Management Of Women Research Articles

Review of triage strategies for atypical squamous cells of undetermined significance among young women.

In the present study we reviewed the existing literature regarding management approaches for ASC-US and highlight their pros and cons. The ASC-US entity emerged from Bethesda classification 2001. We conducted this review using search words ASC-US triage, ASC-US management in young women, triage tests for ASC-US, and ASC-US outcome from the English literature. We included different cervical cancer policies (American, European and for WHO) and research articles published on ASC-US in young women from the year 2001. We searched in Google Scholar, PubMed, MEDLINE (NCBI) library, Embase (Elsevier), Wiley online library as well as Cochrane library. We defined young women as aged 30 years and below. We identified 52 articles which focused on management approaches of ASC-US, seven articles focused on young women aged <30 years. Five of these articles combined ASC-US with low-grade squamous intraepithelial lesions (ASC-US/LSIL) while only two addressed ASC-US as a standalone entity. The limited number of articles restricts the evidence base supporting the adoption of triage strategies. There is yet, no consensus in the literature regarding the management of ASC-US, more so in young women below the age of 30 years. Researchers, however, agree on a few aspects, which include the necessity for applying a conservative strategy for managing ASC-US in young women, avoiding direct referral for colposcopy at the initial detection of ASC-US, and avoiding the use of human papillomavirus (HPV) testing on young women (unless living with HIV). Newer techniques such as HPV E6/E7 messenger RNA (mRNA), and dual staining p16/ki-67, may serve as better triage to identify cases of HPV persistence and integration which may subsequently lead to preinvasive or invasive lesions.

Effects of management of heavy menstrual bleeding of patients undergoing haploidentical hematopoietic stem cell transplantation.

To investigate the benefits of menstrual management in women undergoing hematopoietic stem cell transplantation (HSCT), in whom heavy menstrual bleeding (HMB) can be an underestimated bleeding complication. This was a retrospective cohort study. Patients who had undergone HSCT in the Gynecological Endocrinology Clinic of Peking University People's Hospital were included over 10 years. The data of hematology and menstruation for all participants were collected. The management methods of the intervention group include gonadotropin-releasing hormone agonists (GnRHa), combined oral contraceptives (COC), or low-dose mifepristone. Patients who did not receive management were included in the control group. There were 112 patients included in the intervention group and 218 patients included in the control group. In all, 90.0%(297/330) of patients presented with HMB before HSCT. In the control group, 83.5%(182/218)of patients experienced menstruation in the laminar air-flow room (LAFR), whereas only 22.3%(25/112) did in the intervention group. After leaving the LAFR, the incidence of recurrent uterine bleeding was significantly reduced in the intervention group (17.9%(20/112/)versus 50.9%(111/218), p < 0.001). Patients who did not undergo menstrual management had a higher risk of bleeding than those who did (odds ratio 18.12, p < 0.001). Menstrual management significantly reduces the incidence of HMB in HSCT patients and acts as a protective factor to prevent menstrual bleeding in the LAFR.

Pregnant Women Presenting to Psychiatric Emergency Services: A Retrospective Chart Review from India

Background: Managing psychiatric emergencies during pregnancy is often challenging, as the safety of both the mother and the unborn fetus needs to be considered. This study aimed to examine the nature of psychiatric emergencies in pregnancy, their management, and clinical outcomes in women presenting to a psychiatry emergency room (ER). Methods: Charts of perinatal women consulting psychiatry ER between January 2016 and June 2021 were reviewed for the nature of the psychiatric emergency, pregnancy details, psychiatric symptoms, sociodemographic information, medical comorbidities, clinical diagnosis, and care plan. Results: Among 286 perinatal women who attended psychiatry ER, 57 (19.9%) patients were pregnant. Over half ( n = 30, 52.6%) women were multiparous and in their second trimester ( n = 29, 50.9%). Bipolar disorder ( n = 22, 38.6%) was the most common diagnosis. Agitation/aggression ( n = 34, 59.6%) was the most common reason for visiting ER, with risk of self-harm ( n = 14, 24.6%) and risk of harm to the fetus ( n = 7, 12.3%) being other reasons. Emergency psychotropic medications were used in 32 (56.1%) women, with the use of haloperidol in combination with promethazine ( n = 12, 37.5%) or lorazepam ( n = 8, 25%) being the most common. Conclusion: One-fifth of women in the perinatal period presenting to the ER were pregnant. Agitation and aggression were the most common reasons. Parenteral medications were commonly used, and more than a fifth required inpatient care, emphasizing the seriousness of risk.

Beyond the “wow” factor: the analytic importance of boredom in qualitative research

ABSTRACT In this paper, we perceive boredom as a potential resource for creativity in qualitative research. We present three main arguments. First, boredom is often an inevitable stage on the way to research excitement and can even serve as an important clue leading to analytic surprises. Second, there is a methodological need to reflect on boredom in order to understand the researcher’s perception of meaningfulness and meaninglessness. Particularly, we show how the ‘interview society’, characterized by the dominance of the therapeutic discourse, shapes researchers’ expectations regarding what is considered ‘interesting’ or ‘boring.’ Finally, the researcher’s experience of boredom may provide insights into the very phenomenon under investigation. We flesh out these arguments by showing how the researcher’s boredom during interviews reflects the interviewees’ emotional style, expected of (women) managers in the neoliberal culture: emotional restraint and a façade of rationality and objectivity.

Diagnostic and therapeutic differences in ST-segment elevation acute myocardial infarction according to sex

Introduction: Acute myocardial infarction (AMI) is a manifestation of coronary artery disease, a determinant of mortality for men and women in the fifth decade of life. Objective: To identify the differences in diagnostic and therapeutic tests according to sex in patients with ST-elevation myocardial infarction. Methods: quantitative, cross-sectional, retrospective investigation in 155 patients, 97 men and 58 women, admitted to Coronary Intensive Care, Institute of Cardiology and Cardiovascular Surgery with ST-segment elevation myocardial infarction, January 2020-December 2021. Variables related to diagnosis and treatment were explored. Results: on admission, more than 55% of the patients attended underwent reperfusion treatment, which was a very effective therapy in all cases. Women were more often reperfused by PCI (50 %) and men by thrombolysis (15.5 %). During hospitalization, 77.32 % of men required a second PCI and 52.6 % a PTCA, while 65.52 % of women and 43.10 % of men required a second PCI and 52.6 % a PTCA. 67.7 % (130 cases) with transthoracic ECHO performed were normal, the more severe degrees of involvement of the left ventricular ejection fraction was decreased. Conclusions: There were diagnostic and therapeutic differences according to sex. The left ventricular ejection fraction was more affected in men and a greater number of altered complements. It is necessary to improve the early identification and management of women with ST-segment elevation myocardial infarction

Obstetric management for pregnant women with Klippel-Trenaunay syndrome: A UK case report and review of the literature.

Klippel-Trenaunay Syndrome (KTS) is a rare congenital vascular disorder characterized by extensive capillary and venous malformations that pose unique challenges during pregnancy. This case report discusses the successful management of a 34-year-old pregnant woman with KTS who had two caesarean sections, resulting in the birth of two healthy babies. Despite the lack of evidence-based guidelines for obstetrical management in KTS, a multidisciplinary team collaborated to devise a high-risk thrombosis management plan, involving the use of compression stocking and low molecular weight heparin prophylaxis. The patient's elevated risk of thrombosis, exacerbated during pregnancy, informed the decision of caesarean sections, aligning with finding that in most KTS pregnancies, this method of delivery based on obstetric indications and arteriovenous malformations is chosen. This case highlights the importance of systematic and patient-centered care, advocating for comprehensive obstetric management guidelines to address the unique challenges posed by KTS during pregnancy. Further research is warranted to enhance our understanding and refine guidelines for individuals with vascular abnormalities linked to KTS.

Analysis of Public Health Care Management in Women Suffering from PCOS in India

The concept of "health" is multifaceted and goes beyond simply being free from sickness or illness. Because the concept of health is so nebulous, it is difficult to define. Not only have the most common types of health problems changed over time, but so has our comprehension of health. In the modern world, behaviour often affects one's health because it is influenced by biological, psychological, and social factors. Reproductive processes and events mix with psychological and physiological aspects. In a similar vein, psychological disorders influence reproductive physiology and control reproductive processes. The empirical data points to several aspects that require attention for a deeper comprehension of psychological suffering and ultimately its avoidance. It is quite difficult to learn about the evolution of distress, which means that it is hard to distinguish between acute and persistent manifestations of this condition. According to the few studies that have looked into the problem of psychological discomfort in gynaecology out-patient clinics, women who frequent these clinics are thought to be more distressed than typical—about 50% of them, on average. Additionally, this study will identify the psychosocial variables and aetiology of PCOS in women.

Strategies for Identifying and Recruiting Women at High Risk for Breast Cancer for Research Outside of Clinical Settings: Observational Study.

Research is needed to understand and address barriers to risk management for women at high (≥20% lifetime) risk for breast cancer, but recruiting this population for research studies is challenging. This paper compares a variety of recruitment strategies used for a cross-sectional, observational study of high-risk women. Eligible participants were assigned female at birth, aged 25-85 years, English-speaking, living in the United States, and at high risk for breast cancer as defined by the American College of Radiology. Individuals were excluded if they had a personal history of breast cancer, prior bilateral mastectomy, medical contraindications for magnetic resonance imaging, or were not up-to-date on screening mammography per American College of Radiology guidelines. Participants were recruited from August 2020 to January 2021 using the following mechanisms: targeted Facebook advertisements, Twitter posts, ResearchMatch (a web-based research recruitment database), community partner promotions, paper flyers, and community outreach events. Interested individuals were directed to a secure website with eligibility screening questions. Participants self-reported method of recruitment during the eligibility screening. For each recruitment strategy, we calculated the rate of eligible respondents and completed surveys, costs per eligible participant, and participant demographics. We received 1566 unique responses to the eligibility screener. Participants most often reported recruitment via Facebook advertisements (724/1566, 46%) and ResearchMatch (646/1566, 41%). Community partner promotions resulted in the highest proportion of eligible respondents (24/46, 52%), while ResearchMatch had the lowest proportion of eligible respondents (73/646, 11%). Word of mouth was the most cost-effective recruitment strategy (US $4.66 per completed survey response) and paper flyers were the least cost-effective (US $1448.13 per completed survey response). The demographic characteristics of eligible respondents varied by recruitment strategy: Twitter posts and community outreach events resulted in the highest proportion of Hispanic or Latina women (1/4, 25% and 2/6, 33%, respectively), and community partner promotions resulted in the highest proportion of non-Hispanic Black women (4/24, 17%). Although recruitment strategies varied in their yield of study participants, results overall support the feasibility of identifying and recruiting women at high risk for breast cancer outside of clinical settings. Researchers must balance the associated costs and participant yield of various recruitment strategies in planning future studies focused on high-risk women.

P187 CO-DESIGNING AN INTERVENTION FOR CARDIOVASCULAR DISEASE RISK ASSESSMENT AND MANAGEMENT AFTER HYPERTENSIVE DISORDERS OF PREGNANCY

Background and objective: Women with a history of hypertensive disorders of pregnancy (HDP) are at two-to-fourfold increased risk of developing cardiovascular disease (CVD) within 10 years post-pregnancy. Despite clinical practice guidelines recommending general practitioners (GPs) for ongoing CVD preventative care, no intervention strategies exist within primary care aimed at improving risk assessment or management for women after HDP. This study aimed to co-design an intervention to enhance the implementation of CVD risk assessment and management following HDP for primary care settings in Australia. Methods: Researchers used the Integrated Knowledge Translation (IKT) framework and conducted five co-design meetings with the investigative team and end-users. Meetings were informed by the Behaviour Change Wheel (BCW) framework for intervention development and incorporated research findings from a systematic review and meta-analysis, surveys, and an online discussion. Data from activities and audio recordings following each meeting were analysed iteratively to inform ongoing intervention development. Results: The 18 end-users included women with lived HDP experience (n=8), obstetricians (n=2), midwives (n=5), and GPs (n=3). The target priorities were to improve communication between hospital staff and GPs following HDP occurrence and increase knowledge of GPs and women regarding CVD prevention post-HDP. Part 1 of the intervention is delivered within the hospital setting via physical resources to address communication gaps between hospital and primary care providers for women after post-HDP. Part 2 is delivered via an update to existing GP education platforms and resources for use within GP consultations to provide education for women and GPs on CVD prevention post-HDP. Conclusions: The IKT and BCW frameworks played a crucial role in development of a tailored intervention aimed at bridging gaps in current primary care practice and enhancing implementation of CVD risk assessment and management for women following HDP. This an important step in addressing CVD risk in women of childbearing age.

Women and Leadership: A Case of the Kenyan and South African Banking Sector

Throughout the history of management theories, masculine ideals have dominated the development of organisational leadership structures, often leading to a belief in the inherent superiority of men in leadership roles. Despite progress, many organisations still operate under the assumption that women are somehow deficient compared to men in leadership capabilities. The research objective was to investigate the difficulties Black African women encounter in leadership positions in Kenyan and South African banks, specifically concerning how society views women in leadership roles. The study conducted semi-structured interviews and focus groups involving 41 Black African women managers from the banking sectors of both countries, employing an inter-categorical intersectionality approach. The research revealed a perceived lack of fit for top executive leadership positions among African-Black women. A comparison between masculine and feminine leadership styles underscored the gendered sex-role stereotypes that hindered the advancement of Black African women into top executive roles within the banking sector. In summary, the findings emphasise that, as long as ‘think manager, think male’ persists in leadership, Black African women will continue to encounter obstacles in attaining top executive positions within the banking sectors of Kenya and South Africa. The study’s practical implications are that it emphasises the understanding of women and leadership and its role as an obstacle for Black women managers in the Kenyan and South African banking sectors. The originality of this study is that it contributes to the understanding of women and leadership literature in the banking sectors of Kenya and South Africa, as well as sub-Saharan African countries.

Caesarean sections, indications and outcomes: a cross-sectional study using the Robson classification in a tertiary hospital in Sierra Leone

ObjectiveWHO recommends the use of the Robson’s ‘Ten Groups Classification’ for monitoring and assessing caesarean section (CS) rates. The aim of this study was to investigate the rates, indications and...

ТАКТИКА ВЕДЕНИЯ ПАЦИЕНТОК С ЭНДОМЕТРИОИДНЫМИ КИСТАМИ И БЕСПЛОДИЕМ. КЛИНИЧЕСКИЙ СЛУЧАЙ

Endometriosis is a widespread gynecological disease. There is evidence about the role of heredity in the development of endometriosis, this disease is more common in women whose relatives also suffered from endometriosis. Endometriosis occurs in 5-6% of women in the general population and in more than 50% of women suffering from infertility. Endometrioid ovarian lesion is one of the most common forms of genital endometriosis. The main symptoms of which are chronic pelvic pain, infertility and miscarriage, which leads to a significant decrease in the quality of life and ability to work, and a violation of the psychological status. Painful sensations caused by endometriosis during sexual contact can lead to interruption or avoidance of sexual intercourse and negatively affect the sexual health of endometriosis patients and their partners. Many researchers believe that the treatment of patients with endometriosis should be strictly individual and determined by the following factors: the age of the patient, the localization and prevalence of the pathological process, the severity of the clinical picture of the disease, the duration of the disease, the attitude to pregnancy. Timely diagnosis and treatment make it possible to achieve clinical recovery and prevent infertility. This article discusses current recommendations for the management of women with endometrioid ovarian cysts aimed at improving reproductive performance.

Pharmacotherapy profile for mothers with schizophrenia and bipolar affective disorder in a psychiatric mother–baby unit

AbstractBackgroundPharmacotherapy treatment is used to manage women with schizophrenia and bipolar affective disorder admitted to a mother–baby unit (MBU).AimThe aims of this study were (1) to examine prescribing practices for women with schizophrenia and bipolar affective disorder in an MBU, (2) to assess alignment with the Mental health care in the perinatal period: Australian clinical practice guideline and (3) to examine the classes of typical and atypical antipsychotics prescribed to mothers with schizophrenia.MethodA retrospective audit of women with schizophrenia and bipolar affective disorder admitted to a psychiatric MBU, located in Queensland, Australia, was conducted from March 2017–July 2019. The exclusion criteria included women admitted with depression, anxiety, personality disorders, and postpartum psychosis. Pharmacotherapy treatment details were extracted at commencement of admission, mid‐way through admission, and discharge. Descriptive statistics were completed. This project was exempt due to the local policy requirements that constitute research by the Gold Coast Hospital and Health Service Human Research Ethics Committee (Reference no: EX/2023/QGC/102306). The justification for this exemption was as follows: the study was deemed a quality improvement activity and complied with Chapter 2.3 of the National Statement of Ethical Conduct in Research and involved only routinely collected data.ResultsOf the 53 mothers included in the study, 29 (55%) had schizophrenia and 24 (45%) had bipolar affective disorder. In addition, 97% of women with schizophrenia received atypical antipsychotics. Five women (21%) with bipolar affective disorder (mean age = 31.60 years, standard deviation = 6.19 years) were prescribed sodium valproate, with four women given contraception. Sodium valproate or lamotrigine were prescribed to four women (67%) with bipolar affective disorder whilst breastfeeding. Of mothers prescribed lithium, 92% did not breastfeed. Overall, 44% of women involuntarily admitted received antipsychotic depot medication compared with 38% of voluntary patients. Results are discussed in relation to the national guidelines.ConclusionThis is the first naturalistic study to examine the pharmacotherapy management of postpartum women admitted to a psychiatric MBU with schizophrenia and bipolar affective disorder. The study highlights that prescribing patterns across three time points during admission were generally in alignment with Australian national guidelines.

Hormonal Influences on Skeletal Muscle Function in Women across Life Stages: A Systematic Review

Skeletal muscle function is vital for locomotion, posture, and metabolism, significantly impacting overall health and preventing falls, morbidity, and mortality, especially in elderly populations. This systematic review investigates the influence of hormonal fluctuations on skeletal muscle function across different life stages in women, including adolescence, the reproductive years, and menopause. A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science to identify relevant studies. This review includes 45 studies that met the inclusion criteria, examining the roles of estrogen, progesterone, and other hormones in muscle metabolism, strength, and recovery. The findings highlight significant stage-specific hormonal impacts on muscle function, revealing how puberty, menstrual cycles, pregnancy, and menopause uniquely affect muscle health. Effective hormonal and non-hormonal interventions tailored to each life stage were identified, offering insights for optimizing muscle function and health management in women. This synthesis aims to bridge the gaps in understanding the hormonal regulation of muscle function, providing a foundation for future research and guiding clinical practices.

CARDIAC VALVE DISEASE IN DIABETIC PREGNANT WOMEN: FETAL COMPROMISE AND MATERNAL RISK

Introduction: Cardiac valve diseases represent a significant concern in the management of pregnant women, particularly those with diabetes mellitus, a condition that alters the hemodynamic profile and can exacerbate pre-existing cardiac issues. During pregnancy, a woman's body undergoes physiological changes that can affect the function of the cardiac valves. Diabetes mellitus can accelerate the progression of valvulopathies, leading to complications affecting both the mother and the fetus. Fetal compromise often results from maternal hemodynamic instability and changes in blood flow, while maternal risk includes worsening cardiac symptoms and an increased likelihood of adverse events during pregnancy. Objective: The objective of this systematic review was to analyze the available evidence on the impact of cardiac valve diseases in diabetic pregnant women, focusing on the consequences for the fetus and the risks for the mother. Methodology: To conduct the systematic review, the PRISMA checklist criteria were followed. The search was performed in electronic databases, including PubMed, Scielo, and Web of Science, using five main descriptors: "cardiac valve disease," "diabetic pregnant women," "fetal compromise," "maternal risk," and "diabetes mellitus." Studies published in the last 10 years were included, prioritizing peer-reviewed articles and original research. Inclusion criteria comprised: (1) studies specifically addressing valvulopathies in pregnant women with diabetes mellitus, (2) articles providing data on fetal and maternal outcomes, and (3) research published in peer-reviewed journals. Exclusion criteria included: (1) studies not directly focusing on diabetic pregnant women, (2) research with non-rigorous methodologies or lack of relevant data, and (3) articles published more than 10 years ago. Results: The results indicated that pregnant women with valvulopathies and diabetes mellitus face a heightened risk of complications. Key findings included increased neonatal mortality and maternal cardiovascular complications, such as heart failure and worsening valvular symptoms. Fetal compromise often involved intrauterine growth problems and a higher incidence of prematurity. Conclusion: The review highlighted that the combination of diabetes mellitus and cardiac valve diseases presents a significant challenge in managing pregnant women, with important implications for both maternal and fetal health. Early identification and appropriate management of valvulopathies are crucial to reducing associated risks and improving outcomes for both mother and baby. Future studies should focus on treatment strategies and monitoring approaches that can mitigate these complications and promote better outcomes.

Adapting an evidence-based contingency management and text messaging intervention for South African perinatal women who drink

South Africa has one of the highest prevalence rates globally for fetal alcohol spectrum disorders. Despite this, few interventions are routinely available for countering the adverse effects of perinatal drinking. The current study used the ADAPT-ITT framework to guide the development of a behavioral intervention with remote alcohol use monitoring and provision of financial incentives contingent on alcohol abstinence for people who are pregnant and postpartum. The study aims to maximize the intervention’s relevance, acceptance, and effectiveness in reducing alcohol use during pregnancy and lactation, ultimately improving maternal and infant health outcomes in South Africa. Thirty-two in-depth interviews with people who were pregnant and 16 key-informant interviews with clinic and community members were conducted to help inform the intervention. The adapted intervention was pretested with 20 people who were pregnant or breastfeeding, and additional feedback was obtained from the community collaborative board. While there was widespread support for the intervention elements, some concerns were raised, including perceived high street value of a monitoring device, access to mobile phones to use such a device, frequency of monitoring, cheating when using a remote monitoring device, devices being lost or stolen, and the sustainability of long-term monitoring. The adapted intervention combines alcohol monitoring-based contingency management with text-based health promotion and information on where to access services tailored to maternal populations ready for testing in feasibility and efficacy trials.

Age-associated risk of sarcopenia, falls and fractures: results of Ukrainian cohort study

Background. It is well-known that sarcopenia increases the risk of falls and fractures, and therefore, requires correction to improve the quality of life of elderly people. This research purposed to study the age-related changes in the sarcopenia risk, falls, and fractures in Ukrainian women in the late reproductive and postmenopausal periods. Materials and methods. We examined 573 females aged from 40 to 89 years old. The subjects were grouped by age decades and presence of high sarcopenia risk (HSR). The SARC-F questionnaire measured the sarcopenia risk, and the risk of falls using the Desmond Fall Risk Questionnaire, the 10-year probability of major osteoporotic and hip fractures was assessed by FRAX, and daily activity — according to the IADL scale. Also, we performed the hand grip strength and five-repetition sit-to-stand tests. Results. The frequency of HSR increased with age from 1.5 % in the 40–49-year-old group to 73.7 % in subjects over 80, as well as fracture and fall risks (p &lt; 0.00001 for both indices) related to decreasing independence in the subject’s everyday life. Also, we revealed age-dependent loss of muscle strength according to the hand grip and the five-repetition sit-to-stand tests. After the adjustment of the subjects by age we found that the females with HSR had a higher risk of falls, a lower level of independence, and increased frequency and risk of osteoporotic fractures. Conclusions. Women with HSR have a higher risk of falls, fractures, and more limitations in daily living activities independently from age and body mass index. These findings request comprehensive management of older women with attention to various parameters for the increase of independence and quality of life.

Aging promotes accumulation of senescent and multiciliated cells in human endometrial epithelium.

What changes occur in the endometrium during aging, and do they impact fertility? Both the transcriptome and cellular composition of endometrial samples from women of advanced maternal age (AMA) are significantly different from that of samples from young women, suggesting specific changes in epithelial cells that may affect endometrial receptivity. Aging is associated with the accumulation of senescent cells in aging tissues. Reproductive aging is mostly attributed to the decline in ovarian reserve and oocyte quality, whereas the endometrium is a unique complex tissue that is monthly renewed under hormonal regulation. Several clinical studies have reported lower implantation and pregnancy rates in oocyte recipients of AMA during IVF. Molecular studies have indicated the presence of specific mutations within the epithelial cells of AMA endometrium, along with altered gene expression of bulk endometrial tissue. Endometrial transcriptome profiling was performed for 44 women undergoing HRT during the assessment of endometrial receptivity before IVF. Patients younger than 28 years were considered as the young maternal age (YMA) group (age 23-27 years) and women older than 45 years were considered as the AMA group (age 47-50 years). Endometrial biopsies were obtained on Day 5 of progesterone treatment and RNA was extracted. All endometrial samples were evaluated as being receptive based on the expression of 68 common endometrial receptivity markers. Endometrial samples from another 24 women classified into four age groups (YMA, intermediate age group 1 (IMA1, age 29-35), intermediate age group 2 (IMA2, age 36-44), and AMA) were obtained in the mid-secretory stage of a natural cycle (NC) and used for validation studies across the reproductive lifespan. A total of 24 HRT samples (12 YMA and 12 AMA) were subject to RNA sequencing (RNA-seq) and differential gene expression analysis, 20 samples (10 YMA and 10 AMA) were used for qPCR validation, and 24 NC samples (6 YMA, 6 IMA1, 6 IMA2 and 6AMA) were used for RNA-seq validation of AMA genes across the woman's reproductive lifespan. Immunohistochemistry (IHC) was used to confirm some expression changes at the protein level. Computational deconvolution using six endometrial cell type-specific transcriptomic profiles was conducted to compare the cellular composition between the groups. Comparisons between YMA and AMA samples identified a lower proportion of receptive endometria in the AMA group (P = 0.007). Gene expression profiling identified 491 differentially expressed age-sensitive genes (P adj < 0.05) that revealed the effects of age on endometrial epithelial growth and receptivity, likely contributing to decreased reproductive performance. Our results indicate that changes in the expression of the cellular senescence marker p16INK4a and genes associated with metabolism, inflammation, and hormone response are involved in endometrial aging. Importantly, we demonstrate that the proportion of multi-ciliated cells, as discovered based on RNA-seq data deconvolution and tissue IHC results, is affected by endometrial aging, and propose a putative onset of age-related changes. Furthermore, we propose that aging has an impact on the transcriptomic profile of endometrial tissue in the context of endometrial receptivity. The raw sequencing data reported in this article are deposited at the Gene Expression Omnibus under accession code GSE236128. This retrospective study identified changes in the endometrium of patients undergoing hormonal replacement and validated these changes using samples obtained during a NC. However, future studies must clarify the importance of these findings on the clinical outcomes of assisted reproduction. The findings reported in this study have important implications for devising future strategies aimed at improving fertility management in women of advanced reproductive age. This research was funded by the Estonian Research Council (grant no. PRG1076), Horizon 2020 innovation grant (ERIN, grant no. EU952516), Enterprise Estonia (grant no. EU48695), MSCA-RISE-2020 project TRENDO (grant no. 101008193), EU 874867 project HUTER, the Horizon Europe NESTOR grant (grant no. 101120075) of the European Commission, the EVA specialty program (grant no. KP111513) of the Maastricht University Medical Center (MUMC+), MICIU/AEI/10.13039/501100011033 and FEDER, EU projects Endo-Map (grant no. PID2021-12728OB-100), ROSY (grant no. CNS2022-135999), and the National Science Fund of Bulgaria (grant no. KII-06 H31/2). The authors declare no competing interests.

Development and pilot implementation of a novel protocol to assess capacity and readiness of health systems to adopt HPV detection-based cervical cancer screening in Europe

BackgroundCervical cancer remains a significant public health concern in Europe. Effective introduction and scaling up of human papillomavirus (HPV) detection-based cervical cancer screening (CCS) requires a systematic assessment of health systems capacity. However, there is no validated capacity assessment methodology for CCS programmes, especially in European contexts. Addressing this gap, our study introduces an innovative and adaptable protocol for evaluating the capacity of CCS programmes across varying European health system settings.MethodsOur research team developed a three-step capacity assessment framework, incorporating a health policy review checklist, a facility visit survey, and key informants’ interview guide followed by a strengths, weaknesses, opportunities and threats (SWOT) analysis. Piloting this comprehensive approach, we explored the CCS capacity in three countries: Estonia, Portugal and Romania. These countries were selected due to their contrasting healthcare structures and resources, providing a diverse overview of the European context.ResultsConducted over a period of 9 months, the capacity assessment covered multiple resources, 27 screening centres, 16 colposcopy and treatment centres and 15 key informant interviews. Our analysis highlighted both shared and country-specific challenges. A key common issue was ensuring high compliance to follow-up and management of screen-positive women. We identified considerable heterogeneity in resources and organization across the three countries, underscoring the need for tailored, rather than one-size-fits-all, solutions.ConclusionsOur study’s novelty lies in the successful development of this capacity assessment methodology implementable within a relatively short time frame, proving its feasibility for use in various contexts and countries. The resulting set of materials, adaptable to different cancer types, is a ready-to-use toolkit to improve cancer screening processes and outcomes. This research marks a significant stride towards comprehensive capacity assessment for CCS programmes in Europe. Future directions include deploying these tools in other countries and cancer types, thereby contributing to the global fight against cancer.

Impact of Gender Role Attitudes and Gender Differences on the Evaluation of Female Leaders: Insights from a Survey of Japanese University Students

Women’s active participation in society is desirable. However, it has not increased sufficiently in contemporary Japan, where the ratio of women decision-makers in politics and corporations is low, and gender inequality persists. One reason for this could be people’s negative perception of female leaders. This study focused on female managers as female leaders. It examined whether people’s gender-role attitudes might affect their attitudes about female leaders and whether these attitudes might differ depending on people’s sex (males or females). We administered a collective-style questionnaire survey to university students (N=107, 46 men and 61 women, mean age=20.11, SD=1.04) in Japan. We adopted a three-way between-subjects survey design; gender-role attitudes (traditional or equal) x managers (male condition or female condition) x participants’ sex (male or female). The results indicated that the participants’ gender-role attitudes had a more substantial effect on evaluating female managers than the participants’ gender. People with liberal gender-role attitudes had a highly positive perception of female leaders, whereas those with traditional gender-role attitudes considered female leaders more strictly. The results of this study indicated that gender-role attitudes do not affect the assessment of male leaders, suggesting that individual values might not affect the evaluation of male leaders. In contrast, these variables affected the assessment of female leaders. Therefore, we concluded that gender-role attitudes are essential for promoting the psychological acceptance of women leaders, which suggests the need to develop personnel with egalitarian gender-role attitudes to increase and popularize women managers in Japanese society.