Smoking, poor nutrition, and sexually transmitted infections associated with pelvic inflammatory disease in remote North Queensland Indigenous communities, 1998-2005

Association between cardiovascular health and pelvic inflammatory disease: Analyses of the NHANES 2015 to 2018

While the link between female reproductive function and cardiovascular health (CVH) is well-established, the association between pelvic inflammatory disease (PID) and CVH remains largely unexplored. This study, therefore, sets out to fill this gap in knowledge by investigating the potential relationship between PID and CVH. To ensure the reliability and validity of our findings, data for this cross-sectional study were meticulously collected from the 2015-2018 National Health and Nutrition Examination Survey (NHANES). After applying stringent exclusion criteria, a total of 2442 women were included in the study. The Life Essential 8 (LE8) scoring system, a robust tool developed by the American Heart Association (AHA), was employed to assess the CVH. Logistic regression with multiple variables and smooth curve fitting were utilized to analyze the association. Subgroup and interaction analyses were performed to determine the strength of this association across different demographic groups. The study included 2442 women, with an average CVH score of 66.29 ± 16.27. After accounting for all covariates, each unit increase in CVH score was associated with 2% lower odds of PID prevalence (OR = 0.98, 95% CI: 0.97-0.99). Notably, participants with high CVH had a striking 71% lower odds of PID prevalence compared to those with low CVH. Stratified analyses further revealed a consistent inverse association between CVH score and PID across various subgroups, underscoring the robustness of our findings. The research has uncovered a significant inverse association between CVH and PID. This suggests that improving the CVH level could be a promising strategy for reducing the odds of PID.

Indigenous data governance approaches applied in research using routinely collected health data: a scoping review

Globally, there is a growing acknowledgment of Indigenous Peoples' rights to control data related to their communities. This is seen in the development of Indigenous Data Governance standards. As health data collection increases, it's crucial to apply these standards in research involving Indigenous communities. Our study, therefore, aims to systematically review research using routinely collected health data of Indigenous Peoples, understanding the Indigenous Data Governance approaches and the associated advantages and challenges. We searched electronic databases for studies from 2013 to 2022, resulting in 85 selected articles. Of these, 65 (77%) involved Indigenous Peoples in the research, and 60 (71%) were authored by Indigenous individuals or organisations. While most studies (93%) provided ethical approval details, only 18 (21%) described Indigenous guiding principles, 35 (41%) reported on data sovereignty, and 28 (33%) addressed consent. This highlights the increasing focus on Indigenous Data Governance in utilising health data. Leveraging existing data sources in line with Indigenous data governance principles is vital for better understanding Indigenous health outcomes.

The effect of anterior uterocervical angle (aUCA) and cervical length on the development of pelvic inflammatory disease

This study aims to compare the uterine body longitudinal axis, uterine body transverse axis, uterine cervix longitudinal axis and anterior cervical axis angle measured ultrasonographically between women with pelvic inflammatory disease (PID) and healthy controls. Women aged 18-45 years with PID and healthy controls were included in the study. Demographic characteristics, uterine body long axis, uterine body transverse axis, uterine cervix long axis and anterior cervical axis angle of PID patients and healthy controls were evaluated. Gravida, parity, history of smoking were significantly higher in the PID group (n = 75) than the control group (n = 74). The uterine body longitudinal axis (p = 0.001) and transverse axis (p = 0.005) were significantly lower, and the cervix longitudinal axis (p < 0.001) and the anterior uterocervical angle (p < 0.001) were significantly higher in the PID group than the control group. Binary logistic regression analysis showed that uterine body (UTX) longitudinal axis (p = 0.005), uterine cervix longitudinal axis (p < 0.001) and UCA (p < 0.001) were significant predictors of PID. Uterine body longitudinal axis, uterine cervix longitudinal axis, and UCA can be associated to PID. This article is protected by copyright. All rights reserved.

Molecular epidemiology and socio-demographic risk factors of sexually transmitted infections among women in Lebanon

BACKGROUND

Sexually transmitted infections (STIs) cause a major public health problem that affect both men and women in developing and developed countries. The aim of the study was to estimate the prevalence of 11 STIs among women who voluntarily participated in the study, while seeking gynecological checkup. The existence of an association between the presence of pathogens and symptoms and various sociodemographic risk factors was assessed.

METHODS

A total of 505 vaginal and cervical specimens were collected from women above 18 years of age, with or without symptoms related to gynecological infections. Nucleic acid was extracted and samples were tested by real-time PCR for the following pathogens: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Ureaplasma urealyticum, Urealplasma parvum, Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma girerdii, Gardnerella vaginalis, Candida albicans and Human Papillomavirus (HPV). Positive HPV samples underwent genotyping using a microarray system.

RESULTS

Of the 505 samples, 312 (62%) were screened positive for at least one pathogen. Of these, 36% were positive for Gardnerella vaginalis, 35% for Ureaplasma parvum, 8% for Candida albicans, 6.7% for HPV, 4.6% for Ureaplasma urealyticum, 3.6% for Mycoplasma hominis, 2% for Trichomonas vaginalis, 0.8% for Chlamydia trachomatis, 0.4% for Mycoplasma girerdii, 0.2% for Mycoplasma genitalium and 0.2% for Neisseria gonorrhoeae. Lack of symptoms was reported in 187 women (37%), among whom 61% were infected. Thirty-four samples were HPV positive, with 17 high risk HPV genotypes (HR-HPV); the highest rates being recorded for types 16 (38%), 18 (21%) and 51 (18%). Out of the 34 HPV positives, 29 participants had HR-HPV. Association with various risk factors were reported.

CONCLUSIONS

This is the first study that presents data about the presence of STIs among women in Lebanon and the MENA region by simultaneous detection of 11 pathogens. In the absence of systematic STI surveillance in Lebanon, concurrent screening for HPV and PAP smear is warranted.

Risk of Pelvic Inflammatory Disease in Relation to Chlamydia and Gonorrhea Testing, Repeat Testing, and Positivity: A Population-Based Cohort Study

Background

There is uncertainty around whether the risks of pelvic inflammatory disease (PID) differ following Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) infection. We quantified the risk of PID associated with chlamydia and gonorrhea infection and subsequent repeat infections in a whole-population cohort.

Methods

A cohort of 315123 Western Australian women, born during 1974-1995, was probabilistically linked to chlamydia and gonorrhea testing records and to hospitalizations and emergency department presentations for PID from 2002 to 2013. Time-updated survival analysis was used to investigate the association between chlamydia and gonorrhea testing, and positivity, and risk of PID.

Results

Over 3199135 person-years, 120748 women had pathology test records for both chlamydia and gonorrhea, 10745 chlamydia only, and 653 gonorrhea only. Among those tested, 16778 (12.8%) had ≥1 positive chlamydia test, 3195 (2.6%) ≥1 positive gonorrhea test, and 1874 (1.6%) were positive for both. There were 4819 PID presentations (2222 hospitalizations, 2597 emergency presentations). Adjusting for age, Aboriginality, year of follow-up, health area, and socioeconomic status, compared to women negative for chlamydia and gonorrhea, the relative risk (adjusted incidence rate ratio) of PID was 4.29 (95% confidence interval [CI], 3.66-5.03) in women who were both chlamydia and gonorrhea positive; 4.54 (95% CI, 3.87-5.33) in those only gonorrhea positive; and 1.77 (95% CI, 1.61-1.94) in those only chlamydia positive.

Conclusions

Gonorrhea infection conferred a substantially higher risk than chlamydia of hospitalization or emergency department presentation for PID. The emergence of gonorrhea antimicrobial resistance may have a serious impact on rates of PID and its associated reproductive health sequelae.

Folate Status and Neural Tube Defects in Aboriginal Australians: the Success of Mandatory Fortification in Reducing a Health Disparity

Historically, neural tube defects (NTD) in Australia affected around 1 in every 1000 births; 42% higher for Aboriginal births. Following firm evidence of the protective effect of periconceptional folate, health promotion activities encouraged increased folate intake through diet and supplements and limited voluntary food fortification. A 30% reduction in NTD was observed in non-Aboriginal but not Aboriginal infants, widening the disparity between Aboriginal and non-Aboriginal rates. Mandatory flour fortification with folic acid in 2009, led to further reductions in overall NTD, and greater reduction among Aboriginal infants, such that rates in Aboriginal and non-Aboriginal infants were similar by 2010-2014. Elimination of this disparity will make a small but important contribution to the Australian government's Closing the Gap initiative to reduce disadvantage among Aboriginal people. Long-term, complete, high-quality surveillance data on NTD have been of great value in monitoring trends in and evaluation of public health interventions for NTD in Australia.

Demographic, lifestyle, and reproductive risk factors for ectopic pregnancy

OBJECTIVE

To evaluate the relationship between demographic, lifestyle, and reproductive factors and the risk of ectopic pregnancy (EP).

DESIGN

Prospective cohort.

SETTING

United States.

PATIENT(S)

Nurses' Health Study II cohort comprising 41,440 pregnancies from 22,356 women.

INTERVENTION(S)

Demographic, lifestyle, and reproductive factors self-reported in 1989 then updated every 2 years. Multivariable log-binomial regression models with generalized estimating equations were used to estimate adjusted risk ratios (aRR).

MAIN OUTCOME MEASURE(S)

Ectopic pregnancy.

RESULT(S)

Incident EP was reported in 411 (1.0%) pregnancies. Former and current smokers had 1.22 (95% confidence interval [CI], 0.97-1.55) and 1.73 (95% CI, 1.28-2.32) times, respectively, the risk of EP compared with never smokers. The risk of EP 10 years after quitting was similar to never smokers (aRR 0.90; 95% CI, 0.60-1.33). Women consuming ≥10 g/day of alcohol had 1.50 (95% CI, 1.08-2.09) times the risk of EP compared with never consumers. In utero exposure to diethylstilbestrol (aRR 3.55; 95% CI, 2.51-5.01), earlier initiation of oral contraceptives (aRR 2.64; 95% CI, 1.70-4.09 for <16 years vs. never), intrauterine device use (aRR 3.99; 95% CI, 2.06-7.72), or history of infertility (aRR 3.03; 95% CI, 2.48-3.71) or tubal ligation (aRR 16.27; 95% CI, 11.76-22.53) also were associated with a higher risk of EP.

CONCLUSION(S)

Women who were current or former smokers, consumed ≥10 g/day of alcohol, were exposed to diethylstilbestrol in utero, initiated oral contraceptives at earlier than age 16 years (which may be a marker of riskier sexual behaviors), and who had a history of infertility, intrauterine device use, or tubal ligation had a higher risk of EP.

Prevalence of chlamydia, gonorrhoea, syphilis and trichomonas in Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis

Higher notification rates of sexually transmissible infections (STIs) are reported among Aboriginal and Torres Strait Islander (Aboriginal) compared with non-Aboriginal people in Australia. The aim of this study is to estimate the pooled prevalence of chlamydia, gonorrhoea, syphilis and trichomonas among Aboriginal people in Australia by sex, age-group, setting (clinic vs population/community-based) and population group [adults, pregnant females, young people (12-29 years) and prisoners]. The databases Medline, PubMed and Web of Science were searched in May 2015. A meta-analysis was conducted to estimate the pooled prevalence of the four STIs in Aboriginal people and if possible, by gender, age-group, setting and population group. A total of 46 studies were included. The pooled prevalence was 11.2% (95%CI: 9.4-13.0%) for chlamydia (36 studies), 12.5% (95%CI: 10.5-14.6%) for gonorrhoea (28 studies), 16.8% (95%CI: 11.0-22.6%) for syphilis (13 studies) and 22.6% (95%CI: 18.5-26.7%) for trichomonas (11 studies); however, there was significant heterogeneity between studies (I(2) <97.5%, P<0.01). In the subgroup analysis, a higher pooled prevalence occurred in females than males for chlamydia (12.7% vs 7.7%) and gonorrhoea (10.7% vs 8.1%). The prevalence of chlamydia was 12.4% in clinic-based compared with 4.3% in population-based studies. The highest pooled prevalence by population group was among pregnant females (16.8%) and young people (16.2%) for chlamydia, pregnant females (25.2%) for trichomonas; and young people for gonorrhoea (11.9%). This review highlights the need to decrease the prevalence of STIs among Aboriginal people through community-based programs that target asymptomatic young people.

Diabetes and smoking as predictors of cancer in Indigenous adults from rural and remote communities of North Queensland - A 15-year follow up study

Indigenous Australians generally have a poor health status and an elevated cancer mortality that has increased in recent decades. A cohort of 2,273 Aboriginal and Torres Strait Islander (TSI) adults (18+ years) from 26 remote communities in far North Queensland, who were initially free of cancer, were followed-up for an average of 15 years. The associations of baseline anthropometric, biochemical and behavioural factors with cancer incidence were investigated using competing risk survival analysis. The age-standardised incidence (all cancers) was 5.2 cases/1,000 person-years (pys) (95% CI 4.1-6.6). Liver/bile duct and lung were the most common cancer sites. Overall cancer incidence was significantly higher in TSIs than Aboriginal people. The baseline prevalence of diabetes was 15.6% in Aboriginal and 25.6% in TSI people. The smoking rate of 59.8% for Aboriginal people was higher than the rate of 45.2% for TSIs. At follow-up, the adjusted sub hazard ratios (SHRs) of diabetes for all cancers combined were 1.8 (95% CI, 1.3-2.6), and for digestive system cancers, 2.3 (95% CI, 1.2-4.4). Smokers had a 60% higher risk (SHR 1.6, 95% CI: 1.1-2.0) for all cancers combined and a fourfold risk (SHR 3.7, 95% CI 1.7-8.0) for lung cancers when compared to non-smokers, regardless of age, sex and ethnicity. The most common cancers encountered by this Indigenous cohort and their consequences are potentially preventable in Indigenous Australians by effective management of highly prevalent modifiable risks in primary service settings, screening participation and arranging for good access to treatment services.