Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 46 appraisals
Current psychiatry reports
Postpartum Suicidality beyond Depression: a Systematic Review of Risk Profiles and Prevention Gaps
PURPOSE OF REVIEW: Suicidal ideation and behavior during the postpartum period are increasingly recognized as important contributors to maternal morbidity and mortality, particularly in high-income countries. Although postpartum depression is a well-established risk factor, emerging evidence suggests that suicidality may also occur independently and therefore remain underrecognized in clinical practice. This systematic review aimed to synthesize current evidence regarding the prevalence of suicidal ideation and behavior in the postpartum period and to identify associated risk factors. RECENT FINDINGS: A systematic search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted up to March 2025 following PRISMA guidelines. Twenty studies met inclusion criteria, encompassing 352,726 postpartum women across diverse international settings. Reported prevalence of suicidal ideation ranged from 2.2% to over 50%, depending on the population studied and assessment methods used. The most frequently identified risk factors included postpartum depression, anxiety, trauma history, intimate partner violence, unplanned pregnancy, low socioeconomic status, low social support, and adverse childhood experiences. Notably, several studies reported suicidal ideation even in the absence of clinical depression. Only a limited number of studies addressed preventive interventions. Postpartum suicidality appears to be a multifactorial phenomenon that cannot be explained solely by depressive symptomatology. The findings highlight the need for broader screening strategies that incorporate psychosocial and trauma-related factors in addition to depression. Integrated and trauma-informed approaches to screening and prevention may improve early identification of at-risk individuals. Future research should prioritize longitudinal designs and culturally sensitive investigations to better inform prevention and intervention strategies.
28 July 2026
Read appraisal →Medicine
Risk factors for episiotomy during vaginal birth: A systematic review and meta-analysis
BACKGROUND: Despite the numerous harms associated with episiotomy during vaginal birth, the risk factors for this procedure remain a topic of controversy. This study aimed to identify the potential risk factors for episiotomy during vaginal birth. METHODS: A systematic search was conducted across 7 databases, including PubMed/MedLine, Embase, Cochrane, Web of Science, Chinese Knowledge Infrastructure (CNKI), and Wanfang, up to January 2025. Statistical analyses, including heterogeneity tests, sensitivity analysis, and publication bias assessment, were conducted using Stata 18.0 and Review Manager 5.4. RESULTS: A total of 16 articles were included in this meta-analysis, comprising a sample size of 17,502 individuals. Newborn weight (odds ratio [OR] = 2.393; 95% confidence interval [CI] = 1.627-3.520; P < .001) and oxytocin use (OR = 2.341; 95% CI = 1.652-3.318; P < .001) were identified as significant risk factors for episiotomy. In contrast, maternal age (OR = 0.978; 95% CI = 0.922-1.038; P = .466), the type of childbirth attendant (OR = 0.920; 95% CI = 0.569-1.488; P = .733), and the duration of the second stage of labor (OR = 1.299; 95% CI = 0.781-2.162; P = .314) were not statistically significant risk factors for episiotomy. CONCLUSION: High newborn weight and oxytocin use are associated with higher rates of episiotomy. However, other potential risk factors are still controversial due to a lack of sufficient evidence, highlighting the need for more rigorous studies to strengthen the evidence base.
13 July 2026
Read appraisal →BMJ open
Determinants of cervical screening in Ghana: a systematic review
BACKGROUND: Cervical cancer remains a leading cause of morbidity and mortality among women in Ghana, yet screening coverage is extremely low and organised national programmes are limited. Although several studies have examined determinants of screening, no comprehensive synthesis has summarised the evidence to guide effective policy and intervention design. OBJECTIVE: To synthesise existing evidence on determinants of cervical screening in Ghana and identify opportunities to strengthen national screening strategies. DESIGN: This is a systematic review conducted following Aromataris and Pearson's methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches across PubMed Central, CINAHL, Web of Science, Scopus and grey literature (January 2000-July 2025) identified studies reporting barriers and facilitators of cervical screening in Ghana. Risk of bias was assessed using standard appraisal tools. SETTING: This study was conducted in the context of Ghana. RESULTS: Of 7833 records screened, 32 studies met inclusion criteria. Barriers to cervical screening spanned individual, interpersonal, health system, socio-cultural and structural factors, including poor knowledge, fear, limited access, financial constraints and social norms. Facilitators included knowledge and awareness, provider recommendation, social support, positive health perceptions, healthcare access and cost-related enablers. Overall, 23 studies were rated low risk of bias, while nine were rated moderate risk of bias. CONCLUSION: Cervical screening behaviour in Ghana is influenced by structural, cultural, psychological and informational factors. The reviewed evidence suggests that these determinants do not operate in isolation but interact in ways that may vary across contexts and populations. OSF REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/M4XKT.
11 July 2026
Read appraisal →JMIR nursing
WeChat-Based Nursing Interventions in Women's Mobile Health: Systematic Review
BACKGROUND: Mobile health (mHealth) technology offers new approaches to improve women's health by providing personalized monitoring and real-time guidance. As one of the most widely used social media platforms in China, WeChat has shown great potential in mHealth practice, yet systematic evidence on its application in women's health care remains insufficient. OBJECTIVE: This study aims to systematically review WeChat-based nursing interventions in women's mHealth in order to clarify the application status, intervention modalities, target populations, and effectiveness outcomes. METHODS: Searches were conducted in IEEE Xplore, Web of Science, PubMed, Scopus, ACM Digital Library, and Cochrane Central Register of Controlled Trials between January 2011 and December 2024. Two independent reviewers screened studies; extracted data on study design, intervention forms, target diseases, and outcome indicators; and assessed methodological quality. The Cohen κ coefficient was used to evaluate interreviewer agreement. Publication trends, institutional collaborations, author contributions, and research hotspots were analyzed using VOSviewer (Leiden University) and InCites (Clarivate) for bibliometric analysis. RESULTS: A total of 31 eligible studies published from 2014 to 2024 were included. Most studies were randomized controlled trials (n=27). Intervention modalities mainly included WeChat groups (n=22), official accounts (n=18), applets (n=4), and private chats (n=9), mostly used in combination. The top focused health issues were prenatal care (n=5), breast cancer (n=5), gynecological cancer (n=5), and gestational diabetes mellitus (n=4). Six studies adopted multidisciplinary teams. Cohen κ was 0.71, indicating substantial agreement. Publications grew rapidly after 2018, peaking in 2021 and 2024. A total of 40 institutions participated, with Xi'an Jiaotong University having the highest citation impact. Most studies were at high risk of bias due to a nonblinding design. CONCLUSIONS: WeChat-based nursing interventions improve personalized health information access, self-management ability, treatment compliance, and real-time doctor-patient communication for women. This is the first systematic review to evaluate WeChat mHealth interventions in women's health, filling the research gap. Future research should focus on improving methodological quality, exploring cross-cultural adaptability, conducting long-term follow-up, and integrating wearable devices and electronic health records to further optimize WeChat-based women's health services.
7 July 2026
Read appraisal →Advanced drug delivery reviews
Artificial intelligence and machine learning in smart vaginal formulation development
Vaginal drug delivery in women's health remains underutilized and insufficiently studied, largely due to the complexity and dynamic nature of the vaginal microenvironment. Variations in vaginal pH, hormonal levels, and microbiota composition introduce significant biological variability, complicating formulation design and contributing to inconsistent therapeutic outcomes and poor patient adherence. Conventional vaginal formulations often fail to account for these individual differences, highlighting the need for more adaptive and predictive approaches. Emerging advances in artificial intelligence (AI) and machine learning (ML) offer promising strategies to address these challenges by enabling multi-parameter, data-driven formulation development that explicitly considers biological variability. Despite their transformative potential, the application of AI and ML in vaginal drug delivery remains limited. This review addresses this gap by examining the emerging role of AI/ML in the design, optimization, and development of next-generation vaginal formulations, including mucoadhesive, mucus-penetrating, bio-responsive, and controlled-release systems. Key factors influencing formulation performance, such as vaginal microbiota composition, are discussed, and ethical, regulatory, and technical challenges relevant to integrating AI/ML into vaginal drug delivery are also considered. Although research is in its early stages, existing studies indicate that AI and ML integration can enhance predictability, efficiency, and reproducibility in vaginal formulation development. Finally, we highlight the potential of developing personalized medicines through the integration of AI/ML and digital health monitoring devices to create patient-centered vaginal drug delivery systems, thereby advancing therapeutic outcomes and transforming women's health.
1 July 2026
Read appraisal →Sexual health
A systematic review of barriers to cervical cancer screening among Thai women based on the social ecological model: a multi-level analysis of local evidence
BACKGROUND: Cervical cancer is a significant public health issue in Thailand. Despite the implementation of a national screening program, its coverage remains suboptimal. This study aims to systematically review local Thai evidence and comprehensively analyze the multi-level barriers affecting women's participation in cervical cancer screening using the social ecological model (SEM). METHODS: Systematic searches were conducted in PubMed, Scopus, CINAHL and ThaiJO databases from inception to 2025. Literature was screened according to pre-defined inclusion and exclusion criteria, resulting in the inclusion of 11 studies. The Newcastle-Ottawa scale and a mixed-methods assessment tool were used for rigorous quality appraisal. Thematic synthesis was used to categorize screening barriers into five levels: individual, interpersonal, community, health system and public policy. RESULTS: The key obstacles identified include: at the individual level, lack of knowledge, fear, shame and insufficient risk perception; at the interpersonal level, the influence of family and social norms; at the community level, cultural, religious and regional factors; at the health system level, poor service accessibility and system inefficiencies; and at the public policy level, incomplete health insurance coverage and insufficient awareness campaigns. Many of these obstacles show distinct characteristics of Thai society and culture. CONCLUSION: Barriers to cervical cancer screening among Thai women constitute a complex, multi-level system. Future intervention strategies must move beyond single-level health education, and should develop cross-level, culturally-appropriate, comprehensive measures. These include promoting HPV self-sampling, conducting community empowerment education, optimizing the health service system and strengthening policy support to systematically increase screening participation.
16 June 2026
Read appraisal →PloS one
Motherhood choice in multiple sclerosis (MoMS) - Pilot trial of web-based decision support
BACKGROUD: Uncertainty concerning motherhood is common among women with multiple sclerosis (wwMS). Therefore, we developed and pre-tested a patient decision aid (PtDA) and a nurse-led decision coaching intervention (DC) to support motherhood choice. The DC includes the PtDA, a decision guide on motherhood choice, and decision coaching. METHODS: We conducted a randomised pilot trial across Germany to test feasibility, with decisional conflict (Decisional Conflict Scale, DCS) as an exploratory endpoint. Initially, we planned a 3:1 randomisation ratio (planned; PtDA = 48, DC = 16). Due to recruitment difficulties, we switched to a 1:1 randomisation ratio to ensure an appropriate sample size (PtDA > 20, DC > 10). Women between 18 and 45 years old with relapsing-remitting MS or clinically isolated syndrome, and who had not yet decided about motherhood, were eligible. We recruited two nurses for our decision coaching training course. We used questionnaires to measure decisional conflict, programme feasibility, knowledge, and worries regarding pregnancy in MS. Interviews were conducted to gain in-depth information on the potential feasibility of the programmes. Interviews were analysed thematically and questionnaires descriptively. We conducted explorative group comparisons and merged findings using joint display analysis. RESULTS: We trained two decision coaches in the DC group and recruited 35 wwMS (PtDA = 22; DC = 13) over five months. Median DCS scores in the DC group were 49 at baseline and 15 at follow-up (range 0-100; higher scores indicate greater decisional conflict). In the PtDA group, scores were 54 (baseline) and 31 (follow-up). Explorative group comparison indicated lower decisional conflict at follow-up in the DC group than in the PtDA group (p = 0.035). Interviewees (PtDA = 5; DC = 6; nurses = 2) described both interventions as helpful for decision-making. Qualitative findings indicate greater satisfaction levels in the DC group. CONCLUSION: Both interventions appear useful for wwMS in making motherhood choices. The DC programme seems more promising in supporting decision-making. TRIAL REGISTRATION: German Clinical Trials Register (DRKS); DRKS00038534.
14 June 2026
Read appraisal →Annals of medicine
A body roundness index (BRI)-based predictive model for metabolic syndrome in perimenopausal and postmenopausal women-from a cross-sectional machine learning study to a longitudinal dynamic assessment
BACKGROUND AND AIMS: Metabolic syndrome (MetS) is highly prevalent among perimenopausal and postmenopausal women and poses a major public health challenge because of its association with cardiovascular disease, type 2 diabetes, and premature mortality. However, prediction tools for this population remain limited. Therefore, this study aimed to develop a Body Roundness Index (BRI)-based prediction model for MetS by integrating cross-sectional machine learning and longitudinal assessment. METHODS AND RESULTS: Cross-sectional models were trained using NHANES 2007-2020 and validated in the Affiliated Hospital of Dalian University (2023-2024). Sixteen predictors were selected via LASSO and Boruta, and eight models were evaluated using AUC, calibration, and decision curve analysis. SHAP ranked high-contribution factors. Longitudinal analysis used a 10-year cohort. Annualized change rates and cumulative exposure metrics of five key predictors were combined with baseline values to build Cox models, compared by C-index and time-dependent ROC.The artificial neural network (ANN) demonstrated optimal cross-sectional performance (internal AUC: 0.854; external AUC: 0.878) with good calibration and clinical benefit. SHAP identified BRI, WBC, ALT, MCV, and AST as top contributors, with BRI showing the strongest impact. Longitudinal analysis revealed that integrating annual change rates and annual cumulative exposure of these five predictors achieved optimal discriminative ability (C-index: 0.847), with time-dependent AUCs of 0.853, 0.859, and 0.847 at 1, 3, and 5 years, respectively. CONCLUSION: BRI is significantly associated with MetS in perimenopausal and postmenopausal women. The ANN model provides an efficient cross-sectional screening tool, while incorporating longitudinal trajectories of BRI and key laboratory indicators enhances long-term MetS risk prediction.
7 June 2026
Read appraisal →African journal of reproductive health
Effects of kegel training combined with acupoint application in preventing postpartum pelvic floor dysfunction: A randomized controlled trial
This study investigated the early preventive benefits of combining Kegel exercises with acupoint application at Qi Hai and Guan Yuan points for addressing postpartum pelvic floor dysfunction (PFD). A total of 110 first-time mothers were randomized into two groups: the prevention group, which received the combined intervention, and the control group, which practiced only Kegel exercises. The interventions followed a structured schedule during the postpartum period. At 42 days postpartum, the prevention group showed a notably lower rate of urinary leakage and improved outcomes in Type II pelvic floor muscle strength, ICI-Q-SF scores, and Hamilton Anxiety Scale results (all P<0.05). However, there were no significant differences between the groups in Type I muscle strength, vaginal dynamic pressure, PFDI-20 scores, or anatomical positioning of the bladder and cervix (P>0.05). The treatments were well-tolerated, with only two minor cases of redness and itching at application sites. We conclude that combining Kegel exercises with acupoint application at Qi Hai and Guan Yuan points may effectively reduce postpartum urinary incontinence, strengthen specific pelvic floor muscles, and improve emotional well-being. Cette étude a examiné les bénéfices préventifs précoces de la combinaison d'exercices de Kegel avec l'application d'acupression sur les points Qi Hai et Guan Yuan pour traiter la dysfonction du plancher pelvien (DPP) post-partum. Au total, 110 primipares ont été randomisées en deux groupes : le groupe prévention, recevant l'intervention combinée, et le groupe témoin, pratiquant uniquement les exercices de Kegel. Les interventions ont suivi un calendrier structuré pendant la période post-partum. À 42 jours post-partum, le groupe prévention a montré un taux de fuites urinaires nettement inférieur et de meilleurs résultats pour la force musculaire de type II du plancher pelvien, les scores ICI-Q-SF et les résultats à l'échelle d'anxiété de Hamilton (tous p<0,05). Cependant, aucune différence significative n'a été observée entre les groupes pour la force musculaire de type I, la pression dynamique vaginale, les scores PFDI-20 ou la position anatomique de la vessie et du col de l'utérus (p>0,05). Les traitements ont été bien tolérés, avec seulement deux cas mineurs de rougeurs et de démangeaisons aux sites d'application. En résumé, combiner les exercices de Kegel avec l'acupression sur les points Qi Hai et Guan Yuan pourrait réduire efficacement l'incontinence urinaire post-partum, renforcer des muscles spécifiques du plancher pelvien et améliorer le bien-être émotionnel.
31 May 2026
Read appraisal →Endocrine
Female sexual dysfunction in type 1 diabetes: a systematic review and meta-analysis
BACKGROUND: Female sexual dysfunction (FSD) in type 1 diabetes mellitus (T1DM) is an under-appreciated complication. Despite its profound impact on female health, including reduced quality of life and psychological distress, it remains underrepresented in major diabetes guidelines. Current data synthesis is limited, often excluding older populations or failing to compare diabetes subtypes. We aimed to collate the prevalence of FSD in T1DM, pool the risk of FSD in T1DM compared to controls, compare the risk in T1DM vs. T2DM and to investigate the impact of different variables on these effects. METHODS: PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched to identify cross-sectional/cohort studies including T1DM participants. Proportion of women with FSD in T1DM versus age-matched control/T2DM population (if reported), and population characteristics were extracted. RESULTS: The pooled analysis of 18 studies (N = 2476) indicated FSD prevalence of 37% in adults with T1DM (95% CI: 30%, 43%; I2 = 89%; random-effects model). Analysis restricted to studies (n = 12) using standard FSFI cut-off ≤ 26.5 confirmed the summary estimate as 34% (95% CI: 26%, 41%; I2 = 89%). Trim and fill analysis for publication bias found higher FSD risk in T1DM versus age-matched controls (N = 10, adjusted Risk ratio 2.10; 95% CI: 1.30, 3.39; p = 0.002; I2 = 76%). The higher incidence of FSD in T1DM versus T2DM on subgroup analysis (p-interaction < 0.01) appeared to be influenced by diabetes duration (p < 0.01, R2 = 70%). Depression and diabetes control indicators were among most consistent predictors of FSD, whereas continuous subcutaneous insulin infusion had a protective role. CONCLUSIONS: FSD is prevalent in approximately one-third of women with T1DM, with a higher risk compared to those with T2DM, likely due to earlier onset and longer diabetes duration. Comprehensive care strategies that address both the physiological and psychological aspects of T1DM are warranted to improve sexual health and overall well-being in affected women.
30 May 2026
Read appraisal →JMIR formative research
Real-World Implementation of EndoConnect in Brazilian Primary Care: Formative Study of Usability, Engagement, and Equity in Digital Endometriosis Care
BACKGROUND: Endometriosis is a chronic gynecological condition affecting approximately 10% of women of reproductive age worldwide and is associated with chronic pelvic pain, infertility, and reduced quality of life. In Brazil's Unified Health System (Sistema Único de Saúde [SUS]), diagnostic delays frequently range from 7 to 10 years and disproportionately affect socially vulnerable populations, including rural, low-income, Black, and Indigenous women. Digital health interventions have been proposed as scalable solutions; however, most available applications are developed in high-income settings and do not align with the structural and operational realities of low- and middle-income countries (LMICs). OBJECTIVE: This study aimed to evaluate feasibility, usability, acceptability, and user engagement associated with the real-world implementation of EndoConnect Alpha in primary health care settings, and to explore preliminary patterns of change in symptom burden, knowledge, and care navigation. METHODS: A single-arm, prospective, formative implementation study was conducted in 10 primary health care units in Ceará, Brazil. A convenience sample of 60 participants, including women with suspected or confirmed endometriosis and primary care professionals, used the platform over an 8-week period under real-world conditions. Usability (assessed using the System Usability Scale), acceptability (assessed using the Technology Acceptance Model), engagement metrics, and exploratory outcomes were assessed. All analyses were exploratory, with no control group and no causal inference. RESULTS: High usability and acceptability were observed, with strong user engagement, including a 79% completion rate of educational modules and consistent platform use. Observed decreases in pelvic pain and anxiety were identified, alongside increases in disease-related knowledge, self-reported therapy adherence, and reported gynecological referrals. A positive association between usability and acceptability was also observed. These findings should be interpreted as exploratory signals given the study design. Descriptive subgroup analyses suggested more pronounced trends among rural participants and those with a lower education level. CONCLUSIONS: The real-world implementation of EndoConnect Alpha demonstrated high feasibility, usability, and acceptability within a public primary care setting in a middle-income country. Observed trends suggest potential benefits, particularly among underserved populations; however, causal inference cannot be established. These findings support further controlled evaluation and highlight the relevance of equity-oriented digital health strategies tailored to LMIC contexts.
30 May 2026
Read appraisal →Journal of breast imaging
Breast Arterial Calcification as a Predictor for Future Cardiovascular Events and Mortality: A Systematic Review and Meta-analysis
OBJECTIVE: Breast arterial calcification (BAC) is a surrogate marker of cardiovascular disease (CVD); however, its associations with incident mortality and major adverse cardiovascular events (MACEs) have not been systematically evaluated. The association between BAC and incident MACE and whether this is influenced by the method of BAC assessment was examined. METHODS: PubMed, MEDLINE, and EMBASE were reviewed to June 2025 for studies comparing BAC status with incident MACE (composite of death, myocardial infarction [MI], stroke, heart failure). The primary outcome was all-cause mortality. Random-effects meta-analysis was performed using hazard ratios (HRs) with 95% CIs. Subgroup analysis was conducted by method of BAC measurement and restricted to screening mammography cohorts, PROSPERO registration (CRD42020202612). RESULTS: Of 1118 studies screened, 24 were included (236 475 participants; mean age 58.5 years). Breast arterial calcification presence associated with all-cause mortality (HR, 1.32; 95% CI, 1.20-1.45; P <.0001) (follow-up 0.55-26 years). Increased risk was observed for cardiovascular mortality (HR, 1.38; 95% CI, 1.14-1.66; P = .0009), heart failure (HR, 1.29; 95% CI, 1.20-1.37; P <.0001), stroke (HR, 1.2; 95% CI, 1.11-1.30; P <.0001), and MI (HR, 1.2; 95% CI, 1.15-1.26; P <.0001). When restricted to screening mammography cohorts without concurrent indications for cardiovascular investigation (5 studies, n = 85 647), associations remained significant for all-cause mortality (HR, 1.34; 95% CI, 1.14-1.58; P = .0004), cardiovascular mortality (HR, 1.38; 95% CI, 1.14-1.66; P = .0009), heart failure (HR, 1.48; 95% CI, 1.19-1.86; P = .0005), and stroke (HR, 1.34; 95% CI, 1.08-1.67; P = .008). Associations with incident outcomes were observed only in studies using quantitative BAC assessment (HR, 1.31; 95% CI, 1.19-1.44; P = .002). CONCLUSION: Breast arterial calcification is a promising prognostic marker of mortality and CVD risk. Recognition of this incidental finding may enable timely identification of at-risk individuals.
27 May 2026
Read appraisal →Clinical and experimental dermatology
A systematic review of the barriers to diagnosis of vulval lichen sclerosus in primary care
BACKGROUND: Vulval lichen sclerosus (VLS) is a chronic, inflammatory genital skin condition causing itch, pain, anatomical changes and increased risk of vulval cancer. Diagnostic delay and misdiagnosis are common. Once diagnosed, VLS can be effectively treated using very strong topical corticosteroids. Most women with symptoms of VLS first present to primary care in the UK. OBJECTIVES: To identify patient and professional perspectives on barriers to diagnosis of VLS in primary care through systematic review and thematic synthesis of the literature. METHODS: Separate literature searches of seven databases relevant to patient and professional perspectives were conducted. Two reviewers screened titles and abstracts, with one performing a full text review. Data extracted were coded 'line by line', codes were organized into descriptive themes and subsequently developed into analytical themes. RESULTS: We identified 2468 references; a total of 56 studies met inclusion criteria. Six analytical themes were developed: (i) a medically challenging diagnosis; (ii) cultural and social taboos; (iii) education and knowledge gaps; (iv) feelings and attitudes; (v) inadequate health systems; and (vi) challenges in female genital examination. CONCLUSIONS: This review highlights obstacles for women in achieving a diagnosis of VLS. Education and knowledge gaps were reported by clinicians and patients. Clinicians lack knowledge of vulval skin disease and patients lack knowledge of vulval anatomy. Targeted, comprehensive education for clinicians could expedite diagnosis. Dismissive clinician attitudes compound patient feelings of anxiety and embarrassment, reinforcing taboos and stigma. Acknowledgement of embarrassment and stigma validates feelings, improving patient interactions. Future research priorities should include the development of a diagnostic tool and implementation of a complex intervention to expedite diagnosis.
27 May 2026
Read appraisal →International journal of yoga therapy
Systematic Review on the Effect of Yoga Nidra on Menstrual Disorders Among Adult Women
Menstrual disorders including amenorrhea, premenstrual syndrome, and dysmenorrhea significantly disrupt the normal menstrual cycle and negatively impact quality of life. Yoga nidra, a guided meditation technique, has been explored for its potential therapeutic benefits in menstrual health, although comprehensive evidence remains limited. The present systematic review aimed to assess the effect of yoga nidra on menstrual disorders by analyzing existing research and synthesizing findings. The review followed PRISMA guidelines and involved searches in PubMed/MEDLINE, Cochrane Library, Science Direct, and Google Scholar using keywords related to yoga nidra and menstrual disorders. Studies were selected based on predefined inclusion criteria. A total of seven randomized controlled trials were included. The findings indicated improvements across four key areas of women's health: (1) psychological well-being, (2) hormonal balance, (3) hematological profile, and (4) physiological parameters. These results suggest that yoga nidra may be an effective complementary therapy for managing menstrual disorders because of its noninvasive and low-cost nature. However, further high-quality randomized controlled trials are necessary to confirm its efficacy.
24 May 2026
Read appraisal →Acta dermato-venereologica
Pregnancy in Women with Atopic Dermatitis: A Systematic Review of Concerns and Challenges
Atopic dermatitis (AD) has negative individual and societal implications. However, the potential impact of ADatopic dermatitis on reproduction has only been sporadically investigated. We aimed to provide an overview of pregnancy in ADatopic dermatitis, with a specific focus on concerns, challenges, the number of children, and adverse pregnancy and birth outcomes. A systematic literature search was performed using EMBASE and PubMed up until 19th January 2026 for original articles in relation to reproduction in female ADatopic dermatitis. Twenty-four highly heterogeneous studies were included. Concerns about ADatopic dermatitis in relation to pregnancy and family planning were reported in >50% of the patients in three3 out of four4 studies. Conflicting results were seen regarding fertility and disease severity during pregnancy. Pregnancy rates were similar or increased based on two2 studies. Eleven studies addressed adverse pregnancy and birth outcomes, of which five5 studies unanimously reported a protective or indifferent effect of ADatopic dermatitis on pre-term birth, gestational diabetes and stillbirth. Outcomes such as gestational hypertension, preeclampsia and miscarriage showed divergent results. Overall, ADatopic dermatitis causes considerable worries in relation to family planning. However, this review implies, that pregnancy rates as well as complications in pregnancy and during childbirth in women with ADatopic dermatitis overall are consistent with women without ADatopic dermatitis.
20 May 2026
Read appraisal →Journal of the American Heart Association
Sex Differences Among Young Patients With ST-Segment-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis
BACKGROUND: Female sex is associated with lower incidence of myocardial infarction, especially at younger ages. However, sex differences in mortality and coronary artery disease patterns among young patients with ST-segment-elevation myocardial infarction are not well established. This study evaluated sex differences in in-hospital and 1-year all-cause death and in the extent of coronary artery disease in patients aged ≤45 years with ST-segment-elevation myocardial infarction. METHODS: A systematic review (December 9, 2025) was conducted using PubMed, Cochrane, Embase, major cardiology conference proceedings, and ClinicalTrials.gov. Studies comparing sexes for outcomes were included. Non-English publications, abstracts without full text, and studies published before 2010 were excluded. A random-effects meta-analysis was performed, with results presented as relative risks (RR) and 95% CIs. Heterogeneity was assessed using τ and I2, risk of bias using the Risk of Bias in Nonrandomized Studies of Interventions tool. The study was registered on the International Prospective Register of Systematic Reviews. RESULTS: Eleven studies including 738 029 patients with ST-segment-elevation myocardial infarction (22% women) were analyzed. Female sex was associated with higher unadjusted in-hospital (RR, 1.56 [95% CI, 1.40-1.74]; τ=0.04; I2=0%) and 1-year mortality rate (RR, 1.78 [95% CI, 1.50-2.12]; τ=0.00; I2=0%). Women more frequently had single-vessel disease (73% versus 60%; RR, 1.13 [95% CI, 1.03-1.23]; τ=0.07; I2=67%), while men had 2-vessel (23% versus 18%; RR, 0.76 [95% CI, 0.68-0.85]; τ=0.00; I2=0%;) and 3-vessel disease (16% versus 9%; RR, 0.49 [95% CI, 0.27-0.86]; τ=0.41; I2=33%). CONCLUSIONS: In young patients with ST-segment-elevation myocardial infarction, female sex is associated with higher unadjusted in-hospital and 1-year death despite less extensive CAD. Further studies adjusting for comorbidities and standardizing CAD definitions are needed.
20 May 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Creatine monohydrate for lean mass, strength, and bone density in postmenopausal women: a systematic review and meta-analysis
BACKGROUND: Menopause is accompanied by accelerated losses in muscle mass and strength and declining bone density. Whether creatine monohydrate benefits postmenopausal women are uncertain. METHODS: We systematically reviewed randomized, placebo-controlled trials examining creatine supplementation, with or without resistance training (RT), in postmenopausal women. MEDLINE, Embase, Scopus, Web of Science, SPORTDiscus, and Cochrane CENTRAL were searched from 2000 to August 2025, supplemented by trial registries and reference-list screening. Eligible studies included postmenopausal women aged ≥40-45 years, intervention durations ≥6 weeks for primary analyses, and outcomes including DXA-derived lean mass, one-repetition maximum (1RM) strength, bone mineral density, physical function, and safety. Dual screening, duplicate extraction, and Cochrane RoB 2 assessment were performed. Random-effects meta-analysis used the Paule-Mandel estimator for τ² with Hartung-Knapp-Sidik-Jonkman adjustment. Heterogeneity (τ², I²), 95% prediction intervals, subgroup analyses by RT status, exploratory dose/duration meta-regression, small-study effects, and GRADE certainty were assessed. RESULTS: Seven RCTs (n = 608 randomized; duration 12-104 weeks, median 38 weeks) enrolled postmenopausal women (mean age ≈ 62 y). Lean mass (k = 5; n = 338) favored creatine: mean difference (MD) + 0.37 kg (95% CI + 0.05 to + 0.69; I² = 25%; τ² = 0.01; 95% PI -0.10 to + 0.84). Leg-press 1RM (k = 3; n = 111) improved with creatine: MD + 7.5 kg (95% CI + 2.2 to + 12.8; I² = 0%). Benefits were evident when creatine ≥ 5 g·day⁻¹ was combined with RT; trials using ≤ 3 g·day⁻¹ without RT showed no measurable effect. Bone density was unchanged overall. Adverse events were mild and similar to placebo; renal indices were unchanged. Risk of bias was mostly "some concerns;" one large, preregistered, double-blind RCT was at low risk. CONCLUSIONS: In postmenopausal women, creatine, particularly ≥ 5 g·day⁻¹ with RT, yields small but meaningful gains in lean mass and strength without evidence of harm. Effects on bone density remain unclear.Registration: This review was not prospectively registered. De-identified data and supplementary materials were deposited on OSF after completion of the analysis (DOI: 10.17605/OSF.IO/BVTRZ).
18 May 2026
Read appraisal →African journal of reproductive health
Evaluation of the effects of probiotic supplementation on the ecology and inflammatory factors of female vaginal flora: a systematic review and meta-analysis
This meta-analysis systematically evaluated the effects of probiotic supplementation on vaginal microbiota and inflammatory factors in women. PubMed, Embase, Web of Science, CNKI, and Wanfang were searched from inception to January 2026 for randomized and controlled studies. Outcomes included vaginal pH, Nugent score, and inflammatory cytokines (IL-4, IL-6, IL-10, TNF-α). Fifteen studies were included. Compared with controls, probiotics did not significantly reduce IL-4, IL-6, IL-10, or TNFα levels, nor did they significantly improve Nugent score. However, probiotic supplementation significantly reduced vaginal pH (OR = 0.36, 95% CI: 0.15-0.89; P = 0.03), indicating improved maintenance of a weakly acidic vaginal environment. Sensitivity analyses showed generally stable results, although heterogeneity remained substantial for several outcomes. Overall, probiotics appear effective in modulating vaginal acid-base balance but show limited evidence for improving inflammatory cytokine profiles or restoring vaginal microbiota structure. Current data are insufficient to support routine probiotic use for optimizing vaginal microbiota and inflammatory status. Further high-quality, well-designed randomized controlled trials are required to clarify their clinical benefits. Cette méta-analyse a évalué de manière systématique les effets de la supplémentation en probiotiques sur le microbiote vaginal et les facteurs inflammatoires chez les femmes. Les bases de données PubMed, Embase, Web of Science, CNKI et Wanfang ont été consultées depuis leur création jusqu’en janvier 2026 afin d’identifier des études randomisées et contrôlées. Les critères de jugement comprenaient le pH vaginal, le score de Nugent et les cytokines inflammatoires (IL-4, IL-6, IL-10, TNF-α). Quinze études ont été incluses. Comparativement aux groupes témoins, les probiotiques n’ont pas réduit significativement les concentrations d’IL4, IL-6, IL-10 ou TNF-α, ni amélioré significativement le score de Nugent. En revanche, la supplémentation en probiotiques a significativement réduit le pH vaginal (OR = 0,36 ; IC à 95 % : 0,15–0,89 ; P = 0,03), indiquant un meilleur maintien d’un environnement vaginal faiblement acide. Les analyses de sensibilité ont montré des résultats globalement stables, bien qu’une hétérogénéité substantielle persiste pour plusieurs critères. Dans l’ensemble, les probiotiques semblent efficaces pour moduler l’équilibre acido-basique vaginal, mais les preuves restent limitées quant à leur capacité à améliorer les profils cytokiniques inflammatoires ou à restaurer la structure du microbiote vaginal. Les données actuelles sont insuffisantes pour recommander l’utilisation systématique des probiotiques dans l’optimisation du microbiote vaginal et du statut inflammatoire. Des essais contrôlés randomisés de haute qualité sont nécessaires pour confirmer leurs bénéfices cliniques.
16 May 2026
Read appraisal →European heart journal
Artificial intelligence-based quantification of breast arterial calcifications to predict cardiovascular morbidity and mortality
BACKGROUND AND AIMS: Women are underdiagnosed and undertreated for cardiovascular disease (CVD). Automatic quantification of breast arterial calcification (BAC) on screening mammography can identify women at risk for CVD. This study aimed to determine whether artificial intelligence-based automatic quantification of BAC from screening mammograms predicts CVD and mortality beyond PREVENT scores in a large, racially diverse, multi-institutional population. METHODS: This retrospective cohort study included 123 762 women from two healthcare systems who had screening mammograms. Breast arterial calcification was quantified using a transformer-based neural network for segmentation. Breast arterial calcification severity was categorized as zero (0 mm2), mild (>0-10 mm2), moderate (>10-25 mm2), and severe (>25 mm2). Kaplan-Meier analysis, Cox proportional hazards, and Fine-Gray competing event models were used to examine the association between BAC and major adverse cardiovascular events (MACE). RESULTS: Breast arterial calcification was detected in 16.1% (internal cohort) and 20.6% (external cohort) of women and provided significant prognostic value incremental to the PREVENT score. In PREVENT adjusted models, a clear dose-response was observed. Compared with zero BAC, mild [internal: hazard ratio (HR) 1.32, 95% confidence interval (CI) 1.10-1.59; external: HR 1.28, 95% CI 1.17-1.39], moderate (internal: HR 1.75, 95% CI 1.23-2.50; external: HR 1.79, 95% CI 1.55-2.06), and severe BAC (internal: HR 3.29, 95% CI 2.15-5.05; external: HR 2.80, 95% CI 2.36-3.32) were all prognostic for any MACE. Each 1 mm2 increase in BAC conferred an additional 2%-3% risk for MACE (P < .001). CONCLUSIONS: Automatically quantified BAC is an independent predictor of MACE and mortality, adding prognostic value to the PREVENT score. This approach may provide an opportunistic cardiovascular risk assessment during routine mammography screening without additional radiation exposure to guide earlier and more effective preventive care for women.
16 May 2026
Read appraisal →Biology of sex differences
Importance of integrating biological sex and age analyses in health research
Research findings in human, animal and cell populations may be influenced by biological sex and age. The traditional statistical approach to sex and/or age differences that are discovered in research data is to consider them as confounders that interfere with the ability to make accurate estimations and thus need to be controlled for. This article provides examples of how combining sexes or controlling for sex and/or age may lead to inaccurate findings and overlook important insights. Rather than treating these variables as confounding factors, they should be viewed as variables of importance to the research question. We contend that data should be analyzed according to sex/age as the primary analysis, while controlling for sex and age should be conducted as a secondary analysis. This topic is increasingly important as data are made publicly available and deep learning models/artificial intelligence are used to analyze large volumes of data. Mechanistic insights will continue to be lost if prompt action is not taken to report data according to sex and age and to analyze data by sex and age in health research.
14 May 2026
Read appraisal →International health
Systematic narrative review on Menstrual health and hygiene (MHH) in Nigeria, Ghana, Liberia and The Gambia
Menstrual health and hygiene (MHH) are critical components of women's well-being, yet they continue to be overlooked in many low-resource settings. Addressing MHH issues in West Africa is crucial due to their widespread impact on education, health and gender equality, particularly among adolescent girls and women of reproductive age. This systematic narrative review consolidates the existing literature on MHH practices, knowledge, barriers and interventions in Nigeria, Ghana, Liberia and The Gambia. A comprehensive search was conducted across four databases (PubMed, Scopus, CINAHL Plus and Africa Journals Online) for studies published from 2000 to 2024. The search terms were related to menstruation, hygiene and the four West African countries. Both peer-reviewed articles and grey literature (Google Scholar, policy documents) were included to capture a broad spectrum of findings. Studies were selected based on their relevance to MHH in the target countries and data were extracted and analysed thematically. Of 345 articles identified, 26 studies met the inclusion criteria. Key findings highlighted the widespread lack of adequate MHM resources, such as sanitary products and functional sanitation facilities. Socio-economic disparities, cultural stigma and insufficient educational resources were major barriers to effective MHM. The review also found a strong link between inadequate MHM and adverse outcomes, including school absenteeism, psychological distress and increased vulnerability to infections. This review underscores the pressing need for comprehensive interventions to address MHH as a public health and human rights issue in Nigeria, Ghana, Liberia and The Gambia. Ensuring access to sanitary products, improved sanitation facilities and robust educational programs can help empower girls and women to manage menstruation with dignity, thereby improving their health, education and social participation.
12 May 2026
Read appraisal →Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace
Prevalence of urinary incontinence in patients with chronic cough: a systematic review
Chronic cough-related diseases increase the risk of urinary incontinence (UI) due to repeated intra-abdominal pressure affecting the pelvic floor. Existing studies focus on specific diseases rather than UI as a broader consequence. To determine the prevalence of UI in patients with chronic cough-related diseases and compare it with the prevalence in healthy populations. A systematic review was conducted using Medline, Embase, Cochrane, OVID, Scopus, ProQuest, PEDro, and EBSCO. Two independent reviewers screened studies using predefined criteria in a Microsoft Excel spreadsheet. Only prevalence studies were included. Data were extracted, synthesized, and assessed using the GRADE approach for evidence quality and the STROBE checklist for reporting quality. Prevalence estimates varied widely based on demographic characteristics. UI prevalence ranged from 2.2% to 45% in pediatric patients, 30.4% to 74% in adult women, and 2.4% to 39% in adult men. The quality of evidence was low, while reporting quality was acceptable. UI is a common complication in patients with chronic cough, with a higher prevalence than in healthy populations. Due to the stigma surrounding urogenital disorders, clinicians should actively inquire about UI during patient history-taking and refer affected individuals for appropriate treatment.
11 May 2026
Read appraisal →Taiwanese journal of obstetrics & gynecology
Segmentation of uterus and myoma from MRI image based on deep learning
OBJECTIVE: Myoma is a common gynecologic condition with abnormal muscular and fibrotic tissue growth in the uterus. Compared with sonography, magnetic resonance imaging (MRI) provides more detailed information with a better diagnostic accuracy. However, the interpretation of the imagery is shrewdness- and experience-dependent. The therapeutic strategy of myoma can be directly affected by the relative location and size in the uterus. Hence, this study aimed to generate an objective standardized modality in interpreting the imagery. MATERIALS AND METHODS: Deep learning (DL) was used to train two models using MRI imagery labeled by radiologists: 1) Model Uterus + Endometrium: segmentation of uterus and endometrium; 2) Model Myoma: segmentation of myoma. The myomas were classified based on their relative position in the uterus according to FIGO criteria. Each set of MRI image sequence was obtained from uterine sagittal sections with 5.5-mm interval of 30 slices per case. The dataset was divided into training, validation, and test sets. The number of images was first increased by data augmentation before implementing a DL semantic segmentation DeepLabV3+model. Cross entropy and Dice function were used for the loss and evaluation functions, respectively. RESULTS: The Dice values of uterus, endometrium and myoma segmentation reached 81.55%, 73.49% and 67.34%, respectively. Thus, the 3-D prediction of the uterine, endometrial and myomatous regions had a positive effect on determining the classification of myomas. CONCLUSION: DL can be used as a tool to improve the diagnosis and classification of uterine myoma. This model can also be applied to other gynecologic diseases.
4 May 2026
Read appraisal →Neurology
Idiopathic Intracranial Hypertension Prevalence and Hormonal Contraception: A Meta-Analysis
BACKGROUND AND OBJECTIVES: Women's health advice in people living with idiopathic intracranial hypertension (IIH) is inconsistent, primarily due to an enduring concern that hormonal contraception (HC), including oral contraceptive pills (OCPs) and hormonal intrauterine devices (IUDs), might be associated with a higher prevalence of IIH. This systematic review and meta-analysis examines whether a meaningful association exists between HC use and IIH prevalence. METHODS: Systematic searches of Ovid MEDLINE, Embase, and the Cochrane Library were conducted from their inception to May 14, 2025. Gray literature and citation lists were also reviewed. Observational studies comparing HC use among women with IIH to controls without IIH were included. Noncomparative studies and pharmacovigilance analyses were excluded. Two independent reviewers conducted data extraction, assessed the quality of studies using the Newcastle-Ottawa Scale, and appraised the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A random-effects meta-analysis using the Mantel-Haenszel method in Review Manager 5.4 was conducted to evaluate the association between HC use and IIH prevalence, the primary outcome of interest, with leave-one-out sensitivity analyses and subgroup analyses stratified by HC modality. RESULTS: A total of 13 studies (nIIH = 5,351 and ncontrol = 669,260; mean age = 33.3 years; 100% female) were included. HC use was not significantly associated with IIH prevalence (odds ratio [OR] 0.93, 95% CI 0.69-1.24, p = 0.60, I2 = 82%; n = 12 studies). Subgroup analyses revealed no significant associations for OCPs (OR 0.91, 95% CI 0.72-1.16, p = 0.45, I2 = 25%; n = 6 studies), IUDs (OR 1.45, 95% CI 0.61-3.44, p = 0.39, I2 = 92%; n = 5 studies), or medroxyprogesterone acetate injections (OR 1.21, 95% CI 0.84-1.74, p = 0.30, I2 = 2%; n = 2 studies). Findings were largely robust in sensitivity analyses. Quality assessments ranged from poor to good, with the certainty of evidence rated as very low to low. DISCUSSION: The meta-analysis found no significant association between HC use and IIH prevalence, with consistent results across various HC modalities. This evidence provides confidence to reassure patients with IIH and clinicians that the directed use of HC should be continued as appropriate. The limited quality of available evidence and considerable heterogeneity highlights the necessity for large-scale, well-designed studies, particularly in diverse patient populations, to validate these findings.
3 May 2026
Read appraisal →The Journal of dermatological treatment
Comparative efficacy and safety of platelet-rich plasma (PRP), injectable platelet-rich fibrin (i-PRF) and concentrated growth factors (CGF) for female pattern hair loss (FPHL): a prospective multicenter randomized clinical trial
BACKGROUND: Comparative studies among different autologous platelet concentrate types for FPHL remain lacking. METHODS: Patients with FPHL (Sinclair gradeII-III) were enrolled and randomized to receive 4 sessions of PRP, i-PRF or CGF treatment at 4-week intervals. The primary endpoint was the inter-group comparison of the non-vellus target area hair count (TAHC)-increase (%) at 24 weeks. Secondary endpoints included: within-group changes in TAHC from baseline; within-group changes in hair diameter (HD) from baseline and inter-group comparison of HD-increase (%) at 24 weeks; Growth factor concentrations were quantified to explore correlations with efficacy. RESULTS: Seventy-four patients completed the study. Post-treatment TAHC increased significantly from baseline in all groups (all p < 0.05). The TAHC-increase(%) was significantly greater in the CGF (27.11 ± 14.80%) and i-PRF (26.54 ± 11.46%) groups compared to the PRP group (14.53 ± 8.65%; p < 0.05), with no significant difference between CGF and i-PRF. Regarding HD increase, all three groups showed improvement, with no statistically significant differences observed among groups (p > 0.05). The i-PRF group showed the lowest adverse event rate. Vascular endothelial growth factor (VEGF) concentration demonstrated a significant positive correlation with the percentage increase in TAHC (r = 0.527, R2=0.278, p < 0.05). CONCLUSIONS: CGF and i-PRF demonstrated superior efficacy in increasing TAHC in FPHL patients. The i-PRF group had the lowest adverse event rate. VEGF levels may play a potential role in promoting hair growth.
2 May 2026
Read appraisal →Lancet (London, England)
Clinical and bacteriological effectiveness of three different short-course antibiotic regimens and single-dose fosfomycin for uncomplicated lower urinary tract infections in women (SCOUT): a pragmatic, multicentre, open-label, randomised clinical trial
BACKGROUND: Most guidelines recommend nitrofurantoin, fosfomycin, and sometimes pivmecillinam for uncomplicated urinary tract infections (UTIs), but direct comparisons between these antibiotics are needed. This study evaluated the effectiveness and safety of a single dose of fosfomycin compared with two doses of fosfomycin and short-course regimens of nitrofurantoin and pivmecillinam in women with UTI symptoms. METHODS: This phase 4, pragmatic, multicentre, parallel-group, open-label, randomised clinical trial was conducted in Spanish primary care centres from 2022 to 2024. Women aged 18 years or older with at least one UTI-specific symptom (dysuria, urinary urgency, urinary frequency, or suprapubic tenderness) and a positive urine dipstick test for either nitrites or leukocyte esterase were randomly assigned (1:1:1:1) to one of four treatments: a single 3 g dose of fosfomycin, two 3 g doses of fosfomycin, nitrofurantoin (100 mg three times per day for 5 days), or pivmecillinam (400 mg three times per day for 3 days). Doctors and patients were not masked to group assignment. The primary outcome was the proportion of patients with clinical resolution (defined as the disappearance of all infection symptoms) at day 7. This trial is registered with ClinicalTrials.gov (NCT04959331) and EudraCT (2021-001332-26) and is completed. FINDINGS: Of the 804 patients assessed for eligibility between April 4, 2022 and Nov 14, 2024, 768 patients were randomly allocated (191 to the single-dose fosfomycin group, 194 to the two-dose fosfomycin group, 190 to the nitrofurantoin group, and 193 to the pivmecillinam group). Patients had a median age of 48 years (IQR 34-63). Race and ethnicity data were not collected. Among the 720 women with available data included in the primary analysis, single-dose fosfomycin had the lowest proportion of clinical resolution (109 [59%] of 185 patients), while nitrofurantoin had the highest (128 [74%] of 172 patients; difference 15·5 percentage points [95% CI 5·9 to 25·1] vs single-dose fosfomycin; p=0·0168), followed by pivmecillinam (127 [70%] of 182; difference 10·9 percentage points [1·1 to 20·6]; p=0·2352) and the two-dose fosfomycin group (122 [67%] of 181; difference 8·5 percentage points [-1·4 to 18·3]; p=0·6935). Adverse events occurred in 38 (19·9% [95% CI 14·9 to 26·1) of 191 patients who received single-dose fosfomycin, 51 (26·3% [20·6 to 32·9]) of 194 who received two-dose fosfomycin, 51 (26·8% [21·0 to 33·6]) of 190 who received nitrofurantoin, and 41 (21·2% [16·1 to 27·5]) of 193 who received pivmecillinam. Most adverse events were mild and self-limiting, primarily gastrointestinal. Four serious adverse events occurred, of which one was related to the study treatment (one case of pyelonephritis in the pivmecillinam group). INTERPRETATION: Nitrofurantoin was the most effective treatment and single-dose fosfomycin the least effective treatment for UTIs. Adverse events were mild. The role of fosfomycin as a first-line antibiotic for uncomplicated UTI should be re-evaluated. FUNDING: Carlos III Institute of Health, Spanish Ministry of Science and Innovation, and European Regional Development Fund.
2 May 2026
Read appraisal →The Cochrane database of systematic reviews
Cognitive behavioural therapeutics for insomnia symptoms in the perimenopause through to the early postmenopausal period
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary Objective i) To assess the effects of cognitive behavioural therapy for insomnia (CBT-I) and cognitive behavioural therapy for menopausal symptoms (CBT-M) on sleep disturbances in women in perimenopause through to the early postmenopausal period. Secondary Objectives i) To assess the effects of CBT-I and CBT-M on vasomotor symptoms in women in perimenopause through to the early postmenopausal period. ii) To assess the impact of socioeconomic status on the effectiveness of CBT-I and CBT-M, in order to determine the interventions' impact on health equality.
28 Apr 2026
Read appraisal →The Cochrane database of systematic reviews
Surgery for women with anterior compartment prolapse
BACKGROUND: Anterior compartment prolapse is the most common pelvic organ prolapse. Clinicians have utilised various surgical techniques to minimise the rate of recurrent pelvic organ prolapse (POP). OBJECTIVES: To determine the benefits and harms of surgery for anterior compartment prolapse. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register on 29 April 2024. This includes records indexed in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov and WHO ICTRP. We also handsearched journals, conference proceedings and the reference lists of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared surgical operations in women with anterior compartment prolapse. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed their risk of bias and extracted their data. MAIN RESULTS: We included 41 RCTs evaluating 4531 women. The certainty of evidence ranged from very low to moderate due to risk of bias and imprecision. Anterior native tissue repair versus biological graft at 1 to 2 years There is likely little to no difference between these two methods in terms of awareness of prolapse (RR 1.20, 95% CI 0.80 to 1.81; 5 RCTs, 515 women; moderate certainty). Native tissue repair likely increases the risk of recurrent anterior compartment prolapse (RR 1.53, 95% CI 1.19 to 1.97; 8 RCTs, 707 women; moderate certainty); the result suggests that if 21% of women had recurrent prolapse after biological graft, 24% to 40% would have recurrence after native tissue repair. There may be little to no difference between native tissue repair and biological graft repair groups for repeat surgery for prolapse (RR 0.99, 95% CI 0.45 to 2.17; 6 RCTs, 524 women; low certainty). Surgery for stress urinary incontinence was not reported. There is likely little to no difference between groups in dyspareunia (RR 0.87, 95% CI 0.39 to 1.93; 2 RCTs, 151 women; moderate certainty). De novo dyspareunia was not reported. Anterior native tissue repair versus transvaginal anterior permanent mesh at 1 to 2 years Native anterior tissue repair likely results in more awareness of prolapse than anterior mesh repair (RR 1.77, 95% CI 1.37 to 2.27; 10 RCTs, 1203 women; moderate certainty); the result suggests that if 13% of women were aware of prolapse after mesh repair, 17% to 29% would be aware after native tissue repair. Native tissue repair may result in slightly increased recurrent anterior compartment prolapse (RR 3.21, 95% CI 2.27 to 4.55; 20 RCTs, 2483 women; low certainty). There was moderate heterogeneity (I2 = 73%). The result suggests that if 13% of women had recurrent prolapse after mesh repair, 29% to 58% would have recurrence after native tissue repair. Repeat surgery for prolapse is probably more likely after native tissue repair (RR 2.17, 95% CI 1.31 to 3.58; 14 RCTs, 1799 women; moderate certainty); the result suggests that if 2% of women required repeat surgery after mesh repair, 3% to 8% would do so after native tissue repair. There is likely little or no difference between groups in surgery for stress urinary incontinence (RR 1.32, 95% CI 0.73 to 2.40; 6 RCTs, 967 women; moderate certainty). There is likely little or no difference between groups for dyspareunia (RR 1.06, 0.59 to 1.90; 8 RCTs, 1096 women; moderate certainty). There is likely little or no difference between groups for de novo dyspareunia (RR 0.64, 95% CI 0.36 to 1.12; 11 RCTs, 797 women; moderate certainty); the result suggests that if 7% of women reported dyspareunia after mesh repair, 2% to 8% would do so after native tissue repair. Permanent anterior vaginal mesh versus abdominal sacrocolpopexy at 1 year There may be little to no difference between permanent anterior vaginal mesh and abdominal sacrocolpopexy groups in awareness of prolapse (RR 0.93, 95% CI 0.45 to 1.94; 3 RCTs, 441 women; low certainty). There was some heterogeneity (I2 = 37%). There is likely little or no difference between groups in recurrent anterior compartment prolapse (RR 0.95, 95% CI 0.46 to 1.97; 4 RCTs, 306 women; moderate certainty). There was some heterogeneity (I2 = 69%). The result suggests that if recurrent prolapse occurred in 26% of women after sacrocolpopexy, 12% to 51% would have recurrence after transvaginal mesh repair. There may be little or no difference between groups in repeat surgery for prolapse (RR 1.68, 95% CI 0.56 to 5.04; 3 RCTs, 455 women; low certainty). There may be little or no difference between groups in repeat surgery for mesh complications (RR 2.61, 95% CI 0.62 to 10.99; 2 RCTs, 373 women; low certainty); the result suggests that if 1% of women needed repeat surgery for mesh exposure after sacrocolpopexy, 0.5% to 12% would do so after transvaginal mesh repair. There may be little or no difference between groups in surgery for stress urinary incontinence (RR 0.78, 95% CI 0.20 to 3.12; 2 RCTs, 299 women; low certainty). There was some heterogeneity (I2 = 60%). Dyspareunia was not reported. De novo dyspareunia is probably more likely to be reported with permanent anterior vaginal mesh than after abdominal sacrocolpopexy (RR 2.15, 95% CI 1.17 to 3.98; 2 RCTs, 248 women; moderate certainty); the result suggests that if 10% of women reported dyspareunia after abdominal sacrocolpopexy, 12% to 40% would do so with permanent anterior vaginal mesh. AUTHORS' CONCLUSIONS: Recurrence is probably more likely after native tissue repair than with biological graft or absorbable synthetic mesh at one to two years. We found no data for surgery for stress urinary incontinence. Anterior native tissue repair likely increases awareness of prolapse, recurrence and surgery for prolapse compared with transvaginal anterior permanent mesh repair. It is likely that fewer women report dyspareunia after abdominal sacrocolpopexy than with permanent mesh repair. For other outcomes, there was little or no difference between the groups being compared. Many of the transvaginal permanent meshes evaluated have been removed from the market because of reported complications. Five studies tested mesh kits that are currently available. We suggest that clinicians and women use caution when utilising these products as their long-term safety and efficacy have not yet been established.
28 Apr 2026
Read appraisal →Journal of ethnopharmacology
Tianjing Zelan formula improves polycystic ovary syndrome by regulating steroid biosynthesis and arachidonic acid metabolism
ETHNOPHARMACOLOGICAL RELEVANCE: Polycystic ovary syndrome (PCOS) is a set of symptoms related to menstrual irregularities that can cause infertility in women of reproductive age. Unfortunately, there are currently no authorized treatment medications for PCOS. The Tianjing Zelan (TJZL) formula, a herbal formulation developed from the ancient Chinese medical classic Beiji Qianjin Yaofang in Tang Dynasty, is employed in the clinical management of menstrual irregularities and amenorrhea. However, its clinical characteristics and mechanism have not been systematically evaluated. AIM OF THE STUDY: To reveal the clinical characteristics and mechanisms of TJZL in treating PCOS. MATERIALS AND METHODS: A multicenter and single-arm clinical trial, and two PCOS models were used to evaluate the effectiveness of TJZL. The chemical constituents of TJZL were analyzed by UHPLC-QTOF-MS/MS. In addition, a combination of untargeted metabolomics and transcriptomics was used to reveal the complex therapeutic mechanisms of TJZL on PCOS. Subsequently, a metabolite-gene network analysis was performed to reveal potential differentially expressed genes associated with metabolites in PCOS patients. Key targets and pathways were further validated using quantitative real-time polymerase chain reaction (qRT-PCR), Western blot and immunohistochemistry in PCOS mice. Finally, molecular docking analysis was employed to explore the potential active ingredients of TJZL. RESULTS: Clinical trials provided evidence that TJZL significantly improved the menstrual cycle, sex hormone levels, and hyperandrogenic phenotypes, and reduced insulin resistance in PCOS patients. TJZL significantly improved the fertility, estrous cycle, ovarian morphology, sex hormone levels, and oral glucose tolerance in PCOS model. Transcriptomic and metabolomics results show that TJZL has a significant regulatory effect on metabolites and gene expression profiles in pathways such as steroid synthesis, arachidonic acid metabolism, and fatty acid metabolism. Utilizing metabolite-gene association analysis, We further verified that TJZL significantly improved the expression of genes and proteins related to the ovarian steroidogenesis and arachidonic acid metabolism pathways, including CYP17A1, CYP19A1, HSD17B3 and PTGS2. Furthermore, molecular docking results showed that berberine, rosmarinic acid and glycyrrhizinic acid in TJZL had strong affinity with PTGS2 in arachidonic acid metabolism, and hesperidin, naringin and liquiritin have strong affinity with CYP19A1 in steroid synthesis. CONCLUSION: TJZL exerts beneficial therapeutic effects on PCOS in both clinical and laboratory studies. TJZL improves PCOS by regulating multiple endogenous metabolites and correcting abnormal steroid synthesis and arachidonic acid metabolism in the ovaries. Our research provides a promising therapeutic agent for PCOS patients.
25 Apr 2026
Read appraisal →BMJ open diabetes research & care
Sex differences in glycemic outcomes: a systematic review and meta-analysis of diabetes treatments
UNLABELLED: Sex differences in glycemic outcomes following insulin therapy remain underexplored despite biological and psychosocial factors that may influence individual responses. This systematic review examines sex-specific differences in glycemic control to guide personalized diabetes care and promote health equity. We searched PubMed, Scopus, Cochrane Library, and Google Scholar (August 2014-December 2025) for randomized and observational studies involving adults of both sexes on insulin. Twenty-four studies were included, with certainty of evidence assessed using GRADE. In type 1 diabetes, women showed no significant difference in achieving HbA1c <7% (RR 1.05, 95% CI 0.91 to 1.22; very low certainty) and toward higher time-in-range (SMD 0.78, -0.01 to 1.57; moderate certainty). In type 2 diabetes, men were more likely to achieve HbA1c targets (RR 0.86, 95% CI 0.72 to 1.03; low certainty), while women required higher weight-adjusted insulin doses (SMD 0.55, 0.23 to 0.86; very low certainty). Hypoglycemia risk showed opposing trends in inpatient (RR 0.78, 95% CI 0.33 to 1.83; very low certainty) versus outpatient settings (RR 1.08, 95% CI 0.61 to 1.89; low certainty) with substantial heterogeneity (I2>70%). These findings suggest that sex-related differences in glycemic outcomes vary by diabetes type and treatment context. Given the low certainty and heterogeneity of current evidence, results should be interpreted as hypothesis-generating. This review supports the consideration of biological sex within a broader, individualized diabetes management framework and highlights the need for future sex-stratified analyses with rigorous control of lifestyle and physiological factors. INTRODUCTION: Sex differences in glycemic outcomes following the same insulin therapy in diabetes remain underexplored. Numerous factors, encompassing both biological and psychosocial aspects, could potentially influence individual responses to insulin therapy. This systematic review examines sex-specific differences in glycemic control to guide personalized diabetes care and promote health equity. METHODS: PubMed, Scopus, Cochrane Library, and Google Scholar were searched (August 1, 2014-December 31, 2025) for randomized and observational studies. Eligible studies included adults of both sexes on insulin reporting sex-specific data for predefined outcomes. Data on glycated hemoglobin (HbA1c), blood glucose metrics, hypoglycemia, and insulin dose were extracted. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations. RESULTS: Twenty-four studies were included. In type 1 diabetes, women showed no significant difference in achieving HbA1c <7% (risk ratio (RR) 1.05, 95% CI 0.91 to 1.22; very low certainty) and toward higher time-in-range (standardized mean difference (SMD) 0.78, -0.01 to 1.57; moderate certainty). In type 2 diabetes, men were more likely to achieve HbA1c targets (RR 0.86, 95% CI 0.72 to 1.03; low certainty), whereas women required higher weight-adjusted insulin doses (SMD 0.55, 0.23 to 0.86; very low certainty). Hypoglycemia risk showed opposing trends in inpatient (RR 0.78, 95% CI 0.33 to 1.83; very low certainty) versus outpatient settings (RR 1.08, 95% CI 0.61 to 1.89; low certainty), with substantial heterogeneity (I2 >70%). CONCLUSION: Sex-related differences in glycemic outcomes under insulin therapy were observed, with patterns varying by diabetes type, treatment context, and outcome. Given the low certainty and heterogeneity of the evidence, these findings should be interpreted as hypothesis-generating rather than directive for clinical practice. The results support consideration of biological sex as one component within a broader, individualized diabetes management framework. Future studies should prioritize sex-stratified analyses with rigorous control of polypharmacy, body composition, and lifestyle factors to determine whether sex-specific insulin strategies provide meaningful clinical benefit. PROSPERO REGISTRATION NUMBER: CRD420251144696.
25 Apr 2026
Read appraisal →The Journal of clinical endocrinology and metabolism
Health and adverse events associated with extended oral bisphosphonates among postmenopausal women: a systematic review
BACKGROUND: International guidelines recommend the use of oral bisphosphonates (oBP) for up to 5 years in the treatment of postmenopausal osteoporosis. However, benefits and risks of extending oBP therapy beyond this duration remain uncertain. AIM: To determine the health outcomes (bone mineral density [BMD], fracture risk) and adverse effects (atypical fracture, osteonecrosis of the jaw [ONJ]) of extended oBP therapy beyond 5 years among postmenopausal women. METHODOLOGY: A systematic search of Medline©, EMBASE©, and CINAHL© was conducted from inception to 15 March 2024. Interventional and observational studies published in English were included. Two authors independently performed screening, quality appraisal using the NIH Quality Appraisal tool, and data extraction. The review followed PRISMA guidelines and was registered on PROSPERO (CRD42024475332). High heterogeneity precluded meta-analysis. RESULTS: Eleven studies (4 controlled trials, 7 observational) were included: 3 rated as good quality, 7 as fair, and 1 as poor. Extended oBP therapy beyond 5 years increased BMD at the hip (3/3 studies), femoral neck (3/3 studies) and lumbar spine (5/5 studies). Prolonged oBP use reduced clinical vertebral fracture risk (1/6 studies) but increased the risk of atypical fractures (3/3 studies) and incomplete atypical femoral fractures (1/1 study). None of the included studies assessed or reported ONJ. CONCLUSION: Substantial heterogeneity and limited high-quality evidence preclude definitive conclusions regarding extended oBP use in postmenopausal women. While extended treatment may improve bone density and reduce vertebral fractures, it could also increase atypical fractures. Future high-quality studies are required to inform decisions regarding optimal treatment duration.
25 Apr 2026
Read appraisal →Lancet (London, England)
Overall survival with relacorilant and nab-paclitaxel in patients with platinum-resistant ovarian cancer (ROSELLA): a phase 3 randomised controlled trial
BACKGROUND: Relacorilant is a selective glucocorticoid receptor antagonist that increases the sensitivity of many cancer cell types to chemotherapy. The efficacy and safety of relacorilant plus nab-paclitaxel were assessed in the phase 3 ROSELLA (GOG-3073, ENGOT-ov72, APGOT-Ov10, and LACOG-0223) trial; the combination showed significant improvement in progression-free survival among patients with platinum-resistant ovarian cancer compared with nab-paclitaxel monotherapy. Results of the final overall survival analysis are reported here. METHODS: In this open-label phase 3 trial, patients were randomly assigned 1:1 to receive relacorilant (150 mg orally the day before, day of, and day after nab-paclitaxel infusion) plus nab-paclitaxel (80 mg/m2 intravenously on days 1, 8, and 15 of each 28-day cycle) or nab-paclitaxel monotherapy (100 mg/m2 intravenously on the aforementioned schedule). Patients, aged 18 years or older, with one to three lines of previous anticancer therapy and platinum-resistant disease (progression <6 months from their last dose of platinum) were eligible. The trial was conducted at 117 hospitals and community oncology centres in 14 countries across Australia, Europe, Latin America, North America, and South Korea. Progression-free survival, assessed by blinded independent central review, and overall survival (time from randomisation to death from any cause) were dual primary endpoints. Additional prespecified endpoints included safety, second progression-free survival (time from randomisation to disease progression on subsequent anticancer therapy or death due to any cause, whichever occurred first), and patient-reported outcomes. This trial is registered at ClinicalTrials.gov, NCT05257408, and is ongoing. FINDINGS: Between Jan 5, 2023, and April 8, 2024, 381 patients were randomly assigned to the relacorilant combination group (n=188) or the nab-paclitaxel monotherapy group (n=193). All patients had received bevacizumab; 167 (44%) had received three previous lines of therapy, and 234 (61%) had received a poly(ADP-ribose) polymerase inhibitor. At a median follow-up of 24·8 months (95% CI 23·6-25·7), the addition of relacorilant to nab-paclitaxel resulted in a statistically and clinically significant improvement in overall survival compared with nab-paclitaxel monotherapy (hazard ratio for death 0·65 [95% CI 0·51-0·83]; p=0·0004); 18-month overall survival was 46% and 27%, respectively. The median overall survival in the relacorilant combination group was extended by 4·1 months compared with the nab-paclitaxel monotherapy group (16·0 [95% CI 13·0-18·3] vs 11·9 months [10·0-13·8]). Subsequent anticancer treatments were similar across study groups. Adverse events were similar in both groups when adjusted for duration of study treatment. Neutropenia (121 [64%]), anaemia (115 [61%]), fatigue (101 [54%]), and nausea (82 [44%]) were the most common adverse events in the relacorilant combination group. No new safety signals were observed with additional follow-up since the primary analysis. INTERPRETATION: The addition of relacorilant to nab-paclitaxel led to significantly longer overall survival in patients with platinum-resistant ovarian cancer, without the need for biomarker selection. The findings support relacorilant plus nab-paclitaxel as a potential new standard treatment option for patients with platinum-resistant ovarian cancer. FUNDING: Corcept Therapeutics.
21 Apr 2026
Read appraisal →Medicine
Clinical study on the efficacy of electroacupuncture combined with pelvic floor muscle training for female stress urinary incontinence
BACKGROUND: To evaluate the clinical efficacy and synergistic effects of electroacupuncture (EA) combined with pelvic floor muscle training (PFMT) in the treatment of mild-to-moderate stress urinary incontinence (SUI) in women. METHODS: A single-blind (assessor-blinded), 2 × 2 factorial, randomized controlled trial was conducted. A total of 128 SUI patients were allocated to 4 groups: the EA group (sessions every other day, targeting acupoints including Guanyuan [RN4] and Shenshu [BL23]), PFMT group (3 daily sessions), combination group (EA + PFMT), and waitlist group. The intervention lasted for 4 weeks. The primary outcome was the change in 1-hour pad test leakage volume. Secondary outcomes included 72-hour urinary incontinence episodes and International Consultation on Incontinence Questionnaire-Short Form scores. Data were analyzed using intention-to-treat and factorial analysis of variance. RESULTS: The combination group showed the greatest reduction in leakage volume (6.17 g, 95% confidence interval [CI] = 5.89-6.44), significantly outperforming the EA group (4.53 g, 95% CI = 4.26-4.81), PFMT group (2.13 g, 95% CI = 1.85-2.41), and waitlist group (0.38 g, 95% CI = 0.11-0.66; all P < .001). Factorial analysis confirmed significant main effects for EA (mean difference = 5.35 g, 95% CI = 5.15-5.54) and PFMT (mean difference = 4.15 g, 95% CI = 3.95-4.34; both P < .001), but no interaction effect (P = .686). Secondary outcomes showed consistent improvements in incontinence episodes and International Consultation on Incontinence Questionnaire-Short Form scores. CONCLUSION: Combined EA and PFMT significantly alleviated SUI symptoms. Although no synergy was observed, the additive therapeutic effect provided clinical benefits, offering a promising nonsurgical alternative for SUI management.
20 Apr 2026
Read appraisal →BMC pregnancy and childbirth
Comparative effects of rotational effleurage and connective tissue massage on labor pain, duration, and perineal outcomes in pregnant women: a randomized clinical trial
BACKGROUND: Childbirth is a unique and significant experience in every woman's life. A negative childbirth experience, often due to difficult labor, can adversely affect a mother's feelings toward her baby and their subsequent relationship. Massage, a non-pharmacological pain relief method involving coordinated manipulation of soft tissues by hand, aims to alleviate pain and enhance comfort. This ancient technique is widely used during labor and has demonstrated effectiveness in reducing both the intensity and duration of labor pain. This study aimed to compare the effects of two massage methods-rotational effleurage massage and connective tissue massage (CTM)-on pain intensity and labor outcomes. The study subjects in the two intervention groups received effleurage massage and connective tissue massage, but the control group did not receive any intervention and only routine labor care was provided to them. METHODS: This quasi-experimental, multicenter study was conducted on 90 pregnant women (gestational age 38-40 weeks) admitted in labor at three hospitals. Participants were selected through convenience sampling and randomly allocated into three groups of 30 using permuted block randomization within each center. Although random allocation was performed, due to the multicenter design and non-probability sampling, the study is more accurately classified as quasi-experimental. Written informed consent was obtained from all participants. Data collection tools included a demographic and obstetric questionnaire, the McGill Childbirth Satisfaction Questionnaire, a visual analogue scale for pain, and a labor evaluation checklist. DATA: Statistical analyses were performed using SPSS software version 22 (IBM Corp., Armonk, NY, USA). In this randomized clinical trial, 90 primiparous women were randomly assigned to three groups: effleurage massage, Connective tissue massage, and control. The interventions were performed during the active phase of labor (4-10 cm cervical dilation). Pain intensity was measured using the Visual Analogue Scale at different dilation stages: 3-4 cm, 5-6 cm, 7-8 cm, and 9-10 cm). RESULTS: Pain intensity significantly decreased in both intervention groups compared to the control group at all stages of the active phase of labor (p < 0.001). At 7-8 cm dilation, the mean pain scores were 6.13 ± 0.94 in the effleurage group, 6.23 ± 0.77 in the connective tissue massage group, and 7.87 ± 0.86 in the control group (p < 0.001). Effleurage massage demonstrated greater efficacy than connective tissue massage in reducing pain during the later stages of active labor (p < 0.05). CONCLUSION: Effleurage massage was more effective than connective tissue massage in reducing pain intensity during active labor. Integrating effleurage into maternity care as a non-pharmacological method may improve maternal comfort and support positive birth experiences.
20 Apr 2026
Read appraisal →BMJ sexual & reproductive health
Nurse and midwife interventions to improve access to contraception and abortion in primary care: a systematic review
OBJECTIVES: Amid the unmet need for contraception and safe abortion care globally, harnessing the capabilities of primary care nurses and midwives is vital for facilitating equitable access to these critical healthcare services. We aimed to evaluate the impact of interventions delivered by primary care nurses and/or midwives on facilitating access to contraception and abortion care. STUDY DESIGN: We conducted a systematic review in accordance with PRISMA guidelines and searched five electronic databases in September 2023. A narrative synthesis was conducted with analysis informed by the Levesque et al framework for access to healthcare. RESULTS: Twenty-three articles met the inclusion criteria; 20 related to contraception and three to abortion care. Access to contraception and abortion care was predominantly focused on addressing consumer-related factors such as perception of healthcare needs and support to engage with services. Findings suggested home visiting, telehealth and reproductive counselling interventions by primary care nurses and midwives can be effective at increasing women's access to contraception. There was some evidence these clinicians could be acceptable providers of medical abortion; however, there were no articles on procedural abortion. CONCLUSIONS: Primary care nurses and midwives have the potential to improve women's access to contraception care, particularly through the use of home visiting or telehealth strategies. However, evidence on how nurses and midwives can support access to abortion care is scarce and more research is needed, particularly for procedural abortion. Further research should also target under-studied access factors, including the acceptability of nurses and midwives providing contraception and abortion care and consumers' ability to reach and pay for this healthcare.
15 Apr 2026
Read appraisal →Australian journal of primary health
National and international guidelines for preconception care and comparison with Australian guidelines: a systematic review
BACKGROUND: Guidelines for preconception care are resources that are systematically arranged based on evidence and local contexts to enhance the delivery of high-quality and consistent healthcare. The Royal Australian College of General Practitioners Guidelines (RACGP) for preventive activities in general practice (the Red Book) contains specific components of preconception care items, yet this guideline primarily focuses on general preventive healthcare and may not include a comprehensive list of preconception items based on more recent evidence. This review aimed to compare the recent RACGP guidelines (the 2024 Red Book) with national and international guidelines for preconception care. METHODS: Electronic databases, including PubMed, Embase, Web of Science, CINAHL, and Scopus, were systematically searched following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We also searched clinical guideline registries on professional organisations' websites. Searches were conducted from May to June 2024 and in July 2025. RESULTS: We identified seven other national and international guidelines that recommended what should be done as part of preconception health in clinical practice. Preconception care elements that were not included in the current RACGP guidelines that have evidence of effectiveness were the inclusion of men in preconception care, screening for intimate partners and domestic violence, screening for chlamydia and gonorrhoea infections, and screening for female genital mutilation as part of preconception care. CONCLUSIONS: This review identified four preconception care elements that may potentially improve the implementation of preconception care in Australian practice. This work informs the next steps towards developing a comprehensive preconception medical record tool for use in general practice.
12 Apr 2026
Read appraisal →PloS one
Inconsistent condom use and its associated factors among female sex workers in African countries: Systematic review and meta-analysis
BACKGROUND: Inconsistent condom use represents the most proximal behavioral risk factor for acquisition and transmission of sexually transmitted infections, including human immunodeficiency virus. However, certain situations hinder female sex workers from practicing consistent condom use. This study aimed to assess the pooled estimate of inconsistent condom use among female sex workers and identify factors associated with it. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2020 reporting checklist. Electronic databases (PubMed, Cochrane Library, Epistemonikos, Hinari, and Science Direct), Google Scholar, and other university repositories were searched until March 20, 2024, based on the eligibility criteria. Three independent reviewers screened the titles, abstracts, and full texts. Two independent reviewers extracted the data. The Joanna Briggs Institute quality appraisal checklist was used. The Higgin's I² test was used to quantify heterogeneity. Pooled analysis was conducted using a random-effects model. Sensitivity and subgroup analyses were done. Publication bias was assessed using Egger's regression test and funnel plot. The pooled prevalence and statistical association were declared at a p-value < 0.05 with the 95% CI. RESULTS: A total of 24 studies involving 23,496 female sex workers with a median age of 27.3 years were included. The overall pooled prevalence of inconsistent condom use among FSW in Africa was estimated at 46.73% (95% CI: 37.60, 55.86), I² = 99.59%, and p = 0.00. Condom availability (AOR = 0.68; 95% CI: 0.50, 0.92), depression (AOR = 1.51; 95% CI: 1.00, 2.30), no education (AOR = 1.87; 95% CI: 1.19, 2.93), two or more nonpaying clients (AOR = 2.90; 95% CI: 1.51, 5.54), having >9 current client number (AOR = 0.46; 95% CI: 0.29, 0.74), violence (AOR = 1.74; 95% CI: 1.33, 2.27), and police harassment (AOR = 2.28; 95% CI: 1.03, 5.05) were significant factors. CONCLUSION AND RECOMMENDATION: Inconsistent condom use was high in Africa. Factors including availability of condoms, depression, and education, having two or more nonpaying clients, client numbers, violence, and police harassment were significant factors. Strategies like improving peer education, providing mental health support, empowering women, and improving female sex workers educational status, ensuring condom availability, and strengthening supply for easily accessible condoms can decrease inconsistent condom use and protect FSWs from STI including HIV.
11 Apr 2026
Read appraisal →Journal of medical Internet research
Digital Discourse, Secondary Victimization, and Psychological Harm: Mixed-Methods Analysis of System Justification in the #MeToo Movement
BACKGROUND: The #MeToo movement, initiated in 2006 and amplified on social media in 2017, mobilized women worldwide to share experiences of sexual harassment and assault online. While the movement increased awareness, it also revealed deep social divisions in digital spaces. Supportive discussions promoted solidarity and healing, whereas antagonistic responses reinforced backlash and secondary victimization. In India, the Indian Entertainment Industry (IEI) became a focal point where survivors' disclosures highlighted structural gender inequalities. These polarized reactions function as digital-health signals, reflecting stigma, psychosocial distress, and conditions that shape women's safety and mental well-being. Examining these narratives as indicators of public health risk helps identify patterns of structural inequity and secondary mental health burdens among survivors. OBJECTIVE: This study examined online discourse surrounding #MeToo to identify forms of system-justifying narratives on social media and to assess how #MeTooIndia exposed institutional inequities within the IEI. METHODS: This mixed-methods study comprised 2 components. In study 1, natural language processing was applied to analyze global #MeToo Twitter (subsequently rebranded X) discourse. From an initial corpus of 350,000 tweets, 205,082 were preprocessed, and sentiment and stance detection analysis identified 18,416 tweets expressing negative attitudes toward the movement. Latent Dirichlet allocation topic modeling extracted 22 topics, 12 of which aligned with system-justification categories, revealing distinct lexical and semantic patterns related to gender, institutional, and power dynamics. Two trained coders manually annotated a subsample to ensure conceptual clarity and interrater reliability. Study 2 involved qualitative, semistructured interviews with 20 academic experts in film, gender, and media studies to gather opinions on how #MeTooIndia influenced institutional discourse in the IEI and how these dynamics translate into digital and mental health risks. RESULTS: Analysis of #MeToo Twitter discourse in study 1 identified 4 primary forms of system justification: by gender, by the institutional system, by backlash, and by victim-blaming. Gender and institutional system justifications were the most prevalent. Study 2 reinforced these findings, revealing how experts perceived #MeTooIndia as both empowering and constrained by entrenched institutional and cultural barriers. Together, our findings highlight the dual function of social media in promoting collective advocacy while reproducing conditions linked to gender-based violence, psychological stress, and reduced help-seeking-key digital and mental health concerns. CONCLUSIONS: This mixed-methods study reveals that digital discourse surrounding #MeToo often sustains existing gender and institutional hierarchies rather than dismantling them. Across Twitter data and expert interviews, gender and institutional system justifications emerged as dominant narratives, highlighting how online spaces can reinforce structural inequities while appearing progressive. Although #MeToo amplified visibility and awareness, its potential for lasting institutional change remains limited. These findings underscore the need for trauma-informed digital governance, public health recognition of online hostility as a psychosocial risk, and frameworks that situate digital activism to institutional reforms that support safety and mental well-being.
11 Apr 2026
Read appraisal →Open heart
Sex differences in risk factor control and medication adherence post-ACS: insights from the TEXTMEDS randomised clinical trial
INTRODUCTION: Poor adherence to risk factor control and life-saving medications is a key factor affecting long-term patient prognosis. Evidence indicates that sex plays a significant role in the uptake of both pharmacological and non-pharmacological interventions, ultimately influencing long-term outcomes. This study aimed to quantify sex differences in risk factor management and medication adherence following acute coronary syndrome (ACS). METHODS: This is a secondary analysis of the TEXTMEDS randomised clinical trial - a single-blind, multicentre randomised controlled trial of patients post-ACS. We compared sex differences in achieving clinical and lifestyle targets for secondary prevention, namely blood pressure control (<140/90 mm Hg), low-density lipoprotein cholesterol (LDL-C) (<1.8 mmol/L), healthy body mass index (BMI) (<25 kg/m²), regular physical activity (Global Physical Activity Questionnaire score ≥600), smoking status and adherence to cardioprotective medications (aspirin, beta blockers, ACE/angiotensin receptor blockers, statins, antiplatelets), using adjusted logistic regression models. Medication adherence was defined as taking ≥80% of prescribed doses in the month prior to follow-up, across all five drug classes, unless contraindicated. RESULTS: Of 1379 patients (mean age 58.5±10.7 years; 1095 (79.4%) male), females were less likely than men to achieve LDL-C targets (adjusted OR (aOR): 0.61, 95% CI 0.45 to 0.82) and engage in regular physical activity (aOR: 0.61, CI 0.47 to 0.80), but more likely to achieve a healthy BMI (aOR: 1.47, CI 1.04 to 2.06). Female patients are less likely to adhere to their medication compared with male counterparts (aOR: 0.68, CI 0.50 to 0.92). However, this association weakened and lost statistical significance after further adjustment for socio-economic factors (aOR: 0.71, CI 0.50 to 1.03). There were no significant interactions between sociodemographic or clinical factors and sex in relation to overall medication adherence (P-interactions >0.05). CONCLUSION: This study reveals that female patients are less likely to achieve LDL-C targets and engage in physical activity but more likely to maintain a healthy BMI. Although females showed lower medication adherence, this association weakened after adjusting for socio-economic factors. These findings highlight the importance of sex-sensitive strategies focusing on risk factor control and medication adherence for improving cardiovascular health outcomes. TRIAL REGISTRATION NUMBER: ACTRN12613000793718.
11 Apr 2026
Read appraisal →Cell host & microbe
VIBRANT: A phase 1 randomized trial of multi-strain vaginal L. crispatus live biotherapeutic products in people with bacterial vaginosis
Bacterial vaginosis (BV) is characterized by high microbial diversity. High recurrence rates following antibiotics may stem from poor recolonization by protective Lactobacillus species. This phase 1 randomized trial in the United States and South Africa evaluated two vaginally delivered live biotherapeutic products (LBPs) containing multiple Lactobacillus crispatus strains. After metronidazole treatment for BV, participants received either a placebo or 3 or 7 days of active LBPs. LBP strains were detected by metagenomics in 66.1% (47/71) of participants in the active arms in the first 5 weeks. Among those, nearly half (49%, 23/47) remained colonized at 12 weeks despite the short initial treatment course. Participants were most often colonized by one of three component strains, with no geographic differences in strain colonization observed. LBPs were safe, acceptable, and well tolerated, with no serious adverse events (AEs) reported. These results provide a foundation for the development of transformational interventions aimed at optimizing the vaginal microbiome.
11 Apr 2026
Read appraisal →Cell host & microbe
Vaginal microbiota impacts of a Lactobacillus crispatus live biotherapeutic and predictors of colonization in randomized controlled trial
Bacterial vaginosis (BV) affects >25% of women worldwide and often recurs after standard-of-care metronidazole (MTZ) treatment. LACTIN-V, a live biotherapeutic product (LBP) containing Lactobacillus crispatus strain CTV-05, significantly reduced recurrent BV in a phase 2b clinical trial, but efficacy was incomplete. Here, we characterize microbiota and immune effects using multi-omics and define correlates of treatment success. By week 12, an L. crispatus-dominant microbiota was achieved in 30% of LBP recipients compared with 9% of placebo recipients (benefit ratio: 3.31; p < 0.005). This is primarily due to CTV-05, but native L. crispatus strains are also present and increase over time. Inflammatory cytokines decrease in both arms after MTZ but return to baseline in placebo recipients. Successful L. crispatus colonization is associated with pre-MTZ microbiota, baseline inflammatory profiles, post-MTZ bacterial load, and clinical and behavioral variables. These findings elucidate LBP microbiota effects and identify predictors of treatment success, informing improved intervention strategies to advance women's health.
11 Apr 2026
Read appraisal →PloS one
Randomized trial of transcutaneous tibial nerve stimulation to treat overactive bladder in older women
OBJECTIVES: To evaluate the effects of transcutaneous tibial nerve stimulation (TTNS) associated with behavior therapy (BT) compared to BT alone in the treatment of Overactive Bladder Syndrome (OAB) in older women. STUDY DESIGN: Randomized controlled clinical trial in two groups, G1 that received BT (n = 19) and G2 with the addition of TTNS (n = 19). MAIN OUTCOME MEASURES: The variables analyzed were impact on quality of live (QOL) and degree of discomfort of the symptoms of OAB by International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and voiding habit by a 3-day voiding diary (VD). The assessments were conducted at the beginning and the end of the treatment. RESULTS: Both groups showed a significant reduction in the impact of QOL by ICIQ-OAB. The G1 (BT) reduced the discomfort of nocturia symptoms and urgency urinary incontinence, while in G2 (BT+TTNS), it just did not present a reduction in the discomfort of urinary frequency by ICIQ-OAB. In the VD, despite G1 presenting an episode reduction of urgency urinary incontinence and nocturia, it showed no significant difference. In the G2, the same variables had significant reduction. CONCLUSION: Behavioral therapy reduced OAB symptoms and discomfort in older women, but its combination with TTNS led to greater improvements, particularly in urgency and nocturia. TTNS was safe, well tolerated, and enhanced quality of life, although further studies with larger samples and longer follow-up are warranted. No adverse events or complications were observed, supporting the safety and tolerability of TTNS in older women with OAB.
7 Apr 2026
Read appraisal →Medical education online
AI-assisted learning: ChatGPT for anamnesis in women's health education
UNLABELLED: Artificial intelligence (AI) tools such as ChatGPT are rapidly being adopted in medical education, yet evidence regarding their impact on learners' history-taking (anamnesis) skills remains limited. This gap is particularly relevant in women's health education, where high-quality anamnesis is essential for addressing sensitive, context-dependent concerns and for ensuring the safety of two interrelated patients: mother and fetus. METHODS: This study comprised two phases. First, semi-structured virtual interviews were administered to students and faculty to assess their familiarity with ChatGPT and access to digital technologies. Second, an in-person classroom intervention was implemented within the Women's Health discipline, integrating ChatGPT into history-taking instruction. Students' anamnesis performance was evaluated before and after ChatGPT-assisted learning. Additionally, a novel instructional activity was introduced in which ChatGPT generated cases classified as plausible, intermediate, or physiologically impossible, serving as prompts for guided discussion focused on diagnostic pitfalls, critical appraisal, and clinical reasoning. RESULTS: In the virtual phase, faculty (n = 62) and students (n = 115) completed the questionnaires. The classroom intervention involved 40 medical students participating as part of routine Women's Health teaching activities, with faculty oversight to ensure pedagogical alignment and responsible AI use. A pronounced discrepancy emerged between students' familiarity with ChatGPT (99.1%) and lower levels of familiarity among faculty. Anamnesis performance improved significantly after ChatGPT-assisted learning (p < 0.0001). Students reported increased confidence and perceived enhancement of history-taking quality, and all participants viewed ChatGPT as a valuable educational resource. The AI-generated cases effectively stimulated discussion and reinforced clinical reasoning processes. Findings contributed to the development of a practical guideline for the responsible integration of ChatGPT into Women's Health education. CONCLUSIONS: ChatGPT can enhance anamnesis and promote critical reasoning through structured interaction with AI-generated cases. However, its effective and responsible use depends on targeted faculty development to ensure alignment with pedagogical goals, appropriate oversight, and consistent integration into curriculum.
5 Apr 2026
Read appraisal →Archives of gynecology and obstetrics
Vaginal natural orifice transluminal endoscopic surgery versus laparoscopy for ovarian cystectomy: a prospective, open-label, randomized, non-inferiority pilot trial
PURPOSE: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an innovative minimally invasive procedure. The study aimed to evaluate whether vNOTES achieves non-inferior results compared to conventional laparoscopy in patients undergoing ovarian cystectomy. METHODS: Participants with benign ovarian tumors were randomly assigned (1:1) to undergo laparoscopy or vNOTES. Randomization was stratified based on the size of the ovarian tumor. Patients and surgeons were aware of the allocated procedures. The primary outcome was the proportion of patients successfully treated by the allocated procedure (non-inferiority hypothesis, margin of 15%). The secondary outcomes included operative time, estimated blood loss, time for specimen retrieval, postoperative pain score, use of analgesics, time to first flatus, and perioperative complications. RESULTS: Sixty-four patients were randomly assigned to laparoscopy (n = 32) and vNOTES (n = 32) and were included in the intention-to-treat analysis. The success rates were 100% and 96.9%, respectively. Non-inferiority of vNOTES was demonstrated, as the lower limit of the one-sided 95% confidence interval for the stratified risk difference was -12.7%, which lies above the pre-specified non-inferiority margin of -15%. The vNOTES group exhibited lower pain scores, with a median difference of -1 (95% CI -1 - -1, p < 0.001). CONCLUSION: vNOTES demonstrates non-inferiority to laparoscopy for ovarian cystectomy in selected patients, with notable advantages in cosmetic outcomes and reduced postoperative pain. CLINICAL TRIAL IDENTIFICATION NUMBER: ChiCTR2300070890.
4 Apr 2026
Read appraisal →Open heart
Women's IschemiA TRial to Reduce Events In Non-ObstRuctive CAD (WARRIOR): a randomised controlled trial
IMPORTANCE: Women with angina due to suspected ischaemia referred for coronary angiography often have no obstructive coronary artery disease (ANOCA/INOCA). OBJECTIVE: To determine if intensive medical treatment (IMT) reduces major ischaemic events (major adverse cardiovascular event, MACE) among women with suspected ANOCA/INOCA. DESIGN: Randomised, prospective, blinded-outcomes evaluation. SETTING: 71 sites in the USA. PARTICIPANTS: 2476 women with suspected ANOCA/INOCA. INTERVENTIONS: IMT-high intensity statin, ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) and aspirin versus usual care (UC). MAIN OUTCOMES AND MEASURES: Primary: all cause death, myocardial infarction, stroke/transient ischaemic attack, hospitalisation for angina or heart failure (MACE). Secondary: components of the primary, quality of life and win ratio. RESULTS: Recruitment was lower than planned (n=2476), yielding an aged population (mean, 64 years) with well-controlled blood pressure and low-density lipoprotein cholesterol at baseline, and relatively high rates of statin and ACEI/ARB use. At 2.5 years, 421 events occurred (221 in IMT, 200 in UC) with no difference in the primary outcome (HR=1.13 (95% CI 0.94 to 1.37) for IMT vs UC, p=0.20) or secondary outcomes. Hospitalisations for angina were the dominant contributor to MACE. Sensitivity analysis of contamination provided an estimated HR for IMT versus UC of 0.74 95% CI (0.352 to 1.558), p=0.43. CONCLUSIONS AND RELEVANCE: Among women with suspected ANOCA/INOCA, outcomes were dominated by chest pain and IMT did not improve outcomes, although limited power precludes concluding that it may not be helpful. The findings support the need for more investigation in this population with high burden of angina hospitalisation, health resource consumption and poor quality of life. TRIAL REGISTRATION NUMBER: NCT03417388.
4 Apr 2026
Read appraisal →Journal of behavioral addictions
Gambling in women: A systematic review of interventions and prevention approaches
BACKGROUND: Gambling disorder (GD) is a behavioral addiction with significant psychological, social, and economic consequences. Despite growing female participation and distinct gambling characteristics, research and interventions largely male-centered, overlooking women-specific factors. OBJECTIVES: This systematic review synthesizes evidence on prevention and treatment interventions for women with GD, assessing their effectiveness on gambling behaviors, cognitive and psychological outcomes, and identifying barriers related to access, adherence, and gender-sensitive design. METHOD: A systematic search in PubMed, PsycINFO, and Web of Science (up to September 2025) identified quantitative studies reporting female-specific outcomes in gambling prevention or treatment. Study quality was appraised using National Heart, Lung, and Blood Institute tools, and data on intervention characteristics, outcomes, and participant profiles were extracted. RESULTS: Eighteen studies met the inclusion criteria (five prevention, thirteen treatment). Prevention programs, mostly universal and adolescent-focused, improved gambling knowledge, cognitive distortions, and short term gambling frequency; however, socioemotional effects were inconsistent. Only one study included follow-up assessment. Treatment studies, predominantly cognitive behavioral therapy (CBT)-based, reduced gambling severity and psychological distress, although dropout and relapse rates were higher among women with greater psychopathology or limited support. Person-centered approaches benefited of tailoring interventions to individual profiles. No studies systematically applied gender-sensitive frameworks or disaggregated outcomes by sex in prevention. DISCUSSION AND CONCLUSION: Prevention and treatment programs can benefit women, but standard interventions insufficiently address their unique needs. Gender-sensitive, individualized strategies, inclusion of socioemotional factors, and long-term evaluations are essential to enhance outcomes and inform inclusive public health policies.
4 Apr 2026
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