Afghans are one of the world's largest refugee populations. Afghan women face compounded health risks due to sociocultural restrictions, low literacy, forced displacement, and limited health care access, yet little is known about their experiences with health care after resettlement in the US. To explore health and health care access issues of Afghan refugee women in the US. This qualitative study was part of an ongoing community-based participatory research project started in July 2020. Bilingual investigators conducted semistructured interviews with Afghan refugee women in Dari or English. Dari interviews were interpreted to English by a fluent bilingual investigator, validated by a separate bilingual investigator, and then reviewed with an Afghan immigrant community member for accuracy. Transcribed interviews were analyzed using grounded theory from July 2023 to July 2024. Participants who self-identified as Afghan, were born outside of the US, and were 18 years or older were recruited with convenience and purposive sampling from the San Francisco Bay Area of California through refugee-serving community organizations and word of mouth until data saturation was met. Themes and subthemes about health and health care access. Of 23 Afghan women interviewed (median age, 30 years [range, 19-55 years]), most were married (22 [96%]) and had health insurance (16 [70%]). Their median time of residence in the US was 4 years (range, 1-17 years). Five key themes of health and health care access were identified: (1) health system barriers, such as inadequate interpretation causing miscommunication and mistrust, and insensitive health care including lack of informed consent; (2) sociocultural norms and women's autonomy, with patriarchal gender norms persisting after resettlement and limiting women's decision-making; (3) structural barriers resulting in the use of home remedies, driven by long wait times and negative prior experiences; (4) sociocultural barriers to sexual and reproductive health, with knowledge gaps shaped by intergenerational shame; and (5) mental health challenges, including widespread distress expressed through culturally specific idioms and somatic symptoms. In this qualitative study, Afghan women described multilayered health care barriers, including displacement-related trauma, sociocultural norms, and structural deficiencies. Study findings suggest that culturally sensitive and linguistically appropriate public health interventions and structural changes are needed to improve health care access for Afghan women in the US.
Menstruation is often stigmatized and poorly managed in low-income settings like Nepal, leading to health and social challenges. Women in urban slums face additional barriers due to poverty and limited sanitation. This study explores factors affecting menstrual hygiene practices among women in Budanilakantha slums to inform targeted interventions. A cross-sectional study was conducted among 247 women aged 18-49 years in slum areas of Budanilakantha Municipality, Nepal. Participants were selected using systematic random sampling. Data were collected via a pretested questionnaire and analysed with chi-square tests. Ethical approval was obtained from Nobel College, Pokhara University. Among the 247 women surveyed, 53.8% used sanitary pads and 42.9% used reusable cloth materials (traditionally used fabric pieces) during menstruation. Most participants reported using soap and water for handwashing (66.8%) and external genital cleaning (82.6%), whereas only 38.9% bathed daily during menstruation. Nearly all participants (95.1%) experienced menstrual restrictions, and 57.1% reported being perceived as impure. Statistically significant associations were observed between menstrual hygiene-related awareness and both education and monthly income, while handwashing practice was significantly associated with ethnicity, occupation, and monthly income. These findings suggest that socio-economic conditions and cultural norms are key determinants of menstrual hygiene practices among women living in slum areas. Menstrual hygiene practices in Budanilakantha slum areas are influenced by socio-economic status, cultural taboos, and limited infrastructure. Although basic hygiene is practiced by many, cultural stigma and gaps in hygiene behaviours persist. Comprehensive interventions addressing education, water, sanitation and hygiene infrastructure, and social norms are essential to improve menstrual health and dignity among marginalized women.
Mobile money has emerged as a low-cost financial instrument with strong potential to improve livelihoods, particularly in economies with weak formal financial systems. This paper examines the welfare effects on women and youth in Mozambique, a fragile, post-conflict country exposed to climate shocks. Using 900 household observations from the 2019 FinScope Survey and an instrumental variable approach to address selection bias, the study provides robust evidence on welfare outcomes. Results show that mobile money improves household welfare, with effects driven by active usage rather than mere account ownership. Specifically, mobile money reduces reliance on own food production, indicating improved market integration and liquidity, while enhancing consumption smoothing and investment in human capital. Welfare gains are transmitted through remittances and financial inclusion, strengthening household resilience. Women benefit through increased financial autonomy, consistent with evidence that digital financial services improve women's entrepreneurship, financial decision-making, and economic empowerment [33], while youth rely on remittances to stabilize consumption. However, the instrumental variable approach relies on the assumption that network availability affects welfare only through mobile money adoption, a claim that cannot be fully tested and should be interpreted with caution. These findings suggest that policies should prioritize active usage and ecosystem integration over access alone.
Systemic autoimmune diseases can adversely affect the health of childbearing women and pregnancy outcomes. Additionally, some of theadministered medications are teratogenic, prompting international rheumatological societies to recommend effective contraception and preconception counselling. Given the limited structured education in this field, this study aimed to assess reproductive health awareness and perceptions of family planning among women with systemic autoimmune diseases. A survey-based study was conducted at the Division of Clinical Immunology and Rheumatology, University Hospital Centre Zagreb, Zagreb, Croatia. The sample included 165 women aged 18-50 years who completed the ReproKnow questionnaire assessing reproductive health knowledge, while sociodemographic and clinical data were obtained through interviews and medical records. The median ReproKnow score was 5/10 correct answers indicating moderate knowledge of the studied topic. Greater reproductive health awareness was observed among patients with higher education levels and those diagnosed with SLE or vasculitis. Although one-third of participants stated that their diagnosis affected family planning, only one-fifth reported consistent contraception use, even among those receiving teratogenic medications. Knowledge of contraception efficacy was low (25%), but associated with consistent use. Substantial gaps remain in contraception knowledge and use, highlighting the need for targeted educational interventions and further research to improve reproductive health counselling and contraception practice.
Plasma volume (PV) expansion may support various adaptations associated with heat acclimation (HA), including a potential increase in temperate maximal oxygen uptake (VO2max). The PV response to HA is highly variable, and mechanisms that contribute to this variability are poorly understood, including the potential influence of sex. 26 volunteers (11M;15F) underwent a 10-d HA program that consisted of 120 min of fixed-workload treadmill exercise at 40 °C and 40 %RH. Temperate (~20 °C) VO2max and PV (carbon monoxide rebreathing) were measured before and after HA. Serum aldosterone, estradiol, and progesterone, as well as plasma copeptin, were measured on the first and last day of HA. HA was successfully induced, as evidenced by reductions in body core temperature, heart rate, and sweating rate during exercise in the heat. PV (Pre: 3280 ± 552 mL; Post: 3380 ± 685 mL, P = 0.096) and VO2max (3.06 ± 0.82 L/min; 3.09 ± 0.77 L/min, P = 0.453) were unchanged with HA at the cohort level, and sex did not modify responses to HA (Interaction effects: P > 0.05). ∆Aldosterone was correlated with ∆PV (P = 0.047, r = 0.393, r2 = 0.155,), and ∆progesterone with ∆PV in women (P = 0.039, r = 0.537, r2 = 0.289,). In our young, healthy cohort of men and women, PV and VO2max were unchanged following fixed-workload HA, and the overall adaptive response did not differ based on sex. The PV response was highly variable across individuals such that increases in PV was not observed in most individuals. Inter-individual variability in circulating progesterone may contribute to some of the response in women.
Overactive bladder (OAB) remains a symptom-based diagnosis with limited objective tools for biological characterization. This study evaluated a multimodal profile of OAB by simultaneously assessing urinary and serum biomarkers and ultrasonographic bladder parameters in women with OAB. In this prospective case-control study, 80 women were enrolled (40 OAB patients [OAB-V8 score ≥11], 40 age- and BMI-matched healthy controls). Urinary and serum BDNF, NGF, and substance P were measured by ELISA; oxidative stress markers (TOS, TAS, OSI) were analyzed. Bladder wall thickness, detrusor thickness, and bladder resistive index were assessed by ultrasonography. Correlation and multivariable logistic regression analyses evaluated associations with symptom severity and potential confounding by menopausal duration. Urinary and serum BDNF, NGF, and substance P were significantly elevated in OAB (all p < 0.001), as were ultrasonographic bladder wall parameters (all p < 0.001). Serum NGF showed the highest diagnostic accuracy (AUC 1.000), followed by serum BDNF (0.999), urinary BDNF (0.976), and urinary substance P (0.972). Urinary substance P (ρ = 0.929) and urinary BDNF (ρ = 0.916) correlated most strongly with symptom severity. All four principal biomarkers remained independently associated with OAB after adjustment for menopausal duration. A composite urinary-biomarker-plus-ultrasound model showed a numerically, but not statistically, higher AUC than the best single urinary marker (0.999 vs. 0.976; DeLong's test, p = 0.308). Women with OAB exhibited a distinct multimodal biological profile characterized by neurotrophin activation, oxidative stress imbalance, and structural bladder wall changes. These exploratory findings require external validation in larger prospective cohorts before clinical implementation can be considered.
Sickle Cell Disease (SCD) is a hereditary hemoglobinopathy that poses significant risks during pregnancy, leading to increased maternal complications such as Vaso-occlusive crises, acute chest syndrome, preeclampsia, preterm labor, and perinatal complications such as preterm births, low birthweights and mortality. The complexities surrounding the management of SCD extend beyond the clinical symptoms and require a comprehensive understanding of the social, emotional, and systemic factors that influence patient outcomes. While existing research has largely focused on the epidemiology and clinical outcomes of SCD in pregnancy, little is known about the perspectives of frontline healthcare providers in resource-limited settings. To explore the experiences of healthcare providers in managing pregnant women with sickle cell disease. A qualitative approach with phenomenological research design was employed, utilizing in-depth interviews and Focus Group Discussions (FGDs) to gather insights from healthcare providers at a regional and national referral hospital. Participants included obstetricians, midwives, and general practitioners working in maternity departments. Inductive thematic analysis was conducted to identify key themes and patterns. The study identified several themes based on various health system building blocks and the different levels of the Behavioural Ecological Framework. Individual-level themes included knowledge gaps and awareness, fear and anxiety related to managing a pregnant woman with SCD, and emotional and psychological distress. Community-level influences consisted of religious beliefs, cultural beliefs, as well as myths and misconceptions. At the health systems level, key themes encompassed diagnostic challenges, shortages of critical supplies, lack of management guidelines, and the absence of multidisciplinary and specialized services. A multidisciplinary approach that integrates clinical expertise, patient education, and healthcare system reforms is essential for improving maternal and neonatal health in pregnant women with SCD.
Bacterial vaginosis (BV) is a prevalent vaginal infection in reproductive-age women, associated with various behavioral and metabolic factors. Life's simple 7 (LS7), a cardiovascular health metric from the American Heart Association, includes smoking, physical activity, diet, body mass index, blood pressure, blood lipids, and blood glucose. This study aimed to explore the link between LS7 scores and BV, offering a perspective on comprehensive risk assessment. This cross-sectional study used data from the National Health and Nutrition Examination Survey 2001-2004, including 1203 women aged 18 to 49 years (382 BV, 821 controls). Accounting for National Health and Nutrition Examination Survey' complex design, we applied fasting weight (WTSAF2YR), strata (SDMVSTRA), and primary sampling unit (SDMVPSU). Weighted logistic regression models (Crude, Model 1, and Model 2) examined the LS7-BV association. Model 1 adjusted for age, race, poverty income ratio, marital status, and education; Model 2 further adjusted for white blood cell, lymphocyte, monocyte counts, and globulin. LS7 was analyzed categorically (<8.5 vs ≥ 8.5), with the cutoff determined by receiver operating characteristic curve. We also performed restricted cubic spline analysis, Extreme Gradient Boosting, and subgroup analyses. Weighted baseline analysis showed that the LS7 score in the BV group (8.31 ± 2.01) was significantly lower than that in the normal group (8.93 ± 2.02, P < .001). Weighted logistic regression revealed that each 1-unit increase in LS7 was associated with lower BV odds in the Crude Model (odds ratio [OR] = 0.86, 95% confidence interval [CI]: 0.80-0.92, P < .001) and remained significant in Model 2 (OR = 0.90, 95% CI: 0.82-0.98, P = .013). In categorical analysis, LS7 ≥ 8.5 was associated with lower BV odds than < 8.5 (Crude OR = 0.60, 95% CI: 0.43-0.85, P = .005). Restricted cubic spline analysis showed a significant inverse dose-response relationship (P for overall = .001). Subgroup and sensitivity analyses confirmed consistent inverse associations and robustness. Higher LS7 scores were associated with lower odds of BV. Due to the cross-sectional design, these findings are associational and cannot establish causality.
Transgender Women and Travestis (TWT) are at increased risk for sexually transmitted infections due to contexts of vulnerability related to socioeconomic and behavioral factors. However, data on the prevalence of Human T-lymphotropic viruses type 1 and 2 (HTLV-1/2) in this population remain scarce. This study aimed to investigate the seroprevalence of HTLV-1/2 infection among TWT in five Brazilian capitals. A cross-sectional study was conducted from 2019 to 2021 in five Brazilian capital cities, representing all geographic regions of the country. A total of 1,269 blood samples were tested for HTLV-1/2 antibodies using ELISA and Western Blot assays. Sociodemographic and behavioral data were obtained through structured interviews. Among 1,269 samples, most participants identifying as transgender women (59.18%) or travestis (29.79%) with a median age of 30 years. A total of 12 samples tested positive for anti-HTLV-1/2 (0.94%; CI 95%: 0.53-1.65), with positive cases in Manaus (n = 4, 1.50%), Salvador (n = 4, 2.22%), and Porto Alegre (n = 4, 2.12%), and none in São Paulo or Campo Grande. Associated behaviors included inconsistent condom use and a history of HIV and syphilis. Our study highlights the presence of HTLV-1/2 infection among TWT in Brazil, with regional differences. These findings underscore the need for targeted public health interventions, including increased screening, health education, and access to healthcare services, to address the specific vulnerabilities of this population.
Breast augmentation is a key component of chest feminization in assigned male at birth patients (AMABp). Although both the inframammary and periareolar approaches are used, few studies have compared their outcomes in transgender women. This study aimed to evaluate both techniques regarding surgical outcomes, complications, and patient-reported satisfaction using the BREAST-Q questionnaire. A prospective study was conducted on AMABp undergoing primary breast augmentation performed by two senior surgeons between November 2016 and December 2024. Inclusion criteria included age 18 years or older, body mass index below 30, and at least 12 months of hormone therapy. Patients with previous breast surgery or filler injections were excluded. The type of incision (periareolar or inframammary) was chosen by each patient after preoperative counseling. Postoperative outcomes and satisfaction were recorded. The BREAST-Q Version 2 Augmentation Module was administered online at least 12 months postoperatively. Data were analysed using Mann-Whitney U and Fisher's exact tests (p < 0.05). Ninety-five AMABp were included (55 periareolar, 40 inframammary). Groups were comparable except for implant pocket location. The overall complication rate was 3.7%, with no significant intergroup differences. Secondary aesthetic revisions were more frequent in the inframammary group (28.6% vs. 7.5%; p= 0.026). BREAST-Q scores were high across all domains, without significant differences between groups. Periareolar and inframammary breast augmentation resulted in similar complication rates and BREAST-Q outcomes. In a patient-selected setting, both approaches were associated with high levels of patient-reported satisfaction.
This study aimed to evaluate the effects of photobiomodulation (PBM) alone and in combination with pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) function, sexual and urinary function, and quality of life in women with genitourinary syndrome of menopause. The three-arm clinical trial included women aged 45-65 years who had experienced natural menopause for at least 1 year. Participants were randomized into three groups: PFMT + active PBM, PFMT + sham PBM and isolated PFMT. Interventions lasted 8 weeks, with participants attending two 50-min sessions per week. Outcomes were assessed before and after the 16th session. Although manometry showed no significant differences between groups, the intervention group demonstrated greater numerical improvement. The Female Sexual Function Index (FSFI) total score differed significantly between the PFMT + active PBM and PFMT + sham PBM groups (mean difference = 4.55; 95% confidence interval: 0.57, 8.52; d = 1.05). Significant between-group differences were also observed in the orgasm subdomain in favor of the PFMT + active PBM group compared to the PFMT + sham PBM group. The International Consultation on Incontinence Questionnaire - short form (ICIQ-SF) indicated a clinically significant improvement of 3.06 points in the PFMT + active PBM group compared to the PFMT + sham PBM group following the intervention. Active PBM combined with PFMT showed greater but non-significant improvements in PFM pressure, urinary function and quality of life, while significantly improving only sexual function. Pelvic floor dysfunctions, including impairments in muscle strength, sexual function and urinary continence, are not life-threatening but can cause substantial morbidity and markedly compromise quality of life. Women with genitourinary syndrome of menopause are particularly vulnerable, often experiencing limitations that extend beyond the physical domain to affect social and occupational functioning. Photobiomodulation has emerged as a safe, inexpensive and user-friendly therapeutic option, with accumulating evidence supporting its role in musculoskeletal repair. Given that pelvic floor muscle training (PFMT) is considered the gold-standard treatment, its combination with photobiomodulation may enhance therapeutic outcomes. In this parallel, controlled, blinded clinical trial, we investigated the effects of an 8-week intervention (two sessions per week) of photobiomodulation therapy, delivered either alone or in combination with PFMT. Our findings suggest that the combined approach yielded superior improvements in pelvic floor muscle strength, sexual and urinary function, and overall quality of life compared with photobiomodulation alone. These results highlight the potential of integrating photobiomodulation with PFMT to optimize the management of pelvic floor dysfunction in women with genitourinary syndrome of menopause.
Breast cancer is the most common cancer among women in Jordan, with many cases detected at advanced stages, leading to higher costs and poorer outcomes. Despite mammography's proven benefits for early detection, its use remains low. This study evaluates the cost-effectiveness and budget impact of implementing mammography screening in Jordan's healthcare system. A cost-effectiveness analysis was conducted from the perspective of the Jordanian healthcare system, comparing mammography-based screening with no screening (opportunistic detection) among women ≥ 40 years. A Markov model estimated disease progression, costs, and quality-adjusted life years (QALYs), using primarily local/regional data, supplemented by international sources when necessary. Results were expressed as incremental cost-effectiveness ratios (ICERs), i.e., cost per QALY gained. Sensitivity analyses tested model robustness. A budget impact analysis (BIA) assessed the financial implications of implementing nationwide screening. Comparing mammography-based screening with no screening among women ≥ 40 years, ICER was estimated at $5341 per QALY gained, which is well below Jordan's willingness-to-pay threshold. Over a lifetime horizon, mammography screening among eligible women aged 40-50 years was projected to prevent 779 breast cancer deaths. Both one-way and probabilistic sensitivity analyses confirmed the robustness of the base-case results under uncertainty. Over five years, nationwide screening yielded net savings of $17.6 million compared to current screening estimates. Mammography-based breast cancer screening appears to be a cost-effective strategy in Jordan, with potential to reduce breast cancer mortality. These findings suggest possible improvements in population health outcomes and more efficient use of healthcare resources.
The aim of this study was to assess the impact of standardized benzathine penicillin therapy on adverse pregnancy outcomes in high-titer toluidine red unheated serum test (TRUST) positive (≥ 1:16) syphilis cases and refine prevention of mother-to-child transmission (PMTCT) strategies. This retrospective cohort study analyzed 2,229 pregnant women with syphilis from the National PMTCT System of Taizhou City (2013-2023). Standardized treatment was defined as 3 weekly intramuscular benzathine penicillin doses (2.4 MU each). Multivariable logistic regression adjusted for gestational age, maternal age, and comorbidities was used to analyze the outcomes. A total of 1,651 women (74.1%) received standardized therapy and the risk of adverse pregnancy outcomes was significantly lower in this group compared to those with non-standardized treatment: perinatal death (0.55% vs. 2.60%), congenital syphilis (0.24% vs. 2.60%), preterm birth/low birth weight (7.81% vs. 16.78%), and total adverse outcomes (8.60% vs. 38.75%) (all p < 0.001). Adjusted analysis demonstrated 58% risk reduction with standardized treatment (aOR = 0.42, 95% CI: 0.31-0.57, p < 0.001). Early initiation (≤ 20 weeks) enhanced efficacy (aOR = 2.12, 95% CI: 1.45-3.10, p < 0.001), with married (aOR = 2.41) and educated women (aOR = 1.89) showing higher adherence. Standardized penicillin regimens significantly mitigate adverse pregnancy outcomes by 58%, emphasizing early diagnosis, timely treatment, and targeted patient education for PMTCT success. Marital status and education level were independently associated with treatment adherence.
Obesity is a significant risk factor for female infertility, representing a growing global health concern. Body mass index (BMI) has traditionally been used as the standard measure of obesity; however, the weight-adjusted waist index (WWI) has recently appeared as a novel metric that may provide a more accurate assessment of obesity. This study aims to investigate the association of both BMI and WWI with female infertility. The "2015-2018 National Health and Nutrition Examination Survey" (NHANES) was utilized to derive the data. The study included 2393 women between the ages of 20 and 50 years. Among them, 251 were diagnosed with infertility. Multivariate logistic regression, subgroup analysis, interaction testing, smooth curve fitting, and receiver operating characteristic curve analysis were conducted to examine the associations of WWI and BMI with infertility. Among women, the infertility's prevalence was positively associated with both WWI and BMI levels. Higher WWI was significantly related with raised infertility prevalence (OR = 3.63, 95% CI: 1.96-6.73), as was higher BMI (OR = 2.27, 95% CI: 1.29-4.01). In the WWI subgroup analysis, the association was consistently observed in most subgroups, except for age, race, and education level. In the BMI subgroup analysis, the association was consistent across all subgroups. In the population-based cross-sectional data of this study, WWI and BMI were positively associated with the odds of infertility among US women. This finding suggests that obesity-related measures may have potential value in clinical practice and may help to identify potentially high-risk groups of women with infertility. In addition, the existing results suggest that weight management-related interventions may have potential effects on fertility outcomes, but whether they can reduce the infertility rate, explain the biological mechanism, and guide clinical decision-making needs to be verified by prospective, mechanistic, and interventional trials in the future.
Neck pain is prevalent in postpartum women due to postural stress and muscle dysfunction. Although postural correction exercises are widely used, adding manual therapy techniques such as positional release and Tui-Na may enhance outcomes. However, comparative evidence, particularly using surface electromyography (sEMG), remains limited. This study examined the effects of Tui-Na (TN) versus positional release techniques (PRT) added to postural correction exercises (PCEs) on postpartum neck pain. Sixty women with postpartum neck pain were randomly assigned to three groups for 4 weeks of prescribed treatment. Group A (control) received PCEs, while either PRT or Tui-Na were added to PCEs for Groups B and C, respectively. The primary outcome was neck pain intensity measured by the Visual Analogue Scale (VAS). Secondary outcomes included the Neck Disability Index (NDI) and upper trapezius electromyographic characteristics (normalized root mean square [RMS] and median frequency [MDF]). A two-way repeated-measures MANOVA was used for statistical analysis. Significant multivariate effects were observed for group effects (F = 4.798, p < 0.001, partial η2 = 0.147), time (F = 851.51, p < 0.001, partial η2 = 0.968), and group-by-time interaction (F = 3.87, p < 0.001, partial η2 = 0.122). Pain intensity was significantly reduced in both groups B (p = 0.035) and C (p = 0.003) when compared to group A. UT-MDF was significantly increased in group C when compared to groups A (p < 0.001) or B (p = 0.02). All groups demonstrated significant within-group improvements in all outcome measures. Both Tui-Na and PRT combined with PCEs improved pain and disability in postpartum women with neck pain. Compared with PRT, Tui-Na demonstrated greater improvements in pain intensity and upper trapezius EMG frequency characteristics. However, these findings should be interpreted cautiously because of the short intervention period and lack of long-term follow-up. NCT07261605.
To assess the extent to which expanded carrier screening (ECS) panels capture the genetic conditions for which preimplantation genetic testing for monogenic diseases (PGT-M) is performed. A retrospective observational study conducted at a single university-affiliated PGT unit from 2015 to 2023. Women undergoing PGT-M for autosomal recessive or X-linked genetic conditions were included. Genetic conditions were cross-matched with five ECS panels (four commercial panels and one publicly funded ECS panel) and compared with a targeted, population-specific screening. Coverage was assessed at both the woman and gene levels using paired statistical comparisons. A total of 330 cases were included; seven women underwent PGT-M for two eligible conditions and were therefore counted twice. These cases involved 110 different genes with an uneven distribution: eight genes accounted for 53.2% of cases, while 71 genes were observed in a single case. At the individual-woman level, targeted, population-specific screening showed lower coverage (47.9%) than that of all ECS panels (71.8-91.5%), with overall differences statistically significant (P < 0.001). At the gene level, coverage ranged from 20.9 to 79.1% across panels (P < 0.001). The evaluated ECS panels included 271-787 genes, with the largest panel demonstrating higher case coverage than the other commercial panels. Expanded carrier screening panels capture most autosomal recessive and X-linked genetic conditions for which PGT-M is performed. These findings support the clinical utility of ECS in identifying couples at risk of having children affected by such conditions.
Physical inactivity, maladaptive exercise motives, and body image concerns are highly prevalent among young adult women and are associated with reduced psychological well-being and increased risk for disordered eating. Although previous interventions have addressed physical activity or body image separately, few have simultaneously targeted motivational quality and body-related perceptions within an integrated theoretical framework. This study protocol describes a randomized controlled trial designed to evaluate the effectiveness of a psychoeducational intervention based on Self-Determination Theory and using functionality-oriented body image strategies. The aim is to enhance autonomous motivation for exercise and improve psychological well-being among female university students in Health Sciences. Participants aged 18-25 years will be randomly allocated (1:1) to an experimental group or a wait-list control group following baseline assessment. Outcome measures will be collected at baseline (T0), post-intervention (T1), and six-month follow-up (T2). The intervention consists of six face-to-face group sessions that include autonomy-supportive strategies, competence-building activities, and functionality-based body image content emphasizing body capabilities rather than appearance. The primary outcome is autonomous motivation for exercise, assessed using the Behavioral Regulation in Exercise Questionnaire-3 and operationalized through the Relative Autonomy Index at six-month follow-up. Secondary outcomes include satisfaction and frustration of basic psychological needs, physical activity levels, positive body image, and risk of eating disorders. Data will be analyzed using mixed model for repeated measures under an intention-to-treat framework to account for repeated measures and missing data. Mediation analyses will examine whether changes in autonomous motivation explain the effects of the intervention on physical activity, positive body image, and eating disorder risk. This study will provide evidence on the effectiveness of an integrated, theory-based intervention targeting motivation and body image in young adult women. The trial is registered at ClinicalTrials.gov (Identifier: NCT07506343).
Increased body mass index (BMI) is associated with increased medical costs, but no information is available for Switzerland. We investigated the association of individual BMI categories with healthcare use and healthcare expenditures. Data from an ongoing prospective, community-based study conducted in Lausanne, Switzerland. Information on healthcare use, type of insurance and deductible level were provided by the participants for period 2018-2021. Health expenditures were obtained from health insurers. 1960 participants (64.5 ± 9.6 years, 50.4% women) had data on healthcare use. After multivariable adjustment on socioeconomic and health covariates, participants with obesity were less likely to use complementary medicines or over the counter drugs, odds ratio and (95% confidence interval): 0.74 (0.56-0.98) and 0.61 (0.44-0.85), respectively, while being more likely to be on polypharmacy [1.52 (1.05-2.20)] and benefitting from home care [2.25 (1.19-4.25)]. 907 participants (64.4 ± 9.4 years, 48.6% women) had data on health expenditures. BMI levels were positively associated with total health expenditures (median and [interquartile range]: 3740 [1717-7935], 2815 [666-6170] and 1680 [248-4975] CHF for obesity, overweight and normal weight, respectively, p < 0.001) and expenditures paid by insurance (3189 [820-7262], 2179 [0-5604] and 1019 [0-4205] CHF, respectively, p < 0.001). After multivariable adjustment, participants with obesity still presented higher total expenditures, while no difference was found for insurance-paid expenditures or participants with overweight. People with obesity have higher healthcare use and higher total health expenditures than people with normal weight.
Diabetes is a major global public health problem. Inequity in access to healthcare services represents a significant challenge for healthcare management and particularly affects vulnerable populations, understanding the intersectionality of these social determinants of health is essential. To evaluate the adequacy of care provided to individuals with diabetes in Brazil, considering the intersection of gender, race, and socioeconomic profile. This study was based on data from the Brazilian National Health Survey (2019-2020). 6,967 individuals self-reported a diagnosis of diabetes and composed the study sample. The "adequacy of care" outcome variable was analyzed according to sociodemographic characteristics. The intersection of gender, race and socioeconomic profile was considered according to the intersectionality theory. Descriptive and multivariate analyses were conducted using Poisson regression (prevalence ratio [PR]) with robust variance and corresponding 95% confidence intervals (95%CI). Black women with low income was the predominant profile of people with diabetes (22.0%; 95%CI: 20.5 to 23.3). Prevalent gaps in care delivery encompassed a lack of care for diabetic foot and failure to refer patients to a specialist doctor. The highest prevalence of low adequacy of care was observed in black men (79.6%; 95%CI: 75.7 to 83.1) and women (79.1%; 95%CI: 76.2 to 81.8) with low income. In the multivariate model, low adequacy of care was associated with black women and men with low income (PR = 1.09 [95%CI: 1.00 to 1.20] and 1.10 [95%CI: 1.00 to 1.21]), absence of diabetes-related complications (PR = 1.18 [95%CI: 1.11 to 1.25]), and no history of diabetes-related hospitalization (PR = 1.12 [95%CI: 1.03 to 1.22]). Baseline challenges of living with diabetes in Brazil are further exacerbated for socially vulnerable groups. Our findings highlight structural racism and poverty as critical social determinants of health. Adopting an intersectionality approach enables a more nuanced understanding of health inequities.
Increased nuchal translucency (NT; ≥ 2.5 mm) is closely associated with various chromosomal abnormalities, structural abnormalities, and genetic diseases. However, research on pathogenic copy number variations (CNVs) affecting pregnancy outcomes in fetuses with increased NT remains limited. This study aimed to summarize the clinical features, chromosomal abnormalities and obstetric outcomes of increased NT to provide a clinical reference for prenatal diagnosis. A retrospective analysis was conducted on 180 pregnant women with increased NT who underwent invasive prenatal testing via conventional karyotyping and single nucleotide polymorphism (SNP) array analysis between January 2021 and December 2025. These cases were selected from a cohort of 1,678 pregnant women. Chromosomal karyotyping revealed a total of 24 chromosomal abnormalities. Chromosomal polymorphisms were also observed in four cases, including two cases with pericentric inversion of chromosome 9 [inv(9)(p12q13)], one case with 1qh+, and one case with 21pss (double satellites on the short arm of chromosome 21). In addition, SNP-array analysis detected CNVs in 13 fetuses with normal karyotypes. Among the 24 fetuses harboring pathogenic variants, 21 (87.5%) exhibited aneuploidy. These aneuploid cases included 16 fetuses with trisomy 21 syndrome and 5 fetuses with either trisomy 18 syndrome or Klinefelter syndrome, with trisomy 21 accounting for 76.2% (16/21) of the aneuploid cohort. Among the CNVs detected by SNP-array, one was classified as pathogenic, one as likely pathogenic, and the remaining as variants of uncertain significance (VUS). Postnatal follow-up of 10 infants with VUS revealed growth and speech developmental delays in two cases, while no obvious abnormalities were observed in the remaining eight. Aneuploidy was found to be the predominant type of abnormality in fetuses with increased NT. This study suggests that high-resolution SNP-array exhibit greater sensitivity in detecting chromosomal microstructural abnormalities and can serve as an effective complement to conventional karyotyping.