Search Results (810)

Agrarian women are at the forefront of rural livelihoods increasingly affected by the frequency and severity of climate change impacts. However, their household livelihood resilience (HLR) remains limited due to gender-blind policies, scarce sex-disaggregated data, and inadequate consideration of gender-specific needs in resilience-building efforts. Grounded in participatory feminist research, this study employed a multi-method qualitative approach, including semi-structured interviews and oral history narratives, with 60 women in two climate-vulnerable provinces. Data were analyzed through thematic coding, CATWOE (Customers, Actors, Transformation, Worldview, Owners, Environmental Constraints) analysis, and descriptive statistics. The findings identify nine major climate-related events disrupting livelihoods and reveal a limited understanding of HLR as a long-term, transformative concept. Adaptation strategies remain short-term and focused on immediate survival. Barriers to HLR include financial constraints, limited access to agricultural resources and technology, and entrenched gender norms restricting women’s leadership and decision-making. While local governments, women’s associations, and community networks provide some support, gaps in accessibility and adequacy persist. Participants expressed the need for financial assistance, vocational training, agricultural technologies, and stronger peer networks. Strengthening HLR among agrarian women requires gender-sensitive policies, investment in local support systems, and community-led initiatives. Empowering agrarian women as agents of change is critical for fostering resilient rural livelihoods and achieving inclusive, sustainable development. Full article

Hormonal contraceptives (HCs) are widely used and generally well tolerated; however, their neuroendocrinological effects remain underappreciated in clinical decision-making. Beyond ovulation suppression, HCs influence brain function by modulating key neurotransmitters such as GABA, serotonin, and dopamine, as well as neurosteroids like allopregnanolone and β-endorphin. These interactions help explain why some users experience mood swings, anxiety, or changes in sexual desire, while others report improvements in well-being. In this narrative review, we explore how different estrogenic and progestin components affect central pathways involved in emotional regulation and cognition. Evidence suggests that estradiol or estetrol-based formulations combined with anti-androgenic progestins like drospirenone or nomegestrol acetate may offer a more favourable neuroendocrine profile, particularly in women with a history of mood disorders or hormonal sensitivity. Understanding these neuroendocrine mechanisms may support more personalized contraceptive choices, particularly in women with mood disorders and hormonal vulnerability. Full article

Objective: The aim of this study was to compare micronutrient intake and inadequacy estimates using household consumption and expenditure survey (HCES) and quantitative 24-h recall (24HR) data among women of reproductive age (WRA) in Kasungu district, Malawi. Methods: We conducted a secondary data analysis utilizing HCES dietary data from a subsample of households in rural areas of Kasungu district, which were sourced from the 2019/20 Malawi Fifth Integrated Household Survey (n = 183); and 24HR data were obtained from WRA in a community-based Addressing Hidden Hunger with Agronomy (AHHA) trial in the same district (n = 177). Micronutrient intakes and inadequacy were estimated under two alternative scenarios of large-scale food fortification (LSFF). We standardized apparent nutrient intakes from the HCES data using the adult female equivalent metric. Results: Estimated prevalence of micronutrient inadequacy fell within 20 percentage points between HCES and 24HR for iron (Fe), zinc (Zn), vitamins B2 and B9 under both no fortification and fortification scenarios. There were some discrepancies for the remaining B vitamins, being consistently large for vitamin B3. Conclusions: In the absence of 24HR data, HCES data can be used to make inferences about some micronutrient intakes and inadequacies among rural WRA in Malawi and to inform decisions regarding LSFF, including vehicle selection and coverage. However, additional efforts are needed to improve HCES for dietary nutrient surveillance given existing limitations. Full article

Background/Objectives: Respectful maternity care involves privacy, dignity, and informed choice within the process of delivery as stipulated by the World Health Organization (WHO). Informed consent is a cornerstone of patient-centered care, representing not just a formal document, but an ongoing ethical and clinical process through which women are offered objective, understandable information to support autonomous, informed decision-making. Methods: This narrative review critically examines the literature on informed consent in maternity care, with particular attention to both obstetric-led and midwifery-led models of care. In addition to identifying institutional, cultural, and systemic obstacles to its successful implementation, the review examines the definition and application of informed consent in perinatal settings and evaluates its effects on women’s autonomy and satisfaction with care. Results: Important conclusions emphasize that improving women’s experiences and minimizing needless interventions require active decision-making participation, a positive provider–patient relationship, and ongoing support from medical professionals. However, significant gaps persist between legal mandates and actual practice due to provider attitudes, systemic constraints, and sociocultural influences. Women’s experiences of consent can be more effectively understood through the use of instruments such as the Mothers’ Respect (MOR) Index and the Mothers’ Autonomy in Decision Making (MADM) Scale. Conclusions: To promote genuinely informed and considerate maternity care, this review emphasizes the necessity of legislative reform and improved provider education in order to close the gap between policy and practice. Full article

The empowerment of women in rural areas implies that they have power and control over their lives and participate in individual and collective decision-making. Empowerment depends on autonomy or the ability to act independently. The lack or weakness of autonomy is due to traditional gender roles in rural communities, which reinforce norms and expectations that restrict women, limiting their empowerment and ability to make informed and effective decisions. This context fosters the creation of unequal power structures and women’s dependence on male figures. This article explores the relationship between autonomy and decision-making capacity in rural women. Through a review using the PRISMA approach, we analysed whether the absence of autonomy limits empowerment and decision-making. A total of 141 records were identified, and after excluding duplicate documents, those with no relation to the population and the purpose of this article, 35 articles with research results were included in this review. The categories addressed were empowerment, autonomy, decision-making and sustainable development, the latter emerging in the reviewed literature. Full article

Objective: Shoulder dystocia (ShD) is a rare but serious obstetric emergency associated with significant neonatal morbidity. This study aimed to evaluate the predictive performance of machine learning (ML) models based on fetal biometric ratios and clinical characteristics for the identification of ShD in pregnancies without clinical suspicion of macrosomia. Methods: We conducted a retrospective case-control study including 284 women (84 ShD cases and 200 controls) who underwent spontaneous vaginal delivery between 37 and 42 weeks of gestation. All participants had an estimated fetal weight (EFW) below the 90th percentile according to Hadlock reference curves. Univariate and multivariate logistic regression analyses were performed on maternal and neonatal parameters, and statistically significant variables (p < 0.05) were used to construct adjusted odds ratio (aOR) models. Supervised ML models—Logistic Regression (LR), Random Forest (RF), and Extreme Gradient Boosting (XGB)—were trained and tested to assess predictive accuracy. Performance metrics included AUC-ROC, sensitivity, specificity, accuracy, and F1-score. Results: The BPD/AC ratio and AC/FL ratio markedly enhanced the prediction of ShD. When added to other features in RF models, the BPD/AC ratio got an AUC of 0.884 (95% CI: 0.802–0.957), a sensitivity of 68%, and a specificity of 83%. On the other hand, the AC/FL ratio, along with other factors, led to an AUC of 0.896 (95% CI: 0.805–0.972), 68% sensitivity, and 90% specificity. Conclusions: In pregnancies without clinical suspicion of macrosomia, ML models integrating fetal biometric ratios with maternal and labor-related factors significantly improved the prediction of ShD. These models may support clinical decision-making in low-risk deliveries where ShD is often unexpected. Full article

Women’s decision-making autonomy is widely recognized as a critical determinant of maternal, newborn, and child health (MNCH). However, prevailing measures often conflate genuine autonomy with decisions made within traditional gender roles, risking an overstatement of women’s empowerment. This study examines the extent to which reported female decision-making autonomy reflects authentic agency versus role-based compliance in a patriarchal context. A cross-sectional study was conducted among 280 male household heads in Kakamega County, Kenya, whose partners were pregnant or recently postpartum. Using multi-stage cluster sampling and structured interviews, men reported on household and MNCH decision-making and their rationales, categorized as gender-role conformity, belief in gender equality, or other reasons. Although 40.4% reported that their partners made decisions independently, only 11.4% attributed it to a belief in women’s equality; 28% framed it within traditional gender roles. Men were over four times more likely to perceive women’s decisions as role-based than autonomous (AOR = 4.40; 95% CI: 2.48–5.78). Younger men (18–34) were more likely to report female decision-making (AOR = 5.54; 95% CI: 5.08–7.27), without necessarily endorsing egalitarian norms. Findings highlight the urgent need for gender-transformative MNCH interventions that move beyond surface-level autonomy to address deeper structural inequities. Full article

Background/Objectives: Despite the psychological benefits of breast reconstruction (BR) after mastectomy, uptake remains limited among women with breast cancer. This study explores psychosocial and personality predictors of BR intentions in the pre-mastectomy phase, aiming to inform strategies for mental health promotion in oncology care. Methods: This cross-sectional analysis used preoperative data from a longitudinal study at a university hospital in Greece. Women with primary breast cancer scheduled for mastectomy completed a battery of validated self-report measures, including the International Personality Item Big-Five Factor Markers (IPIP-BFFM), the Hospital Anxiety and Depression Scale (HADS), and the Short Form-36 Health Survey (SF-36). Demographic, clinical, and psychosocial data were also collected. Binary logistic regression was used to examine predictors of (a) BR information-seeking and (b) BR intention. Results: Seventy-four women participated (mean age = 61.1 years). Older age predicted lower BR intention (Exp(b) = 0.897, 95% CI: 0.829–0.970) and information-seeking (Exp(b) = 0.925, 95% CI: 0.859–0.997). Single/divorced status was associated with reduced BR information-seeking (Exp(b) = 0.053, 95% CI: 0.005–0.549). Openness to experience significantly predicted both outcomes (BR information-seeking: Exp(b) = 1.115, 95% CI: 1.028–1.209); BR intention: Exp(b) = 1.095, 95% CI: 1.016–1.181). Higher physical health-related QoL scores were associated with increased BR intention (Exp(b) = 1.039, 95% CI: 1.007–1.072), whereas higher mental health-related QoL (Exp(b) = 0.952, 95% CI: 0.912–0.994) and higher depression scores (Exp(b) = 0.797, 95% CI: 0.638–0.996) were linked to decreased BR intent. No psychological factor significantly predicted information-seeking. Conclusions: These findings underscore the value of psychosocial screening and personality-informed counseling prior to surgery. By identifying individuals less likely to seek information or consider BR, pre-mastectomy assessments can contribute to tailored, mental health-promoting interventions and support informed, patient-centered surgical decision-making. Full article

Background/Objectives: Young female cancer survivors often face specific informational needs related to the physical and emotional effects of cancer and its impact on life plans, particularly fertility and parenthood. However, few tools are tailored to assess these needs during this critical life stage. This study aimed to (i) validate a multidimensional measure—the Satisfaction with Information Provided to Young Oncology Patients Scale (SIPYF-CPS)—to assess the specific informational needs of young adult female cancer survivors; and (ii) explore preferences regarding the provision of information and counseling. Methods: A total of 124 women (M[age] = 38.18; SD = 5.49; range 21–45), 76.6% diagnosed with breast cancer, participated in the study. Psychometric analyses included exploratory factor analysis and correlation coefficients to assess reliability and construct validity. Convergent validity was evaluated through standardized measures of anxiety, reproductive concerns, and quality of life. Results: A final 22-item measure demonstrated strong reliability and validity, capturing four factors: (i) Disease-Related Information, (ii) Symptoms and Functional Limitations, (iii) Implications for Fertility and Parenthood, and (iv) Support Services. Participants expressed low satisfaction with information on fertility preservation, sexual health, and support services. Lower satisfaction was moderately associated with higher anxiety and depression while positively related to quality of life. Most participants preferred phased, face-to-face communication throughout the illness trajectory. Conclusions: The SIPYF-CPS is a valid, multidimensional tool that captures the complex and evolving informational needs of young female cancer survivors. Its clinical use may promote earlier, personalized, and emotionally responsive communication—supporting psychological well-being, informed decision-making, and long-term survivorship care. Full article

Reproductive health literacy (RHL) is essential to women’s ability to make informed reproductive health (RH) decisions and is a key determinant of RH outcomes. Resettled refugee women often experience poorer RH outcomes, yet there is limited research on their RHL and its influence on RH decision-making. This scoping review aims to (1) to evaluate existing methods for measuring RHL among resettled refugee women and (2) to characterize the relationship between RHL, RH decision-making, behavior, and outcomes among refugee women residing in high-income countries. A search of peer-reviewed literature published in English found limited direct measurement of RHL. Measurement methods were primarily qualitative or based on unvalidated survey instruments, limiting comparability and generalizability. The current methodologies do not adequately capture RH knowledge or RHL proficiency. A range of additional factors were found to influence RH decision-making and behavior, supporting the need for a means to accurately measure RHL. Further quantitative research is needed to clarify the extent to which RHL and knowledge influence RH behavior and outcomes. The development of a culturally relevant, validated RHL instrument that integrates knowledge and contextual influences would support healthcare providers and public health agents in serving and designing effective interventions for refugee women post-resettlement. Full article

Breast cancer accounts for one in four new malignant tumors in women, and misdiagnosis can lead to severe consequences, including delayed treatment. Among patients classified with a BI-RADS 3 rating, the risk of very early-stage malignancy remains over 2%. However, due to the benign imaging characteristics of these lesions, radiologists often recommend follow-up rather than immediate biopsy, potentially missing critical early interventions. This study aims to develop a deep learning (DL) model to accurately identify very early-stage malignancies in BI-RADS 3 lesions using ultrasound (US) images, thereby improving diagnostic precision and clinical decision-making. A total of 852 lesions (256 malignant and 596 benign) from 685 patients who underwent biopsies or 3-year follow-up were collected by Southwest Hospital (SW) and Tangshan People’s Hospital (TS) to develop and validate a deep learning model based on a novel transfer learning method. To further evaluate the performance of the model, six radiologists independently reviewed the external testing set on a web-based rating platform. The proposed model achieved an area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of 0.880, 0.786, and 0.833 in predicting BI-RADS 3 malignant lesions in the internal testing set. The proposed transfer learning method improves the clinical AUC of predicting BI-RADS 3 malignancy from 0.721 to 0.880. In the external testing set, the model achieved AUC, sensitivity, and specificity of 0.910, 0.875, and 0.786 and outperformed the radiologists with an average AUC of 0.653 (p = 0.021). The DL model could detect very early-stage malignancy of BI-RADS 3 lesions in US images and had higher diagnostic capability compared with experienced radiologists. Full article

Background: Uterine rupture is a rare but severe obstetric complication with significant maternal and neonatal consequences. While partial uterine ruptures (PURs) are generally associated with less severe outcomes, complete uterine ruptures (CURs) carry a higher risk of serious impact on both mother and child. The present study aimed to evaluate outcomes and identify risk factors for each type of rupture, and also to define high- and low-risk uterine ruptures based on clinical outcomes. Methods: A retrospective analysis of 112 uterine rupture cases, including 29 CURs and 83 PURs, was conducted at the Women’s Hospital of the University of Cologne from October 2010 to January 2021. Results: Maternal outcomes revealed that CUR was associated with higher risks of prolonged hospitalization (p = 0.003), postpartum hemorrhage (p < 0.001), maternal transfusion (p = 0.003), and ICU transfer (p = 0.004) compared to PUR. Neonatal outcomes showed a significantly higher risk of severe acidosis (p < 0.001), low APGAR scores (p < 0.001), NICU transfers (p = 0.004), and resuscitation needs (p = 0.016) in CUR cases. Factors increasing the risk of CUR included pathological CTG (OR = 1.9, 95% CI: 0.99–7.14, p = 0.05), abdominal pain (OR = 2.63, 95% CI: 1.10–6.25, p = 0.03), previous vaginal birth (OR = 7.14, 95% CI: 0.025–20, p < 0.001), and no uterine contractions (OR = 7, 95% CI: 1.21–40.56, p = 0.03). A previous cesarean section significantly increased the risk of CUR (OR = 4.94, 95% CI: 1.38–17.67, p = 0.014), whereas more than two cesarean sections reduced the risk (OR = 0.66, 95% CI: 0.13–3.22, p = 0.61). A comparison of CUR with maternal and neonatal high-risk rupture groups revealed that low gestational age and a history of previous cesarean sections were significant risk factors for neonatal high-risk rupture. Conclusion: Vaginal birth and abdominal pain were identified as key risk factors for CUR, which lead to severe maternal and neonatal outcomes. Recognizing these risk factors can help clinicians optimize risk stratification and decision-making, and enhance monitoring strategies to prevent adverse outcomes. Full article

Urinary incontinence is characterized by the involuntary leakage of urine. The primary cause of stress urinary incontinence in women is the weakening of the pelvic floor muscles. Stress urinary incontinence (SUI) is a significant global health problem that impacts mainly middle-aged women, with a severe impact on their quality of life. Traditional diagnostic methods and treatments often fail, although technological innovations have improved diagnostic accuracy, such as specific questionnaires or transperineal ultrasound. While medical therapies and surgical procedures are continuously being developed, controversies about the correct choices regarding diagnostic and treatment methods continue to exist. The aim of our review was to identify the innovative diagnostic tools and effective treatment procedures for SUI. A narrative review was conducted due to the heterogeneity of the studies. New methods for diagnosis and treatment have gained ground, and we have covered them in our review; however, the field continues to expand. A personalized approach to diagnosis is also a requirement because of the limitations of conventional urodynamic studies, and we emphasize the importance of such personalization in enhancing clinical decision making. Future medical strategies that combine both preventive and therapeutic care are desirable. Newer technologies were brought to light in this review, including stem cell therapy and laser therapy. Full article

While the interest and participation in general endurance training and recreational sports competitions have continuously increased in recent decades, the number of recreational master-level endurance athletes has additionally multiplied. Athletes, active men and women older than 40 years of age, who participate in competitive athletics are usually referred to by the term master athletes (MAs). Previous research revealed the significant benefits of regular moderate physical activity, i.e., its positive influence on cardiovascular risk factors and cardiovascular health; however, recent data have raised concerns that long-term endurance exercise participation is associated with cardiac remodeling and potential adverse cardiovascular outcomes. Previous research also indicated potential structural, functional, and electrical remodeling in MAs due to prolonged and repeated exposure to high-intensity endurance exercise—a condition known as athlete’s heart. In this review, we focus on the association between extreme levels of endurance exercise and potential cardiovascular controversies, such as arrhythmogenesis due to new-onset atrial fibrillation, accelerated coronary artery atherosclerosis, and exercise-induced cardiac remodeling. Additionally, the exercise-dependent modulation of immunological response, such as proteomic response and cytokine alterations, is discussed. Furthermore, we discuss the impact of nutritional supplements in MAs and their potential benefits and harmful interactions. We aim to provide sports medicine practitioners with knowledge of these contemporary longevity controversies in sports cardiology and to highlight the importance of shared decision making in situations of clinical uncertainty. Full article

Background/Objectives: In recent years, there has been a significant increase in the number of women with breast cancer. Breast cancer prediction is defined as a medical data analysis and image processing problem. Experts may need artificial intelligence technologies to distinguish between benign and malignant tumors in order to make decisions. When the studies in the literature are examined, it can be seen that applications of deep learning algorithms in the field of medicine have achieved very successful results. Methods: In this study, 11 different deep learning algorithms (Vanilla, ResNet50, ResNet152, VGG16, DenseNet152, MobileNetv2, EfficientB1, NasNet, DenseNet201, ensemble, and Tuned Model) were used. Images of pathological specimens from breast biopsies consisting of two classes, benign and malignant, were used for classification analysis. To limit the computational time and speed up the analysis process, 10,000 images, 6172 IDC-negative and 3828 IDC-positive, were selected. Of the images, 80% were used for training, 10% were used for validation, and 10% were used for testing the trained model. Results: The results demonstrate that DenseNet201 achieved the highest classification accuracy of 89.4%, with a precision of 88.2%, a recall of 84.1%, an F1 score of 86.1%, and an AUC score of 95.8%. Conclusions: In conclusion, this study highlights the potential of deep learning algorithms in breast cancer classification. Future research should focus on integrating multi-modal imaging data, refining ensemble learning methodologies, and expanding dataset diversity to further improve the classification accuracy and real-world clinical applicability. Full article