stress and PTB and SGA and to assess potential effect modification by race/ethnicity. To evaluate associations between prenatal stressful life events and PTB and SGA among U.S. women (n = 177,113; representing 9.6 million births) participating in the Pregnancy Risk Assessment Monitoring System (2016-2021). Cross-sectional analysis using national PRAMs data, a population-based surveillance system that employs stratified random sampling of recent mothers from state birth certificate files. Participants were surveyed 2-6 months postpartum about experiences before, during, and after pregnancy; responses were linked to birth records. Thirteen prenatal life stressors were assessed using self-reported PRAMS survey items. Weighted Poisson regression accounted for the complex sampling design to estimate adjusted prevalence ratios (aPR) for partner-related, traumatic, financial, and emotional stress, controlling for key confounders. Effect modification by race/ethnicity was assessed using interaction terms. The prevalence of SGA and PTB was 9.5% and 9.1%, respectively. Additionally, 58% of participants experienced at least one of the thirteen life stressors. After adjustment for maternal age, race/ethnicity, maternal education, marital status, and pre-pregnancy BMI, we found a 6% (95% CI: 0%-10%) and 5% (95% CI: 0%-10%) higher prevalence of SGA for traumatic and financial stress, respectively; and a 7% (95% CI: 3%-12%) and 6% (95% CI: 1%-10%) higher prevalence of PTB for financial stress and emotional stress, respectively. While Hispanic ethnicity or non-white race was associated with a higher prevalence of PTB or SGA, stratification by race/ethnicity showed no effect modification (Wald tests, P > 0.10). We identified that traumatic and financial stressors were associated with increased 5-6% higher prevalence of SGA, while financial and emotional stressors were associated with a 6-7% higher prevalence of PTB in a nationally representative sample. Race and ethnicity did not modify these associations, but persistent disparities highlight the need for targeted interventions. Future research should incorporate prospective designs, measures of perceived stress, and biomarkers to clarify mechanisms and inform strategies to reduce stress-related risks for mothers and infants.
Despite the initiation of catch-up human papillomavirus (HPV) vaccination in Japan in April 2022, uptake remains suboptimal. Understanding determinants of vaccination behavior is essential to develop effective strategies to improve coverage. We aimed to identify factors associated with HPV vaccination acceptance in the target population. An online survey was conducted in May 2024 among all students at Saga University (n = 5777) using a web-based questionnaire. The survey included 30 items covering background characteristics, knowledge about HPV vaccine, and attitudes toward HPV vaccine. Female respondents aged 17-27 y, corresponding to the catch-up HPV vaccination target population, were included. Factors associated with vaccination acceptance were examined using multivariable logistic regression, adjusting for possible confounders related to baseline characteristics, knowledge, and attitudes. Data from 406 female respondents were analyzed, including 275 in the acceptance and 131 in the non-acceptance groups (acceptance rate, 68%). The median age was 20 y (interquartile range [IQR], 19-21) in both groups. The proportions of participants with ≥3 doses of COVID-19 vaccine (77% versus 59%) and those enrolled in the Faculty of Medicine (45% versus 15%) were higher in the acceptance group. Adequate knowledge about free vaccination (adjusted odds ratio [aOR] 3.86), routine vaccination (aOR 5.72), and obligation to make efforts to receive vaccination (aOR 2.21) were positively associated with acceptance, whereas anxiety about vaccination was negatively associated (aOR 0.37). These findings suggest that targeting knowledge gaps and vaccine-related anxiety through interventional studies may be key to improving HPV vaccine uptake in the catch-up generation.
Neonatal encephalopathy refers to disturbed neurological function in the neonatal period and has multiple potential aetiologies. A systematic review showed that neonatal encephalopathy, hypoxic-ischaemic encephalopathy, and perinatal asphyxia are often used interchangeably in clinical trials and communications. We aimed to establish an international, consensus-based definition as a preliminary step towards standardising terminology. Findings from a systematic review of definitions guided the creation of a real-time Delphi survey. Three consensus meetings were held to finalise the definition, which was approved by the steering committee. Participants were recruited from a broad range of stakeholder groups, including health-care providers; researchers; parents, family members, guardians, or representatives of children with neonatal encephalopathy; or adults who had neonatal encephalopathy as infants. From Feb 1 to May 31, 2024, the survey received 235 complete and 143 partial responses. Respondents were from 52 countries, with 75 (20%) from low-income and middle-income countries. Although most respondents were health-care workers, 23 (6%) represented parents and caregivers. 62 individuals participated in at least one consensus development meeting. The final definition was organised into primary, secondary, and tertiary domains. The primary domain is as follows: neonatal encephalopathy is a heterogeneous clinical condition characterised by abnormal or impaired brain function with multiple potential causes. It presents with an altered level of consciousness and may include seizures, abnormal primitive and deep tendon reflexes, altered muscle tone, posture or movements, or an abnormal brain-related breathing pattern. Neonatal encephalopathy can be associated with a heightened risk of morbidity and mortality. This Delphi process established a novel consensus definition for neonatal encephalopathy, with contributions from a diverse range of international stakeholders, including families. Adopting consensus-based terminology and definitions will enhance communication among health-care professionals and families, facilitate research and data synthesis, improve the interpretation and application of research findings, and ultimately improve care.
Rheumatic disease significantly alters a child's quality of life. Rheumatologists often apply a patient global assessment score (PGA) in real time to gauge quality of life, effectiveness of treatment, and disease activity for clinical and research purposes. Previous studies showed a discrepancy between the PGA and objective disease activity measures. This study explores patients' self-reported reasons behind their PGA score, especially the role of anxiety and depression. This is a single-center, cross-sectional, survey-based study. Seventy-one patients 12-18 years old with JIA, SLE or JDM completed a survey including the PGA, Patient Health Questionnaire-9 (PHQ9) and Screen for Childhood Anxiety Related Disorders (SCARED). The associations of high (≥ 3) and low (< 3) PGA scores with mental health scores and reasons for selecting a PGA were analyzed using appropriate nonparametric tests. Twenty-seven participants (38.0%) had clinically significant anxiety symptoms and sixteen (22.5%) had moderate or worse depressive symptoms. Patients with high PGA scores were more likely to have clinically significant depressive (32.4% vs. 11.8%, p = 0.05) or anxiety symptoms (48.6% vs. 26.5%, p = 0.05) compared to patients with low PGA scores. Patients with either high depressive symptoms or anxiety symptoms were more likely to report trouble sleeping, feeling stressed about their disease, feeling anxious or sad/depressed, having to take too many medications, and an inability to participate in sports/activities as reasons for their PGA score compared to patients without high depressive or anxiety symptoms. In contrast, the degree of objective disease activity was only associated with the reason "inability to participate in sports". Mental health likely influences how adolescents with rheumatic disease view the impact of their disease on their quality of life and functioning. This is important to consider when applying PGA scores in research studies and clinical care. The rheumatology community must develop efficient ways to better evaluate and treat potential factors mediating their patients' overall health and functioning.
Aim Healthcare providers' beliefs about childbirth, as a natural or medical process, shape labor management and women's birthing experiences. This study aimed to objectively assess providers' attitudes using the Birth Beliefs Scale (BBS). Materials and methods A cross-sectional online survey was conducted during a maternity-care conference at a tertiary center in November 2025. Participants completed a web-based questionnaire based on the BBS. The survey assessed beliefs about birth as a natural process, such as seeing birth as normal, safe, and something women's bodies are designed for, emphasizing trust in the body, acceptance of pain as intrinsic, and minimal intervention unless necessary. Questions on beliefs about birth as a medical process covered perceptions of childbirth as dangerous and risky, safe only in hindsight, requiring medical supervision, and viewing labor pain as unnecessary and manageable pharmacologically. Independent t-tests compared continuous variables between two groups, while one-way ANOVA with Bonferroni post-hoc tests assessed differences across multiple groups. Ordinal alpha coefficients evaluated the internal consistency of both BBS subscales, with statistical significance set at p < 0.05. Given the ordinal nature of Likert-scale items, the ordinal alpha coefficient was employed to assess internal consistency and reliability of the two BBS subscales within this study population, accounting for potential differences from the original validation context. Results Of the 178 respondents, 56 (31.5%) were obstetricians, 52 (29.2%) midwives, 18 (10.1%) nurses, 12 (6.7%) childbirth educators, 11 (6.2%) doulas, and 29 (6.3%) others. Among the respondents, 104 (58.4%) worked in the private sector. Overall, BBS-natural scores were high. However, BBS-medical scores differed significantly by age, profession, and sector. Younger providers, obstetricians, and private-sector clinicians showed stronger beliefs favoring medical intervention during childbirth. Conclusion Participants largely endorsed naturalistic views of birth, but attitudes varied substantially across provider groups, age brackets, and practice settings. These differences reflect the influence of training and institutional culture on childbirth perceptions. Targeted inter-professional education, supportive institutional policies, and strengthened midwifery models may help promote balanced, evidence-based, woman-centered maternity care in India.