Search Results (874)

Background/Objectives: Severe thrombocytopenia (platelet count ≤ 50,000/µL) is a diagnostically heterogeneous condition during pregnancy, encompassing obstetric and non-obstetric etiologies that require distinct management approaches. The aims of this study were to determine the etiological distribution of severe thrombocytopenia during pregnancy and to evaluate its management strategies and perinatal outcomes in a tertiary perinatology center. Methods: This retrospective cohort study included 203 pregnant women with severe thrombocytopenia (platelet count ≤ 50,000/µL) stratified into three groups: Group A (30,000 < platelet count ≤ 50,000/μL, n = 123), Group B (10,000 < platelet count ≤ 30,000/μL, n = 54), and Group C (<10,000/µL, n = 26). Demographic characteristics, etiological diagnoses, treatment modalities, and perinatal outcomes were evaluated. Results: The etiological distribution varied significantly across severity groups (p = 0.001). HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome was the most common cause overall (36.5%) and predominated in milder thrombocytopenia (Group A: 40.7%; Group B: 42.6%), whereas non-obstetric etiologies, such as immune thrombocytopenia (ITP), were significantly more frequent in Group C (57.7%). Treatment intensity increased with severity, with 79.7% of Group A requiring no intervention compared to only 26.9% of Group C (p = 0.001). Gestational age at delivery (median 37 weeks, p = 0.587) and birth weight (mean 2547 ± 968 g, p = 0.191) were comparable across severity groups. Minimum platelet count showed no significant correlation with delivery timing, birth weight, or hemoglobin decline. Conclusions: Severe thrombocytopenia in pregnancy exhibits distinct etiological patterns that vary according to platelet count severity. Favorable perinatal outcomes are achievable with appropriate diagnosis and management in specialized centers, underscoring the importance of comprehensive diagnostic evaluation rather than relying solely on platelet count thresholds for clinical decision-making. Full article

Introduction: Neurodevelopmental disorders (NDs), including autism spectrum disorder and related conditions, are increasingly recognized among women of reproductive age, yet their unique needs during pregnancy and childbirth remain poorly studied. Communication differences, sensory sensitivities, and co-occurring psychiatric conditions may complicate maternity care, leading to higher risks of adverse outcomes and ethical challenges in clinical practice. This study aimed to examine pregnancy complications, delivery outcomes, and postpartum characteristics in women with NDs, compared with a control group, and to identify specific barriers in perinatal care. Methods: A retrospective observational study was conducted at the National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, including 18 pregnant women with confirmed NDs and 21 matched controls with uncomplicated pregnancies. Data were extracted from medical records and included demographic parameters, pregnancy course, complications, labor management, neonatal outcomes, and documented communication or ethical issues. Comparative analyses were performed using chi-square or Fisher’s exact tests for categorical variables and Student’s t-test or Mann–Whitney U test for continuous variables. Results: Pregnant women with NDs had significantly higher rates of pelvic girdle pain (66.7% vs. 23.8%, p = 0.01), vaginal bleeding (44.4% vs. 14.3%, p = 0.04), anxiety (61.1% vs. 19.0%, p = 0.007), and depression (50.0% vs. 14.3%, p = 0.02) compared with controls. Persistent daily nausea was also more common (50.0% vs. 14.3%, p = 0.03). Attendance of prenatal physician visits was lower in the ND group (66.7% vs. 95.2%, p = 0.02). Cesarean delivery occurred in 83.3% of ND women versus 23.8% of controls (p < 0.001), with psychiatric recommendations often cited as the indication. Breastfeeding was declined in 94.4% of ND cases versus 4.8% of controls. Labor duration was prolonged, and neonatal anthropometrics were lower in the ND group. Communication difficulties were documented in 83.3% of ND participants, and postpartum depressive symptoms were identified in 77.8%. Conclusions: Pregnant women with NDs face a multidimensional vulnerability in maternity care, including higher frequencies of pain, bleeding, nausea, anxiety, and depression, prolonged labor, markedly increased cesarean rates, reduced breastfeeding initiation, and smaller neonatal anthropometrics. Frequent communication barriers, guardian decision-making, and postpartum separation further complicate care. These findings underscore the necessity of neurodiversity-informed, individualized perinatal strategies, integrating sensory accommodations, trauma-informed communication, and proactive mental health support to improve both clinical outcomes and patient experiences. Full article

Breast cancer remains the most commonly diagnosed malignancy and a leading cause of cancer-related mortality among women worldwide. Neoadjuvant chemotherapy (NAC) is increasingly used, particularly in aggressive subtypes such as HER2-positive and triple-negative breast cancer, where achieving a pathological complete response (pCR) is strongly associated with improved outcomes. Early and accurate assessment of therapeutic response is therefore essential to enable timely treatment adaptation. Conventional imaging methods—including magnetic resonance imaging (MRI), computed tomography (CT), mammography, and B-mode ultrasound—mainly detect macroscopic tumor shrinkage and often lagging behind biological alterations, as they rely primarily on size-based assessment. Quantitative ultrasound (QUS) is an emerging, non-invasive technique that analyzes raw radiofrequency (RF) ultrasound data to extract spectral, scattering, and attenuation parameters, allowing detailed characterization of tumor microstructure. When combined with parametric mapping, texture analysis, and advanced radiomic or deep learning approaches, QUS can capture subtle tissue alterations at an early stage of therapy and help predict pathological response before conventional imaging detects morphologic change. Integration with molecular and clinical data further enhances predictive performance, enabling adaptive and personalized treatment strategies. This narrative review summarizes current evidence on the clinical utility of QUS in monitoring NAC response in breast cancer, outlines the methodological foundations of this technology, and discusses key challenges to its broader implementation—particularly the need for standardized acquisition and processing protocols, robust interpretive algorithms and large, prospective, multicenter validations to confirm its impact on clinical decision-making and patient outcomes, and to accelerate its translation into precision oncology practice. Full article

Despite growing evidence that diverse leadership enhances decision-making and innovation, little is known about how gendered expectations and structural barriers intersect to shape women’s leadership experiences in Greece. This qualitative study draws on semi-structured interviews with sixteen (N = 16) senior women leaders across healthcare and other professional sectors. The data are analyzed using thematic analysis to explore how participants navigate stereotypes, microaggressions, and work–life integration challenges. Findings reveal a core mechanism of gendered constraint in which structural barriers and interpersonal dynamics shape leadership enactment. These dynamics are mitigated through strategies such as mentorship, boundary setting, and inclusive practices. A central contribution of the study is the proposed Leadership Recognition and Resilience (LRR) framework, which conceptualizes the dynamic interplay between leadership purpose, recognition, and gendered constraints and highlights how adaptive strategies sustain agency, well-being, and organizational influence. The study extends role-congruity theory by introducing the concept of a glass acknowledgment ceiling, a subtle form of gendered resistance that limits recognition and authority even after women attain leadership positions. These findings underscore the importance of systemic reforms, culturally sensitive leadership development, and supportive networks to sustain women’s leadership and advance genuine gender equity in organizational contexts. Full article

Financial literacy is essential for sustainable social and economic development, but several demographics and financial behaviors can influence informed decision-making. In this investigation, we examine the interaction between Financial Literacy (FL) and Financial Wellbeing and Behavior (FWB) across 286 Brazilian education professionals. We employ a two-step approach for analysis: step one is determining the influential demographic variables for Financial Literacy (FL); in step two, FL serves as a primary variable for explaining Financial Wellbeing and Behavior (FWB). We utilize both multiple regressions and supervised machine learning for factor verification for both concepts. The findings show that superior Financial Literacy is a highly significant and substantial positive antecedent of excellent Financial Wellbeing and Behavior ($p<0.01$). We also find that a significant gender gap exists in financial knowledge, such that women significantly underperform men on financial literacy tests. Machine learning models confirm that FL is the strongest feature for FWB prediction by far and that gender is the strongest antecedent of a consumer’s level of financial literacy. These findings suggest that policymakers must do more than provide primary financial literacy; they also need to deploy behavioral insights to raise long-term financial freedom and close the gender gap. Upscaling teacher financial literacy is a strategic social sustainability investment that promotes the explicit Sustainable Development Goals, including “Quality Education,” “Gender Equality,” “Decent Work” and “Economic Growth”. Full article

Vitamin D (VD), due to its hormonal action, plays a crucial role in calcium homeostasis and bone metabolism, and its deficiency has been associated with musculoskeletal disorders such as osteoporosis, fractures, and osteomalacia, as well as a growing attention of chronic conditions and certain cancers. Despite its physiological relevance and widespread prevalence, particularly among older individuals, patients with chronic diseases, institutionalized populations and pregnant or lactating women, clinical approaches to diagnosing and managing vitamin D deficiency (VDD) remain heterogeneous across guidelines and healthcare settings. This reflects a lack of consensus regarding the benefits and limitations of universal versus selective screening, the definition of adequate serum concentrations, and the clinical indications for supplementation across different patient profiles. This narrative review explores key controversies in the clinical management of VDD, including current perspectives on screening strategies and target populations, indications for empirical supplementation, criteria for biochemical monitoring, and therapeutic goals in bone-related outcomes. In particular, the review discusses the rationale for adopting a 30 ng/mL (75 nmol/L) threshold for adequate serum 25(OH) concentrations in skeletal health, the role of vitamin D and calcium in osteoporosis treatment, and the pharmacological advantages of cholecalciferol compared to other vitamin D compounds. Through a synthesis of available evidence and expert consensus, the review aims to support clinical decision-making in the prevention and treatment of VDD and to identify areas that require further clarification or research. This review aims to support evidence-based clinical decision-making. Full article

Background/Objectives: Women who have genetic predisposition to breast cancer often opt for risk-reducing mastectomy with immediate reconstruction. Evaluating their satisfaction and quality of life is essential for guiding shared decision-making. Methods: This exploratory study assessed quality-of-life outcomes in two cohorts of patients undergoing bilateral prophylactic nipple-sparing mastectomy with immediate prepectoral implant-based reconstruction. Only patients without postoperative complications (necrosis, infection) were included. Each patient completed the BREAST-Q questionnaire both preoperatively (1–2 days before surgery) and postoperatively. Results: Postoperative BREAST-Q scores demonstrated significant improvement, with self-confidence increasing from 40.75 to 44.33, satisfaction with breast size and appearance from 50.42 to 58.50, and general esthetic/functional satisfaction from 26.92 to 33.17 (all p < 0.01). In contrast, physical comfort decreased from 48.00 to 32.42 (p < 0.001). Preoperative responses may have been influenced by anticipatory stress related to the imminent surgery and concern regarding the breast area to be operated. In contrast, postoperative results reflect psychological relief and satisfaction following a successful surgery, with no complications. Conclusions: Nipple-sparing mastectomy with immediate prepectoral reconstruction is associated with high patient-reported satisfaction and perceived improvements in quality of life, particularly regarding body image and emotional well-being. However, functional limitations such as reduced physical comfort should also be acknowledged. These findings further support evidence-based recommendations for prophylactic surgery in high-risk patients. Full article

Background/Objectives: Management of acute episodes of lower urinary tract infection (LUTI) depends on whether they are sporadic or recurrent. We aimed to define factors that differentiate patients with acute sporadic cystitis (AC) from those with recurrent cystitis (RC) and thereby improve individualized care. Methods: We performed a post hoc analysis of prospectively collected data from the multinational GPIU.COM study. Female patients with an acute LUTI episode completed the Acute Cystitis Symptom Score (ACSS) and underwent a routine clinical and laboratory evaluation, including a physical examination, ultrasonography, urinalysis, and urine culture and antimicrobial susceptibility testing. Risk factors for recurrence were evaluated using the Lower Urinary Tract Infection Recurrence Risk (LUTIRE) nomogram and the ORENUC classification. Statistical analysis followed a robust stepwise approach. Significant variables were assessed by relative risk (RR), and logistic regression was used to estimate odds ratios (ORs). Model performance was evaluated using the area under the curve (AUC), the Hosmer–Lemeshow test, variance inflation factor (VIF), and bootstrap sampling. Results: A total of 106 women were included (AC n = 50; RC n = 56). Patients with RC more frequently presented with a history of constipation, a severe impact of symptoms on daily activities, multiple uropathogens, and trace proteinuria. Pyuria was inversely associated with RC. Logistic regression identified chronic constipation, severe impact of symptoms on daily activities, and multiple uropathogens as independent predictors of RC. Three predictive models showed consistent discrimination between AC and RC (AUC = 0.80, 0.82, and 0.84). Conclusions: AC and RC showed notable differences in certain symptom profiles, quality of life, urinalysis, and microbiological findings. Combining high-value predictors from LUTIRE and ORENUC into a comprehensive prognostic algorithm could improve assessment of recurrence risk. A refined classification of LUTIs with recurrence grading is warranted to guide decision-making and prevention strategies. Full article

Women experience realistic and symbolic gender intergroup threats across diverse social contexts, which can profoundly influence their decision-making processes. Drawing on intergroup threat theory, this research investigated how perceived gender intergroup threats affect women’s intertemporal choice behavior and examined cognitive appraisal as a potential mediating mechanism. Study 1 (N = 281) found a negative correlation between gender intergroup threat perception and delay discounting through questionnaires. Study 2 (N = 154) experimentally manipulated threat perception and demonstrated that both realistic and symbolic gender threats enhanced consideration of future consequences, with cognitive appraisal serving as a complete mediator of these effects. Study 3 (N = 120) employed a recall paradigm, providing convergent evidence that heightened realistic threat perception and associated threat appraisal increased preferences for delayed, long-term outcomes. These findings suggest that perceived gender intergroup threats promote future-oriented decision-making among women, potentially as an adaptive strategy to manage threat-related risks, and the mediating role of cognitive appraisal further elucidates the psychological mechanisms underlying this behavioral shift. This research advances the theoretical understanding of how intergroup threat dynamics shape women’s economic behavior and extends knowledge of gender threat interactions in decision-making contexts. Full article

Financial literacy, defined as the set of knowledge, skills, and attitudes that enable individuals to make informed economic decisions and manage resources efficiently, is fundamental for social inclusion and the reduction of inequalities. This study, through a systematic review of the scientific literature using the PRISMA methodology, selected 120 primary studies that met the inclusion and exclusion criteria and presented a low risk of bias. These studies examined aspects related to financial literacy programs, the populations benefited, their effects, the challenges encountered, and the lessons that can guide the replication of these initiatives. The results show that the most frequent programs include training in basic financial concepts—savings, budgeting, access to banking services and microfinance—as well as workshops, seminars, and group training sessions. The populations most benefited were rural communities and women, although informal workers, migrants, and refugees could also significantly improve their financial inclusion and economic resilience. Among the positive effects, improvements were observed in income and expense management, increased savings, investment planning, preparation for emergencies and retirement, and the strengthening of economic empowerment and the sustainability of microenterprises and small enterprises. These findings highlight the importance of implementing financial literacy programs adapted to specific contexts to promote inclusion and economic well-being. Full article

Robotaxi services represent a major step in the commercialization of autonomous driving, offering efficiency, consistency, and safety benefits. However, despite technological advances, their large-scale adoption is far from guaranteed. Most urban users already rely on mature ride-hailing platforms such as Didi and Uber, making the real behavioral question not whether to adopt Robotaxi, but whether to migrate from existing services. Prior studies based on TAM, UTAUT, or trust models have primarily examined users’ initial adoption decisions, overlooking the substitution behavior that better captures how people shift between competing mobility services in real contexts. This study addresses this gap by applying the Push–Pull–Mooring (PPM) framework to examine users’ migration from ride-hailing to Robotaxi services, based on survey data collected from 1206 respondents across four Chinese cities (Beijing, Shanghai, Guangzhou, and Wuhan). The model was tested using structural equation modeling and multi-group analysis (SEM–MGA). Push factors reflect negative experiences with ride-hailing, including social anxiety and insecurity caused by drivers’ behaviors; pull factors emphasize Robotaxi’ autonomy and service reliability; while mooring factors capture habitual ride-hailing use and perceived Robotaxi risk. Findings indicate that push and pull factors significantly promote migration intentions, whereas mooring factors hinder them. Among all factors, perceived risk exerted the strongest negative effect (β = −0.36), underscoring its critical role as a barrier to Robotaxi migration. Gender differences are also evident, with women more sensitive to risks and men more influenced by reliability. By situating adoption within a migration context, this study enriches high-risk innovation theory and offers practical guidance for designing gender-sensitive and user-specific promotion strategies. Full article

Background: Thalassemia has been recognized as a critical public health issue in Bangladesh, especially among pregnant women, due to its hereditary nature and the lack of early screening infrastructure. Early identification of at-risk individuals is essential to prevent the transmission of this genetic disorder to future generations and to reduce the burden on an already strained healthcare system. Methods: In this study, an innovative framework for thalassemia risk assessment has been developed by integrating Multi-Criteria Decision-Making (MCDM) methods—specifically AHP-TOPSIS—with machine learning algorithms including Random Forest, XGBoost, and CatBoost. Explainable Artificial Intelligence (XAI) techniques such as SHAP and LIME have also been incorporated to improve model transparency and trustworthiness. Real-world clinical and demographic data, consisting of 16 features and 1200 samples, have been collected through a structured survey and processed using rigorous feature selection and ranking methods. Risk stratification has been performed to classify patients into high, medium, and low categories, enabling targeted intervention. Results: Among all models, the XGBoost classifier trained on AHP–TOPSIS–prioritized features achieved a consistent accuracy of 99.28% under stratified 20-fold cross-validation, demonstrating robust diagnostic classification performance. The model predominantly captures hematologic patterns characteristic of thalassemia manifestations, functioning as an assistive diagnostic framework rather than a causal risk predictor. The explainability of predictions, ensured through comprehensive visual and statistical analyses, further enhances the model’s clinical transparency and reliability. Conclusions: The proposed MCDM–machine learning framework demonstrates strong potential for improving thalassemia risk assessment, enabling early detection and informed decision-making in maternal healthcare. The proposed framework should be regarded as a preliminary proof-of-concept system that demonstrates the feasibility of integrating Multi-Criteria Decision-Making (AHP–TOPSIS) with advanced machine learning and explainable-AI techniques for thalassemia assessment. Although the model achieved strong diagnostic performance under nested cross-validation, additional external validation and inclusion of causal predictors are required before clinical deployment. Full article

Background/Objectives: Pharmacological prevention is an evidence-based strategy to reduce the incidence of hormone receptor-positive breast cancer in high-risk women. Despite strong data from randomized trials, clinical uptake remains low. This review aims to summarize the efficacy, safety, and clinical implementation of pharmacoprevention and explore novel approaches to improve uptake. Methods: A comprehensive literature review was conducted on pharmacologic agents used for breast cancer risk reduction, including selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). The review also examines risk assessment models, guideline recommendations, barriers to implementation, and emerging strategies such as low-dose therapies and digital decision aids. Results: Tamoxifen, raloxifene, and AIs significantly reduce the incidence of estrogen receptor-positive breast cancer in high-risk populations. However, adverse effects and poor awareness limit their use. Personalized risk models and newer approaches, including low-dose tamoxifen, digital health tools, and emerging agents such as SERDs and GLP-1 receptor agonists, may improve acceptability and adherence. Conclusions: Pharmacoprevention offers substantial benefits in appropriately selected women. Future efforts should focus on new drugs, precision risk stratification, individualized decision-making, and overcoming barriers to implementation to maximize the impact of preventive strategies in breast cancer control. Full article

Background: Proper nutrition supports maternal and fetal health. Gaps in nutritional knowledge (NK) and nutritional literacy (NL) can affect maternal and fetal health. NK refers to knowing facts and processes about nutrition, while NL is a broader component that includes competencies and skills needed to obtain, understand, and apply nutrition information to make dietary decisions. NL and NK limitations may contribute to adverse maternal and neonatal outcomes. This scoping review aims to understand the relationship between NK, NL, and pregnancy outcomes, offering insights into areas for future nutrition-based interventions. Methods: Seven databases were searched for studies assessing NK and NL among pregnant women. A total of 5080 articles were identified, with 4249 retained after removing duplicates. Following title and abstract screening, 18 articles underwent full-text review, and 11 met the inclusion criteria. Data were extracted, analyzed, and categorized into nine key themes. Results: All eleven studies employed survey-based methods; ten focused on NK and one on NL. Overall, NK was generally low. The evidence for an association between NK or NL and pregnancy outcomes was limited. Education, income, occupation, and family influence were identified as key factors influencing the NK and NL of pregnant women. Education and income levels were identified as having the most significant impact on NK overall. Only one study accessed the relationship between NK and adverse birth and neonatal outcomes, and this only included HDP and preterm labor. Also, only one out of the eleven studies was conducted in the US. Conclusions: In this review, we found that NK and NL among pregnant women was generally low, with limited evidence linking it to pregnancy outcomes; education and income emerged as the most influential factors of NK and NL. Future studies in high-income countries are recommended to assess the association between NL and adverse maternal outcomes, especially GDM. Full article

Background/Objectives: Older adults with breast cancer may suffer from over- and undertreatment if intensity of therapy does not align with their physiologic age. We sought to evaluate the association between physiologic age, chronologic age, and treatment patterns in women ≥ 70 years with non-metastatic breast cancer. Methods: Patients ≥ 70 diagnosed with non-metastatic breast cancer 10/2021–3/2024 who had received surgical therapy and frailty (Geriatric-8) and life expectancy (Schonberg index) screening at our institution were identified from our institutional database. Descriptive analyses were run using chi-square tests of proportion. In the largest subgroup (patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2)-disease), multivariate logistic regression adjusting for patient- and disease-level characteristics was used to assess the relationship between life expectancy < 10 years and the omission of sentinel lymph node biopsy (SLNB) and radiation therapy (RT). Results: Of 272 patients, 104 (38.2%) screened positive for frailty and 64 (23.5%) had a life expectancy of <10 years. On bivariate analysis, a higher proportion of frail patients (44 (42.3%) had a life expectancy < 10 years, while 20 (11.9%) robust patients had a life expectancy < 10 years (p < 0.001). Most patients (226, 83.1%) had HR+/HER-2 negative disease; 10 (3.7%) had HER2+ disease; and 33 (12.1%) had triple-negative breast cancer (TNBC) (p < 0.001). Life expectancy was not significantly associated with omission of SLNB (life expectancy < 10 years: reference; life expectancy ≥ 10 years: OR 0.81 95% CI [0.20–3.28]) or RT (life expectancy < 10 years: reference; life expectancy ≥ 10 years: OR 1.14, 95% CI 0.44–2.93]) in patients with stage I–II HR+/HER-2− disease on adjusted analysis. Conclusions: While patients at risk for frailty and limited life expectancy are relatively common in our population, these measures may not significantly influence patient and clinician treatment decision making. Future efforts to tailor therapy by measures of physiologic age are needed. Full article