Burden Of Women Research Articles

Sex disparity of cerebral white matter hyperintensity in the hypertensive elderly: The Shanghai Changfeng study.

White matter hyperintensity (WMH) is associated with vascular hemodynamic alterations and reflects white matter injury. To date, the sex difference of tract-specific WMH and the relationship between high blood pressure (BP) and tract-specific WMH remain unclear. We recruited 515 subjects from the Shanghai Changfeng study (range 53-89 years, mean age 67.33 years). Systolic and diastolic blood pressure (SBP and DBP) were collected and used to calculate pulse pressure (PP). Magnetic resonance T1 and T2 FLAIR images were acquired to measure WMH and calculate WMH index. The ANCOVA test was performed to test the difference between sexes, and the linear regression model was used to examine the associations between BP and WMH index. Men showed higher WMH index than women in all white matter tracts (p < .001, respectively) except for the bilateral superior longitudinal fasciculus (SLF) and its left temporal part (tSLF). High SBP and PP was associated with a lower WMH index on the left corticospinal tract (CST), SLF, tSLF and right cingulum in hippocampus (p ≤ .001, respectively) in women, while high DBP was associated with a higher WMH index on the bilateral CST (left p < .001; right p=.001), left inferior longitudinal fasciculus (p < .001) and inferior fronto-occipital fasciculus (p=.002) in men. Men tend to have more WMH compared to women. A high SBP/PP relates to a lower WMH burden in women. This suggests that women could benefit from higher blood pressure in older age.

Sex‐specific mediational effects of microglial activation on Alzheimer’s disease proteinopathy in older adults

AbstractBackgroundWomen show disproportionate burden of Alzheimer’s disease (AD) pathology and higher AD dementia prevalence compared to men, yet the mechanism(s) driving these vulnerabilities are unknown. There is sexual dimorphism in immunologic functioning and neuroimmune processes are implicated in AD genesis. Using neuropathology indicators from human brain tissue, we examined the mediational role of microglial activation on the relationship between amyloid and tau and how it differs by sex.Method187 decedents (64% female; 89 years‐old at death; 62% non‐demented) from the Rush Memory and Aging Project completed neuropathological evaluations with brain tissue quantified for microglial activation, amyloid‐β, and tau. Proportion of morphologically activated microglia was determined via immunohistochemistry (HLA‐DP‐DQ‐DR) and morphological staging (stage I, II, or III). Amyloid and tau burden were quantified via immunohistochemistry (M00872 or AT8, respectively). Using causal counterfactual modeling, we estimated the mediational effect of microglial activation on the amyloid to tau relationship in the whole sample and stratified by sex (amyloid→ microglial activation→ tau). Alternative models tested the role of microglia activation as the precipitating event (microglial activation→ amyloid→ tau).ResultMicroglial activation significantly mediated 67% (95%CI 32‐90) of the relationship between amyloid and tau in the whole sample; however, stratified analyses suggested this effect was stronger and only statistically significant in women. 57% (95%CI 20‐100) of the effect of amyloid‐β on tau was mediated through microglial activation in women, compared to 19% (95%CI 0‐62) in men. Secondary models suggested that mediational effects were driven by cortical versus subcortical microglial activation. Alternative models suggested that in women, microglial activation was a significant exposure both preceding the amyloid‐β to tau relationship (50%, 95%CI 22‐89) and directly related to tau burden (50%, 95%CI 11‐78). In contrast, in men, only the direct effect of microglial activation to tau reached significance (74%, 95%CI 34‐99) (mediational effect: 25%, 95%CI 1‐66).ConclusionOur models suggest a reciprocal, bidirectional relationship between amyloid‐β and microglial activation that accounts for tau burden in women. In men, direct independent (non‐mediational) relationships between microglial activation or amyloid‐β with tau were observed. Microglial activation may be disproportionately important for AD pathogenesis in women.

Tau and memory performance in women: Advantages of visuospatial over standard verbal memory tests

AbstractBackgroundThe accumulation of pathological tau in the medial temporal lobe is a hallmark of early Alzheimer’s disease (AD) that leads to memory decline. The majority of studies in AD use exclusively verbal memory tests to detect this memory loss, which is problematic because women have a lifelong advantage in verbal memory such that these tests may be less responsive to early AD. In our Women: Inflammation and Tau Study (WITS), we used both verbal and nonverbal memory tests, with the hypothesis that the nonverbal test would more accurately reflect tau in women.MethodWITS is a study of older women (aged 65+) with high risk for AD by way of the AD polygenic hazard score and mild cognitive deficits. Data are from 16 participants thus far. Tau PET imaging was completed using the MK6240 ligand. Two volume‐weighted composite of Braak III&amp;IV regions and metatemporal regions were our regions of interest (ROIs). Memory tests were the Rey Auditory Verbal Learning Test (RAVLT) and Brief Visuospatial Memory Test‐Revised (BVMT). Both tests have multiple learning trials in addition to delayed recall. A series of linear regression models separately examined RAVLT and BVMT scores in relation to tau burden in each ROI. We used Akaike Information Criterion (AIC) to compare model fits.ResultPoorer performance in both RAVLT and BVMT delayed recall was significantly related to greater tau in each ROI (ps&lt;.01); however, relationships were stronger with the BVMT. For the metatemporal ROI, RAVLT explained 14.6% of the variance in tau, while BVMT explained 44.6% (Figure 1). For the Braak III&amp;IV ROI, RAVLT explained 10.1% of the variance and BVMT explained 29.8%. The AIC implied superiority of the models with BVMT over the models with RAVLT.ConclusionOur preliminary results show that tau burden in women is better reflected by visual memory performance than verbal memory. Reliance on verbal memory may not be ideal in studies of AD involving women. Upon replication, our results suggest that visual memory performance may be a more accurate clinical marker of early AD with better prognostic value in women that can lead to improved effect sizes and more efficient clinical trials.

The Burden of Disease in Germany at the National and Regional Level.

.Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates. DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers. In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region. The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.

Newspaper media framing of maternal obesity in the UK: a review and framework synthesis

BackgroundNews media is powerful at framing health, shaping public perceptions and demand for policy. The effects of news media include perpetuating obesity discrimination, which threatens public health. Two-thirds of pregnant women report experiencing bodyweight-related stigma. The aim of this review was to explore the portrayal of maternal obesity in UK newspaper outlets. MethodsNexisUni was searched for newspaper articles published between Jan 1, 2010, and May 31, 2021, reporting content on obesity during pregnancy. Articles were screened against inclusion criteria. Integrated quantitative and qualitative analytics supported a novel framework synthesis to characterise the content of the articles. Findings442 articles were included: 261 (59%) published in tabloids and 181 (41%) in broadsheets. We identified three overarching themes: blame; responsibility; and burden of women with obesity. Subthemes were health outcomes (primarily of the infants); impact on the UK National Health Service (NHS); causes of and solutions for obesity; and calls for action. Women were blamed for their bodyweight, pregnancy risks, and NHS care requirements. Solutions were framed as the woman's responsibility to reduce her own and future generations' bodyweight, prevent adverse pregnancy outcomes, and alleviate the burden on the NHS. The burden of maternal obesity was consistently placed on women, as a burden on individuals (ie, themselves, their children, and health professionals), society, and the NHS. Patterns in language framed the so-called problem and scale of maternal obesity, emphasised risk and danger, and were alarmist, aggressive, and violent. Articles platformed purported experts' voices, such as professional organisations representatives, rather than women's lived experiences. The article narratives were underpinned by oversimplifications of obesity development, weight management, and causal pathways to health outcomes. InterpretationUK newspapers negatively frame and oversimplify maternal obesity. Exposure to blaming and alarmist messaging could increase women's guilt and internalised weight bias, which can harm maternal and child physical and mental health during this life phase. The newspaper media should instead be harnessed to destigmatise maternal obesity, promote maternal wellbeing, and improve public health. The interdisciplinary, multinational research team and novel, rigorous methods are strengths of this review. A limitation is the focus on article texts but not on accompanying images. FundingNone.

Angiotensin receptor blockers are equally effective in women and men; a systematic review and meta-analysis

Abstract Background Hypertension is the leading risk factor for cardiovascular disease (CVD) and is the most substantial and neglected health burden in women. While treatment of high blood pressure is essential in the global prevention strategies of CVD it is assumed that effectiveness of pharmacological treatment may be hampered by sex differences. However, it is still not known whether sex differences exist in the effect of the antihypertensive medications. Purpose To evaluate sex-stratified effects for angiotensin receptor blockers (ARBs) on blood pressure (BP) and cardiac function in female compared to male hypertensive participants. Methods A series of systematic reviews and meta-analysis was performed. PubMed and EMBASE were systematically searched for studies evaluating the effects of the five major groups of antihypertensive medication from 1945 to May 2020. Randomized control trials and observational studies in humans (≥18 years) were included investigating beta-blockers (BB), angiotensin converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), calcium channel blockers (CCB), and diuretics. In this study data on ARB's was analyzed. Studies had to present both baseline and follow-up measurements of at least one of the outcome variables of interest and present their data in a sex-stratified manner. Data on BPand cardiac function where retrieved from studies. Risk of bias was assessed using the Cochrane risk of bias tool. Results The search strategy resulted in 73,867 hits. After first screening based on title and abstract, 15,130 articles where suitable for full test screening. After excluding all studies that matched the exclusion criteria, 205 studies with 15,570 participants where eligible for analysis for the five antihypertensive drugs. Studies investigating ARB's (n=17) where used in this review. Seven trials (41%) had a low risk of bias. ARB decreased BP significantly and comparably in both women and men. Systolic BP −18.2 mmHg (95% CI, −24.8 to −11.5) vs −20.1 mmHg (95% CI, −26.7 to −13.6) and diastolic BP −11.6 mmHg (95% CI, −14.7 to −8.4) vs −12.3 mmHg (95% CI, −16.4 to −8.1). LVEF did not change significantly in either group. LV mass was only reported in males and did not change significantly −11.8 g (95% CI, −25.6 to 1.9). Conclusion Our meta-analysis shows that based on the current studies, no sex differences exists in the effect of ARB on blood pressure or cardiac function. Funding Acknowledgement Type of funding sources: None.

Influence of gender on coronary atherosclerosis and inflammatory biomarker profile: a CT angiographic study

Abstract Background and aims The burden of coronary atherosclerosis differs between men and women. Beyond traditional cardiovascular risk factors, inflammatory biomarkers can influence plaque formation and progression. We analyzed the influence of gender difference on coronary atherosclerosis and inflammatory cytokines. Methods Coronary CT-Angiography was performed in 301 patients and plaque morphology was quantitatively and qualitatively assessed using semi-automated software (Autoplaque version 2.5, Cedars-Sinai Medical Center, Los Angeles, CA). We analyzed total (TPV), non-calcified (NCPV), calcified (CPV) and low-density plaque volume in mm3 (LDPV, defined as plaque attenuation &amp;lt;30HU). Serum was analyzed for various cytokines including Interleukin (IL)-1a, IL-1b, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-13, Il-15, IL-17, TNF-a, IFNg, CRP, MCP-1, MIP-1a, Eotaxin, G_CSF and GM-CSF using Luminex assay. Results Out of 301 patients, 94 (31%) were female and 207 (69%) were male. As compared to women, men were significantly younger (62 vs. 57 years, p&amp;lt;0.001) and showed a higher BMI (28 vs. 26 kg/m2, p=0.005). No differences were seen for hypertension, hyperlipidemia, diabetes, smoking habits and family history of CAD. All plaque characteristics showed significant higher values in men as compared to women (all p&amp;lt;0.05). In men, cytokine profile showed significantly lower serum levels for IL-2 (3.20 [3.20; 7.01] vs. 4.31 [3.20; 9.68]; p=0.01) and Interferon-gamma (3.20 [3.20; 14.72] vs. 8.76 [3.20; 26.26]; p&amp;lt;0.001) and significantly higher levels for MCP-1 (224 [117; 327] vs. 155 [49; 260]; p&amp;lt;0.001). In multivariable logistic regression analysis, Interferon-gamma showed significant inverse association to male gender (OR 0.35; 95% CI: 0.17–0.72; p=0.004), but IL-2 and MCP-1 did not. The association of Interferon-gamma to gender was independent of age (OR 0.57; 95% CI: 0.43–0.76; p&amp;lt;0.001) and BMI (OR 2.12; 95% CI 1.25–3.62; p=0.006) Conclusion Coronary plaque volume and morphology significantly differs between men and women and so does the inflammatory cytokine profile. Albeit significantly lower coronary plaque burden in women, serum levels of interferon-gamma - a known pro-inflammatory cytokine - was significantly higher in women with independent association to gender. Whether interferon-gamma plays contradicting roles in the process of coronary atherosclerosis in men and women needs to be explored in future studies to identify potential gender-specific targets for therapeutic interventions. Funding Acknowledgement Type of funding sources: None.

Neuromyelitis optica spectrum disorder in Western China impacts employment and increases financial burden in women.

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) often leads to disability and exerts a heavy toll on the work and life of affected female patients. This study aimed to analyze the current employment situation and economic burden as well as the risk factors for unemployment in female patients with NMSOD.MethodsWe compared the following unemployment- and employment-related aspects in with NSMOD, which were investigated using questionnaires: the specific impact of NMOSD on work, medical expenses, and factors affecting unemployment.ResultsWe enrolled 351 female patients with NMOSD. More than half (54.1%, 190/351) of participants reported that the disease led to unemployment. The unemployment group was significantly older (46.9 ± 12.1 years vs. 39.3 ± 9.4 years, P = 0.000), had a higher annual recurrence rate (ARR) (0.6 [inter quartile range [IQR]:0.4–0.9] vs. 0.5 [IQR: 0.3–0.8], P = 0.141), and a higher severe disability rate (44.2% vs. 11.2%, P = 0.000) than the employment group. Moreover, unemployed patients had lower education levels. The factors influencing unemployment included low education (junior middle-school or below), age, higher ARR, and severe disability (odds ratio [OR] = 6.943, P = 0.000; OR = 1.034, P = 0.010; OR = 1.778, P = 0.038; and OR = 4.972, P = 0.000, respectively). Medication and hospitalization costs constituted the principal economic burdens.ConclusionThe heavy financial burden, employment difficulties, and high unemployment rate are the most prominent concerns of female patients with NMOSD who require more social support and concern.

Burden of Cancer and Utilization of Local Surgical Treatment Services in Rural Hospitals of Ethiopia: A Retrospective Assessment from 2014 to 2019.

Global cancer estimations for Ethiopia announced 77 352 new cases in 2020 based on the only population-based registry in Addis Ababa. This study characterizes cancer patients in rural Ethiopia at 8 primary and secondary hospitals between 2014 and 2019. All clinically or pathologically confirmed cancer cases that were diagnosed between 1 May 2014 and 29 April 2019 were included. A structured data extraction tool was used to retrospectively review patients' charts and descriptive analysis was done. A total of 1298 cancer cases were identified, of which three-fourths were females with a median age of 42 years. Breast (38%) and cervical (29%) cancers were the most common among females, while prostate (19%) and oesophageal cancers (16%) were the most common among males. Only 39% of tumors were pathologically confirmed. Nearly two-thirds of the cases were diagnosed at an advanced stage. Surgery was the only accessible treatment option for more than half of the cancer patients, and systemic treatment (except endocrine) was rarely available. One in 5 patients did not receive the recommended surgical procedure, half due to patient refusal or lack of the patient returning to the hospital. The pattern of cancer diagnoses in rural hospitals shows an exceptionally high burden in women in their middle-ages due to breast and cervical cancers. Advanced stage presentation, lack of pathology services, and unavailability of most systemic treatment options were common. The surgery was offered to nearly 60% of the patients, showing the significant efforts of health workers to reduce sufferings.

Addressing Autoimmune and Immune-mediated Skin Disease Burden in Women.

According to the National Institutes of Health (NIH), more than 23.5 million people in the United States suffer from confirmed autoimmune diseases, which are a leading cause of disability (NIH Autoimmune Diseases Coordinating Committee, 2005). Recent evidence suggests that the prevalence of autoimmune biomarkers is growing in the United States, with 41 million Americans testing positive (Dinse et al., 2020). Autoimmune disorders must, therefore, be an increasing priority for health policymakers and researchers.

Assessing the prevalence and association between physical, emotional, and sexual of intimate partner violence against women in Nigeria

BackgroundSeveral studies were carried out on prevalence and associated factors of physical, emotional, and sexual violence against women. However, little attention was given to a comprehensive study that assesses the association between physical, emotional, and sexual violence against women. Thus, this study aimed to assess the association between physical, emotional, and sexual violence against women and their prevalence.MethodsA retrospective cross-sectional design was implemented based on the 2018 Nigeria Demographic and Health Survey involving 8061 married women aged 15–49. A log-linear statistical model for the three-way table was used to assess the association between emotional, physical, and sexual violence. SAS statistical software was used for data management and parameter estimation.ResultsAmong a total of 8061 women considered in the study 3022 (37.49%), 4216 (52.3%) and 1186 (14.71%) women have experienced physical, emotional, and sexual violence, respectively. The estimated odds of the interaction between emotional and physical violence (e1.9281 = 6.876); physical and sexual violence (e−2.0529 = 0.128) were significantly differ from 1.0 with p-values < 0:0001 and 0.0201, respectively.ConclusionOver 33 percent of women experienced at least one incident of physical, emotional, or sexual violence in their lifetime. Physical violence against women has a significant association with emotional and sexual violence. However, it does not imply physical violence causes the other violence since cross-sectional data used for the analysis and other factors were not taken into consideration. The lack of a three-way association between emotional, physical, and sexual violence was also perceived. Therefore, as the prevalence of intimate partner violence against women s high, Nigeria as a country needs to strive to reduce it with the collaboration of other nations in the world to achieve Sustainable Development Goal (SDG). Design and apply guidelines to aware of the community about intimate partner violence against women and besides, take appropriate sentencing on those who commit the violence are the better approaches to prevent violence. Traditional habits that might be the cause of violence should be avoided to reduce or prevent the burden of women due to violence.

Healthcare Costs and Resource Use Associated With Cervical Intraepithelial Neoplasia and Cervical Conization: A Retrospective Study of German Statutory Health Insurance Claims Data

Background: Cervical intraepithelial neoplasia (CIN) can be a consequence of human papillomavirus (HPV) infection. High-grade CIN (CIN2/CIN3) may develop from persistent HPV infection and progress to cervical cancer if left untreated. Management of CIN includes conservative surveillance or ablation and excision by conization. Internationally, CIN and its treatment generate a considerable economic burden, but no current data regarding costs and resource use from the perspective of the German statutory health insurance exist. Objectives: The aim of this study was to explore the health economic burden in women with CIN diagnoses who either underwent cervical conization or were managed conservatively. Methods: We conducted a retrospective claims data analysis using the InGef Research Database from 2013 to 2018. Healthcare costs and resource utilization in a 24-month observation period (1:1:1 matching) were compared in 18- to 45-year-old women with CIN (1-3) who underwent a conization procedure (study cohort 1) and in women with CIN (1-3) who did not undergo conization (study cohort 2) to women with neither CIN nor conization (control group). Results: For each group, 2749 women were identified. Mean total healthcare costs after 24 months were higher in study cohort 1 (€4446, _P_&lt;.01) and study cohort 2 (€3754, _P_=.09) compared with the control group (€3426). Comparing study cohort 1 and 2 to controls, mean differences were highest in age groups 41-45 years (cohort 1: €5115 vs €3354, _P_&lt;.01; cohort 2: €4152 vs €3354, _P_=.14). Significantly more women were hospitalized at least once in study cohort 1 (57.46%, _P_&lt;.01) and study cohort 2 (38.74%, _P_&lt;.01) compared with the control group (31.14%). Frequency of outpatient physician visits was significantly higher in both study cohorts (43.23 visits, P&lt;.01 and 38.60 visits, _P_&lt;.01) compared with the control group (32.07 visits). Conclusion: Our results revealed 30% and 10% increased total healthcare costs in women with CIN undergoing invasive treatment (study cohort 1) and conservative management (study cohort 2), respectively, compared with a control group of women with no CIN in a 2-year follow-up period.

Healthcare Costs and Resource Use Associated With Cervical Intraepithelial Neoplasia and Cervical Conization: A Retrospective Study of German Statutory Health Insurance Claims Data

Background: Cervical intraepithelial neoplasia (CIN) can be a consequence of human papillomavirus (HPV) infection. High-grade CIN (CIN2/CIN3) may develop from persistent HPV infection and progress to cervical cancer if left untreated. Management of CIN includes conservative surveillance or ablation and excision by conization. Internationally, CIN and its treatment generate a considerable economic burden, but no current data regarding costs and resource use from the perspective of the German statutory health insurance exist. Objectives: The aim of this study was to explore the health economic burden in women with CIN diagnoses who either underwent cervical conization or were managed conservatively. Methods: We conducted a retrospective claims data analysis using the InGef Research Database from 2013 to 2018. Healthcare costs and resource utilization in a 24-month observation period (1:1:1 matching) were compared in 18- to 45-year-old women with CIN (1-3) who underwent a conization procedure (study cohort 1) and in women with CIN (1-3) who did not undergo conization (study cohort 2) to women with neither CIN nor conization (control group). Results: For each group, 2749 women were identified. Mean total healthcare costs after 24 months were higher in study cohort 1 (€4446, P&lt;.01) and study cohort 2 (€3754, P=.09) compared with the control group (€3426). Comparing study cohort 1 and 2 to controls, mean differences were highest in age groups 41-45 years (cohort 1: €5115 vs €3354, P&lt;.01; cohort 2: €4152 vs €3354, P=.14). Significantly more women were hospitalized at least once in study cohort 1 (57.46%, P&lt;.01) and study cohort 2 (38.74%, P&lt;.01) compared with the control group (31.14%). Frequency of outpatient physician visits was significantly higher in both study cohorts (43.23 visits, P&lt;.01 and 38.60 visits, P&lt;.01) compared with the control group (32.07 visits). Conclusion: Our results revealed 30% and 10% increased total healthcare costs in women with CIN undergoing invasive treatment (study cohort 1) and conservative management (study cohort 2), respectively, compared with a control group of women with no CIN in a 2-year follow-up period.

Healthcare Costs and Resource Use Associated With Cervical Intraepithelial Neoplasia and Cervical Conization: A Retrospective Study of German Statutory Health Insurance Claims Data.

Background: Cervical intraepithelial neoplasia (CIN) can be a consequence of human papillomavirus (HPV) infection. High-grade CIN (CIN2/CIN3) may develop from persistent HPV infection and progress to cervical cancer if left untreated. Management of CIN includes conservative surveillance or ablation and excision by conization. Internationally, CIN and its treatment generate a considerable economic burden, but no current data regarding costs and resource use from the perspective of the German statutory health insurance exist. Objectives: The aim of this study was to explore the health economic burden in women with CIN diagnoses who either underwent cervical conization or were managed conservatively. Methods: We conducted a retrospective claims data analysis using the InGef Research Database from 2013 to 2018. Healthcare costs and resource utilization in a 24-month observation period (1:1:1 matching) were compared in 18- to 45-year-old women with CIN (1-3) who underwent a conization procedure (study cohort 1) and in women with CIN (1-3) who did not undergo conization (study cohort 2) to women with neither CIN nor conization (control group). Results: For each group, 2749 women were identified. Mean total healthcare costs after 24 months were higher in study cohort 1 (€4446, P<.01) and study cohort 2 (€3754, P=.09) compared with the control group (€3426). Comparing study cohort 1 and 2 to controls, mean differences were highest in age groups 41-45 years (cohort 1: €5115 vs €3354, P<.01; cohort 2: €4152 vs €3354, P=.14). Significantly more women were hospitalized at least once in study cohort 1 (57.46%, P<.01) and study cohort 2 (38.74%, P<.01) compared with the control group (31.14%). Frequency of outpatient physician visits was significantly higher in both study cohorts (43.23 visits, P<.01 and 38.60 visits, P<.01) compared with the control group (32.07 visits). Conclusion: Our results revealed 30% and 10% increased total healthcare costs in women with CIN undergoing invasive treatment (study cohort 1) and conservative management (study cohort 2), respectively, compared with a control group of women with no CIN in a 2-year follow-up period.

Epidemiology, management, and outcomes of atrial fibrillation among 30 million citizens in Shanghai, China from 2015 to 2020: A medical insurance database study

SummaryBackgroundAtrial fibrillation(AF) has become a significant public health concern in China, with population aging and urbanization.MethodsData screening was performed for 30,244,930 subjects with medical insurance in the Shanghai Municipal Health Commission database between 2015 and 2020. Patients diagnosed with AF were identified and further assessed for treatment information and clinical outcomes, as well as sex differences and impact of COVID-19 pandemic on AF managment.FindingsAF prevalence was 0.88% in Shanghai, which increased with age and reached 6.70% at subjects 80 years and over. AF was more prevalent in women compared with men (0.89% vs. 0.88%, p<0.0001), which could be attributed to higher AF burden in women over 80 years. Driven by increased prescription of non-vitamin K antagonist oral anticoagulants, anticoagulant use increased from 19.46% in 2015 to 56.57% in 2020. The number of left atrial appendage closure increased from 0.16% in 2015 to 1.23% in 2020. Rhythm control strategy was increasingly adopted, as the use of antiarrhythmic drugs doubled and ablation increased by 21% in 2020 compared to 2015. Compared with men, women were less prone to receive rhythm control treatments, including antiarrhythmics, ablation and cardioversion, but more likely to adopt rate control drugs. During the 5.5 years follow-up, the incidences of stroke, transient ischemic attack, systemic embolism, bleeding, myocardial infarction, and in-hospital death were 6.09%, 5.74%, 1.44%, 5.11%, 8.41%, and 12.84% in patients with index diagnosis of AF in 2015, respectively.InterpretationThe burdens of AF and AF-related outcomes in Shanghai are high. Management of AF is markedly improved in recent years, and was not or only slightly impeded by the COVID-19 pandemic. There are sex differences in the prevalence, management, and outcomes of AF.FundingShanghai Hospital Development Center, National Natural Science Foundation of China and Shanghai Municipal Science and Technology Commission.

Does Journal Content in the Field of Women's Health Represent Women's Burden of Disease? A Review of Publications in 2010 and 2020.

Background:Historically, women's health has focused on reproductive health. However, noncommunicable and communicable diseases comprise much of the burden of disease in women.Methods:A quantitative analysis of the main health content of articles published in six women's health journals (WHJ) and five general medical journals (GMJ) in 2010 and 2020 was conducted to categorize the main medical area topics of published articles and the life stage under study. Findings were compared with the leading causes of disease in women according to the Global Burden of Disease (GBD) study.Results:There were 1483 articles eligible for analysis. In total, in WHJ, 44% of topics were reproductive health, increasing from 36% in 2010 to 49% in 2020, which was similar to GMJ. Noncommunicable disease was the next most addressed topic, with cancer being the major disease area covered. When compared with the GBD study, major disease areas such as infectious disease, cardiovascular disease, and musculoskeletal disorders were underrepresented as topics in women's health publications. Most articles that focused on a particular life stage were on pregnancy or the reproductive years, with very few articles on menopause.Conclusion:Women's health publishing remains largely focused on reproductive health topics, with few articles on many of the major causes of morbidity and mortality in women. Journals, researchers, funders, and research priority setters should embrace a broader view of women's health to effectively cover content that reflects the broad range of health issues impacting women across the life span.

Beyond the ‘Feminization of Agriculture’: Rural out-migration, shifting gender relations and emerging spaces in natural resource management

In international research and development discourses, the ‘Feminization of Agriculture’ is often used as a vague umbrella term referring to an increase in women's labor burden and responsibilities in agriculture as a result of male out-migration. However, the term is under-conceptualized, and fails to reflect changing gender relations in agriculture and natural resource management, with the potential consequence of ill-defined agriculture and gender research programs. This paper challenges narratives of the ‘Feminization of Agriculture’. Drawing from feminist political ecology, this paper conceptualizes gender relations more broadly by highlighting gendered subjectivities and power relations in agriculture in contexts of male out-migration. I propose a conceptual framework to explore shifts in (1) socio-spatial struggles over resources, (2) influence within agrarian households and communal spaces, (3) aspirations, feelings of insecurity and self-determination. I build on extensive participatory fieldwork conducted in three countries, Nepal, India and Bangladesh.The conceptual framework helps analyze how some gender norms and relations are renegotiated in contexts of male out-migration. While unequal power relations shape everyday struggles in agriculture and natural resource management, for some women, increased mobility, social engagement and handling cash create new spaces to influence, move, and communicate. Importantly, everyday struggles over agricultural, water and land resources remain shaped by gender, age, caste, land ownership, remittances and household position, particularly those living with the family in-laws. Research and development programs need to take intersectionality into account and explore emerging spaces for influence, but also be aware of persistent gender norms and power relations which shape agricultural practices, aspirations and self-determination. I conclude by arguing for the need to expand the ‘Feminization of Agriculture’ debate towards a broader understanding of socio-spatial change and gendered subjectivities within agriculture.

The socio-ecological contradictions of land degradation and coastal agriculture in south India

This paper examines the drivers and impacts of degradation of agricultural land in a village in a South Indian coastal delta. Drawing on insights from political economy and political ecology scholarship, it argues that there is a dialectical relation between land degradation and social inequalities, i.e. the biophysical degeneration of land is not only caused by human and environmental factors but it also generates social contradictions which further intensify both land degradation and social inequalities. The paper demonstrates, firstly, that coastal land degradation has been generated in the form of soil salinity through a confluence of the inherent environmental vulnerabilities of the region, forces of commoditization (especially those associated with shrimp aquaculture), existing social hierarchies and state policy. Secondly, it shows that social groups differentiated by caste, class and gender have experienced these changes differently. A small, relatively well-off section of the locally dominant caste landowners has benefitted from shifting from paddy to shrimp aquaculture, which is leading to a further increase in salinisation. Others have to bear the brunt of decreasing productivity of land for crop cultivation, leading them to abandon or reduce cultivation and increase dependence on non-agricultural sources of income, especially through male outmigration. Women's burden of work has increased while their capacity to earn wage-income has declined. Without any concerted state effort to either restore the land or to alleviate the widespread agrarian distress, land degradation has developed into a continuously evolving downward spiral, but one where there will still be some winners and many losers.

Burden of Women's Infectious Disease and Analysis of Current Awareness and Value Perceived of the Obstetrical and Gynecological Specialty

Aim: Given the relevance of irresistible infections to the wellbeing of women, we intended to evaluate the current attentiveness, interest and relevance of the unresisted obstetrical and gynecological infection among the residents and residents of contemporary obstetrics and gynecology. Methods: Two independent assessments which deal with attention, appreciation. Sub-specialty premiums were also sent out to (1) an irregular 22 percent sample of residents in obstetrics and gynecology and (2) all Gynecology obstetrics mailed out. Results: More than two-thirds of the chief students in the scientific section were aware of the specialty and 68,2% respected compelling disease experts. About a third of the employees were attentive to the specialization. The formal training of clinical specialists in the field of intractable diseases was reported by thirty-six percent of chief residents. Conclusion: Pakistani obstetrics and residents of gynecology and leaders have little knowledge of the sub-specialty. There is an open specialty to formal instruction by practitioners skilled in the field for residents in irresistibly infected object ology and gynecology. These findings may lead to continuous enrollment efforts in obstetrical and gynecology sub-specialties of irresistible diseases. Keywords: Women's Infectious Disease, Obstetrical and Gynecological Specialty, Pakistani Population.

A systematic review of the patient burden of Crohn\u2019s disease-related rectovaginal and anovaginal fistulas

BackgroundCrohn’s disease (CD)-related rectovaginal fistulas (RVFs) and anovaginal fistulas (AVFs) are rare, debilitating conditions that present a substantial disease and treatment burden for women. This systematic literature review (SLR) assessed the burden of Crohn’s-related RVF and AVF, summarizing evidence from observational studies and highlighting knowledge gaps.MethodsThis SLR identified articles in PubMed and Embase that provide data and insight into the patient experience and disease burden of Crohn’s-related RVF and AVF. Two trained reviewers used pre-specified eligibility criteria to identify studies for inclusion and evaluate risk of bias using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for observational studies.ResultsOf the 582 records identified, 316 full-text articles were assessed, and 16 studies met a priori eligibility criteria and were included. Few epidemiology studies were identified, with one study estimating the prevalence of RVF to be 2.3% in females with Crohn’s disease. Seven of 12 treatment pattern studies reported that patients had or required additional procedures before and/or after the intervention of interest, demonstrating a substantial treatment burden. Seven of 11 studies assessing clinical outcomes reported fistula healing rates between 50 and 75%, with varying estimates based on population and intervention.ConclusionsThis SLR reports the high disease and treatment burden of Crohn’s-related RVF and AVF and identifies multiple evidence gaps in this field. The literature lacks robust, generalizable data, and demonstrates a compelling need for substantial, novel research into these rare and debilitating sequelae of CD.Registration The PROSPERO registration number for the protocol for this systematic literature review is CRD42020177732.