Women In High-income Countries Research Articles

Translating biological insights into improved management of endometrial cancer.

Endometrial cancer (EC) is the most common gynaecological cancer among women in high-income countries, with both incidence and mortality continuing to increase. The complexity of the management of patients with EC has evolved with greater comprehension of the underlying biology and heterogeneity of this disease. With a growing number of novel therapeutic agents available, emerging treatment regimens seem to have the potential to helpto address the concerning trends in EC-related mortality. In this Review, we describe the epidemiology, histopathology and molecular classification of EC as well as the role of the new (2023) International Federation of Gynecologists and Obstetricians (FIGO) staging model. Furthermore, we provide an overview of disease management in the first-line and recurrent disease settings. With increasing use of molecular profiling and updates in treatment paradigms, we also summarize new developments in this rapidly changing treatment landscape.

Maternal birthplace and experiences of perinatal healthcare in Belgium: Evidence from a cross-sectional survey

BackgroundPatient experience is an important part of perinatal care quality. Migrant women in high-income countries often report more negative experiences than non-migrants, but evidence in Europe is patchy. In this study, we compared the experiences of two migrant populations with non-migrants, taking into account socioeconomic characteristics. MethodsWe surveyed mothers born in Belgium, North-Africa, and Sub-Saharan Africa (n = 877) using an adapted version of the Migrant-Friendly Maternity Care Questionnaire. Two patient experience scores were created using multiple correspondence analyses: a) information and communication with healthcare professionals and overall satisfaction with pregnancy care, and b) patient-centred aspects and satisfaction with delivery care. Through descriptive analyses and multivariable logistic regressions we estimated the associations of maternal characteristics with each score. ResultsOverall, positive experiences were reported in terms of communication (83 %) and patient-centred care (86 %). North African immigrants with low language proficiency had higher odds of negative communication experience (especially problems understanding information) (ORa: 2.30, 95 %CI 1.17–4.50), regardless of socioeconomic position. Among women with language barriers, 88 % were never offered a professional interpreter, relying on family members for translation. Patient-centred care was not associated with maternal birth region but was rated more negatively by older mothers, those with longer residence in Belgium, and higher majority-language proficiency. ConclusionIn Belgium, perinatal care experiences were generally positive, although communication with immigrants was suboptimal. Language barriers, single motherhood, and unstable housing increased communication issues. Our findings underline the necessity to improve information-exchange with immigrants and socioeconomically vulnerable women.

Evaluating Validated Diet Quality Indices Used in Pregnant Women in High-Income Countries: A Systematic Review.

Diet quality indices (DQIs) assess the level of adherence to dietary recommendations and a specified dietary pattern in populations; however, there is limited evidence regarding the construct criteria and validation methodology of DQIs used in pregnant women. The objectives of this study were to (i) identify and describe characteristics of DQIs that have been validated for use in pregnant women in high-income countries, and (ii) evaluate criteria used to develop DQIs and validation methodologies employed. CINAHL, Embase, Medline, SCOPUS, and Web of Science were systematically searched for eligible articles published between 1980 and November 2022 that focused on DQIs validated for use in pregnant women from high-income countries. Characteristics, development criteria, and validation methodologies used in the included articles were extracted by one reviewer and checked by a second reviewer. A narrative synthesis and descriptive statistics were used to summarize the review findings. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Six articles with 5 validated DQIs were identified. In total, 3777 participants were included - five articles had pregnant women aged 31-50 years and in their second trimester. Food frequency questionnaires were used as the dietary assessment method in all studies, and 3 DQIs were used to assess dietary intake at 1 time point, using 2 different dietary assessment methods. No indices fulfilled preferred features for the DQI development criteria developed by Burggraf et al (2018). Construct validity was assessed by all DQIs, followed by criterion validity (n = 4) and test-retest reliability (n = 2). Limited high-quality validated DQIs for use in pregnant women in high-income countries were identified. Scoring for DQI components were not specific to nutrient requirements for pregnant women. Findings from this review may inform the development of DQIs that evaluate specific dietary requirements and specific food safety considerations applicable to pregnancy. https://osf.io/u2hrq.

#796 Obstetric nephrology in Europe: a survey of nephrologists’ self-reported experience and training

Abstract Background and Aims Chronic kidney disease (CKD) is estimated to affect 3% of pregnant women in high-income countries. The prevalence of CKD in pregnancy is predicted to rise due to advancing maternal age, obesity, and co-morbidities. There is a paucity of evidence regarding nephrologists’ experience in and exposure to women's health in Europe. North American literature reports two thirds of nephrologists self-reported a lack of confidence in women's health issues. This survey aimed to assess the confidence in and exposure to women's health among nephrologists in Europe. Method An anonymized online survey was conducted using the survey monkey platform from March to April 2023. A validated survey was utilised to ensure internal and external validity with minimal modifications made (Hendren, 2019). It was disseminated via email to Irish Nephrology Society membership, via link sharing on social media and messaging applications. Results were analysed using GraphPad prism. Results Demographics: A total of 75 participants responded, of those 52 identified as practising in Europe (22 Ireland and 30 other European countries). The results of respondents from Europe are detailed below. 63.46% (33) of respondents identified as female. 9.61% (5) were under 30 years of age, 42.3% (22) were aged from 30-40 years, 23.07% (12) were aged from 40-50 years, 23.07% (12) were aged from 50-60 years, and 1.92% (1) respondent over 60 years of age. Service provision: Women with kidney disease who are planning pregnancy are seen by the following Physicians: General or Transplant Nephrologist 63.46% (33), Nephrologist who specializes in pregnancy 42.31% (22), High Risk Obstetrician or Maternal Foetal Medicine Specialist 38.42% (20), Specialized interdisciplinary kidney disease in pregnancy clinic (Obstetrician and Nephrologist) 26.92% (14),Primary care doctor/family doctor 15.38% (8), Obstetrical Internal Medicine specialist 7.69% (4). Women with kidney disease who are pregnant are seen by the following Physicians: Nephrologist who specializes in pregnancy 40.38% (21), Specialized interdisciplinary kidney disease in pregnancy clinic (Obstetrician and Nephrologist) 34.62% (18),High Risk Obstetrician or Maternal Foetal Medicine Specialist 50% (26), General or Transplant Nephrologist 50% (26), Primary care doctor/family doctor 11.54% (6), Obstetrical Internal Medicine specialist 7.69% (4). 17.42% (9) of respondents had cared for <1 pregnant woman in the last year. Education: 73.07% (38) of respondents noted receiving dedicated education in women's health while in specialty training. Resources that were identified as potentially be helpful for counselling and management of women of childbearing age with CKD included: Interdisciplinary guidelines established by Obstetrics and Nephrology 80.77% (42), continuing education seminars or case based materials 78.85% (41), referral to a nephrologist with special interest and/or training in women's health 53.85% (28), patient education pamphlets or videos with shared decision making tools 44.23% (23), and access to e-consultation in 21.15% (11). Pregnancy counselling: 57.69% (30) of Nephrologists were confident/very confident in counselling on pregnancy outcomes by CKD stage. 48.08% (25) of Nephrologists were confident/very confident in counselling on foetal outcomes by CKD stage. 63.46% (33) of respondents offer pre-conception counselling to less than one women per month. Conclusion Nephrologists practising in Europe have varied exposure to and confidence in caring for women with kidney disease who are planning pregnancy or are pregnant. There is potential for improvement in training and expansion of combined obstetric and nephrology pre-conceptual counselling and pregnancy care. Further consultation with patient advocacy groups is required to plan future care delivery.

Abstract PO1-24-06: Prolactin Hormone-Induced Mammary Differentiation and Anti-tumorigenic Role in Breast Cancer

Abstract The premise of differentiation therapy in cancer is a strategy that aims at engaging-forward differentiation and cellular reprograming restricting the proliferative, tumor repopulation, stemness, EMT and metastatic capacities of tumor cells leading to the cessation of the aggressive tumor phenotype and offering the cancer patients improved survival for decades. Therefore, deciphering molecular mechanisms deriving differentiation in normal mammary and breast cancer cells may allow the discovery of innovative differentiation-based biomarkers and therapeutics in breast cancer. Lactation is an intricate process that results in the ability of the breast cells to produce a complex nutritious biological fluid to nurse the new-born. While the beneficial effects of breastfeeding to the infant is irrefutable, its effects on maternal health are less investigated especially in relation to breast cancer that still affects 1 in 8 women in high income countries and 1 in 20 globally. Importantly, epidemiological studies have linked breastfeeding to reduced risk of breast cancer by promoting terminal differentiation of the breast epithelial cells. While breastfeeding process is regulated by multiple hormones, growth factors, and transcriptional regulators, the lactation hormone prolactin (PRL) is known to be directly implicated in the hormonal control of breastfeeding. Extensive research including our own work has shown that PRL/PRL receptor (PRLR) pathway derives mammary gland development and importantly mammary epithelial cell terminal differentiation allowing successful lactation. In contrast the role of PRL in breast cancer is still to be fully defined. Importantly, we have accumulated compelling evidence using in-silico publicly available patient data sets and molecular data implicating this pathway as a clinically relevant pro-differentiation pathway driving differentiation and cellular reprograming suppressing stemness, EMT, metastasis and tumorigenesis in breast cancer. To better characterize PRL signaling mediating its pro-differentiation effects, we used large-scale unbiased proteomics analysis of PRLR/interacting proteins in breast cancer cells. Our analyses revealed several novel PRLR-interactors. We have further confirmed these interactions through co-immunoprecipitations/western blotting analyses in breast cancer cells representative the different breast cancer subtypes. We also examined their functional contributions to mammary differentiation and tumorigenesis using in vitro and in vivo assays. Moreover, we defined their potential clinical relevance using bioinformatics in silico databases of breast cancer. Together our study delineates novel PRL/PRLR-downstream signaling mediators important for mammary differentiation and tumorigenesis and may thus be useful as biomarkers and/or therapeutic targets in breast cancer. Citation Format: Dana Hamam, Suhad Ali. Prolactin Hormone-Induced Mammary Differentiation and Anti-tumorigenic Role in Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-24-06.

Pregnant and postpartum women’s experiences of the indirect impacts of the COVID-19 pandemic in high-income countries: a qualitative evidence synthesis

BackgroundPregnant and postpartum women’s experiences of the COVID-19 pandemic, as well as the emotional and psychosocial impact of COVID-19 on perinatal health, has been well-documented across high-income countries. Increased anxiety and fear, isolation, as well as a disrupted pregnancy and postnatal period are widely described in many studies. The aim of this study was to explore, describe and synthesise studies that addressed the experiences of pregnant and postpartum women in high-income countries during the first two years of the pandemic.MethodsA qualitative evidence synthesis of studies relating to women’s experiences in high-income countries during the pandemic were included. Two reviewers extracted the data using a thematic synthesis approach and NVivo 20 software. The GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was used to assess confidence in review findings.ResultsSixty-eight studies were eligible and subjected to a sampling framework to ensure data richness. In total, 36 sampled studies contributed to the development of themes, sub-themes and review findings. There were six over-arching themes: (1) dealing with public health restrictions; (2) navigating changing health policies; (3) adapting to alternative ways of receiving social support; (4) dealing with impacts on their own mental health; (5) managing the new and changing information; and (6) being resilient and optimistic. Seventeen review findings were developed under these themes with high to moderate confidence according to the GRADE-CERQual assessment.ConclusionsThe findings from this synthesis offer different strategies for practice and policy makers to better support women, babies and their families in future emergency responses. These strategies include optimising care delivery, enhancing communication, and supporting social and mental wellbeing.

A Scoping Review of Risk Factors of Hypertensive Disorders of Pregnancy in Black Women Living in High-Income Countries: An Intersectional Approach.

Hypertensive disorders of pregnancy (HDP) are maternity-related increases in blood pressure (eg, gestational hypertension, preeclampsia, and eclampsia). Compared with women of other races in high-income countries, Black women have a comparatively higher risk of an HDP. Intersectionality helps to provide a deeper understanding of the multifactorial identities that affect health outcomes in this high-risk population. In this review, we sought to explore the literature on HDP risk factors in Black women living in high-income countries and to assess the interaction of these risk factors using the conceptual framework of intersectionality. We conducted this review using the Arksey and O'Malley methodology with enhancements from Levac and colleagues. Published articles in English on HDP risk factors with a sample of not less than 10% of Black women in high-income countries were included. Six databases, theses, and dissertations were searched from January 2000 to July 2021. A thematic analysis was used to summarize the results. A final total of 36 studies were included from the 15 480 studies retrieved; 4 key themes of HDP risks were identified: (1) biological; (2) individual traditional; (3) race and ethnicity, geographical location, and immigration status; and (4) gender related. These intersectional HDP risk factors intersect to increase the risk of HDP among Black women living in high-income countries. Upstream approaches are recommended to lower the risks of HDP in this population.

Migration and severe maternal outcomes in high income countries: systematic review and meta-analysis

Abstract Background Literature focusing on migration and maternal health inequalities is inconclusive. This is potentially explained by heterogeneous definitions and settings. Our objective was to assess migrants’ risk of severe maternal outcomes compared to native women in high income countries overall, according to host country, and by the migrant's region of birth. Methods Systematic literature review and meta-analysis using MEDLINE/Pubmed and EMBASE databases between 1990 and 25 March, 2022. Observational studies comparing the risk of maternal mortality or all-cause or cause-specific severe maternal morbidity in high income countries between migrant, defined by birth outside the host country, and native women, were included. Case-control and case studies were excluded. We performed random-effects meta-analyses when possible. Subgroup analyses were planned by host country and migrant's region of birth. Results From 2010 unique references, 36 studies reporting data from 32 databases were included. In Europe, migrants had a higher risk of maternal mortality than native women (RR 1.4;95%CI 1.1-1.6), but not in USA and Australia. Migrants born in sub-Saharan Africa (RR 3.3;95%CI 2.5-4.4), Latin America and the Caribbean (RR 2.8;95%CI 1.2-6.9), and Asia (RR 1.8;95%CI 1.3-2.4) were at higher risk of maternal mortality than natives, but not those born in Europe or the Middle East and North Africa. Patterns were similar for all-cause severe maternal morbidity. Conclusions The differential risk of severe maternal outcomes in migrant versus native women in high income countries varies by host country and by women's region of origin. Our findings provide insight into the mechanisms of these inequalities. Key messages • In high income countries, the differential risk of severe maternal outcomes in migrants (born outside the host country) compared to natives, varies by the host country and the region of birth. • Our findings strengthens the evidence supporting the need to fight migrant’s health inequalities and to customise related health policies in each context.

What factors influence a Quality Improvement Collaborative in improving contraceptive services for foreign-born women? A qualitative study in Sweden

BackgroundImproved contraceptive services could reduce the unmet need for contraception and unintended pregnancies globally. This is especially true among foreign-born women in high-income countries, as the health outcomes related to unmet need of contraception disproportionally affect this group. A widely used quality improvement approach to improve health care services is Quality Improvement Collaborative (QIC). However, evidence on to what extent, how and why it is effective and what factors influence a QIC in different healthcare contexts is limited. The purpose of this study was to analyse what factors have influenced a successful QIC intervention that is aimed to improve contraceptive service in postpartum care, mainly targeting foreign-born women in Sweden.MethodsA qualitative, deductive design was used, guided by the Consolidated Framework for Implementation Research (CFIR). The study triangulated secondary data from four learning seminars as part of the QIC, with primary interview data with four QIC-facilitators. The QIC involved midwives at three maternal health clinics in Stockholm County, Sweden, 2018–2019.ResultsFactors from all five CFIR domains were identified, however, the majority of factors that influenced the QIC were found inside the QIC-setting, in three domains: intervention characteristics, inner setting and process. Outside factors and those related to individuals were less influential. A favourable learning climate, emphasizing co-creation and mutual learning, facilitated reflections among the participating midwives. The application of the QIC was facilitated by adaptability, trialability, and a motivated and skilled project team. Our study further suggests that the QIC was complex because it required a high level of engagement from the midwives and facilitators. Additionally, it was challenging due to unclear roles and objectives in the initial phases.ConclusionsThe application of the CFIR framework identified crucial factors influencing the success of a QIC in contraceptive services in a high-income setting. These factors highlight the importance of establishing a learning climate characterised by co-creation and mutual learning among the participating midwives as well as the facilitators. Furthermore, to invest in planning and formation of the project group during the QIC initiation; and to ensure adaptability and trialability of the improvement activities.

Food insecurity as a cause of adiposity: evolutionary and mechanistic hypotheses.

Food insecurity (FI) is associated with obesity among women in high-income countries. This seemingly paradoxical association can be explained by the insurance hypothesis, which states that humans possess evolved mechanisms that increase fat storage to buffer against energy shortfall when access to food is unpredictable. The evolutionary logic underlying the insurance hypothesis is well established and experiments on animals confirm that exposure to unpredictable food causes weight gain, but the mechanisms involved are less clear. Drawing on data from humans and other vertebrates, we review a suite of behavioural and physiological mechanisms that could increase fat storage under FI. FI causes short-term hyperphagia, but evidence that it is associated with increased total energy intake is lacking. Experiments on animals suggest that unpredictable food causes increases in retained metabolizable energy and reductions in energy expenditure sufficient to fuel weight gain in the absence of increased food intake. Reducing energy expenditure by diverting energy from somatic maintenance into fat stores should improve short-term survival under FI, but the trade-offs potentially include increased disease risk and accelerated ageing. We conclude that exposure to FI plausibly causes increased adiposity, poor health and shorter lifespan. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part II)'.

Interventions to improve perinatal outcomes among migrant women in high-income countries: a systematic review protocol

IntroductionWomen who are migrants and who are pregnant or postpartum are at high risk of poorer perinatal outcomes compared with host country populations due to experiencing numerous additional stressors including...

Association between migration and severe maternal outcomes in high-income countries: Systematic review and meta-analysis.

Literature focusing on migration and maternal health inequalities is inconclusive, possibly because of the heterogeneous definitions and settings studied. We aimed to synthesize the literature comparing the risks of severe maternal outcomes in high-income countries between migrant and native-born women, overall and by host country and region of birth. Systematic literature review and meta-analysis using the Medline/PubMed, Embase, and Cochrane Library databases for the period from January 1, 1990 to April 18, 2023. We included observational studies comparing the risk of maternal mortality or all-cause or cause-specific severe maternal morbidity in high-income countries between migrant women, defined by birth outside the host country, and native-born women; used the Newcastle-Ottawa scale tool to assess risk of bias; and performed random-effects meta-analyses. Subgroup analyses were planned by host country and region of birth. The initial 2,290 unique references produced 35 studies published as 39 reports covering Europe, Australia, the United States of America, and Canada. In Europe, migrant women had a higher risk of maternal mortality than native-born women (pooled risk ratio [RR], 1.34; 95% confidence interval [CI], 1.14, 1.58; p < 0.001), but not in the USA or Australia. Some subgroups of migrant women, including those born in sub-Saharan Africa (pooled RR, 2.91; 95% CI, 2.03, 4.15; p < 0.001), Latin America and the Caribbean (pooled RR, 2.77; 95% CI, 1.43, 5.35; p = 0.002), and Asia (pooled RR, 1.57, 95% CI, 1.09, 2.26; p = 0.01) were at higher risk of maternal mortality than native-born women, but not those born in Europe or in the Middle East and North Africa. Although they were studied less often and with heterogeneous definitions of outcomes, patterns for all-cause severe maternal morbidity and maternal intensive care unit admission were similar. We were unable to take into account other social factors that might interact with migrant status to determine maternal health because many of these data were unavailable. In this systematic review of the existing literature applying a single definition of "migrant" women, we found that the differential risk of severe maternal outcomes in migrant versus native-born women in high-income countries varied by host country and region of origin. These data highlight the need to further explore the mechanisms underlying these inequities. PROSPERO CRD42021224193.

A Prospective Evaluation of the Quality of Life and Mental Health Implications of Mastectomy Alone on Women in sub-Saharan Africa.

Assess quality of life and mental health implications of mastectomy for breast cancer on sub-Saharan African women. Mortality rates amongst women diagnosed with breast cancer in sub-Saharan Africa (SSA) are high, with disparities in survival relative to women in high income countries partly attributed to advanced disease at presentation. Fears of the sequelae of mastectomy are a prominent reason for presentation delays. There is a critical need to better understand the effects of mastectomy on women in SSA to inform preoperative counseling and education for women with breast cancer. Women with breast cancer in Ghana and Ethiopia undergoing mastectomy were followed prospectively. Breast related quality-of-life and mental health measures were evaluated preoperatively, 3 and 6 months postoperatively, using BREAST-Q, PHQ-9, and GAD-7. Bivariate and logistic regression analyses evaluated changes in these measures for the total cohort and between sites. A total of 133 women from Ghana and Ethiopia were recruited. The majority of women presented with unilateral disease (99%) and underwent unilateral mastectomy (98%) with axillary lymph node dissection. Radiation was more common in Ghana ( P <0.001). Across most BREAST-Q subscales, women from both countries reported significantly decreased scores at 3 months postoperative. At 6 months, the combined cohort reported decreased scores for breast satisfaction (mean difference, -3.4). Women in both countries reported similar improvements in anxiety and depression scores postoperatively. Women from Ghana and Ethiopia who underwent mastectomy experienced a decline in breast-related body image while also experiencing decreased levels of depression and anxiety.

Interventions to improve maternity outcomes for migrant women in high-income countries: preliminary findings from a systematic review

Interventions to improve maternity outcomes for migrant women in high-income countries: preliminary findings from a systematic review

The pooled prevalence of perinatal partner violence against postpartum women for index child: A systematic review and meta-analysis

BackgroundThe continuous intimate partner violence against postpartum women (perinatal partner violence) is an important indicator of severe violence. However, its prevalence estimates remain dissimilar and show a high variability for three mutually exclusive time periods for index birth: before, during, and after pregnancy. Therefore, this study aimed to determine pooled prevalence of continuous violence against postpartum women (VAPW) for the index child. MethodWe performed a comprehensive search for PubMed, EMBASE, CINAHL, PsycINFO, POPLINE, Google, and Google Scholar databases. We included studies reporting the prevalence of VAPW for index child. The meta-analysis was conducted using STATA 14 software, and the forest plot was used to present the pooled estimate. Cochrane Q-statistics and І2 were used to assess heterogeneity. Funnel plots, Egger’s, and Begg’s tests were used to check publication bias. ResultThis systematic review and meta-analysis included a total of sixteen studies with a total of 36,758 participants. The overall pooled prevalence of VAPW for the index child was 9.96% (95% CI: 8.30%, 11.59%). The pooled estimate of lifetime VAPW for index child was 29.27% (95% CI: 23.26%, 35.27%). The overall estimates of lifetime physical, sexual, and psychological VAPW were 11.35%, 6.3%, and 14.74% respectively. In Sub-group analysis, the summary estimate was higher for low-middle income countries, 35.07% (95%CI: 10.15%, 59.98%) and low-income countries, 17.40% (95% CI: 14.08%, 20.72%) than for high-income settings (3.27%, 95% CI: 2.18%, 4.37%). ConclusionApproximately one out of every ten postpartum women experiences ongoing violence for the index child. When compared to postpartum women in high-income countries, a significant proportion of postpartum women in low- and middle-income countries experience continuous violence. This calls for a universal routine screening program in the continuum of care and working proactively on community-level intervention that prevent violence against women.

Planned Home Birth as a Safe Alternative to Hospital Birth for Low-Risk Women: A Systematic Review

Home birth is a widely practised norm among women in most developing countries. Studies continue to evaluate the safety of planned home birth (PHB) for low-risk women in high-income countries. However, such studies are scarce in Africa and other developing countries. The study examined PHB as a safe alternative to planned hospital birth for low-risk women. An electronic search was carried out on databases such as Medline database, Cochrane, Google Scholar, PubMed, and CINAHL to identify studies published in English from January 2007 to December 2017. A Meta-analytic study, systematic reviews, and observational (prospective and retrospective) studies were included in the literature reviews. The studies were analyzed using descriptive and narrative synthesis. The strength and or limitations of each study were assessed. Sixteen eligible articles were finally reviewed. PHB is equally safe in terms of complication (especially postpartum haemorrhage) compared to planned hospital birth. PHB would have a similar outcome in reducing maternal death for low-risk women if compared with planned hospital birth. Although neonatal asphyxia is mixed across studies, PHB is associated with a similarly low rate of neonatal intensive care unit admission. It was also indicated that there was no increase in neonatal mortality for PHB, especially for parous women. PHB compared to the hospital is associated with a similar low risk of maternal complications, maternal deaths, newborn complications, and newborn deaths, especially for parous women. Therefore, PHB is a safe alternative to hospital birth for low-risk women. While studies that are more recent are required to evaluate its feasibility and safety in developing countries, PHB (if properly attended) may reduce maternal and newborn complications and death associated with unplanned home births.

Determination and Evaluation of Sense of Coherence in Women in Semi-urban Nepal: A part of the Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) Trial

Background Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals’ overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal.&#x0D; Objective To determine and evaluate women’s SOC before and after a health education intervention.&#x0D; Method This study was conducted as a part of the Heart-health Associated Research, Dissemination, and Intervention in the Community in the semi-urban Jhaukhel- Duwakot Health Demographic Surveillance Site in Nepal. Jhaukhel and Duwakot were selected as the control and intervention areas, respectively. Participants were women with children aged 1-7 years. Eight hundred and fifty-seven women before and 1,268 women after the health education intervention participated in the study. The statistical analysis was carried out with chi-square tests and one-way uni-variate ANOVA.&#x0D; Result Women’s total SOC mean values at baseline were 51.1-57.4 and at follow up 54.4-54.9 in the intervention and control area, respectively. At baseline, SOC was significantly weaker in the intervention area compared to the control area (p &lt; 0.001). At follow-up three months later, SOC was significantly stronger in the intervention area than in the control area (p &lt; 0.001).&#x0D; Conclusion Nepalese women had weaker SOC than women in high-income countries, but comparable to neighboring country India with similar cultural features. Empowerment of women through community participation and health education strengthened SOC. The SOC-13-questionnaire in its Nepali version is recommended to be further evaluated.

Support for healthy breastfeeding mothers with healthy term babies.

Support for healthy breastfeeding mothers with healthy term babies.

Database Mining Detected a Cuproptosis-Related Prognostic Signature and a Related Regulatory Axis in Breast Cancer.

Background Breast cancer is the frequent cause of disease burden related to cancer among women. It affects one in 20 women globally and up to one in eight women in high-income countries. Cuproptosis is a copper-induced modality of mitochondrial cell death that is involved in tumor proliferation and metastasis. Methods To construct a prognostic cuproptosis-related signature, LASSO Cox regression analysis was employed. Additionally, ceRNA was developed with an aim of exploring the possible lncRNA-miRNA-mRNA regulatory axis in breast cancer. Results The expression of FDX1, DLD, DLAT, LIAS, LIPT1, GLS MTF1, and PDHA1 was downregulated, while CDKN2A expression level was elevated in breast cancer in contrast with normal tissue. We furthermore reviewed the genetic mutation landscape of genes linked to cuproptosis in breast cancer. Prognosis analysis revealed poor OS and RFS rates in breast cancer patients with elevated levels of CDKN2A and PDHA1 and low levels of MTF1, DLD, LIPT1, and FDX1. We then constructed a cuproptosis-related signature with six genes (DKN2A, MTF1, PDHA1, DLD, LIPT1, and FDX1) for breast cancer, which predicted the OS rate with an accuracy that ranged from medium to high. Further analysis demonstrated a significant correlation between the cuproptosis-related prognostic signature and pTNM stage, MSI score, drug sensitivity, TMB score, and immune cell infiltration. Moreover, we identified the lncRNA XIST/miR-92b-3p/MTF1 regulatory axis for breast cancer. Conclusion Multiomics approaches were used to create a cuproptosis-related signature with six genes (DKN2A, MTF1, PDHA1, DLD, LIPT1, and FDX1) for breast cancer. We discovered the lncRNA XIST/miR-92b-3p/MTF1 regulatory axis for breast cancer, which has not yet been investigated previously.

Development of a Comprehensive Household Food Security Tool for Families with Young Children and/or Pregnant Women in High Income Countries.

Despite increasing rates of food insecurity in high income countries, food insecurity and its related factors are inconsistently and inadequately assessed, especially among households with young children (0–6 years) and pregnant women. To fill this gap, researchers from the U.S. and Australia collaborated to develop a comprehensive household food security tool that includes the known determinants and outcomes of food insecurity among parents of young children and pregnant women. A five-stage mixed methods approach, including a scoping literature review, key informant interviews, establishing key measurement constructs, identifying items and scales to include, and conducting cognitive interviews, was taken to iteratively develop this new comprehensive tool. The resulting 78-item tool includes the four dimensions of food security (access, availability, utilization, and stability) along with known risk factors (economic, health, and social) and outcomes (mental and physical health and diet quality). The aim of this novel tool is to comprehensively characterize and assess the severity of determinants and outcomes of food insecurity experienced by households with young children and pregnant women.