Gynecologic Health Research Articles

A Systematic Review of Interpersonal Interactions Related to Racism in Studies Assessing Breast and Gynecological Cancer Health Outcomes Among Black Women.

To identify how studies measure racism-related variables at the interpersonal level and identify associated breast and gynecological cancer disparities among Black women. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Searches were conducted in PubMed, CINAHL Plus, and Scopus using terms centered on racism and cancer. Inclusion criteria consisted of the study being conducted in the USA with Black or African American women and the study stating an outcome or focus identified as a breast or gynecological cancer health disparity. Two researchers independently screened titles and abstracts and full texts articles and completed quality assessments of included studies. Data were extracted into a matrix table, and common concepts were identified and synthesized using the matrix method. The quality of included studies was assessed using the Joanna Briggs Institute's critical appraisal tools. Thirteen studies that examined the effect of racism-related variables operating at the interpersonal level on breast, cervical, and ovarian cancer outcomes in Black women were identified for inclusion. Across studies, racism-related variables were measured as discrimination, trust, racism, and clinician-patient interactions. Additionally, across studies, disparities were identified in cancer screening, treatment received, survivorship quality of life, and incidence. This review highlights the need for valid, reliable, and consistent measurement of racism operating at the interpersonal level to first understand its impact on cancer health disparities and to also facilitate the development and evaluation of interventions aimed at mitigating interpersonal-level racism.

Association Between Helicobacter pylori, Adverse Gynecological and Pregnancy Outcomes, and Some Cancers: An Overview of Metanalyses

Context: The number of meta-analyses published about Helicobacter pylori-associated diseases that clinicians must comprehensively know about are scarce. This overview aims to give comprehensive knowledge on the fascinating topic of Helicobacter pylori-associated diseases. Methods: The search strategy was to systematically screen the articles evaluating the association between H. pylori infection and gynecological and reproductive health issues and cancers published on the authentic databases of Scopus, MEDLINE, and Web of Sciences from the inception until 2022. Results: Fifteen meta-analyses were included in the overview. The H. pylori infections were significantly associated with general adverse pregnancy outcomes such as gestational diabetes mellitus, preeclampsia, and hyperemesis gravidarum and adverse birth outcomes such as birth defect and fetal growth restriction. H. pylori infection was not associated with a deficiency of micronutrients (B2, folate, and ferritin) but was associated with an increased risk of iron-deficiency anemia during pregnancy. In esophagus cancer, H. pylori infection was significantly reduced in adenocarcinoma but not in esophageal squamous cell carcinoma. There was no significant association between H. pylori infection and the risk of asthma. The results also indicated a significant association between H. pylori infection and an elevated risk of colorectal cancer, colorectal adenoma, and the risk of asthma and lung cancer. Results of metanalysis are not consistently reproducible regarding spontaneous abortion and pancreatic cancer. Conclusions: Our overview revealed a significant relationship between H. pylori infection and several cancers, namely colorectal, lung, and colorectal adenoma, as well as gynecological and reproductive health issues.

The effect of online and face-to-face active learning methods on learning attitudes

AimThis study aims to compare the effects of online and face-to-face education models using active learning methods on students' learning attitudes. MethodsThis retrospective and quasi-experimental study included total 203 third-grade nursing students who took the Obstetrics and Gynecological Health Nursing course face-to-face and online in the fall semester of the 2019–2020 and 2020–2021. Active Learning Methods Questionnaire and the Scale Attitude Towards Learning (SATL) were used. ResultsThe mean score of active learning methods of the students receiving online education (77.35 ± 18.63) was higher than the face-to-face education group (67.00 ± 20.67). Although there was no difference between the face-to-face and online education groups in terms of the effort to learn and caring for learning, online students had a lower attitude towards learning avoidance (t: 6.540, p: 0.000). There was a negative and low-level significant correlation between the evaluation of active learning methods and the total score of SATL in the online education group (r = −0.200; p = .043), no correlation in face-to-face group (r: 0.004; p: 0.963). ConclusionOnline education, which uses active learning methods, affected positively students' attitudes towards learning and decreased their avoidance of learning more than face-to-face education. This study has shown that active learning methods allow online students to question theoretical knowledge, convey it to patient care, contribute to clinical knowledge, and facilitate their learning and analytical thinking based on the more positively evaluation by online students.

Indigenous Peoples' Experience and Understanding of Menstrual and Gynecological Health in Australia, Canada and New Zealand: A Scoping Review.

There are a variety of cultural and religious beliefs and customs worldwide related to menstruation, and these often frame discussing periods and any gynecological issues as taboo. While there has been previous research on the impact of these beliefs on menstrual health literacy, this has almost entirely been confined to low- and middle-income countries, with very little information on high-income countries. This project used the Joanna Briggs Institute (JBI) scoping review methodology to systematically map the extent and range of evidence of health literacy of menstruation and gynecological disorders in Indigenous people in the colonized, higher-income countries of Australia, Canada, and New Zealand. PubMed, CINHAL, PsycInfo databases, and the grey literature were searched in March 2022. Five studies from Australia and New Zealand met the inclusion criteria. Only one of the five included studies focused exclusively on menstrual health literacy among the Indigenous population. Despite considerable research on menstrual health globally, studies focusing on understanding the menstrual health practices of the Indigenous populations of Australia, New Zealand, and Canada are severely lacking, and there is little to no information on how Indigenous beliefs of colonized people may differ from the broader society in which they live.

Impact of Socioeconomic Disparities, General Health, Reproductive, and Exercise Status in Indian Women with Lumbopelvic Pain

Background: Evidence suggests links between several health conditions and lumbopelvic pain (LPP) in women beyond the commonly associated musculoskeletal origins of LPP. Objective: This study explored the association of LPP with general health conditions, stress, exercise, and socioeconomic status in Indian women. Methods: In a cross-sectional study, 500 urban women from diverse socioeconomic backgrounds were asked to fill out a self-report questionnaire that sampled their health and reproductive status. Results: Women sampled were in the age range of 18-62 years. Overall, the prevalence of LPP was found to be 76.8% and was predominantly observed in women from the lower socioeconomic strata (70.5%), compared to women from the higher strata (29.4%). Multivariate logistic regression identified gynecological issues, such as menstrual problems (O.R.= 472.86, p<0.0001); polycystic ovarian syndrome (O.R.= 125.04, p=0.010); and health issues, such as urinary incontinence (O.R.=3078.24, p=0.001); chronic cough (O.R.= 84.97, p<0.0001); stress (O.R.= 474.27, p<0.0001) as being significantly related to LPP. Additionally, ‘no exercise’ (O.R.= 360.15, p <0.0001) was also strongly associated with LPP. Conclusion: Our data suggest that LPP is a significant problem in Indian women, with a greater prevalence in women from the lower strata of society. Importantly, given that several general, gynecological health issues, psychological stress, and a lack of exercise are associated with it, there is a need for LPP sensitization at a community and public health level. Regarding its prevention and long-term management, it is important to rule out and consider the impact of these factors on LPP, beyond its musculoskeletal origins.

Ethical Considerations for the Delivery of Obstetric and Gynecologic Care During a Pandemic: ACOG Committee Statement No. 6.

Obstetrician-gynecologists (ob-gyns) are essential to providing high-quality health care, and this duty remains unchanged during pandemics. This Committee Statement discusses ethics related to the provision of obstetric and gynecologic care during a pandemic caused by a highly transmissible pathogen. As health care guidelines related to pandemics are created by institutions, ob-gyns have a responsibility to advocate for obstetric and gynecologic health priorities. Additionally, many clinical practice decisions made to reduce the spread of the infectious agent and maximize physicians' ability to care for those who need help will have ramifications on patient satisfaction, the patient-physician relationship, and equity in health outcomes. Obstetrician-gynecologists are obligated to protect themselves, their patients, and others by using appropriate protective measures (such as personal protective equipment and diagnostic testing) and observing institutional, state, and federal guidelines for the appropriate isolation and care of patients with suspected or confirmed disease.

Pediatrik nöroloji polikliniğine başvuran hastalarda tamamlayıcı ve alternatif tıp uygulamalarının kullanımı

Introduction: Despite the developments in pharmacologic treatments, traditional and complementary therapies have recently gained popularity in our country, as well as around the world.
 Aim: To question complementary and alternative medicine practices CAMP during clinical visits of pediatric neurology patients, to raise awareness of families and patients about the use of complementary and alternative medicine, and to prevent possible negative interactions.
 Methods: This prospective survey study was conducted with the parents of 300 pediatric patients aged between 6 months and 18 years, who were being treated at the Child Neurology Clinic between March 1st and May 30th, 2020. For the study, 360 patients’ parents who came to the Pediatric Neurology clinic for treatment were randomly selected, and a face-to-face survey lasting 2 minutes was conducted with 300 patients’ parents who agreed to participate in the study.
 This study was approved with the decision number E-20-12-62 at the meeting dated 21.12.2020 of the Clinical Research Ethics Committee of SBU Ankara Dr Sami Ulus Gynecology and Childhood Health and Diseases Training and Research Hospital.
 Results: Three hundred parents (56% women) participated in the study. Just over half (55.3%) of the patients were followed up with a diagnosis of epilepsy, 56.6% of the parents stated that they had used traditional and complementary therapy methods before, 43.4% stated that they did not use it, 46.54% stated that they used prayer and 23,9% used vitamin methods, respectively.
 Conclusion: In neurologic diseases, parents use traditional and complementary therapies as treatment methods, creating an alternative to modern medicine. Families and patients should be informed by investigating the reasons and frequency of using traditional and complementary therapies, raising the awareness of parents, and determining the possible harm caused by traditional and complementary therapies.

CRITICAL ANALYSIS OF RAJASWALA PARICHARYA IN RELATION TO MEN-STRUAL DISORDERS A CROSS-SECTIONAL SURVEY STUDY

In women, menstruation is a common phenomenon that periodically repeats. During this phase, there is shedding of the endometrial layer which flows out of the body through the vagina along with blood. Due to these physio-logical changes and hormonal fluctuations, normal activities become stressful and demand measures to over-come the stress. Rajaswala Paricharya explained in Ayurveda can be considered as one such measure which is conceptualized to overcome this stress and maintain the health of women. This proposes various indications and contraindications of foods and activities during this phase. Since this Paricharya helps to overcome the most vul-nerable phase of the Menstrual cycle it might conceptually have positive long-term effects on the menstrual and gynecological health. This relation is studied through a cross-sectional survey study with a sample size of 100 women belonging to Shivamogga City, Karnataka. The 24 rules explained under Rajaswala Paricharya across different classics were considered and the survey was conducted to collect the data relating to their following of Rajaswala Paricharya along with data on menstrual and gynecological disorders. We find a marginal difference in the occurrence of gynecological disorders among women who have followed more than 80% of the mentioned rules. 44.44% of these women have any of the gynecological disorders where as 55.56% have no gynecological disorders. But in consideration of symptoms during menstruation, the women following a higher number of rules have a lesser number of menstrual symptoms. Women following more than 65% of the mentioned rules have an average of 2-3 symptoms, whereas women following less than 65% of Rajaswala Paricharya have an average of 4 menstrual symptoms. This represents the significance of following Rajaswala Paricharya.

P-545 Efficacy, safety and acceptability of a vaginal tampon for the collection of biospecimen samples: a systematic review and meta-analysis

Abstract Study question Are self-collected vaginal tampons, as a biospecimen collection tool, comparable to current gold-standard methods in their efficacy, safety and acceptability? Summary answer Tampon efficacy for detection of gynaecological abnormalities was comparable to that of gold-standard methods in addition to being widely accepted with minimal reported adverse effects. What is known already Women’s services have poor attendance. Fear and embarrassment surrounding gynaecological health remain prevalent. Numerous long term sequalae can result from lack of gynaecological care include pelvic inflammatory disease, infertility and malignancy. Self-collection vaginal tampon samples have the potential to increase screening and diagnosis rates for multiple gynaecological conditions. Although the menstrual tampon as a biospecimen collection device has been demonstrated to be able to identify various gynaecological abnormalities, currently, possibly due to its novelty and lack of information on validity, they are not routinely used. Study design, size, duration Systematic review was conducted following PRISMA guidelines and prospectively registered with PROSPERO (CRD42022374857). A primary search through online databases was conducted, identifying 151 studies. Following this, title and abstract screening, full-text review and forward and backward citation searching were conducted in respective order, leading to a total of 92 studies for analysis. Participants/materials, setting, methods PubMed, MEDLINE, Cochrane Library, Scopus, and Web of Science were searched for eligible studies. All primary studies reporting the acceptability, efficacy or safety of vaginal tampons as a biospecimen collection device in comparison to other conventional methods of collection were included. Data was stratified based on which quantitative and/or qualitative variables were reported, baseline characteristics, and the abnormality being screened for. The Modified Newcastle Ottawa scale was used to assess risk of bias. Main results and the role of chance This systematic search identified 92 eligible studies, exploring HIV, HPV, HSV, Chlamydia trachomatis, Neisseria gonorrhoeae, cervical cancer, endometrial cancer, bacterial vaginosis, Candida albicans, Actinomyces israelii, Gardnerella vaginalis, Atopobium vaginae, and Trichomonas vaginalis. Menstrual tampons were compared to both clinician and self-collected samples including an endocervical swab, cervical brushing, cervicovaginal lavage, various tissue biopsies and urine samples. Detection of most gynaecological abnormalities did not profoundly vary between tampon collection versus gold-standard method. Self- collected tampon specimens were widely accepted with factors including lower pain scores, a greater willingness to use, convenient accessibility (especially in developing areas), and avoidance of embarrassment being reported. Very few papers reported adverse side effects and in those that did, vaginal tampon collection methods were regarded as less traumatic with a decreased likelihood of bleeding as compared to other methods including cervical swabs. Limitations, reasons for caution The effect of tampon sampling prior to other specimen collection methods could contribute to results that favoured tampon collection. A biopsy was not performed in some studies, leading to an unknown true disease status. Wider implications of the findings The use of menstrual tampons in clinical practice may help overcome barriers to accessing healthcare and participation in screening, necessary for preventing avoidable gynaecological conditions and their associated long-term complications. Further research is required to explore the optimisation of tampon specimen collection, including transportation and storage requirements. Trial registration number Not applicable

O-258 Characterization of vaginal microbiota during IVF fresh embryo transfer (IVF-ET) and in early pregnancy

Abstract Study question Does the composition of vaginal microbiota affect the success of IVF-ET? Does vaginal microbiota profile change intra-individually from IVF-ET to early pregnancy? Summary answer L. crispatus is associated with successful IVF outcome. The individual composition of vaginal microbiota tends to shift towards Lactobacillus-dominance between IVF-ET and early pregnancy. What is known already Lactobacilli are the most abundant species in healthy female reproductive tract microbiota and especially Lactobacillus crispatus is associated with good gynecological health. The composition of vaginal microbiota may also play an important role in infertility and the success of IVF. Women with Lactobacillus-dominated vaginal microbiota may have higher pregnancy rates after IVF-ET compared to women with non-Lactobacillus dominance, but the results have been controversial. In healthy pregnancy, vaginal microbiota is usually lactobacilli-dominated, whereas miscarriages are associated to a non-lactobacillus dominance. The intra-individual shift on the vaginal microbiota from ET to early pregnancy has not been studied earlier. Study design, size, duration This observational and longitudinal study investigates the effect of vaginal microbiota on the success of fresh IVF-ET. Another aim was to study the intra-individual changes in the microbiota profile between IVF-ET and early pregnancy. We recruited 76 subfertile women undergoing IVF with their own gametes between November 2019 and September 2021 in the Reproductive Medicine Unit, Helsinki University Hospital and in Oulu University Hospital. Main outcomes were clinical pregnancy and live birth. Participants/materials, setting, methods Study population composed of 76 subfertile women under 40 years of age. One IVF cycle including fresh embryo transfer was studied. Vaginal swabs were taken at the time of IVF-ET and at 8th gestational week. Samples were frozen in − 20 °C and moved to − 80 °C within four weeks. Microbiota analysis was performed with next-generation sequencing of 16S rRNA gene using Illumina MiSeq technology. Clinical data were collected from the patient registries and background questionnaires. Main results and the role of chance Altogether 30 (39.5%) of the 76 women achieved pregnancy after IVF-ET and 26 (34.2%) had live birth. The relative abundance of L. crispatus among women who achieved clinical pregnancy (46.9% vs. 19.1%, q = 0.003) and live birth (43.3% vs. 19.1%, q = 0.006) was significantly higher compared to women who did not. After adjusting for age, parity and gravidity, the results remained similar when comparing clinical pregnancy (q = 0.039), but in live birth, the difference lost significance (q = 0.14) Vaginal samples were taken at the 8th gestational week from 21 of 30 women who got pregnant. All samples were dominated by Lactobacillus species, mainly by L. crispatus (n = 16, 76.2%). Only two (9.2%) women had L. iners dominated microbiota at the early pregnancy. When comparing samples taken during fresh IVF-ET and early pregnancy, L. crispatus had significantly higher relative abundance in early pregnancy samples compared to the samples taken at the ET (71.5% vs. 43.4%, q = 0.001), whereas the relative abundance of L. iners (10.1% vs. 24.1%, q = 0.004), and G. vaginalis (0.8% vs. 14.7%, q = 0.004) decreased. Altogether 13 women had an intra-individual shift in their microbiota profiles. Limitations, reasons for caution The small sample size was the main limitation of our study. Larger studies are needed to confirm our findings and their relationship with the success of IVF-ET. Wider implications of the findings Vaginal microbiota at the time of fresh IVF-ET has an impact of the success of IVF treatment. Also, the intra-individual composition of vaginal microbiota between IVF-ET and early pregnancy changes in some women. The vaginal microbiota modification through probiotics in order to optimize the result of IVF warrants more studies. Trial registration number Not applicable

Mucoadhesive 3D printed vaginal ovules to treat endometriosis and fibrotic uterine diseases

Gynaecological health is a neglected field of research that includes conditions such as endometriosis, uterine fibroids, infertility, viral and bacterial infections, and cancers. There is a clinical need to develop dosage forms for gynecological diseases that increase efficacy and reduce side effects and explore new materials with properties tailored to the vaginal mucosa and milieu. Here, we developed a 3D printed semisolid vaginal ovule containing pirfenidone, a repurposed drug candidate for endometriosis. Vaginal drug delivery allows direct targeting of the reproductive organs via the first uterine pass effect, but vaginal dosage forms can be challenging to self-administer and retain in situ for periods of more than 1–3 h. We show that a semisoft alginate-based vaginal suppository manufactured using semisolid extrusion additive manufacturing is superior to vaginal ovules made using standard excipients. The 3D-printed ovule showed a controlled release profile of pirfenidone in vitro in standard and biorelevant release tests, as well as better mucoadhesive properties ex vivo. An exposure time of 24 h of pirfenidone to a monolayer culture of an endometriotic epithelial cell line, 12Z, is necessary to reduce the cells’ metabolic activity, which demonstrates the need for a sustained release formulation of pirfenidone. 3D printing allowed us to formulate mucoadhesive polymers into a semisolid ovule with controlled release of pirfenidone. This work enables further preclinical and clinical studies into vaginally administered pirfenidone to assess its efficacy as a repurposed endometriosis treatment.

СОВРЕМЕННЫЙ СОЦИО-СОМАТИЧЕСКИЙ ПОРТРЕТ ЖЕНЩИНЫ С ПАТОЛОГИЧЕСКИМ КЛИМАКСОМ

Introduction. Nowadays, the number of menopausal women in the world population has strong tendency to increase. According to statistics the majority have a moderate and severe course of it. This is the reason preventive gerontology develops today, especially climatology. That is why using new machine learning technologies is relevant today. Such method as gradient boosting helped us to identify the characteristic features and factors that cause the pathological course of menopause in women which made it possible to draw up a medical «portrait» of such patients. Using the knowledge of these factors influence it is easily to recognize women needs to be observed even before the manifestations of menopause. Aim. The aim of the study is to conduct a socio-somatic «portrait» of a modern patient with a pathological menopause. Material and methods. A detailed survey of 1275 women aged 45–60 years was carried out with an assessment of the socio-cultural status, general somatic and gynecological health. The received data were sorted and categorized using modern statistical processing methods and machine learning method - gradient boosting. Results and discussion. Firstly, there are factors with high influence on menopausal syndrome developing: level of education, oncological anamnesis, diseases of the gastrointestinal tract, vegetative and insomnia disorders, the use of intrauterine contraceptives, the number of children 2 or more, the presence of abortions in anamnesis. The rest of the questionnaires were characterized as having only a small impact. This is a pathology of the thyroid gland, the cardiovascular system; hyperplastic processes in history; occupation, namely social and medical workers, as well as a negative attitude towards menopause. The greater number of these features one woman has, the higher the likelihood of developing a pathological menopause she gets. Conclusion. The collective image we have received of a modern patient with pathological menopausal syndrome is based on aspects of the life and health of women which it is worth paying attention on. This can serve as a kind of guideline for clinicians in order to achieve correction of hypoestrogenism with the development of a pathological menopause.

Jinekolojik Kanser Farkındalığının Sağlık Sorumluluğu ve Sağlık Okuryazarlığı ile İlişkisinin İncelenmesi

Objective: Women's awareness of gynecological cancers is important for early diagnosis and screening. Health responsibility and health literacy can affect gynecological cancer awareness. Therefore, in this study, it was aimed to examine the relationship between women's gynecological cancer awareness and health responsibility and health literacy. 
 Methods: The study was designed as cross-sectional. Data were collected from 409 women aged 20-65 working in university units in Turkey between February 2021 and May 2021. In data collection, demographic information, obstetric, gynecologic, and general health characteristics of women, the Gynecological Cancer Awareness Scale (GCAS), the Turkish Health Literacy Scale (THLS-32) and the Health Promoting Lifestyle Profile II/ Health Responsibility Subscale were used. Descriptive, comparative and multiple regression analyzes were conducted. 
 Results: The total mean score of GCAS was 158.65±16.01 and 8.3% of the participants had insufficient health literacy. A significant regression model, F (df1=14, df2=394) =10.849, p< .001, and 25% of the variance in the dependent variable (R2adjusted = .25) was found to be explained by the independent variables. In the model, the variables that predict and contribute most to women's awareness of gynecological cancer are health responsibility (β= .21, t (394) = 4.35, p< .01), and THLS-32 (β= .20, t(394)= 4.33 , p< .01). 
 Conclusions: As a result, it is important to consider especially health responsibility and health literacy levels while developing intervention programs for women's awareness of gynecological cancer.

(056) Theo Mei Technique (TMT) – A Specific Method Eliminating or Reducing Menstrual Ppain

Abstract Introduction A large portion of women experience significant menstrual pain for one to three days every month that interferes with daily activities and sleep causing lost time from work, school, family or other activities and reduced productive life. Objective Provide women a natural solution to reduce or eliminate period pain using the body’s own hormones (endorphins and oxytocin) without the side effects medicinal approaches. Methods Triggering the body’s pain fighting hormones is the central theme. There are two key elements of this technique (TMT): multiple self-induce orgasms and specific time spacing. A woman’s body is capable of multiple orgasms and each time releases the necessary hormones to fight pain. The intensity of each orgasm greatly contributes to the amount of endorphins released and typically is apparent by full body shaking contractions. The timing of the orgasms allows the hormones to distribute throughout the body and builds upon the previous hormone amounts. The technique was explained in detail to each patient to ensure a consistent understanding level and methodology. Each participant provided feedback how much pain was reduced and how long this effect lasted if the pain reoccurred. They also provided other observations about physiological changes or effects from the technique. Results This research study has spanned 42 months with 46 participants. Some of the women have been using TMT for 36 – 42 months, most of the women for at least 15 months and more recently three additional women for 4 months. The women ages ranged from 21 to 48 years. There are nine related combinations (mother /daughter/sister). After each patient completed the technique the effects were immediate and each patient reported an exhilarated feeling for the first time being free of period pain. The data revealed each time the patient used TMT the pain was completely eliminated. Duration of effects lasted from 7 to 10 hours. If the patient felt pain returning the patient simply repeated the technique for another painless span of time. All the participants continue to voluntarily use this technique each month. The participants voluntarily provide information concerning quality of sexual activity and gynecological health changes (typically improved). The authors and participants were surprised how completely this technique worked. The results show this technique is very effective in eliminating the pain women suffer during menstruation. The patients felt medications were not needed and stopped using them on their own. The intensity of the technique and repeated use also strengthened the pelvic floor muscles. The study is collecting more data about the additional benefits of this technique. Conclusions The participants in this research study group significantly improved their lives by using TMT every month. All of these women are essentially pain free during their monthly period. The TMT effects were obvious to others around the participants and kept asking what had changed. The effectiveness of long term participation of these patients has not diminished. Disclosure No

Telemedicine: A Natural Evolution of Obstetric and Gynaelogical health Care System of Bangladesh during COVID-19 Pandemic

Background: The word Telemedicine literally translates to ‘healing at a distance’. Here remote diagnosis and treatment of patients is done by means of telecommunication technology. First published record of telemedicine is in the first half of the 20th century when ECG was transmitted over the telephone line. In Bangladesh telemedicine was not so popular as patients prefer face to face visit to a medical practitioner. But in Covid-19 Pandemic to prevent transmission and Lock down situation telemedicine becomes popular and emerges as a natural evolution of Obstetrics and Gynaecologic health care system in Bangladesh.
 The Aim of the study: To see the outcome of patients taking telemedicine for their Obstetric and Gynaecologic problems. The reasons of seeking consultation through telemedicine are also studied.
 Materials and Methods: This is a Cross sectional prospective study done during Lock down period in Bangladesh. Study period was 27th March to 20th May. Total 201 women got telemedicine service free of cost via sms, messenger, imo, whatsapp, email using smart phone were included in this study. The data was collected, edited and tabulated by hand tabulation. Calculation was done on scientific calculator.
 Results: About 96.51% patients suffering from Obstetrics and Gynaecological diseases were cured by taking medicine, counselling and assurance through telemedicine. Majority of pregnant women(23.88%) sought telemedicine service for consultation about advice regarding diet, medicine, anxiety about ANC visits. 2.48% women were worried about Tetanus Toxoid vaccine.Women (.99%) suffering from Gynaecological diseases such as Fibroid uterus, Uterine Prolapse were seeking for operation.3.48% women suffereing from DUB and managed by medication . Only 3.48% patients were required to refer to Hospital for Emergency admission.
 Conclusion: Telemedicine can’t give solution to all problems, but it definitely helps in managing women suffering from Obstetric and Gynaecological diseases at a large extent especially during awakward situation like Covid 19 pandemic.
 Bangladesh J Obstet Gynaecol, 2021; Vol. 36(1): 23-27

La santé sexuelle des hommes trans : entre problèmes de catégorisation et invisibilisation

Sexual minorities have been disproportionally impacted by the HIV-Aids epidemic. Their high prevalence motivated sexual health research that first focused on gay men, then trans women. Trans men have been considered at very low risk of exposition, Hence the scarce number of research about them. However, an emerging literature is showing diversified and surprising results regarding the reasons for their initial exclusion. This article seeks to establish the state of knowledge on trans men's sexual health through a French and international literature review. Trans men have a variety of partners, sexual and non-sexual practices (IDU) that leads to categorize them at high risk of HIV exposure. The proportion of trans men who are HIV positive still is difficult to assess. It is estimated to be high in the USA, and close to zero in France. Low screening rates, difficulties accessing health care, and identification problems in the very classification of people suggest that they might be more of them. Trans men also report discriminations in access to health care services, and specific health vulnerabilities. Gynecology and reproductive health are rarely even mentioned. Rethinking the categories used in research would produce a more accurate representation of the varied realities of trans people.

Gynecological morbidity and treatment-seeking among older adult (aged 45–59) women in India

BackgroundWomen’s gynecological health needs are not limited to the reproductive years of their life. Women are at risk of hormonal changes, gynecological malignancies, and various genitourinary conditions as they move toward menopause and beyond. Concerns about older women’s sexual and reproductive health and rights (SRHR) continue to be taboo in many countries, of little interest to researchers and professionals in the field of healthcare, and a “blind spot” in discussions about policy as a whole. Despite the widespread agreement, the life course approach to addressing SRHR concerns has received minimal attention. The study estimates the prevalence, assesses the correlates, and treatment-seeking of gynecological morbidity (GM) among older adult women aged 45–59 years (N = 18,547) in India.MethodThe analysis was based on the nationally representative Longitudinal Ageing Study (2016–2017) data that adopted a multistage stratified area probability cluster sampling to select respondents. The outcome variables used in this analysis were ‘had any GM’ and ‘sought treatment for any GM.’ Women with any morbidity such as per vaginal bleeding, foul-smelling vaginal discharge, uterus prolapses, mood swings/irritability, fibroid/cyst, and dry vagina causing painful intercourse were considered to have any GM. Of the respondents with GM, who sought a doctor’s consultation or treatment were considered ‘sought treatment for any GM.’ Binary logistic regression was conducted to examine the adjusted effect of socioeconomic and demographic predictors of GM and treatment-seeking. Stata (V 16) was used for statistical analyses with a 5% significance level.ResultsFifteen percent of the women had any GM, and only 41% of them sought treatment. Age, marital status, education, number of pregnancies, hysterectomy, involvement in household decision-making, social group, religion, wealth status, and region were significantly associated with GM. The odds of treatment-seeking were higher among women with 10+ years of schooling (OR 1.66, CI 1.23, 2.23), with hysterectomy (OR 7.36, CI 5.92, 9.14), with five-plus pregnancies (OR 1.25, CI 0.96, 1.64), and those from the richest (OR 1.91, CI 1.40, 2.60) households than their respective counterparts.ConclusionMany older adult women experience GM, and treatment-seeking is inadequate. The GM prevalence and treatment-seeking vary considerably by socioeconomic and demographic characteristics. Results suggest community-level awareness generation and the inclusion of this otherwise ignored group in programs targeting better health and wellbeing of women.

Population-level use of gynecological health services by female youth with intellectual/developmental disabilities in British Columbia Canada

BackgroundThere is evidence that female youth with intellectual/developmental disabilities (IDD) experience poorer gynecological care compared to female youth without disabilities. ObjectiveThe objective of this study was to obtain baseline data on visits to a health care provider for a gynecological issue for females with IDD and compare that information to the experiences of female youth without IDD. MethodsThis study is a retrospective cohort study using population-level administrative health data from 2010 to 2019 for females aged 15–24 years, with and without IDD. Results6452 female youth with IDD and 637,627 female youth without IDD were identified in the data. Over the ten-year period, 53.77% of youth with IDD and 53.68% of youth without IDD had a visit to a physician for a gynecological issue. However, as females with IDD aged, the number of people seeing a physician for a gynecological issue decreased. In the group aged 20–24 years, 15.25% of females with IDD and 24.47% of females without IDD (p < 0.0001) had a Pap test done at any time; 25.94% of females with IDD had a visit for contraception management and 28.38% of females (p < 0.0001) without IDD had a visit for contraception management. Gynecological care also varied by type of IDD. ConclusionsFemales with IDD had a similar number of visits for a gynecological issue as female youth without IDD. However, the reasons for visits and the age at which visits occurred differed between youth with and without IDD. As females with IDD transition into adulthood, gynecological care must be maintained and improved.

Re: Working remotely: a perspective on telemedicine in delivery of obstetrics and gynaecology health care

The Obstetrician & GynaecologistVolume 25, Issue 2 p. 157-158 Letters and Emails Re: Working remotely: a perspective on telemedicine in delivery of obstetrics and gynaecology health care Jacqueline Sia MBChB BSc (Hons) MRCOG, Corresponding Author Jacqueline Sia MBChB BSc (Hons) MRCOG [email protected] orcid.org/0000-0002-1820-3194 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKCorresponding Author:[email protected]Search for more papers by this authorSophie Strong MBBS BSc (Hons) MRCOG, Sophie Strong MBBS BSc (Hons) MRCOG orcid.org/0000-0002-4724-0998 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorTriada Doulgeraki MBBS, Triada Doulgeraki MBBS orcid.org/0000-0002-2542-4542 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorEmily Benson MBChB BA (Hons), Emily Benson MBChB BA (Hons) Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorElizabeth Ball MD PhD FRCOG, Elizabeth Ball MD PhD FRCOG orcid.org/0000-0001-8739-090X Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UK Centre for Maternal & Child Health Research, School of Health Sciences, City University of London, London, UKSearch for more papers by this author Jacqueline Sia MBChB BSc (Hons) MRCOG, Corresponding Author Jacqueline Sia MBChB BSc (Hons) MRCOG [email protected] orcid.org/0000-0002-1820-3194 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKCorresponding Author:[email protected]Search for more papers by this authorSophie Strong MBBS BSc (Hons) MRCOG, Sophie Strong MBBS BSc (Hons) MRCOG orcid.org/0000-0002-4724-0998 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorTriada Doulgeraki MBBS, Triada Doulgeraki MBBS orcid.org/0000-0002-2542-4542 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorEmily Benson MBChB BA (Hons), Emily Benson MBChB BA (Hons) Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorElizabeth Ball MD PhD FRCOG, Elizabeth Ball MD PhD FRCOG orcid.org/0000-0001-8739-090X Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UK Centre for Maternal & Child Health Research, School of Health Sciences, City University of London, London, UKSearch for more papers by this author First published: 03 February 2023 https://doi.org/10.1111/tog.12859Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume25, Issue2April 2023Pages 157-158 RelatedInformation

Association of laparoscopically-confirmed endometriosis with long COVID-19: a prospective cohort study

Women are at greater risk than men of developing chronic inflammatory conditions and "long COVID." However, few gynecologic health risk factors for long COVID-19 have been identified. Endometriosis is a common gynecologic disorder associated with chronic inflammation, immune dysregulation, and comorbid presentation with autoimmune and clotting disorders, all of which are pathophysiological mechanisms proposed for long COVID-19. Therefore, we hypothesized that women with a history of endometriosis may be at greater risk of developing long COVID-19. This study aimed to investigate the association between history of endometriosis before SARS-CoV-2 infection and risk of long COVID-19. We followed 46,579 women from 2 ongoing prospective cohort studies-the Nurses' Health Study II and the Nurses' Health Study 3-who participated in a series of COVID-19-related surveys administered from April 2020 to November 2022. Laparoscopic diagnosis of endometriosis was documented prospectively in main cohort questionnaires before the pandemic (1993-2020) with high validity. SARS-CoV-2 infection (confirmed by antigen, polymerase chain reaction, or antibody test) and long-term COVID-19 symptoms (≥4 weeks) defined by the Centers for Disease Control and Prevention were self-reported during follow-up. Among individuals with SARS-CoV-2 infection, we fit Poisson regression models to assess the associations between endometriosis and risk of long COVID-19 symptoms, with adjustment for potential confounding variables (demographics, body mass index, smoking status, history of infertility, and history of chronic diseases). Among 3650 women in our sample with self-reported SARS-CoV-2 infections during follow-up, 386 (10.6%) had a history of endometriosis with laparoscopic confirmation, and 1598 (43.8%) reported experiencing long COVID-19 symptoms. Most women were non-Hispanic White (95.4%), with a median age of 59 years (interquartile range, 44-65). Women with a history of laparoscopically-confirmed endometriosis had a 22% greater risk of developing long COVID-19 (adjusted risk ratio, 1.22; 95% confidence interval, 1.05-1.42) compared with those who had never been diagnosed with endometriosis. The association was stronger when we defined long COVID-19 as having symptoms for ≥8 weeks (risk ratio, 1.28; 95% confidence interval, 1.09-1.50). We observed no statistically significant differences in the relationship between endometriosis and long COVID-19 by age, infertility history, or comorbidity with uterine fibroids, although there was a suggestive trend indicating that the association may be stronger in women aged <50 years (<50 years: risk ratio, 1.37; 95% confidence interval, 1.00-1.88; ≥50 years: risk ratio, 1.19; 95% confidence interval, 1.01-1.41). Among persons who developed long COVID-19, women with endometriosis reported on average 1 additional long-term symptom compared with women without endometriosis. Our findings suggest that those with a history of endometriosis may be at modestly increased risk for long COVID-19. Healthcare providers should be aware of endometriosis history when treating patients for signs of persisting symptoms after SARS-CoV-2 infection. Future studies should investigate the potential biological pathways underlying these associations.