Women Of Age Research Articles

Problematic Periods Costing Young Women-The Impact of Menstrual Symptoms on Work and Study.

Menstrual disorders are common, but their economic and social impact is still underreported. This study used a cross-sectional design to investigate menstrual symptom prevalence, impacts and economic burden in Australian women of reproductive age. One thousand two hundred thirty-eight responses were analysed (median age 33 years). Most respondents (77%) reported having bothersome menstrual symptoms, and almost half (44%) reported missed days of work or study because of their symptoms. Those aged 18-24 years were more likely to report bothersome menstrual symptoms, and time away from work and study, than those aged 35-44 years. The economic burden due to menstrual symptoms was approximately AUD $14.2 billion per year.

Towards 90-70-90 targets: Individual and community level factors associated with cervical cancer screening among women of reproductive age in Tanzania: A multi-level analysis based on 2022 Tanzania demographic and health survey.

Cervical cancer is a major public health problem worldwide, and is mainly caused by human papillomaviruses. More than 90% of cervical cancer cases can be prevented by using a human papilloma vaccine and screening. Despite the ongoing global cervical cancer screening target, uptake remains unacceptably low in sub-Saharan Africa such as Tanzania. Although cervical cancer is the leading cause of mortality in Tanzania, evidence on the individual- and community-level factors associated with cervical cancer screening among women of reproductive age is scarce. Therefore, this study aimed to determine the individual- and community-level factors associated with cervical cancer screening among women of reproductive age in Tanzania. This study used data from the 2022 Tanzania Demographic and Health Survey (TDHS). A weighted sample of 15,140 women of reproductive age was included in this study. Given the effect of clustering and binary nature of the outcome variable, we used a multilevel binary logistic regression model. The adjusted odds ratio (AOR) with 95% Confidence Interval (CI) was statistically significant. Moreover, the model with the lowest deviance best suited the data. The overall uptake of cervical cancer screening among Tanzanian women was 7.28% (95% confidence interval [CI]: 6.87%, 7.70%). Women's age (25-34, 35-49), women with primary, secondary, and higher educational levels, being employed, a high household wealth index, visiting health facilities in the last 12 months, owning mobile phones, urban residence, and southern highlands, Southern, and Zanzibar administrative zones, were significantly associated with cervical cancer screening. Cervical cancer screening among women in Tanzania was low. Low uptake underscores the need for increased focus on addressing the coverage of the 2030 Sustainable Development Goals (SDGs). The study would help policymakers create programs that consider education, employment, visiting health facilities, mobile phones, wealth, residence, and administrative zones, which would make women undergo cervical cancer screening. Pointing to women living with low cervical cancer screening could help increase their uptake and achieve the targets of the national and World Health Organization.

Hypoxic conditions affect transcriptome of endometrial stromal cells in endometriosis and promote TGFBI axis

BackgroundEndometriosis is characterized by the ectopic growth of endometrial-like cells, causing chronic pelvic pain, adhesions and impaired fertility in women of reproductive age. Usually, these lesions grow in the peritoneal cavity in a hypoxic environment. Hypoxia is known to affect gene expression and protein kinase (PK) activity. We aimed to explore the changes in the transcriptome and PK activity characteristic of eutopic and ectopic endometrium in endometriosis under hypoxia.MethodsEutopic (EuESCs) and ectopic (EcESCs) endometrial stromal cells were exposed to hypoxia (1% O2) or normoxia (20% O2) for 48 hours. We assessed PK activity and examined transcriptome using mRNA-seq in cells cultured under hypoxic or normoxic conditions. Enzyme-linked immunosorbent assay, quantitative reverse transcription-PCR and immunohistochemistry were performed for the downstream analysis of Transforming Growth Factor Beta Induced (TGFBI) expression.ResultsThe kinase assay revealed a minor decrease in cAMP-dependent PK (PKAc) and Akt activity and a trend towards an increase in Rho-dependent PK (ROCK) activity in response to exposure to hypoxic conditions in EcESCs. A wider examination of the hypoxia-mediated changes in transcriptomes of cultured cells revealed that the genes related to aerobic glycolysis and cellular metabolism were upregulated in EuESCs exposed to hypoxia. In contrast, EcESCs had a single differentially expressed gene (TGFBI) upregulated under hypoxic conditions. This gene was also found to be overexpressed in EuESCs exposed to hypoxia vs normoxia, and in EcESCs vs EuESCs in normoxia. The level of secreted TGFBI in the spent culture media was accordingly high in the EcESC cultures and in the EuESC culture exposed to hypoxia. In the eutopic endometrial tissue biopsies, TGFBI mRNA and protein expression depended on the menstrual cycle phase, with higher levels observed in the proliferative phase. TGFBI staining showed the protein localized to the stroma and around the blood vessels. In the secretory phase, TGFBI protein expression was stronger in ectopic endometrium compared to paired eutopic endometrium.ConclusionsWithin this study, we showed hypoxia-mediated transcriptome changes characteristic of EuESCs and EcESCs and identified TGFBI as a potential therapeutic target for endometriosis due to its role in fibrosis and angiogenesis.

Diversity in Naturally Acquired Immunity to Group B Streptococcus: A Comparative Study of Women from Bangladesh, Malawi, and the United Kingdom.

Significant disparities in Group B Streptococcus (GBS) colonisation and neonatal disease rates have been documented across different geographical regions. For example, Bangladesh reports notably lower rates compared to the United Kingdom (UK) and Malawi. This study investigates whether this epidemiological variability correlates with the immune response to GBS in these regions. Qualitative and quantitative analyses of naturally acquired immunoglobulin G (IgG) antibodies against GBS capsular polysaccharides (CPS) and the Alp protein family were conducted in serum samples from women of childbearing age in the UK, Bangladesh, and Malawi. The efficacy of these antibodies in clearing vaginal colonisation or protecting newborns from GBS infection was assessed using humanised mouse models. Bangladeshi women displayed the highest diversity in serotype distribution, with elevated immunoglobulin G (IgG) levels in the serum against GBS capsular polysaccharides (CPS)- Ia, Ib, II, III, IV, and V, as well as Alp family proteins. In contrast, Malawian sera demonstrated the weakest antibody response. Bangladeshi sera also showed heightened IgG-mediated complement deposition, opsonophagocytic killing and neonatal Fc receptor (FcRn)-binding while tested against CPS Ib. In a humanised FcRn mouse model, Bangladeshi sera led to faster clearance of GBS virulent serotype Ib vaginal colonisation. Additionally, offspring from dams passively immunised with Bangladeshi sera demonstrated notably increased survival rates. This study demonstrates significant variability in the immune response to GBS across different geographical regions. These findings underscore the importance of understanding GBS-induced immune response in diverse populations, which may significantly impact vaccine efficacy in these regions.

Under-5 Malaria and Fever Morbidities as Correlates of Anaemia in Niger: A Heteroscedasticity-Consistent Ordered Probit Approach

Background: The relationship between malaria/other febrile infections and anaemia among under-5 children is a subject of significant policy relevance among African health policy makers. The international significance of addressing anaemia is prominently underscored in the third Sustainable Development Goal (SDG). This paper therefore analysed the effect of malaria/other febrile infections and other maternal and child’s demographic variables on the prevalence of anaemia in Niger. Methods: We utilized the under-5 children’s module of the Malaria Indicator Survey (MIS) for 2021, which was collected from women of reproductive age (15–49) in selected households. The data were analysed with heteroscedasticity-consistent ordered probit regression model. Results: The results showed that 73.73% of the children was anaemic, while malaria and other febrile infections were present in 14.00% and 33.87%, respectively. Anaemia was highest in the Tillaberi and Dosso regions, where 84.12% and 79.12% of the children were anaemic. The ordered probit regression revealed that anaemia was promoted by malaria, other febrile infections, being a male child, second of multiple birth, and birth order, while wealth index, age, urban residence, and access to newspaper and television reduced it. Conclusions: Anaemia remains a major public health problem among under-5 children in Niger. A comprehensive healthcare intervention to address the problem should consider regional, sectoral, and gender differences in the incidences, with drastic efforts towards prevention of malaria and other fever-inducing illnesses. In addition, interventions to promote households’ economic status, reduce maternal fertility, and facilitate preventive practices through nutrition enhancement and health-related media programs hold some promise.

Investigating Aging-Related Endometrial Dysfunction Using Endometrial Organoids.

Ageing of the endometrium is a critical factor that affects reproductive health, yet its intricate mechanisms remain poorly explored. In this study, we performed transcriptome profiling and experimental verification of endometrium and endometrial organoids from young and advanced age females, to elucidate the underlying mechanisms and to explore novel treatment strategies for endometrial ageing. First, we found that age-associated decline in endometrial functions including fibrosis and diminished receptivity, already exists in reproductive age. Subsequently, based on RNA-seq analysis, we identified several changes in molecular processes affected by age, including fibrosis, imbalanced inflammatory status including Th1 bias in secretory phase, cellular senescence and abnormal signalling transduction in key pathways, with all processes been further validated by molecular experiments. Finally, we uncovered for the first time that PI3K-AKT-FOXO1 signalling pathway is overactivated in ageing endometrium and is closely correlated with fibrosis and impaired receptivity characteristics of ageing endometrium. Blocking or activation of PI3K by LY294002 or 740Y-P could attenuate the effect of ageing or accelerate dysfunction of endometrial organoids. This discovery is expected to bring new breakthroughs for understanding the pathophysiological processes associated with endometrial ageing, as well as treatment strategies to improve reproductive outcomes in women of advanced reproductive age.

Maternal high-fat diet orchestrates offspring hepatic cholesterol metabolism via MEF2A hypermethylation-mediated CYP7A1 suppression

BackgroundMaternal overnutrition, prevalent among women of childbearing age, significantly impacts offspring health throughout their lifetime. While DNA methylation of metabolic-related genes mediates the transmission of detrimental effects from maternal high-fat diet (HFD), its role in programming hepatic cholesterol metabolism in offspring, particularly during weaning, remains elusive.MethodsFemale C57BL/6 J mice were administered a HFD or control diet, before and during, gestation and lactation. Hepatic cholesterol metabolism genes in the liver of offspring were evaluated in terms of their expression. The potential regulator of cholesterol metabolism in the offspring’s liver was identified, and the function of the targeted transcription factor was evaluated through in vitro experiments. The methylation level of the target transcription factor was assessed using the MassARRAY EpiTYPER platform. To determine whether transcription factor expression is influenced by DNA methylation, in vitro experiments were performed using 5-azacitidine and Lucia luciferase activity assays.ResultsHere, we demonstrate that maternal HFD results in higher body weight and hypercholesterolemia in the offspring as early as weaning age. Maternal HFD feeding exacerbates hepatic cholesterol accumulation in offspring primarily by inhibiting cholesterol elimination to bile acids, with a significant decrease of hepatic cholesterol 7α-hydroxylase (CYP7A1). RNA-seq analysis identified myocyte enhancer factor 2A (MEF2A) as a key transcription factor in the offspring liver, which was significantly downregulated in offspring of HFD-fed dams. MEF2A knockdown led to CYP7A1 downregulation and lipid accumulation in HepG2 cells, while MEF2A overexpression reversed this effect. Dual luciferase reporter assays confirmed direct modulation of CYP7A1 transcription by MEF2A. Furthermore, the reduced MEF2A expression was attributed to DNA hypermethylation in the Mef2a promoter region. This epigenetic modification manifested as early as the fetal stage.ConclusionsThis study provides novel insights into how maternal HFD orchestrates hepatic cholesterol metabolism via MEF2A hypermethylation-mediated CYP7A1 suppression in offspring at weaning.

Exploring women’s sexual and reproductive health needs in Zabol’s suburbs, Iran: a qualitative study

BackgroundSuburban populations in developing countries are affected by poor environmental conditions affecting their ongoing health. Given the low reproductive health indicators of women residing in the suburbs of eastern Iran, planning to improve their health by assessing the needs of the target group through qualitative research is essential. The present study seeks to elucidate the views of women living in the suburbs of Zabol, Iran, regarding sexual and reproductive health needs.MethodsThis qualitative study was conducted in healthcare centers in the suburbs of Zabol in 2023. The sample comprised 22 women, including 16 women of reproductive age (age 15–49 years) living in the suburbs and six key informants (service providers and people who were in close contact with these women). The sample was selected purposively with maximum variation. Data were collected through semi-structured, in-depth, individual interviews, which continued until data saturation was reached. The data were then analyzed using conventional content analysis.ResultsThe data analysis yielded seven categories (gender-based violence, psychological problems, women’s lack of empowerment, barriers to equity in sexual and reproductive health, support seeking, sexual issues, and pregnancy, childbirth, and postpartum care needs) and 24 subcategories.The results revealed that suburban women did not have adequate information or knowledge about their sexual and reproductive health or the available services, and most of them suggested that they required training.ConclusionWomen living in the suburbs of Zabol were faced with challenges in their sexual and reproductive health and well-being. It is crucial to provide these women with sexual and reproductive health education and services that are accessible and suitable to their conditions by targeted interventions aiming to improve their health and well-being.The findings of the current study can serve as a basis for future health policymaking, planning, and research by providing evidence and strengthening the body of knowledge about this domain of health.

Exploring machine learning algorithms to predict not using modern family planning methods among reproductive age women in East Africa

BackgroundThe use of the modern family planning method provides chances for women to reach optimal child spacing, increase quality of life, increase economic status, achieve the desired family size, and prevent unsafe abortions and maternal and perinatal deaths. However, use modern family planning is low among reproductive age women in East Africa. Therefore, this study aimed at predicting not using modern family planning and identifying its associated factors among reproductive age women in east Africa using machine learning methods.MethodsThe data set was obtained from a demographic health survey in East Africa. This study used data on weighted sample of 92,564 women who were in their reproductive age. Python software was utilized for data processing, and machine learning models such as Random Forest (RF), Decision Tree (DT), XGB (Extreme Gradient Boosting), SVM (Support Victor Machine), and K-Nearest Neighbor Decision Tree (DT) were implemented. In this work, we evaluated the predictive models’ performance using performance assessment criteria such as accuracy, precision, recall, and the AUC curve.ResultIn this study, 92,564 reproductive women’s was used in the final analysis. Among the proposed machine learning models, XGB performed best overall in the proposed classifier, with an accuracy of 98.7%, precision of 99.8%, recall of 98%, 99.9% AUC score, had high specificity 98%, sensitivity 99.8%, and low error rate discovery was 0.013%. The most significant determinants of not using modern family planning in East Africa: lack of education, age 25–29, living in a rural area, being single, not knowing how to use a contraceptive, and smoking cigarette.ConclusionExtreme Gradient Boosting proved effective in predicting not using modern family planning, offering valuable insights for interventions and policy decisions in East Africa. Machine learning could help achieve early prediction and intervention on reproductive women’s not using modern family planning. This leads to a recommendation for policy direction to reduce child and maternal mortality and improve living standards in east Africa.

Metamorphosis of Aged Women Into a Yokai () From the Viewpoint of Plastic Surgery and Gerontophobia.

The aim of this study is to analyze the transformation of aged women into yokai in Japanese literature, examining this metamorphosis from the perspectives of plastic surgery and gerontophobia. The Noh play "Adachigahara" explores the transformation of an outcast into a monstrous figure, highlighting how poverty, isolation, and aging can lead to a person's demonization, both metaphorically and literally. In "Rokujō no Miyasudokoro", Lady Rokujō's transformation into a vengeful spirit is tied to themes of aging, abandonment, and the societal devaluation of women as they grow older. Her supernatural metamorphosis is a way to reclaim power in a society that has rendered her invisible. In "The Life of an Amorous Woman", the transformation is symbolic, as the woman's loss of beauty and status leads her to be ostracized, reflecting how society often dehumanizes those who are old and poor. The Yamauba legend encapsulates the fear of the elderly, especially women who live on the fringes of society. Her transformation into a yokai represents the culmination of societal rejection, fear of aging, and isolation. From the view of plastic surgery, the transformation of women into yokai reflects contemporary anxieties about aging and the extreme measures some take to maintain youth. These women morph into beings that embody society's vilification of the elderly, particularly targeting those who defy or do not conform to ideals of youthfulness. From the perspective of aversion to the elderly, the transformation into yokai symbolizes society's rejection of the elderly, portraying them as figures of fear and revulsion.

Body mass index and age at menarche as predictors of adverse reproductive outcomes

Introduction. The continuum and pregnancy outcomes in adolescent girls and women of reproductive age, differences between them are partly predetermined by pregestational factors, in particular body mass characteristics. Today, the key role is assigned to the age at menarche, which indicates the achievement of mature reproductive function.Aim. To identify and compare the relationship between the age at menarche combined with the pregestational body mass index (BMI) and the adverse reproductive outcome (ARO) variant in women of reproductive age and adolescent girls.Materials and methods. At total of 967 women with ARO were enrolled in the prospective cohort multicenter study. The patients were divided into cohorts based on their age groups (adolescent girls (n = 182) or women of reproductive age (n = 785)) and the ARO variants. Four groups of women were identified: women with non-developing pregnancy (NDP) (n = 244), women with extra-uterine pregnancy (EP) (n = 115), women with spontaneous miscarriage (SM) (n = 299), and women with preterm birth (PB) (n = 309).Results and discussion. It was found that a later ARO corresponds to a higher BMI: a more probable BMI for SM is over 23, for NDP is 23 and less; for PB is over 25, for SM is 25 and less. No threshold BMI limit distinguishing between EP and NDP was identified. The BMI for adolescent girls is generally significantly lower than the BMI for women of reproductive age; it is significantly higher in EP as compared with women of reproductive age and comparable in SM. A trend towards a higher BMI in SM compared to NDP both in women of reproductive age with BMI over 24 and in adolescent girls with BMI over 20 but with different threshold limits is shown. The threshold BMI limit distinguishing PB from SM in reproductive age is 25 and higher, and in adolescent girls it does not reach 23.Conclusion. In clinical practice, it is recommended to use navigators for predicting ARO variants based on pregestational BMI and/or age at menarche, taking into account the age group of patients, which are obtained using classification trees.

Nurses’ Perspectives of Geophagic Women of Childbearing Age Accessing Healthcare in the Reproductive Healthcare Services in Tshwane District, Gauteng Province: An Exploratory Study

Geophagy is an ancient widespread practice that is common amongst women of childbearing age globally. Geophagy is one of the leading causes of iron deficiency and pregnancy complications amongst women of childbearing age resulting in maternal, neonatal, and child morbidities and mortalities globally. The concept of geophagy has yet to be incorporated in the reproductive health services in the healthcare facilities. A qualitative study was conducted using focus group discussions and in-depth interviews to explore the views/perspectives of nurses regarding geophagic women of childbearing age accessing healthcare in the reproductive healthcare services in Tshwane District, Gauteng Province. The findings revealed that nurses perceived geophagic women of childbearing age to be iron deficient and lack proper knowledge and understanding of the potential health risks and dangers of soil eating. Mental health and substance use disorders, food and nutrition deficiencies, absence of geophagy health education, and promotion programs were highlighted as some of the aspects that play a role towards the practice of geophagy amongst women of childbearing age accessing healthcare in Tshwane District, Gauteng Province. Thus, a conclusion can be made that geophagy health education and promotion programs in the antenatal care units must be prioritized by government.

Hand Osteoarthritis in Elderly Women with Primary Knee Osteoarthritis: Prevalence and Pattern in the Indian Population

Aim: The aim of this study was to estimate prevalence of hand osteoarthritis (HOA) and identify patterns in female patients with symptomatic primary knee osteoarthritis (KOA) presenting in a rheumatology outpatient department (OPD). Methods: A hospital-based cross-sectional study was done among 145 female patients with primary KOA, as per American College of Rheumatology (ACR) criteria, utilising the right knee as the index knee. The presence of Kellgren–Lawrence (K-L) grade ≥2 radiological changes in two of three groups of hand joints in dominant hand was used to identify hand arthritis (HOA). Symptomatic HOA (SHOA) was defined as existence of hand discomfort within preceding month. Hand disability was measured using the Health Assessment Questionnaire (HAQ); a mean score of >0.5 was deemed to be a significant disability. Global Hand Kellgren–Lawrence Score (KLTOT) was used to assess radiographic severity of HOA. Results: The prevalence of HOA was found in 96 (66%) patients, with a higher prevalence in patients above 60 years of age. At the individual joint level, 102 (71.7%) patients had DIP involvement, 96 (66.2%) had PIP involvement, 40 (27.5%) had metacarpophalangeal (MCP) involvement, and 57 (34.4%) had involvement in the base of the thumb. SHOA was found in 48 (33%) patients, and significant disability was noted in 38 (26.2%) patients. There was a significant positive correlation between global KLTOT and body mass index (BMI) ( P = .004) and between global KLTOT and HAQ ( P = .002). A significant difference was found between HOA and the radiographic severity of the KOA ( P = .003) in comparison to patients without HOA. Conclusion: HOA is common in elderly women, especially those with primary KOA.

Abdominal lymphangioleiomyomatosis in a man presenting with gastrointestinal hemorrhage as the first manifestation: a case report

Lymphangioleiomyomatosis (LAM) is a rare, low-grade malignant condition that typically affects women of childbearing age and primarily involves the lungs. While cases involving males and affecting the gastrointestinal tract are exceedingly uncommon. This report discusses an unusual case of abdominal LAM in a male patient with gastrointestinal hemorrhage. The patient, a 70-year-old man, had been experiencing recurrent abdominal pain, occasional black stools, dizziness, and fatigue for over a month before being admitted to the hospital. Diagnostic electronic gastroscopy identified ulcers in the gastric and duodenal bulb with hemorrhage. An abdominal CT scan revealed multiple cystic foci in the retroperitoneum and mesentery, but no masses were found. Despite receiving medical treatment, the patient continued to have black stools and eventually underwent laparoscopic distal subtotal gastrectomy. The pathological results of the excised distal gastric specimens showed LAM-like lesions in the submucosal layer of the pylorus, mesentery of the side of the lesser curvature of the stomach, and small intestine, leading to a diagnosis of abdominal LAM. However, even after the surgery, the patient still experienced recurrent black stools and developed new symptoms of chest tightness and shortness of breath. A follow-up chest CT revealed bilateral pleural effusion and multiple lung cysts, indicating a worsening condition. The patient was then prescribed oral Sirolimus, which resulted in an improvement in symptoms, including black stool, chest tightness, and shortness of breath. This case report provides a detailed account of the progression of an unusual gastrointestinal LAM case and suggests that a combination of surgery and Sirolimus may be effective in managing the condition.

Quality intrapartum care and associated factors in East Africa: multilevel analysis of recent demographic and health survey

BackgroundThe time during labor and delivery is crucial for the survival of both women and their infants, as complications that occur during this period can significantly increase the risk of morbidity and mortality. In developing nations, women of reproductive age and their infants are still at risk of morbidity and death from complications associated with pregnancy and childbirth. Morbidity and death from complications of pregnancy and childbirth can be prevented through the utilization of quality care during labor and delivery. However, there is limited evidence on the magnitude and factors associated with quality intrapartum care in East Africa. Therefore, this study assessed the magnitude and associated factors of quality intrapartum care among women in East Africa.MethodsIn this study, we used the most recent Demographic and Health Survey (DHS) dataset from 2015 to 2023, covering 11 East African countries. STATA version 18 software was used for data analysis. Multi-level modeling was applied due to the hierarchical or nested structure of DHS data. Variables with a p-value of less than 0.25 in the bivariate multi-level logistic regression model were included in the multivariable multi-level logistic regression analysis. Variables with p-values less than 0.05 were considered significant factors associated with receiving quality intrapartum care.ResultsThe prevalence of receiving quality intrapartum care in East Africa was 56.38% [95% confidence interval (CI): 56.03, 56.7]. Women with primary education [Adjusted Odds Ratio (AOR) = 1.39, 95% CI: 1.33, 1.46], secondary education (AOR = 1.62, 95% CI: 1.53, 1.62), and higher education (AOR = 1.46, 95% CI: 1.33, 1.60), those in the middle (AOR = 1.28, 95% CI: 1.23, 1.34) and rich (AOR = 1.36, 95% CI: 1.31, 1.43) wealth index categories, women with one (AOR = 1.17, 95% CI: 1.09, 1.25) or 2–4 (AOR = 1.22, 95% CI: 1.16, 1.28) living children, those who perceived the distance from the health facility as not a big problem (AOR = 1.28, 95% CI: 1.24, 1.33), and women living in Rwanda (AOR = 1.30, 95% CI: 1.19, 1.41) had higher odds of receiving quality intrapartum care. Residing in rural areas (AOR = 0.82, 95% CI: 0.78, 0.86), and being from Ethiopia, Kenya, Madagascar, Malawi, Mozambique, Tanzania, Uganda, Zambia, or Zimbabwe, were factors negatively associated with receiving quality intrapartum care.Conclusion and recommendationsNearly half of the women in East African countries did not receive quality intrapartum care. Both individual and community-level variables were significantly associated with receiving quality intrapartum care in East Africa. Improving the quality of intrapartum care requires enhancing women's education, addressing socioeconomic challenges, and increasing access to health facilities through targeted interventions.

Advances in the Diagnosis of Atypical Polypoid Adenomyoma Combining Immunohistochemical and Molecular-Based Approaches: Case Report and Review of the Literature

Atypical polypoid adenomyoma (APA) is a benign uterine lesion with a premalignant potential and occurs in women of reproductive age. The histological pattern is characterized by irregular epithelial proliferation and muscular stroma. Based on a case report, we performed a systematic review of the literature to assess the main immunohistochemical and molecular markers that contribute to its differential diagnosis against endometrial adenocarcinoma (EC). The distinction is essential for offering to patients a conservative treatment compared to the radical management required for endometrial cancer, a critical issue for the significant physical and psychological consequences that one procedure or another can have on women’s health. We performed a meta-analysis of the immunohistochemical markers used for the histological diagnosis of APA, comparing it with our case study. The evaluated markers were beta-catenin, h-caldesmon, desmin, vimentin, smooth muscle alpha-actin, CD10, Ki67, estrogen receptor (ER), progesterone receptor (PR), pan-cytokeratin, PTEN, PMS2, MSH2, MSH6, p53, MLH1, and p16. Discrepancies were observed in the expression of CD10, h- caldesmon, and p16 when comparing APA with EC. The results of the case evaluated by our team showed beta-catenin nuclear expression and positive immunostaining for pan-cytokeratin, ER, and PR in the glands; smooth muscle actin and desmin positive expression in stromal muscle; and p16 positive immunostaining in squamous morules. Moreover, the c.94G>T p. (Asp132Tyr) mutation in the CTNNB1 gene was detected. This study supports the combination of appropriate immunohistochemical and molecular markers, along with the presumptive histological diagnosis, and determines the correct classification of the lesion as APA and not as other malignant pathologies, allowing for the establishment of a treatment protocol adjusted to the biological reality of this pathology.

Gender Differentials in Economic Independence and Health Status of Elderly in India: Evidence from National Sample Survey

This study examines gender differences in economic independence and health status among elderly people in India, using 2017–8 data from the National Sample Survey Organisation (NSSO). It explores these aspects in relation to factors like residence, age, literacy, marital status and principal activity. The findings show that elderly women are more economically dependent than men, with age, lack of education and widowhood increasing dependency. Married individuals tend to enjoy better health, while higher literacy and economic engagement improve male health. The study calls for revamping social security schemes and implementing female-centric measures to address the gender disparities among India’s elderly.

Upper arm deep vein thrombosis in a patient with active lupus

Upper extremity deep vein thrombosis (UEDVT) is relatively rare, and much less as an initial presentation of systemic lupus erythematosus (SLE). Primary UEDVT should be considered in individuals with unilateral arm swelling where the brachial, axillary, and subclavian veins are frequently involved. SLE is a chronic autoimmune disease that predominantly affects women of childbearing age and of African descent. Patients present with clinical features ranging from arthritis and arthralgias (over 90% of patients with SLE) to life-threatening hematologic, or central nervous system involvement. Individuals have an increased risk of arterial and/or venous thrombosis where the most important risk factor is the presence of antiphospholipid antibodies. Even within this condition, thrombotic events are typically seen in the legs, and UEDVT remains an unusual presentation. Here, we present a case of a 36-year-old female of African descent with a recent medical history of small joint arthralgia and vaginal bleeding due to uterine fibroids, for which she was prescribed a short course of prednisolone and norethisterone, respectively. She presented with a 2-week history of unilateral swelling in the left arm. Doppler ultrasound and later computed tomography scan with contrast indicated left UEDVT. Further investigations throughout her admission led to the diagnosis of SLE, while antiphospholipid syndrome - a common contributor to thrombosis in SLE - was notably ruled out. The patient was initiated on anticoagulants. The patient went on to later rapidly develop lupus nephritis and started on high-dose prednisolone. Given the high risk of bleeding, the decision to postpone the kidney biopsy was taken. There is limited data available about UEDVT when compared to lower extremity DVT and even fewer studies on SLE patients with thrombosis in the absence of antiphospholipid syndrome. Keeping this in mind, clinicians need to recognize idiopathic UEDVT as a potential early sign of SLE and maintain a high level of suspicion.

The Effect of Physical Activity on Premenstrual Syndrome: A Systematic Review.

Physical, emotional, and behavioural symptoms that can significantly impact daily life are the hallmarks of premenstrual syndrome (PMS), a common illness affecting women of reproductive age. There are many different ways to manage PMS, and there is mounting evidence that physical activity may be helpful in reducing symptoms. With an emphasis on different exercise modalities such as weight training, yoga, and aerobic activity, this systematic review attempts to investigate how physical activity affects the management of PMS symptoms. A systematic review of studies published between 2009 and 2023 was conducted, adhering to PRISMA guidelines. Articles from PubMed, Embase, and the Cochrane Library were evaluated based on inclusion criteria focusing on the effects of physical activity on PMS symptoms. The findings indicate that regular participation in exercises such as weight training, yoga, and aerobic activities significantly reduces fatigue, improves mood regulation, and alleviates physical discomfort associated with PMS. These results highlight the benefits of exercise as an effective, non-pharmacological intervention for managing PMS symptoms. Incorporating regular physical activity into daily routines can serve as a practical and sustainable approach to managing PMS symptoms. Women suffering from PMS can experience improved physical and psychological well-being through diverse forms of exercise, including yoga and aerobic workouts. This underscores the role of exercise as a holistic and accessible intervention for enhancing women's health.

Behavioral Changes In Contraceptive Use Among Women Of Reproductive Age With Unmet Needs Following Family Planning Counseling

The low participation of women of childbearing age in participating in family planning services has led to an increase in the incidence of unmet need in Indonesia. This research aims to determine the differences in knowledge, attitudes, and decision-making in women of childbearing age who have unmet needs before and after being given family planning counseling in the working area of the UPTD Puskesmas Tabanan III. This research uses a pre-experimental research design. The sample for this research is women of childbearing age (WUS) with unmet needs in the UPTD Puskesmas Tabanan III sample of 40 people. The data was then analyzed univariately and bivariately using the Wilcoxon test. The results show that there are differences in knowledge, attitudes, and decision-making in women of childbearing age who have unmet needs before and after being given family planning counseling. It is hoped that health workers will maintain and improve the quality of providing family planning services to the community.