Women Of Age Research Articles

Factors Influencing Modern Family Planning Utilization and Barriers in Women of Reproductive Age in the Iringa Region, Tanzania: A Mixed-Methods Study.

Preventing unwanted pregnancies, achieving optimal child spacing, and improving quality of life are benefits of modern family planning (FP). This study aimed to assess modern FP use, identify the factors influencing its use and determine the barriers to FP use among women of reproductive age. A mixed-methods approach was conducted in the Iringa Region between March and July 2022. Conveniently, 368 women of reproductive age were included in the quantitative study, and 48 were purposively selected for the qualitative study based on reported barriers to using modern FP. Interviewer-administered questionnaires and interview guides were used for data collection. The factors of modern FP use were determined using multivariable logistic regression analysis. The p < 0.05 was considered to be significant. For qualitative data, all interviews were recorded and transcribed. Data were analyzed manually through thematic analysis. The prevalence of modern FP use was 181 (49%). Being married (adjusted odds ratio [AOR] = 5.44, 95% confidence interval [CI] = 1.77-16.73, p = .003), parity of 6 and more (AOR = 2.43, 95% CI = 1.99-5.95, p = .052), availability of modern FP methods (AOR = 1.71, 95% CI = 1.03-2.85, p = .038), and women with primary education level (AOR = 2.99, 95% CI = 1.03-3.25, p = .001), women with secondary and higher education (AOR = 3.53, 95% CI = 1.41-4.38, p = .001), were predictors for modern FP utilization. Four main themes merged (1) individual barriers, (2) hospital barriers, (3) cultural barriers, and (4) knowledge of modern FP methods. The use of modern FP increases with women's education. There is a need for the government to invest in women's education and raise awareness and knowledge of the benefits of modern FP methods.

Trends in breast cancer among elderly women: Development in estrogen and HER2 subtypes in the last ten years.

Increasing life expectancy increases breast cancer (BC) rates in elderly, where better health allows for improved tolerance of treatments. We assessed trends in BC incidence of tumor subtypes for women with focus on the elderly. Changes in BC incidence in women by age from 2012 to 2021 were assessed using data from the Nordic countries. We calculated the incidence of BC subtypes by age group using data from the Danish Breast Cancer Group (DBCG) database. We used generalized linear models assuming a Poisson distribution. In the Nordic countries, 205305 women were diagnosed with BC between 2012 and 2021. In Denmark, 50858 BC patients were diagnosed between 2012 and 2022, identified with tumor characteristics. Incidence of BC among women aged 80+ increased significantly across the Nordic Countries, with 1.24% per year (95% CI: 0.07 %: 2.41 %). In Denmark, in the 80+ group, the ER+/HER2- subtype had the highest increase, with 1.98% per year (95% CI: 1.10 %: 2.87 %). Across the Nordic countries, incidence of BC in women aged 80+ increased. In Denmark, rising incidence of BC is driven by the ER+/HER2- subtype in the 80+ group, which has the best prognosis and gentle treatments. More elderly BC patients will require treatment and follow-up in the future.

Low maternal iodine intake and subsequent risk of pharmacologically treated hypertension: A population-based prospective cohort study.

Iodine deficiency is linked to multiple adverse health outcomes, but there is scarce knowledge regarding iodine intake and development of chronic hypertension. We aimed to investigate the prospective association between habitual dietary iodine intake and pharmacologically treated hypertension in mothers up to 10 years after delivery. The present study is based on data from an ongoing pregnancy cohort and includes 58,629 women without thyroid dysfunction and hypertension at baseline. The study outcome was new-onset hypertension defined according to antihypertensive medication use initiated 90 days after delivery registered in the national prescription database. We estimated hazard ratios (HR) with 95% Confidence Intervals (95% CI) using Cox regression models. During a median follow-up duration of 7.1 years, a total of 1422 (2.4%) women developed new-onset hypertension. There was a non-linear association between dietary iodine intake and new-onset hypertension. Women with iodine intakes lower than 100μg/day had significantly higher risk than those with iodine intakes in the recommended range 150-199μg/day (adjusted HR, 1.29; 95% CI: 1.09, 1.53). This was evident in normotensive pregnancies (adjusted HR 1.25; 95% CI: 1.01, 1.54) and in women with gestational hypertension (adjusted HR 1.35; 95% CI: 1.00, 1.83). The association between low iodine intake and hypertension remained in all sensitivity analyses considering pre-pregnancy and pregnancy-related factors. This study suggests that women with iodine intakes below 100μg/day have a higher likelihood of new-onset hypertension and adds supporting evidence to the importance of correcting mild-to-moderate iodine deficiency in women of reproductive age.

Reproductive functions and fertility preservation in transgender men: A French case series.

Transgender men face reproductive challenges due to the potential impact on fertility of gender-affirming hormone therapy (GAHT) and surgical interventions. Testosterone therapy during "female to male" transition leads to anovulation and amenorrhea. Although these effects are typically reversible upon stopping treatment, the long-term effects of androgens on future fertility and health of potential children remain poorly known. Despite being long overlooked, the desire for parenthood is a significant reality among transgender men. Advances in medical techniques and legislative changes now make fertility preservation (FP), primarily through oocyte cryopreservation, possible for transgender men. Yet, published data on FP outcomes for this population are still limited. We conducted a retrospective study to compare ovarian stimulation outcomes between transgender men and presumed fertile women from an oocyte donation program. Between June 2018 and February 2022, 118 transgender men were referred to the FP consultation, of whom 13 ultimately underwent FP through oocyte vitrification following ovarian stimulation. These 13 individuals were compared to a control group of 13 matched female oocyte donors. We did not observe any significant difference in the clinical and biological outcomes of ovarian stimulation, including duration of stimulation, total FSH dose administered, number of oocytes retrieved, and number of mature oocytes obtained. Our experience suggests that FP through oocyte vitrification after ovarian stimulation is feasible and effective for transgender men, with outcomes comparable to those of cisgender women of the same age. Larger studies are necessary to validate these findings and assess the long-term success rates.

Effects of Chlorpyrifos on gut dysbiosis and barriers integrity in women with a focus on pregnancy and prebiotic intervention: Insights from advanced in vitro human models.

Chlorpyrifos (CPF), a commonly used organophosphate pesticide, poses potential risks to human health, particularly affecting the gut microbiota (GM), intestinal barrier (IB), and blood-brain barrier (BBB). CPF-induced gut dysbiosis compromises the integrity of both the IB and the BBB, leading to increased intestinal permeability, inflammation, and bacterial translocation, all of which may impact neurological health. Although CPF's effects on the GM are documented, limited research explores how these impacts differ in women, particularly during pregnancy. To address this gap, this study investigates CPF's effects using three advanced human in vitro models: the Simulator of the Human Intestinal Microbial Ecosystem (SHIME®) to mimic the gut environment of women of child-bearing age and pregnant women, a Caco-2 model for the IB, and a BBB model to assess CPF's effects and the protective role of the prebiotic inulin. Microbiological analyses of SHIME® supernatants, including bacterial culture and quantification of short-chain fatty acids (SCFAs) and CPF metabolites, were conducted to assess gut composition and pesticide degradation. We also examined the effects of CPF-induced dysbiosis on IB and BBB permeability to FITC-Dextran, focusing on bacterial translocation after 4h of exposure to CPF-treated SHIME® supernatants. Our results revealed significant intestinal imbalance, marked by an increase in potentially pathogenic bacteria in the GM of both non-pregnant and pregnant women exposed to CPF. This dysbiosis led to a significant shift in SCFAs ratio and increased IB permeability and bacterial translocation across the IB, but not the BBB. Notably, inulin supplementation restored GM balance and prevented bacterial translocation, highlighting its potential as a preventive measure against CPF-induced dysbiosis. This study enhances our understanding of the health risks associated with CPF exposure in women, with implications for maternal and fetal health, and underscores the importance of considering physiological states such as pregnancy in toxicological research.

Current management of acute appendicitis in adults: What you need to know.

Acute appendicitis is one of the most common acute surgical diseases in the world today. Acute appendicitis can present with a well-recognized clinical presentation with abdominal pain which localize in the right lower quadrant. This presentation is more typical in men than in women of child baring age. Several clinical and laboratory calculations can be used to increase the likelihood of making a correct diagnosis. Various imaging modalities can be used to make the diagnosis which include ultrasound, computer tomography, and magnetic resonance imaging. Each study has well known sensitivity/specificity of positive predictive value of making the diagnosis of appendicitis. The management of acute appendicitis is based on the presentation of the patient and dividing it into uncomplicated and complicated disease. Each requires management with antibiotics and followed with timely appendectomy. Recent studies have demonstrated nonoperative management of uncomplicated appendicitis without no fecalith that can be managed with antibiotics alone. Complicated acute appendicitis should undergo timely surgical intervention. Patients presenting with a large appendiceal abscess or phlegmon should undergo percutaneous drainage and antibiotic management. There are certain patient populations that should be considered for surgical intervention. Pregnant patients as well as immunosuppressed patients should undergo timely surgical intervention to decrease the risk of complications. This review outlines the current principles of the diagnosis, imaging, and treatment of acute appendicitis based on the best available evidence of acute appendicitis in adults.

Too busy with the "rat race" to have kids? Longitudinal evidence on the impact of peer grit on the fertility of reproductive-age women in China.

China is currently facing a notable decline in fertility rates. This research introduces a novel perspective on the factors influencing fertility among women of reproductive age, representing the first attempt to examine the impact of peer grit on female fertility. Analyzing nationally representative panel data from China and leveraging plausibly exogenous variations in peer exposure across cohorts, we find that peer grit is associated with a reduction in fertility behavior and intentions. The negative effects of peer grit are robust across alternative measures of core metrics and estimation techniques addressing endogeneity concerns. Additionally, our findings suggest that the influence of peer grit on women's fertility behavior and intentions may be mediated by changes in educational attainment and employment stability, operating through a mechanism known as the demonstration effect.

Risk of postpartum depression in women with allergic disorders: A nationwide cohort study involving 1,017,507 women

BackgroundAllergic symptoms and depression are prevalent ailments in childbearing age women. This study assessed the risk of maternal postpartum depression (PPD) associated with prenatal allergic disorders. MethodsFrom 1,017,507 eligible women of 20–49 years old with singleton live births and 20-week or more gestational age in the birth registry of Taiwan, from 2011 to 2020, we identified cohorts with and without allergic disorders matched by propensity score in the size of 457,826. Cumulative incident PPDs in one year after births were assessed from insurance claims data. Odds ratios (OR) of PPD were measured by each allergic type and multiple types, comparing with the controls. ResultsWith an overall cumulative PPD incidence 1.25-fold higher in the allergic cohort than in the controls (0.69 % versus 0.55 %), the rate was the highest in women with asthma: 0.94 % with an adjusted OR of 1.71 (95 % CI = 1.49–1.95), followed by those with allergic rhinitis, allergic conjunctivitis and atopic dermatitis. The rate increased from 0.65 % for those with one allergic disorder to 1.06 % for those with 4 or 5 disorders, and the corresponding adjusted OR increased from 1.17 (95 % CI = 1.10–1.24) to 1.92 (95 % CI = 1.36–2.69). LimitationThe claims data lack detailed information on socio-demographic status, lifestyle, laboratory result, physical activity, and family medical history. ConclusionsWomen with prenatal allergic disorder(s) are at an increased risk of PPD in addition to the impact of pregnancy. Prompt and efficient intervention for PPD prevention is needed for women with allergic disorders, particularly for those with asthma and multiple disorders.

Development and validation of a risk prediction model for gestational diabetes mellitus in women of advanced maternal age during the first trimester.

With the global rise in advanced maternal age (AMA) pregnancies, the risk of gestational diabetes mellitus (GDM) increases. However, few GDM prediction models are tailored for AMA women. This study aims to develop a practical risk prediction model for GDM in AMA women. Data were obtained from a prospective observational cohort of AMA pregnant women from the Obstetrics and Gynecology Hospital in Shanghai, China. Singleton pregnancies with complete OGTT results at 24-28 weeks were selected and divided into training (70%) and validation (30%) sets. First-trimester predictors, including demographic, metabolic parameters, and clinical history, were evaluated for statistical significance. A multivariate logistic regression model was developed, with performance evaluated using receiver operating characteristic (ROC) curves and calibration plots. Predictors were primarily incorporated as categorical variables in a nomogram to enhance model convenience. A model using continuous predictors was also tested for comparison. A total of 1904 AMA women were included, with GDM incidence rates of 18.3% (243/1333) in the training set and 19.3% (110/571) in the validation set. Significant predictors for GDM diagnosis at 24-28 weeks included maternal age, GDM history, first-trimester fasting plasma glucose, mean arterial pressure, and triglyceride levels. The categorical model achieved an area under the ROC curve of 0.717 (95% CI: 0.682-0.753) in the training set and 0.702 (95% CI: 0.645-0.758) in the validation set. The Hosmer-Lemeshow test indicated good calibration (p = .97 in the training set; p = .66 in the validation set). The model with category and continuous predictors exhibited similar performance. This study developed and validated a practical early risk prediction nomogram for GDM in AMA women, using commonly available clinical data. The model shows good predictive performance and is resource-efficient, making it suitable for real-world clinical implementation.

Exploring knowledge, attitudes, and the use of modern contraceptive methods among women of reproductive age in Abuja, Nigeria

Contraceptive use in Sub-Saharan Africa, including Nigeria, is critically important for reducing unintended pregnancies, unsafe abortions, and maternal mortality. This study investigates the knowledge, attitudes, and practices regarding modern contraceptive methods among women of reproductive age (15–49 years) in Gwarinpa, Abuja, Nigeria. Using a descriptive cross-sectional design, data were collected from 206 women through a semi-structured electronic questionnaire. The study found that 71% of participants used modern contraceptive methods, with oral contraceptives being the most popular. A majority (85%) had favourable attitudes towards contraceptive use, and 88.3% were aware of the benefits of modern contraceptives. However, cultural and religious opposition (42%) posed significant barriers. Despite concerns about side effects, the study revealed that access to contraception was generally not a major issue. Health facilities played a major role in providing information, though other sources, such as the Internet and social networks, were also influential. The study suggests that targeted interventions are needed to overcome cultural barriers and improve contraceptive uptake, particularly in rural and underserved areas, contributing to better maternal health outcomes in Nigeria.

Screening of Oxidative Stress-related Biomarkers and Antioxidant Drugs for Polycystic Ovary Syndrome Based on Bioinformatics and Molecular Docking.

Polycystic ovary syndrome (PCOS) is a prevalent endocrine and metabolic disorder affecting women of reproductive age. Oxidative stress (OS) is suggested to play a significant role in the development of PCOS. Using antioxidants to reduce OS and maintain a healthy balance in the body could be a novel treatment approach for PCOS. This study analyzed transcriptome data from the Gene Expression Omnibus database, focusing on genes associated with OS. By implementing two machine learning algorithms, three OS-related biomarkers-HMOX1, MMP9, and KLF2-were successfully identified. To evaluate the diagnostic potential of these biomarkers, a Logistic regression model was employed. Additionally, granulosa cells were collected from healthy individuals and infertile women with PCOS, and the reliability of HMOX1, MMP9, and KLF2 was verified by quantitative real-time PCR experiments. Furthermore, small molecule drugs targeting proteins encoded by genes HMOX1 and MMP9 were predicted through the Drug Signature Database. Molecular docking of drugs to proteins identified two antioxidants, butein and demethoxycurcumin, as potential candidates for PCOS therapy.

Association between changes in genital immune markers and vaginal microbiome transitions in bacterial vaginosis

Bacterial vaginosis (BV), characterized by an imbalance in the vaginal microbiota, is a prevalent condition among women of reproductive age and a risk factor for human immunodeficiency virus, sexually transmitted infections, and preterm birth. BV is generally considered to induce mucosal inflammation, but the specific pathways and cell types involved are not well characterized. This prospective study aimed to assess associations between microbial changes and mucosal immune responses in BV patients. Therefore, samples from 20 premenopausal women with BV and treated with metronidazole were analyzed. Vaginal swabs, menstrual cup, and endocervical cytobrush samples were collected before treatment, weekly for four weeks, and at 2, 4, and 6 months for Nugent scoring, immune cell populations and cytokine analysis. Of 105 study intervals, 27 (25.7%) showed improvement in Nugent category, 61 (58.1%) remained unchanged, and 17 (16.2%) worsened. Improvement correlated with decreased monocytes (p = 0.005), while worsening was linked to increased monocytes (p < 0.001) and dendritic cells (p = 0.02). B cells (p = 0.02) and IFN-γ-induced chemokines - IP-10 (p = 0.007), MIG (p = 0.049), and ITAC (p = 0.005) - were associated with improvement. In conclusion, although the T-cell-associated chemokines IP-10, ITAC, and MIG were strongly associated with improvements in Nugent category, our findings indicate that antigen-presenting cells, particularly monocytes, show the most dynamic response to shifts in the vaginal microbiota in patients with BV.

Construction of tetrahedral mesh phantom for Chinese women of childbearing age.

Although the Boundary Representation (BREP) method creates detailed surface phantoms of Chinese women of childbearing age, these phantoms cannot be directly used in Monte Carlo simulations. They must first be converted into voxel phantoms, a process that may diminish some of the inherent advantages of the surface phantoms. Therefore, the aim of this study is to construct a tetrahedral mesh (TM) phantom of Chinese women of childbearing age based on the BREP phantom, incorporating micron-level structural refinements to certain organ tissues while maintaining the original model's structure. This TM phantom can be directly implemented into Monte Carlo codes to calculate the absorbed dose at different photon energies, demonstrating that both the structure and position of organ tissues affect the radiation dose. By achieving more accurate dose assessments, we can optimize radiation protection measures and reduce the potential risks to women of childbearing age.&#xD.

Does pregnancy in adolescence increase the chances of osteoporosis among aged women? Findings from the ELSI study.

Bone mineral density changes during the life span, rising rapidly during adolescence, plateauing around 30 years of age and decreasing in later years. Life events such as pregnancy and lactation temporarily reduce bone density, and their long-term effects on osteoporosis development are still unclear. This study aimed to analyse the association between pregnancy in adolescence and osteoporosis in aged women. This was a cross-sectional study conducted with data from the ELSI-Brazil baseline (2015-2016). The sample consisted of 2634 women aged 60 years old or over with complete information for the variables of interest. Data collection was conducted through individual home interviews and physical assessments. The dependent variable was osteoporosis and the independent variable of interest was pregnancy in adolescents under 20 years of age. The association between the variables was tested using multiple logistic regression. The prevalence of osteoporosis was 32%, and the percentage of women who reported pregnancy in adolescence was 38%. After adjusting for socio-economic and health variables, an association was observed between pregnancy in adolescence and osteoporosis (OR = 1.38; 95% CI = 1.09-1.73), which indicates that specific bone health interventions for teenage mothers could help prevent osteoporosis later in life. Women who reported pregnancy before age 20 were more likely to report osteoporosis in old age, indicating that pregnancy in adolescence can be a criterion for directing actions to prevent osteoporosis in aged women.

Global burden and trends of severe periodontitis among women of childbearing age, 1990-2021.

The global burden and trend of severe periodontitis, as well as its association with sociodemographic development, among women of childbearing age (WCBA) have been unclear so far. This study aims to assess the epidemiological pattern of severe periodontitis in WCBA from 1990 to 2021 and provide projections through 2040. Data on the incidence, prevalence, and disability-adjusted life years (DALYs) of severe periodontitis among WCBA from 1990 to 2021 were retrieved from the Global Burden of Disease (GBD) study 2021. The Bayesian age-period-cohort model was run to project the age-standardized incidence rate (ASIR) through 2040. In 2021, an estimated 26,315,786 incident cases, 257,234,399 prevalent cases, and 1,680,425 DALYs were reported globally. From 1990 to 2021, a consistent annual increase in the age-standardized rate of severe periodontitis was observed, and the ASIR is projected to continue to rise until 2040. Additionally, the burden of severe periodontitis demonstrated a downward trend with increasing sociodemographic development. In 2021, age-specific rates of severe periodontitis increased with age, with the most significant changes occurring in younger age groups. The rising global burden of severe periodontitis, along with regional and age variations, highlights the urgent need for innovative prevention and healthcare strategies to reduce this burden among WCBA globally. Women of childbearing age (WCBA) represent nearly a quarter of the global population, yet there is a significant gap in consistent global and regional surveillance data on severe periodontitis in this group. Our study revealed that severe periodontitis among WCBA poses a substantial public health challenge worldwide. From 1990 to 2021, the age-standardized rate of severe periodontitis increased globally, with the most significant rise observed in regions with middle socioeconomic development. This condition disproportionately affects women in their prime years, with the fastest growth seen among younger WCBA. It is essential that healthcare providers recognize the gender disparities and societal factors related to socioeconomic development that contribute to the risk of severe periodontitis in this population. To address this issue effectively, it is crucial to develop region- and age-specific prevention strategies, as well as targeted healthcare interventions.

Considering the nutritional benefits and health implications of red meat in the era of meatless initiatives

Driven by perceived health and environmental benefits, initiatives to remove red meat from recommended eating patterns are increasingly being implemented in United States institutions, including schools and hospitals. While these efforts aim to address important issues, they may inadvertently lead to unintended consequences, particularly regarding essential nutrient intake for certain populations. This perspective considers the nutritional value of red meat, examines its potential health benefits, and highlights nutritional risks when intake is reduced or eliminated. Red meat is a nutrient-dense food that provides highly bioavailable protein and several essential micronutrients often lacking in the diet, including iron, zinc, and vitamin B12. These nutrients can be limited or absent in many plant-source foods as well as in some animal-source foods. Red meat’s micronutrient profile is especially valuable for young children and women of reproductive age, including pregnant women. In addition, the protein density of red meat is beneficial for individuals managing obesity and older adults at risk of sarcopenia. Many epidemiological studies suggest potential associations between excessive red meat consumption and increased risk of certain chronic diseases, but this evidence does not conclusively implicate red meat in the development or progression of chronic disease. The nutritional and health implications of reducing red meat consumption must be balanced against the low certainty of evidence used to discourage red meat intake when making dietary recommendations.

Reproductive Health Problems Among Women in Selected Terai Districts of Nepal: A Critical Medico-Legal Assessment

Reproductive health challenges persist among women in Nepal's Terai districts, posing a considerable public health burden. The aim is to investigate the prevalence and determinants of reproductive health issues, including Pelvic Inflammatory Disease (PID), Pelvic Organ Prolapse (POP), cervical lesions, cervical cancer, and their associated risk factors. This research utilizes a mixed-methods strategy to thoroughly investigate reproductive health issues among women of reproductive age in specific Terai districts of Nepal. The quantitative aspect of the study encompasses a cross-sectional survey administered to 570 women, employing Slovin's formula for sample size determination and pretested semi-structured questionnaires. Through the saturation theory, along with in-depth exploration and targeted analysis, 40 participants were interviewed, enabling a comprehensive understanding of the investigated phenomenon. The obtained data was analyzed in SPSS with the level of significance &lt;0.005 level. The results indicate a high prevalence of uterine prolapse (42.5%) and cervical cancer (57.5%) within the surveyed population. Pelvic Inflammatory Disease POP, cervical lesions, and cervical cancer are notably linked to various factors including age, ethnicity, economic status, health-seeking behavior, age at first childbirth, nutritional status, and workload (p&lt;0.005). Qualitative analysis identified underlying factors contributing to these reproductive health challenges and insights into health-seeking behavior and treatment practices. These findings highlight the critical need for tailored interventions and healthcare initiatives to tackle the prevalent reproductive health issues. Enhanced awareness of available reproductive health services is crucial for women's well-being. This study offers valuable insights into the complex landscape of reproductive health problems in Nepal's Terai region, laying the groundwork for evidence-based interventions and policy development aimed at enhancing the reproductive health outcomes for women in this demographic.

Valproate discontinuation in girls and women of childbearing age with epilepsy: An Italian multicenter retrospective study on prescribing patterns and outcomes.

This study aimed to identify prescribing behaviors in women of childbearing potential (WOCP) with epilepsy already taking valproate (VPA), and to investigate the relationship between VPA maintenance, substitution, reduction, or withdrawal as part of polytherapy, and seizure worsening or relapse. We retrospectively reviewed the prescription behaviors and seizure outcomes in WOCP (16-50 years of age) with epilepsy, referred to eight Italian epilepsy centers, who were taking VPA for at least 1 year between 2014 and 2019. Among 750 women (~12% of all WOCP), 528 (70.4%) maintained VPA unchanged throughout the observation period, 103 (13.7%) replaced VPA with another antiseizure medication (ASM), 90 (12%) reduced VPA, and 29 (3.9%) discontinued VPA in polytherapy. Focal epilepsy was most strongly associated with VPA withdrawal (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.38-6.38), whereas generalized epilepsy was most associated with its non-withdrawal (reduction/switch/maintenance) (OR .31, 95% CI .14-.68). Intellectual disability, higher seizure frequency, and higher VPA doses were linked to VPA continuation. VPA withdrawal from polytherapy was associated with a higher risk of tonic-clonic seizure worsening (OR 2.91, 95% CI 1.09-7.77) compared to non-withdrawal. VPA was rarely withdrawn or substituted in WOCP with epilepsy, in secondary and tertiary care settings following European regulatory restrictions. This likely reflects a population with severe epilepsies where VPA is difficult to replace; whereas women with milder epilepsies likely discontinued VPA earlier, as evidenced by its low overall prescription frequency. Withdrawal of VPA from a polytherapy regimen was associated with a threefold increased risk of seizure exacerbation.

The effect of circuit training on muscle synthesis’s indices, neurotrophic factors, and physical fitness in elderly women: a randomized controlled trial

The effect of circuit training on muscle synthesis’s indices, neurotrophic factors, and physical fitness in elderly women: a randomized controlled trial

Optimizing iron absorption: Superiority of alternate day dosing

Dear Madam, Pakistan is one of the leading countries in iron deficiency and iron deficiency anaemia, ranking 2nd in South Asia, involving 53% of children under the age of 5 years along with 41.7% of women of reproductive age.[1] Last assessed by the National Nutritional Survey (year of the survey?). Pakistan had suffered a total economic loss, over 10 year period of 12.25 billion dollars which makes it essential to focus on controlling risk factors to prevent this prevailing issue.[2] This can be done by the use of iron supplements. In a randomised double-blind placebo-controlled study, patients receiving iron supplementation on alternative days for 6 months as opposed to consecutive day-intake for 90 followed by a placebo for a subsequent 90 days were studied. While the baseline variables showed little difference amongst the two groups, after 6 months the prevalence of iron deficiency was 11.4% in the consecutive day group versus 3% in the alternative day group (P= 0.049.) Despite the variation in serum ferritin at days 46 and 93, 4 months post treatment, median serum ferritin remained higher in the alternate day group as compared to the consecutive day group(P=0.03.). At equal iron doses, in consecutive and alternate day groups, the latter experienced fewer gastrointestinal adverse effects. Serum hepcidin was consistently higher in the consecutive-day group at various points (P &lt; 0.001), with a significant difference at the end of treatment. This can be attributed to the upregulation of serum hepcidin by acute intake of iron doses and the resulting increase in liver stores over the course of 3 months.[3] This corroborated previous research that dosing oral iron intake in this method held superiority in efficacy and in lowering iron deficiency amongst individuals. The general population should be aware of the correct use of iron supplements to ensure maximum efficacy as awareness has been found to significantly impact adherence. .[4] Studies in Pakistan have not investigated this aspect of iron supplementation and it is essential that such aspects be explored in a third world country like Pakistan as alternate day iron supplementation would prove to be more economical for patients. Also, reduced Gastrointestinal side effects would improve patient compliance leading to more favourable results. Moreover, physicians should also be made aware to ensure proper counselling of patients leading to favourable outcomes.