Expanding Pathology: Risk Reduction, Illicit Procedures, and Catholic Health Care

Sex and the Catholic Church in Guatemala

Military service involves potential exposure to a range of physical, chemical, and biological hazards that could impact reproductive health. Females represent 20% of Australian Defence Force (ADF) members and, like many military services, the ADF is prioritizing their recruitment and retention. However, given that females have different physiology and anthropometry, specific female occupational research is essential. This systematic review aimed to retrieve and summarize the findings of research involving currently serving ADF personnel with outcomes relevant to male or female reproductive health or any aspect of female health. Reproductive and female health studies between January 2002 and April 2023 that included serving ADF members were identified through a systematic search of 5 scientific databases. Data were extracted and synthesized, alongside a risk of bias assessment following PRISMA-ScR guidelines. Overall, 8 studies relating to reproductive health and 14 studies related to female health were identified. Studies were methodologically heterogeneous: few studies were at low risk of bias and few covered the same health outcome, preventing pooling of data. Four studies of males concluded that deployment to the Middle East was not associated with risk of infertility or birth defects. Female reproductive health studies provided very limited data. Other female health research primarily covered musculoskeletal disorders and injuries from basic training. Studies of reproductive and female health in ADF members do not currently provide a cohesive or comprehensive body of evidence in either area. This review serves as a systematic map of the existing evidence to identify gaps and set future strategic research agendas. More high-quality longitudinal studies with sex-stratified analyses are urgently needed, as is a strategic focus on health outcomes that may affect military preparedness and fitness for deployment.

One of the contributions to the Catholic healthcare ministry made by the late Cardinal Bernardin is a set of criteria for Catholic healthcare systems to use in choosing partners for joint ventures and affiliations (Bernardin, 1994). He based his criteria on the premise that appropriate partners are those who will ultimately strengthen and enhance the Catholic presence in healthcare in general, and the Catholic identity of the Catholic facility in particular. Hence, the preferred partner is another Catholic party. A second option is another not-for-profit system or facility that shares “in a substantive way our Catholic vision and values.” This choice of partner can be problematic in that, even if common vision and values are affirmed, the Catholic identity of the Catholic partner may be diluted. This situation could occur, for example, as a result of the shift from an exclusive Catholic sponsorship to an arrangement of co-sponsorship. It could also result from the need, in some cases at least, for material cooperation by the Catholic system in some prohibited procedures. The growing reluctance in some quarters to approve material cooperation even for the sake of a continued Catholic presence in healthcare (e.g., Smith, 1996) makes such partnerships especially troublesome. In addition to diluting the identity of the Catholic partner, choosing non-Catholic partners may, in some instances, damage the presence of Catholic healthcare by putting other Catholic facilities in the same service area at financial risk. A third partner option is a for-profit system. For-profit healthcare had been judged by the Cardinal to be inimical to Catholic identity, and is ruled out (Bernardin, 1995; Place, 1998). These criteria have proven to be helpful. They are helpful, however, only within the limited context of their grounding premise: the need to preserve and promote Catholic healthcare’s ministry. The “healthcare” ministry is not the only public ministry of the Church. Nor does the healing ministry of the Church need to be viewed solely as an end, sought for its own sake. It is also possible and legitimate to view the healthcare ministry as a vehicle through which to pursue or fulfill another Church ministry. The criteria for choosing partners in healthcare can also be premised on a desire to strengthen and preserve a different public ministry of the Church. At the very least, this could allow choices of partners being made with more enthusiasm and creativity

Developing a Reproductive Health Survivorship Care Plan (SCP-R) for Female Adolescent and Young Adult Leukemia and Lymphoma Survivors

What About the Boys? The Importance of Including Boys and Young Men in Sexual and Reproductive Health Research

In November 2009, U.S. Conference of Catholic Bishops issued Ethical and Religious Directives for Catholic Health Care Services, requiring that all patients--including those in so-called persistent vegetative state--be provided with artificial hydration and nutrition if such care could extend life indefinitely. (1) The directives--particularly directive 58--prompted outcry from death-with-dignity movements and confusion within hospital ethics committees. Barbara Coombs Lee, president of Compassion and Choices, was quoted as saying that new directive could potentially create 300,000 Terri Schiavo cases, equal to number of feeding tubes inserted in United States each year. (2) Some hospital ethics committees debated whether their hospitals would be obliged to accept patients who refused such treatment as transfers from local Catholic hospitals. These discussions raise several questions with direct bearing on patient care: Do bishops have authority over Roman Catholic health care institutions? Do bishops' directives represent a departure from--or even a radicalization of--traditional Catholic teaching? How might these directives change clinical practice? The answer to first question is straightforward. U.S. bishops exercise spiritual and structural authority over Catholic institutions in their respective dioceses, but extent to which their authority affects institutions varies by bishop. Depending on influence of other interest groups, some bishops take a proactive role; others allow health care leadership to function autonomously. Next, a brief consideration of evolution of Catholic position on end-of-life care is warranted. In his 1957 Address to an International Congress of Anesthesiologists, Pope Pius XII spoke of obligation to provide ventilator support to unconscious patients without hope for recovery. He emphasized that physicians have a duty to provide ordinary (not extraordinary) treatments as necessary to preserve health and life. In contrast to ordinary care, a stricter obligation (defined as extraordinary) would be too burdensome for majority of patients and would impede what he described as a higher, spiritual good. In 1980, Congregation for Doctrine of Faith (the papal office overseeing Catholic doctrine) adopted a Declaration on Euthanasia that noted that due to technological advancement, delineation between ordinary and extraordinary means of sustaining life had grown muddled. However, declaration permitted physicians (with patient consent) to discontinue treatment if harm would outweigh benefit. The declaration was clear: patients who refused care in such circumstances were not suicidal; rather, they were accepting of human condition. Between 1980 and 2001, various groups within Church--including Pontifical Council on Health Affairs (1981), Pontifical Academy of Sciences (1985), and U.S. Conference of Catholic Bishops (1992)--continued to reflect on these issues, reinforcing notion that minimal care, including feeding, is obligatory. However, as 1992 U.S. Conference of Catholic Bishops stated, the teaching of Church has not resolved question whether medically assisted nutrition and hydration should always be seen as a form of normal care. (3) In 2001, U.S. Conference of Catholic Bishops issued directives for Catholic health care services that would be forerunner for directives of 2009. Directive 58 called for a presumption in favor of providing nutrition and hydration to all patients, including patients who require artificial means, as long as burdens do not outweigh benefits. (4) It was not until a 2004 address by Pope John Paul II on Life-Sustaining Treatments and Vegetative State that Catholic Church specifically addressed issue of medically assisted alimentation for irreversibly ill patients. …

Review Questions/Objectives The objective of this review is to synthesise the best available evidence on the effectiveness of population based (public health) risk reduction programs and services (interventions) on sexual and reproductive health risk taking among young people (aged 10 to 24 years old) in developing countries (countries with low and middle gross national income (GNI) per capita as defined by World Bank). The specific review questions are: 1. What is the effectiveness of population based (public health) risk reduction programs and services (interventions) on risky sexual behaviors among young people? 2. What are the characteristics of population based interventions that are effective in reducing risky behaviors among young people? 3. What specific outcome measures best assess the impact of interventions that effectively reduce sexual risk taking among adolescents in developing countries? Inclusion Criteria a. Types of Participants The review will consider individuals of ages 10 to 24 years residing in developing countries. b. Types of interventions The review will consider population based (public health) risk reduction programs and services that target young people in developing countries. c. Types of Outcomes Anticipated outcomes related to reduction in risky sexual behavior among young people include the following: Primary outcomes: Abstinence rates, rates of early/premarital sexual initiation, numbers of sexual partners, condom use at first sex, consistent and correct contraceptive (condom) use during sexual encounters among the study population, alcohol and/or substance use prior to or during sexual encounters (short term outcomes). Secondary outcomes: Pregnancies and their outcomes including rates of abortion, births (live and still), etc., STI rates, HIV/AIDS rates, maternal mortality and educational attainment levels of adolescents in the study population (Long term outcomes).

This study examined the implications of Pope Paul VI’s encyclical Humanae Vitae on the Catholic faithful in the Kumasi Archdiocese of Ghana. The purpose of the study was to assess the effectiveness of natural family planning methods, such as abstinence and the rhythm method, endorsed by the encyclical, and to explore how these teachings align with the reproductive health goals of Catholic women in the region. A mixed-methods approach was employed, using questionnaires and interviews with Catholic Parish Priests, Catechists, Church leaders, and healthcare practitioners. Data were thematically analyzed to provide a comprehensive understanding of the lived experiences of the Catholic community regarding birth control. The findings reveal that many Catholics in the Kumasi Archdiocese lack sufficient knowledge of Humanae Vitae and its promotion of natural birth control methods. This awareness gap has led to varied interpretations and practices, with some Catholics resorting to methods that better suit their personal and family needs. The study concludes that the Catholic Church needs to step up its efforts in educating the faithful on the ethical considerations of birth control, aligning religious teachings with the practical realities of the community. This research contributes to scholarship by highlighting the disconnection between papal teachings and the everyday experiences of Catholic laity, calling for a reassessment of Humanae Vitae to better support the reproductive health and well-being of Catholics globally. Keywords: Birth Control, Scriptures, Humanae Vitae, Stewardship, Ethical, Contraception.

Catholic health care facilities account for approximately one sixth of the U.S. health care market, have recently demonstrated successful growth, and serve as the only local hospital in certain remote locations. The Ethical and Religious Directives for Catholic Health Care Services is a set of guidelines created and revised by church leaders that applies the church's teaching, particularly as it relates to concern for human dignity, to modern-day medical practice; all Catholic health care facilities and providers within these facilities are required to abide. Strict interpretation of these directives limits family planning and most infertility services. Many women, however, do not anticipate differences to reproductive health care based on Catholic affiliation, and recent patient reports and legal enactments have highlighted the tension that arises when women are unable to receive medically indicated family planning services. In this article, I demonstrate that reproductive health care services are not consistently prohibited and that clinics often do not inform patients when scheduling appointments when restrictions exist. I highlight ethical concerns about patient autonomy as it relates to modern-day practice and recommend solutions including greater transparency and efforts to improve uniformity of practice at Catholic health care facilities.

The female reproductive system consists of the ovaries, the female gonads, and the reproductive track organs of the fallopian tubes, uterus, cervix, and vagina. It functions to provide hormonal support and anatomical structure for the production of new offspring. A number of endogenous and exogenous factors can impact female reproductive health and fertility, including genetic vulnerability, medications, environmental exposures, age, nutrition, and diseases, etc. To date, due to the ethical concerns of using human subjects in biomedical research, the majority of studies use in vivo animal models and 2D cell/tissue culture models to study female reproduction. However, the complexity and species difference of the female reproductive system in humans makes it difficult to compare to those of animals. Moreover, the monolayered cells cultured on flat plastics or glass lose their 3D architecture as well as the physical and/or biochemical contacts with other cells in vivo. Further, all reproductive organs do not work alone but interconnect with each other and also with non-reproductive organs to support female reproductive, endocrine, and systemic health. These facts suggest that there is an urgent and unmet need to develop representative, effective, and efficient in vitro models for studying human female reproduction. The prodigious advancements of bioengineering (e.g. biomaterials, 3D printing, and organ-on-a-chip) allow us to study female reproduction in an entirely new way. Here, we review recent advances that use bioengineering methods to study female reproduction, including the bioengineering models of the ovary, fallopian tube, uterus, embryo implantation, placenta, and reproductive disease.

Adolescent urology

BackgroundReproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood. This cross-sectional study evaluated the association between psychopathology and reproductive health risk among European adolescents.MethodsA structured self-report questionnaire was delivered to 12,395 pupils of 179 randomly selected schools in 11 European countries within the EU funded “Saving and Empowering Young Lives in Europe” (SEYLE) project. The questionnaire included items about sexual initiation and reproductive health risk factors, such as number of sexual partners, frequency of condom use, and pregnancy involvement. Psychopathology was evaluated with validated instruments and/or ad-hoc questions.ResultsOf 11,406 respondents (median age 15; interquartile range [IQR] 14–15; 57% females), 18.8% reported sexual initiation. Sixty percent of them also reported at least one reproductive risk factor. Sexual initiation was significantly more common among pupils older than 15 years (38% versus 13.2% younger pupils) and males (21.3% versus 16.9% females). It was also more common among pupils with depression (age/sex-adjusted odds ratio [aOR] 1.871), anxiety (aOR 2.190), severe suicidal ideation (aOR 2.259), self-injurious behaviour (aOR 2.892), and suicide attempts (aOR 3.091). These associations were particularly strong among pupils ≤15 years old and, for overt psychopathology, among pupils with low non-sexual risk behaviour profile and females. Depression (aOR 1.937), anxiety (aOR 2.282), severe suicidal ideation (aOR 2.354), self-injurious behaviour (aOR 3.022), and suicide attempts (aOR 3.284) were associated with higher reproductive health risk, defined by an increasing number of coexisting reproductive risk factors.ConclusionsThese findings suggest an alignment between mental and reproductive health risk and support the value of cross-domain collaboration in adolescent health. The association between psychopathology and reproductive health risk, as well as its variations with age, sex, and associated risk behaviours, should be considered when designing health-promoting or disease-preventing interventions for adolescents.

BackgroundFemale sex workers (FSWs) are a population sub-group most affected by the HIV epidemic in India and elsewhere. Despite research and programmatic attention to FSWs, little is known regarding sex workers' reproductive health and HIV risk in relation to their experiences of violence. This paper therefore aims to understand the linkages between violence and the reproductive health and HIV risks among a group of mobile FSWs in India.MethodsData are drawn from a cross-sectional behavioural survey conducted in 22 districts from four high HIV prevalence states (Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu) in India between September 2007 and July 2008. The survey sample included 5,498 FSWs who had moved to at least two different places for sex work in the past two years, and are classified as mobile FSWs in the current study. Analyses calculated the prevalence of past year experiences of violence; and adjusted logistic regression models examined the association between violence and reproductive health and HIV risks after controlling for background characteristics and program exposure.ResultsApproximately one-third of the total mobile FSWs (30.5%, n = 1,676) reported experiencing violence at least once in the past year; 11% reported experiencing physical violence, and 19.5% reported experiencing sexual violence. Results indicate that FSWs who had experienced any violence (physical or sexual) were significantly more likely to be vulnerable to both reproductive health and HIV risks. For example, FSWs who experienced violence were more likely than those who did not experience violence to have experienced a higher number of pregnancies (adjusted odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.0-1.6), ever experienced pregnancy loss (adjusted OR = 1.4, 95% CI = 1.2-1.6), ever experienced forced termination of pregnancy (adjusted OR = 2.4, 95% CI = 2.0-2.7), experienced multiple forced termination of pregnancies (adjusted OR = 2.2, 95% CI = 1.7-2.8), and practice inconsistent condom use currently (adjusted OR = 1.97, 95% CI: 1.4-2.0). Among FSWs who experienced violence, those who experienced sexual violence were more likely than those who had experienced physical violence to report inconsistent condom use (adjusted OR = 1.8, 95% CI: 1.4-2.3), and experience STI symptoms (adjusted OR = 1.3, 95% CI: 1.1-1.7).ConclusionThe pervasiveness of violence and its association with reproductive health and HIV risk highlights that the abuse in general is an important determinant for reproductive health risks; and sexual violence is significantly associated with HIV risks among those who experienced violence. Existing community mobilization programs that have primarily focused on empowering FSWs should broaden their efforts to promote reproductive health in addition to the prevention of HIV among all FSWs, with particular emphasis on FSWs who experienced violence.

Relevant studies increasingly indicate that female reproductive health is confronted with substantial challenges. Emerging research has revealed that the microbiome interacts with the anatomy, histology, and immunity of the female reproductive tract, which are the cornerstone of maintaining female reproductive health and preventing adverse pregnancy outcomes. Currently, the precise mechanisms underlying their interaction and impact on physiological functions of the reproductive tract remain elusive, constituting a prominent area of investigation within the field of female reproductive tract microecology. From this new perspective, we explore the mechanisms of interactions between the microbiome and the anatomy, histology, and immunity of the female reproductive tract, factors that affect the composition of the microbiome in the female reproductive tract, as well as personalized medicine approaches in managing female reproductive tract health based on the microbiome. This study highlights the pivotal role of the female reproductive tract microbiome in maintaining reproductive health and influencing the occurrence of reproductive tract diseases. These findings support the exploration of innovative approaches for the prevention, monitoring and treatment of female reproductive tract diseases based on the microbiome.

Female dominion in family planning has underestimated men's participation in female reproductive health. To assess male's involvement in female reproductive health with regard to safe motherhood and family planning and to explore the factors influencing the participation of males in reproductive and sexual health. A community-based, mixed-method study was conducted from May 2018 to January 2019 in urban Puducherry. All eligible couples with at least one child were included. Two-stage random sampling with a sample size of 373 was considered. Data were collected separately among spouses using epi-collect 5 and analyzed using the SPSS software version 23. Qualitative data were obtained using free-listing and pile-sorting techniques, analyzed in Anthropac software. 39.9% had planned their pregnancy. Only 33.5% of couples had decided together with the place of delivery. 76.7% of wives wish to involve their husbands in family planning. 88.2% of wives and 89.8% of husbands chose tubectomy as the preferred method of permanent contraception. Both husband and wife were involved in child rearing among 60.3% of participants. The changing dynamics of society, health-care provider initiative, and literacy level favored males' involvement in females' reproductive health. Men were involved in planning the pregnancy, supporting their spouse by accompanying for antenatal checkups, discussing with their partners about the complications faced during pregnancy. Health care facility-related factors and faith were perceived as hindering factors for males' involvement in reproductive health by either gender.