Psychological Outcomes In Women Research Articles

Type and Frequency in Use of Nutraceutical and Micronutrient Supplementation for the Management of Polycystic Ovary Syndrome: A Systematic Scoping Review.

Lifestyle strategies are considered first-line treatment for the management of polycystic ovary syndrome (PCOS). However, complementary therapies, including nutrient supplementation, have been identified as a potential adjunct therapy. Therefore, we systematically mapped the available literature to identify the type and frequency of the use of nutraceutical and micronutrient supplementation for the management of PCOS features. A systematic search of the literature was conducted using CINAHL, Cochrane reviews, Medline, PsycINFO, Scopus and LILACS. All types of study designs were included if they reported on the use of nutraceuticals and/or micronutrient supplementation on features of PCOS in women aged ≥18 years. A total of 344 articles were included. Forty-one supplements were identified, with the most frequently investigated being inositols (n = 86), vitamin D (n = 53), N-acetylcysteine (n = 27) and omega-3 fatty acids (n = 25). Reproductive outcomes were the most commonly reported (n = 285; 83%), followed by metabolic (n = 229; 67%), anthropometric (n = 197; 57%) and psychological (n = 8; 2%). Our results identified that nutraceutical and micronutrient supplementation require further investigation of psychological outcomes in women with PCOS. Moreover, adequately powered primary studies are warranted to investigate therapeutic doses needed for clinical benefits.

Effects of mindfulness-based intervention for women with infertility: a systematic review and meta-analysis.

This review aimed to examine the effects of mindfulness-based interventions on physical and psychological outcomes in women with infertility. Studies were included if participants were women diagnosed with infertility, were over the age of 18, and the design was a randomized controlled trial of a mindfulness-based intervention program. Two independent reviewers undertook eligibility screening, data extraction, and methodological quality assessment. We used RevMan software version 5.4 (The Cochrane Collaboration) to conduct the meta-analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was followed. Ten articles were finally included in the current meta-analysis. The results of the meta-analysis revealed large, significant effects of mindfulness-based interventions that can effectively reduce depression[SMD = -1.28, 95% CI (-1.95, -0.60), P < 0.0001], anxiety [SMD = -0.89, 95% CI (-1.26, -0.51), P < 0.00001] symptoms, and improve five domains of health-related quality of life (physical function [MD = 9.47, 95% CI (4.33, 14.61), P = 0.0003], general health [MD = 15.77, 95% CI (7.62, 23.92), P = 0.0002], vitality [MD = 14.85, 95% CI (4.95, 24.74), P = 0.003], role-physical [MD = 22.44, 95% CI (14.97, 29.91), P < 0.00001] and social function [MD = 8.27, 95% CI (3.56, 12.97), P = 0.0006)] in women with infertility. The current meta-analysis results revealed that mindfulness-based interventions could effectively reduce depression and anxiety symptoms and improve health-related quality of life in women with infertility. Future rigorously designed, high-quality research is required to demonstrate whether mindfulness-based intervention programs can effectively reduce perceived stress and BMI.

Circulating endocannabinoids and psychological outcomes in women with PTSD

BackgroundRecent research has attempted to elucidate the relationship between blood-based biomarkers (e.g., endocannabinoids; eCBs: including N-arachidonoylethanolamine [AEA] and 2-arachidonoylglycerol [2-AG]) and mental health outcomes in psychiatric populations such as posttraumatic stress disorder (PTSD). Prior research suggests that adults with PTSD may have altered circulating eCB tone and a blunted mobilization of eCBs (particularly 2-AG) in response to stress (e.g., aerobic exercise), although our understanding has been limited in part due to heterogenous samples and small sample sizes. MethodsA subset of data was pooled from five studies in which women with and without PTSD (N = 98) completed questionnaires related to mood states and a blood draw prior to and following a bout of moderate-intensity aerobic exercise in order to determine: 1) whether circulating eCBs differ between groups and whether depressive and PTSD symptom severity are associated with baseline eCBs, 2) whether a bout of aerobic exercise increases circulating eCBs in adult women with PTSD, and 3) whether circulating eCBs are associated with overall mood states and exercise-induced improvements in mood states in women with and without PTSD. ResultsPTSD diagnoses were not associated with baseline concentrations of eCBs. Greater depressive symptom severity and PTSD symptom severity within the negative alteration in cognition and mood cluster were associated with lower circulating AEA. Circulating AEA significantly increased following aerobic exercise for both groups, whereas circulating 2-AG only increased in women without PTSD. Greater circulating AEA within the PTSD group was associated with lower depressive mood, confusion, and total mood disturbance. ConclusionsThese findings suggest that greater circulating AEA is associated with better overall mood and lower depressive and PTSD symptom severity, and that an acute bout of moderate-intensity aerobic exercise increases circulating AEA (but not 2-AG) in adult women with PTSD. These findings are consistent with the idea that greater eCB tone (particularly AEA) following pharmacological and/or non-pharmacological manipulations may be beneficial for improving psychological outcomes (e.g., mood, cognition) among PTSD, and possibly other psychiatric populations.

Understanding the Psychophysiological and Sensitization Mechanisms Behind Fibromyalgia Syndrome: A Network Analysis Approach.

Current evidence suggests that fibromyalgia syndrome (FMS) involves complex underlying mechanisms. This study aimed to quantify the multivariate relationships between clinical, psychophysical, and psychological outcomes in women with FMS by using network analysis to understand the psychobiological mechanisms driving FMS and generating new research questions for improving treatment strategies. Demographic (age, height, weight), clinical (pain history, pain intensity at rest and during daily living activities), psychophysical (widespread pressure pain thresholds [PPT]), sensory-related (PainDETECT, S-LANSS, Central Sensitization Inventory [CSI]) and psychological (depressive and anxiety levels) variables were collected in 126 women with FMS. Network analysis was conducted to quantify the adjusted correlations between the modeled variables and to assess their centrality indices (i.e., the connectivity with other symptoms in the network and the importance in the system modelled as network). The network showed several local associations between psychophysical and clinical sensory-related variables. Multiple positive correlations between PPTs were observed, being the strongest weight between PPTs on the knee and tibialis anterior muscle (ρ: 0.33). PainDETECT was associated with LANSS (ρ: 0.45) and CSI (ρ: 0.24), whereas CSI was associated with HADS-A (ρ: 0.28). The most central variables were PPTs over the tibialis anterior (the highest Strength centrality) and CSI (the highest Closeness and Betweenness centrality). Our findings support a model where clinical sensory-related, psychological, and psycho-physical variables are connected, albeit in separate clusters, reflecting a nociplastic condition with a relevant role of sensitization. Clinical implications of the findings, such as developing treatments targeting these mechanisms, are discussed.

Prevalence and Determinants of Unintended Pregnancy among Married Women Seeking Antenatal Care at Bwaila District Hospital in Lilongwe, Malawi

In many countries, women fall pregnant much sooner than desired and have more pregnancies and bear more children than they want. Pregnancies are usually associated with an array of negative health, economic, social and psychological outcomes for women and children. Preventing unintended pregnancies through family planning is an integral component in limiting associated consequences and population growth. However, despite widely available contraceptives, the demand for family planning among married women is still high. A quantitative study was conducted to explore the prevalence and determinants of unintended pregnancy among married women seeking antenatal care at Bwaila District Hospital in Lilongwe, Malawi. Permission was granted by the relevant authorities to conduct the study. Between July and August 2019, 413 married pregnant women were interviewed. The women gave written consent before joining the study and all the completed questionnaires were personally collected daily. Descriptive statistics were used to analyse the data while nonparametric tests were used to explore associations amongst the variables. The mean age of the participants was 23 years and 43.1% of the participants reported that their most recent pregnancy was unintended. Multivariate analysis revealed that young age (18–25 years), low education level and preference for the sex of the child were significant determinants of unintended pregnancy. Inconsistent use of family planning methods increased the risk of unintended pregnancy. Unintended pregnancy among married women indicates the need for improving education among women to delay marriage to the universal minimum of 18 years, and increasing access to long-term family planning methods to avoid failure and discontinuation of contraceptives.

Una descripción general de la psicoterapia para pacientes con cáncer de mama: revisión sistemática de ensayos controlados aleatorios

Introduction: Psychological morbidities are common in breast cancer patients. Clinical conditions like depression, cognitive alterations, anxiety, distress, fear of cancer, sleep di-sorders, and fatigue may persist in cancer survivors. Therefore, psychological interventions are an essential treatment for breast cancer. Objective: To identify psychological interventions and psychological outcomes for women with breast cancer. Methods: Five databases were searched: EMBASE, ScienceDirect, MEDLINE (Ovid), CENTRAL(Ovid) y PsycINFO (APAPsyNET), from Jan 2014 to Jun 4th, 2018. Two authors reviewed all title articles and abstracts in databases and selected potentially eligible studies. A narrati-ve synthesis of results was used due to the heterogeneity in randomized controlled trials, population characteristics, psychotherapies applied, outcomes, and timing of assessments. Results: This overview included 14 randomized controlled trials which comprise 1914 par-ticipants (included non-metastatic and metastatic), across 21 articles. The most common psychological interventions were cognitive-behavioral based. The principal psychological outcomes assessed were depression, quality of life, fatigue, and anxiety. Conclusion: Results from this review are useful to clarify an overview of intervention in psychological morbidities in breast cancer. Comorbidities vary, contribute costs to patients, and there is insufficient empirical evidence about psychotherapies to resolve all psychologi-cal morbidities in breast cancer patients.

Predictors of Psychological Distress in Women with Endometriosis during the COVID-19 Pandemic.

Background: Endometriosis is a multifaceted chronic pain condition that can have a negative impact on mental health. Patients suffering from chronic pain may face an additional psychological burden during adversity, such as the COVID-19 pandemic. The main aim of this research was to evaluate the prevalence of self-reported depression and anxiety, the influence of demographic, endometriosis-specific, pandemic-specific factors, and resilience on mental health outcomes of patients with endometriosis. Methods: An online survey was conducted through patient support groups of women suffering from endometriosis during the first wave of the COVID-19 pandemic. The PHQ-4 questionnaire, which combines two items of the Patient Health Questionnaire for Depression (PHQ-2) and two items from the Generalized Anxiety Disorder Scale (GAD-2) was used to assess self-reported mental health. The Brief Resilience Score (BRS) was employed to evaluate resilience. Independent risk and protective factors for mental health were investigated by multivariate logistic regression analyses. Results: The PHQ-4 questionnaire was completed by 274 respondents. More than 40% reached depression (PHQ-2) and anxiety (GAD-2) scores of ≥3, and more than 20% achieved PHQ-2 and GAD-2 scores of ≥5. High resilience was found to be a reliable and strong independent protector for the probability of developing adverse psychological outcomes: OR 0.295, p < 0.001 for developing generalized anxiety disorder (GAD-2 ≥ 3), and OR 0.467, p < 0.001 for having major depression (PHQ-2 ≥ 3). Conclusions: Pain-induced disability is an independent risk factor for developing major depression and anxiety, while resilience was identified as a potential protective parameter in terms of positive psychological outcomes in women with endometriosis. The results of this study may help to identify women at risk for adverse mental health outcomes and should encourage healthcare practitioners to establish strategies for the reduction of negative psychological and psychiatric impacts on patients with endometriosis.

Strangulation as an Acquired Brain Injury in Intimate-Partner Violence and Its Relationship to Cognitive and Psychological Functioning: A Preliminary Study.

The aim of this work was to examine the relationship between strangulation-related alterations in consciousness (AIC) and cognitive and psychological outcomes in women who have experienced intimate partner violence (IPV). Participants were recruited from a variety of settings, including women's shelters and support programs. A total of 99 women were enrolled in the study. After applying exclusion criteria for factors that could mask or confound the effects of strangulation, 52 women remained for analyses. Cross-sectional, retrospective. We used several cognitive measures to assess learning, long-term and working memory, visuomotor speed, cognitive flexibility, and nonverbal cognitive fluency as well as several psychological measures to assess posttraumatic stress symptomatology, general distress, worry, anhedonic depression, and anxious arousal. We also used the Brain Injury Severity Assessment interview to examine the association between strangulation-related AICs and these measures of cognitive and psychological functioning. Women who had experienced strangulation-related AICs performed more poorly on a test of long-term memory (P < .03) and had higher levels of depression (P < .03) and posttraumatic stress symptomatology (P < .02) than women who had not experienced strangulation-related AIC. When controlling for potential confounding variables, including number of IPV-related traumatic brain injuries, women who had experienced strangulation also performed more poorly on a measure of working memory. This is the first report to assess strangulation in this manner and demonstrate links to cognitive and psychological functioning. These preliminary data contribute to our knowledge of strangulation and its effects on women who have experienced IPV.

Differential Effects of Intuitive and Disordered Eating on Physical and Psychological Outcomes for Women with Young Children.

Pressure to lose weight can increase the risk of developing disordered eating behaviours, negative body image and depressive symptomatology. Eating intuitively may counteract these negative outcomes. This research examined the unique relationship between intuitive eating and disordered eating on body mass index (BMI), body image and depressive symptoms for women of young children. A survey of women with a child aged between six and 48months, included the Intuitive Eating Scale, Eating Attitudes Test-26, Body Shape Questionnaire and Edinburgh Postnatal Depression Scale. Multivariate analysis of variance (MANOVA) was conducted as an omnibus test to estimate the effect of intuitive and disordered eating on BMI, negative body image and depressive symptoms. Of the 419 sample (M age = 32.06), 32% were classified with disordered and 32% with intuitive eating. MANOVA and regression analysis found disordered eating positively associated with depressive symptoms, (β = 0.303) and negative body image (β = 0.318). Intuitive eating was associated with lower depressive symptoms (β = - 0.183)and negative body image (β = - 0.615). Disordered eating (β = - 0.194)and intuitive eating (β = - 0.586)both contributed to lower BMI, with the association stronger for intuitive eating. The early parenting period involves a high risk for developing disordered eating behaviours. Eating patterns are modifiable factors, illustrating the potential for positive and preventive health outcomes through adopting intuitive eating behaviours. There is an opportunity for healthcare professionals to promote physical and psychological health including for women in the early parenting period.

Exploring the impact of exercise and mind-body prehabilitation interventions on physical and psychological outcomes in women undergoing breast cancer surgery.

To compare the impact of exercise and mind-body prehabilitation interventions on changes in quality of life and cancer treatment-related symptoms in women with newly diagnosed breast cancer. The following describes a secondary analysis of a randomized window of opportunity trial (The Pre-Operative Health and Body Study). Forty-nine women were randomized to participate in either an exercise prehabilitation intervention or a mind-body prehabilitation intervention from the time of enrollment to surgery. Participants (N = 47) completed measures of quality of life, anxiety, depression, and stress at the time of enrollment (T1), post-intervention/surgery (T2), and one-month post-surgery (T3). Changes in outcome measures between groups were compared over time using longitudinal models. Mind-body group participants experienced significant improvements in cognitive functioning in comparison to exercise group participants between T1 and T3 (difference in average change: -9.61, p = 0.04, d = 0.31), otherwise, there were no significant differences between groups. Within group comparisons demonstrated that both groups experienced improvements in anxiety (exercise: average change = -1.18, p = 0.03, d = 0.34; mind-body: average change = -1.69, p = 0.006, d = 0.43) and stress (exercise: average change = -2.33, p = 0.04, d = 0.30; mind-body: average change = -2.59, p = 0.05, d = 0.29), while mind-body group participants experienced improvements in insomnia (average change = -10.03, p = 0.04, d = 0.30) and cognitive functioning (average change = 13.16, p = 0.0003, d = 0.67). Both prehabilitation interventions impacted cancer treatment-related symptoms. Further work in larger groups of patients is needed to evaluate the efficacy of prehabilitation interventions on quality of life in women with breast cancer. Pre-operative exercise and mind-body interventions may impact physical and/or psychological effects of cancer diagnosis and treatment in women with breast cancer. ClinicalTrials.gov Identifier: NCT01516190. Registered January 24, 2012.

MON-042 The Effect of Exercise Training on Reproductive and Cardiometabolic Outcomes in Women with Polycystic Ovary Syndrome: A Pilot Randomized Controlled Trial

Exercise may improve cardiometabolic, reproductive and psychological outcomes in women with Polycystic Ovary Syndrome (PCOS). Clinical Practice Guidelines recommend exercise to treat PCOS, but the most effective exercise prescription is unclear. The aim of this randomized controlled trial was to evaluate the effects of six months of thrice weekly high-intensity interval training (HIIT) and continuous aerobic exercise training (CAET) programs compared with no exercise in previously-inactive women aged 18–40 years with PCOS. The primary outcome was change in ovulation rate. Ovulation was assessed with daily at home ovulation prediction kits, and confirmed with serum progesterone levels. Fisher’s exact test was used to compare groups. Secondary outcomes included change in BMI, waist circumference, blood pressure, A1C, fasting glucose, fasting insulin, and lipids and were analyzed using repeated measures mixed models. 47 women were randomly assigned to no exercise control (n=17), HIIT (n=16), or CAET (n=14). 22/33 (66.7%) women ovulated during the intervention period: no exercise: 8/12 (66.7%), HIIT: 8/11 (72.7%), and CAET: 6/10 (60%); NS between groups. BMI decreased significantly in the CAET group compared with control (-1 kg/m2, p=0.01) and compared with HIIT (-0.9 kg/m2, p=0.04). Mean waist circumference decreased significantly in all groups with no significant difference between groups. There were no significant within- or between- group changes for body weight. No within- or between group differences were identified for mean blood pressure, A1C, fasting glucose, fasting insulin, or triglycerides. Mean LDL-C was significantly different between the HIIT and CAET groups (-0.33 mmol/L, p=0.03), as LDL-C decreased in the HIIT group but not in the CAET group. HDL-C increased in the HIIT group compared with the no exercise group (0.18 mmol/L, p=0.04), with no significant difference between the CAET and no exercise groups (p=0.47). In conclusion, CAET and HIIT interventions in women with PCOS did not affect ovulation rates. CAET and HIIT both were effective at improving anthropometrics and some cardiometabolic health markers in women with PCOS. Further studies are needed to determine optimal exercise prescriptions for reproductive, anthropometric and cardiometabolic outcomes in women with PCOS.

Medical and Mental Health Implications of Gestational Surrogacy and Trends in State Regulations on Compensated Gestational Surrogacy

As the New York State legislature considers legalizing compensated gestational surrogacy this legislative session, this report provides insight into (1) the impact of surrogacy on the medical and mental health of women who become surrogates and the children born through gestational surrogacy, and (2) how other state legislatures have addressed compensated gestational surrogacy in recent years. Medical research demonstrates that there is significant growth in gestational surrogacy in the United States. The number of families working with gestational surrogates has quadrupled in the new millennium. Weill Cornell Medicine physicians and medical students reviewed the published literature on the medical and mental health impacts to women who undergo in vitro fertilization (IVF) to become gestational carriers. Although people outside the medical community have questioned the health and psychological impacts of surrogates to prohibit gestational surrogacy, the scientific literature review demonstrates that there are in fact no significant adverse medical or psychological outcomes for women who are gestational carriers nor the children they give birth to.

Acceptability and preliminary test of efficacy of the Mind programme in women with breast cancer: An acceptance, mindfulness, and compassion-based intervention

Although there is some evidence on the efficacy of mindfulness-based interventions in improving health and psychological outcomes in women with breast cancer, further research is needed to understand these findings’ clinical significance. Furthermore, Acceptance and Commitment Therapy (ACT) intervention studies on breast cancer are scarce, and no compassion-based intervention has been tested for cancer patients. Given the complementarity and compatibility of mindfulness practice, ACT, and Compassion Focused Therapy, the current study combined these approaches to develop an integrative intervention specifically adapted to cancer patients, the Mind programme. Participants were recruited at the Radiotherapy Service of the Coimbra University Hospital (CHUC) and were assigned to one of two groups: the experimental group (Treatment As Usual + Mind Programme (8 weekly sessions and homework assignments) – n = 15) and the control group (Treatment As Usual – n = 17). There was a 100% retention on the experimental group, during the intervention. The effect size for psychological health (g = 0.79) was particularly noteworthy, suggesting that the intervention presented benefits that are comparable to mindfulness only-based interventions. The experimental group also improved on physical health (g = 0.16), quality of social relationships (g = 0.42), depression symptoms (g = −0.42), and stress (g = −0.32). Participants reported it was important for them to take part in the programme, and that it improved the way they deal with difficulties. Results indicate that the Mind programme may be a useful complement to the medical treatment of breast cancer and support the combination of acceptance, mindfulness, and compassion-based components in this context. Having an accessible and integrative psychological programme for people with cancer may significantly help improving quality of life and mental health in this population. Further implications are discussed.

Treatment Fidelity in Mind-Body Interventions.

To contribute to the treatment fidelity literature by providing real-world examples and suggestion for future research and potential clinical application, this article reports on implementation, assessment, and evaluation of treatment fidelity in mind-body self-care approaches in at-risk women. Aligning with best practices, treatment fidelity was integrated into three randomized clinical trials. The first examined the effects of a tai chi intervention designed to decrease cardiometabolic risk factors in women; the second examined the effects of a tailored guided imagery intervention on pregnancy outcomes in African American women; and the third explored effects of a mindful physical activity intervention (yoga) on psychological outcomes in women with moderate to severe depressive symptoms. Each of the studies successfully designed, implemented, and evaluated strategies to address recommended treatment fidelity components. These strategies provided qualitative and quantitative data that informed intervention refinement, directions for future research, and application in clinical practice. The treatment fidelity framework used here is based on best practices and was a feasible and reliable approach for ensuring and reporting on treatment fidelity, which is contributing to future research to foster translation of potentially effective mind-body self-care approaches into practice.

Pharmacological and surgical treatment of nonreproductive outcomes in polycystic ovary syndrome: An overview of systematic reviews.

Polycystic ovary syndrome (PCOS) affects up to 13% women and is associated with significant complications. The quality of evidence supporting the recommendations on treatment of nonreproductive outcomes in PCOS is unknown. To summarize and appraise the methodological quality of systematic reviews and meta-analyses evaluating pharmacological and surgical treatments for nonreproductive outcomes in PCOS. A literature search from MEDLINE, EMBASE, CINAHL PLUS and PROSPERO was performed from inception until 15th of September 2017. Article selection, data extraction and quality appraisal of included reviews were performed in duplicate. A narrative synthesis of the findings was conducted. This overview included 31 reviews. The quality was low for 7 (23%), moderate for sixteen (52%) and high for 8 reviews (26%). Two reviews assessed psychological outcomes. Metformin improved anthropometric (7 of 10 reviews), metabolic (4 of 14 reviews) and endocrine outcomes (3 of twelve reviews). Thiazolidinediones improved metabolic (2 of 5 reviews) and endocrine outcomes (one of 5 reviews) but worsened weight gain (5 of 5 reviews). Combined oral contraceptive pill (COCP) improved clinical hyperandrogenism (2 of 2 reviews). Statins improved lipid profile (3 of 3 reviews) and testosterone level (2 of 3 reviews). There was no conclusive evidence from included systematic reviews regarding the use of other interventions. There is reliable evidence regarding the use of metformin for anthropometric outcomes and COCPs for hyperandrogenism in women with PCOS but not for other interventions. There is significant gap in knowledge regarding the management of psychological outcomes in women with PCOS which needs further evaluation.

Urinary and psychological outcomes in women with interstitial cystitis/bladder pain syndrome following hyaluronic acid treatment

ObjectiveTo investigate urinary and psychological symptoms in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) after intravesical hyaluronic acid (HA) treatment. Materials and methodsThirty patients with newly diagnosed with IC/BPS undergoing 4 weekly intravesical HA instillations followed by 5 monthly instillations were recruited. Pre-treatment evaluation included a urinalysis and urinary culture, a 3-day voiding diary, and cystoscopy with hydrodistention of the bladder. Questionnaires containing hospital anxiety and depression scale (HADS), O'Leary-Sant score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12), and a pain visual analog scale were completed before and after treatment. Thirty age-matched, asymptomatic women were recruited as controls for assessing HADS scores, and comparison of urinary and psychological symptoms in patients before and after HA treatment. ResultsThe mean age (range 25–71 years old) and symptomatic duration (range 1–11 years) were 47 and 4.5, respectively. When compared with the control group, patients with IC/BPS had a significant increase in HADS depression subscale score and total score. Frequency, nocturia, bladder capacity, IC symptom and problem index scores, and pain score improved after 6 months of intravesical HA treatment. After HA treatment, 73% (n = 22) of patients showed improvement in their urological symptoms, but no significant changes were found in their HADS and PISQ-12 scores. ConclusionsBladder pain and lower urinary tract symptoms in patients with IC/BPS may improve after a 6-month intravesical HA treatment. However, no significant changes in their psychological and sexual functional scores were found.

013 Associations Between Partner Responses to Low Interest/Arousal and the Sexual and Relationship Wellbeing of Women with Sexual Interest/Arousal Disorder and their Partners

Low sexual interest/arousal is prevalent in women of all ages and is associated with poorer sexual and relationship wellbeing compared to women without this difficulty. Women who are partnered are almost 5 times more likely to be sexually distressed by low interest/arousal than unpartnered women, suggesting that interpersonal factors are relevant to the experience of these problems. Previous research suggests that the way partners respond to a sexual difficulty is associated with sexual and psychological outcomes for women with genito-pelvic pain, a sexual difficulty also affecting sexual desire. Using data from both partners, we examined whether affective partner responses to low sexual interest/arousal was associated with the sexual, relationship, and psychological wellbeing of women with Female Sexual Interest/Arousal Disorder (SIAD) and their partners. Women diagnosed with SIAD (N = 57) and their partners completed a measure of partner reponse to low interest/arousal consisting of 23 bipolar emotional pairs (e.g., hostile vs. warm). Women with SIAD reported on their perception of their partners’ response to their low sexual interest/arousal, while partners reported on their own responses. All participants completed standardized measures of sexual desire, sexual satisfaction, relationship satisfaction, sexual distress, and anxiety. Data was analyzed using the Actor-Partner Interdependence Model to account for the non-independence of the data.

Subsequent fertility, pregnancy, and gynecologic outcomes after fetoscopic laser therapy for twin-twin transfusion syndrome compared with normal monochorionic twin gestations

An improved survival and quality of life for neonatal survivors after fetoscopic laser therapy for twin-twin transfusion syndrome has been reported. However, little is known about the medium-term maternal effects after fetoscopic laser therapy with respect to reproductive and gynecologic outcomes. The objective of this study was to document reproductive, obstetric, gynecological, and psychological outcomes in women who underwent fetoscopic laser therapy for twin-twin transfusion syndrome. This was a monocentric controlled study on consecutive women who underwent fetoscopic laser therapy for twin-twin transfusion syndrome between 2007 and 2013 at the University Hospitals Leuven (cases; n= 198). Controls were women followed up during the same time period for an uncomplicated monochorionic diamniotic twin pregnancy and with an uneventful course (controls; n= 211). All patients received a questionnaire inquiring on their fertility, later pregnancies, and gynecological outcomes. The response rate was 50.4% (cases: n= 95; controls: n=109). Most baseline characteristics were similar across both groups. Women in the fetoscopic laser therapy group attempted a new pregnancy more frequently (34% [31 of 92] vs 21% [22 of 107] in controls; P < .05) and became pregnant more often (100% [31 of 31] vs 82% [18 of 22]; P<.05).We observed a shorter interpregnancy interval in cases than controls (median interval, 12 [interquartile range, 5-27] vs 24 [interquartile range, 15-30] months) (P < .05). This was also observed in cases who lost one or both fetuses or babies in the index pregnancy (median interval, 9 [interquartile range, 3.5-25.5] months; P < .05). The complication rate during subsequent pregnancies (26% [8 of 31] vs 11% [2 of 19]; P=.194) and at delivery (17% [5 of 30] vs 11% [2 of 19]; P= .554) were comparable. More women who underwent fetoscopic laser coagulation reported relevant psychological symptoms (44% [40 of 92] vs 21% [23 of 107]; P < .05). When only women in whom there was a double-surviving twin pair were considered, there were no differences in psychological symptoms compared with controls (16% [15 of 55] vs 21% [23 of 107]; P= .411). Gynecological problems were equally frequent in both groups (20% [18 of 92] vs 31% [33 of 107]; P= .069). No adverse medium-term maternal effects with respect to fertility, obstetric, and gynecological outcomes were observed after fetoscopic laser therapy. However, these women reported more psychological or emotional problems than women with monochorionic diamniotic who did not have laser therapy, in particular when this was complicated by a fetal loss.

Injuries of Women Surviving Intimate Partner Strangulation and Subsequent Emergency Health Care Seeking: An Integrative Evidence Review

IntroductionNonfatal strangulation by a current or former intimate partner is a distinct mechanism of violence with the potential for severe injury or death. As nonfatal strangulation has gained recognition for its significant medical and legal implications, there have been multiple calls for nursing and other health care providers to improve practices related to strangulation screening, assessment, and treatment. Given that US estimates suggest higher prevalence of strangulation of women than of men, this integrative evidence review examines existing literature related to women’s injuries and their subsequent experiences in seeking health care after surviving intimate partner strangulation. MethodsFollowing PRISMA guidelines, 5 electronic databases were searched, ultimately resulting in 13 articles for inclusion. ResultsOverall, nonfatal intimate partner strangulation was associated with multiple negative physical and psychological outcomes for women, although only 5% to 69% of strangled women sought health care in studies reporting this finding. DiscussionNonprobability sampling, participant self-reports, and relatively small sample sizes were frequently encountered limitations across studies. Heterogeneity of women’s ages and race/ethnicities also limited comparisons. However, existing research provides a beginning framework to support practice and future inquiry.Image 1

Influence of the disease label 'polycystic ovary syndrome' on intention to have an ultrasound and psychosocial outcomes: a randomised online study in young women.

Does the disease label 'polycystic ovary syndrome' (PCOS) have an impact on desire for medical testing and psychosocial outcomes? When given the disease label PCOS in a hypothetical scenario, participants had higher intention to have an ultrasound, perceived the condition to be more severe and had lower self-esteem than those not given the disease label. Widening diagnostic criteria and improved imaging sensitivity have increased the number of reproductive-aged women diagnosed with PCOS from 4% to 8% to up to 21%. The uncertain clinical benefit of knowing this diagnosis needs to be weighed against the potential for poor psychological outcomes in women labelled with PCOS. This experimental online study randomised 181 young women to receive one of four hypothetical scenarios of a doctor's visit in a 2 (PCOS disease label versus no disease label) x 2 (information about unreliability of ultrasounds in clarifying diagnosis versus no information) design. Participants were university students (mean age: 19.4). After presenting the scenario, intention to have an ultrasound, negative affect, self-esteem, perceived severity of condition, credibility of the doctor and interest in a second opinion were measured. Participants were then presented with a second scenario, where the possibility of PCOS overdiagnosis was mentioned. Change in intention and perceived severity were then measured. Participants given the PCOS label had significantly higher intention to have an ultrasound (mean = 6.62 versus mean = 5.76, P = 0.033, 95% CI(difference) = 0.069-1.599), perceived the condition to be more severe (17.17 versus 15.82, P = 0.019, 95% CI(difference) = 0.229-2.479) and had lower self-esteem (25.86 versus 27.56, P = 0.031, 95% CI(difference) = -3.187 to -0.157). After receiving overdiagnosis information, both intention and perceived severity decreased, regardless of condition (both P < 0.001). This study used hypothetical scenarios; it is likely that for women facing a real diagnosis of PCOS, outcomes would be more affected than in the current study. The hypothetical design, however, allowed the symptoms and risks of PCOS to be held constant across conditions, the impact on intention and psychosocial outcomes directly attributable to the effect of the disease label. These findings demonstrate the potential negative consequences of PCOS labelling. It is crucial we consider the impact of the label before diagnosing more women with PCOS when clinical benefit of this diagnosis is uncertain. This paper was written with support from a NHMRC grant awarded to the Screening and Test Evaluation Program. J.J. is supported by an NHMRC Early Career Fellowship. K.M. is supported by an NHMRC Career Development Fellowship. The authors declare that no competing interests exist. ACTRN12617000111370. 20/01/2017. 01/06/2015.