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UK university experts to partner on reproductive health research

The initiative will be covering all aspects of the reproductive lifecourse, including menopause, contraception, infertility and urogynaecology

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A group of UK university experts will collaborate on researching policy and patient experience for reproductive health provision, as part of a new Policy Research Unit (PRU).

The National Institute for Health and Care Research (NIHR) has awarded over £100m in funding to 20 new PRUs across England.

An estimated £20m of this funding has been given to PRUs being hosted by University College London, one of which will focus on reproductive health.

Covering all aspects of the reproductive lifecourse, including menopause, contraception, infertility and urogynaecology, the PRU will be a collaboration between the Universities of Birmingham, Oxford and Warwick, the London School of Hygiene and Tropical Medicine and Hywel Dda University Health Board.

“This much welcomed funding, going to a range of important health care issues, has rightly prioritised reproductive health,” said professor Dame Lesley Regan, women’s health ambassador for England.

“This is an important step in our mission to deliver the Women’s Health Strategy and emphasises the vital role that research plays in our understanding of the key issues that will determine how we improve women’s health and wellbeing.”

Dr Louise Jackson, associate professor at the Institute of Applied Health Research at the University of Birmingham, will be providing health economics expertise, reflecting her experience in evaluating interventions across a wide range of reproductive health and women’s health, including integrated health services, referral pathways and remote consultations for sexual and reproductive health.

She will also be co-leading the Models of Care theme, which will involve exploring and evaluating different ways of providing care for reproductive health, including through digital technology.

She commented: “The Institute of Applied Health Research has a reputation for impactful research in reproductive health and women’s health, both within the UK and globally.

“I am looking forward to working as part of the PRU’s multidisciplinary team to ensure government and arm’s length bodies have the best possible information and economic evidence available when making policy decisions about reproductive health.”

Fiona de Londras, professor of global legal studies at Birmingham Law School – who will be providing reproductive rights expertise across the PRU’s research, – added: “I am very pleased to bring this expertise to the PRU, and to ensure the full integration of human rights in the economic, evaluative, clinical, and participatory work that this vital investment in reproductive health will undertake.”

Diagnosis

Being female not a universal stroke risk factor for patients with AF, study finds

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Female sex may not raise stroke risk across all atrial fibrillation (AF) patients, with higher risk mainly seen in women aged 75 and older, a study suggests.

Researchers said stroke prevention for women with the condition should be more personalised, especially for patients under 75.

Dr Amitabh C Pandey, director of cardiovascular translational research at Tulane University School of Medicine, said: “For years, female sex has been included as a risk factor along with other factors such as high blood pressure and diabetes, meaning women were more likely to be prescribed anticoagulants.

“Our study shows younger women may not have as much added stroke risk as previously thought, while older women, particularly those over 75, appear to have a higher risk that deserves close attention.”

The new Tulane University study challenges a long-standing assumption in heart care that being female automatically increases stroke risk for patients with atrial fibrillation.

Atrial fibrillation, often called AF, is a common heart rhythm disorder that causes the heart to beat irregularly.

It is associated with a higher risk of stroke and is often treated with anticoagulants, also known as blood thinners.

The study found that stroke risk did not increase equally across all female patients with AF.

Instead, researchers said being female may act more as a risk modifier, with increased stroke risk seen primarily among women aged 75 and older or those with a greater burden of other health conditions.

Clinicians often use a scoring system to decide whether people with AF should be prescribed blood thinners.

The system gives points for factors including age, heart failure, diabetes, previous stroke, vascular disease and high blood pressure.

Women also receive one point for sex alone.

Researchers said this can mean women with AF become eligible for blood thinners earlier or more often than men with otherwise similar risk profiles.

While blood thinners can help prevent clot-related strokes, they can also increase the risk of bruising, prolonged bleeding, gastrointestinal bleeding and other serious complications.

The researchers analysed approximately 950,000 patients with AF using TriNetX, a large anonymised electronic health record database.

They compared stroke outcomes between male and female patients across three age groups: younger than 65, 65 to 74, and 75 and older.

Male and female patients were matched based on age, other health problems and whether they had been prescribed anticoagulation medicine.

Among patients younger than 75, the study found no significant difference in one-year stroke risk between men and women.

However, among patients aged 75 and older, women had a modest but statistically significant increase in stroke risk compared with men.

In patients aged 75 and older with no additional risk factors beyond age, women had about one additional stroke per 629 patients compared with their male counterparts.

The findings support growing interest in a newer AF risk score, known as CHA2DS2-VA, which removes sex as a standalone risk factor.

However, researchers said more studies are needed and medical guidance remains inconsistent.

Han Feng, assistant professor at Tulane University School of Medicine, said: “This general approach came from women being underrepresented in AFib trials and studies comprising only about one-third of study populations.

“Our study shows not all women with AFib have the same risk profile, and these decisions should be individualised.

Pandey said: “These findings highlight the need for modern tools and approaches that can personalise risk profiles to individuals.

“The goal is not to undertreat patients who need stroke prevention, but to better identify who is most likely to benefit from anticoagulation and who may be exposed to unnecessary risk.”

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Diagnosis

AI may help accelerate breast cancer diagnosis for high-risk women – study

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AI may help speed breast cancer diagnosis for high-risk women after abnormal mammograms, a study suggests.

Women with abnormal mammograms often wait weeks to learn whether they have breast cancer.

Researchers at UC San Francisco and UC Berkeley said an AI-guided workflow could help reduce that wait by quickly identifying those most likely to have the disease. Some women could move from imaging to evaluation, and sometimes biopsy, in a single day.

Dr Maggie Chung, first author of the study, said: “This is a really an exciting time.

“This moves us closer to personalised care, where we can tailor a plan so that each patient gets the right intervention at the right time.”

The study used an open-source AI model called Mirai.

The model was trained on hundreds of thousands of mammograms linked to patients’ cancer outcomes.

A mammogram is an X-ray scan of the breast used to look for signs of cancer. A biopsy involves taking a small tissue sample to test for disease.

The AI tool is designed to detect subtle patterns in screening mammograms and predict a woman’s cancer risk.

Researchers at UC San Francisco and UC Berkeley applied the model to more than 4,100 screening mammograms at Zuckerberg San Francisco General Hospital and Trauma Center.

Mirai identified 525 women, about 12.7 per cent of screened patients, as high risk.

Those patients could receive an interpretation of their mammograms immediately after the scan and have additional diagnostic imaging for suspicious areas on the same day.

Some women who needed biopsies were also able to have them on the same day.

The researchers said Mirai reduced the wait time for diagnostic evaluation from several weeks to about an hour.

For women who were ultimately diagnosed with breast cancer, it reduced the average wait for biopsy from more than two months to fewer than 10 days.

The researchers stressed that Mirai does not replace radiologists or make diagnoses on its own.

Instead, it acts as a triage tool to help physicians identify the patients who can benefit most from accelerated care.

The team analysed more than 114,000 archival mammograms before launching the programme, to ensure the model would capture enough high-risk patients without overloading the clinic with too many expedited evaluations.

The researchers said they hope AI will support a more personalised approach to breast cancer screening tailored to each patient’s breast cancer risk.

Chung said: “Right now, many women follow the same screening schedule but their individual risk can be very different.

“AI risk assessment gives us the chance to identify the women most likely to benefit from expedited care and get them what they need.”

Adam Yala, senior author of the study and a data scientist at UC Berkeley, said: “This is a powerful example of how AI can be a collaborative partner for physicians.

“It shows how we can improve care when we bring clinicians and data scientists together to design these systems.”

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Fertility

Infertility may be risk factor for early menopause, study suggests

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Women with primary infertility may face a higher risk of early menopause and reach it about a year earlier, a study suggests.

The findings suggest women with primary infertility may be more likely to enter menopause before the age of 45.

The increased risk appeared most notable among women with unexplained infertility or a history of endometriosis.

Dr Stephanie Faubion, medical director for The Menopause Society, said: “This study shows that women with primary infertility, specifically those with unexplained infertility or a history of endometriosis, were at risk for early menopause.

“Given that early menopause is linked to adverse long-term health consequences, these women may benefit from counselling that they are at risk of early menopause.

“This will allow them to monitor for early menopause and to seek treatment with hormone therapy, if indicated.”

Early menopause is usually defined as menopause before age 45, while premature menopause is menopause before age 40.

Women who experience menopause earlier may face symptoms for longer and have a higher risk of long-term health problems.

These can include cardiovascular disease, osteoporosis and neurocognitive disorders. Osteoporosis weakens bones, while neurocognitive disorders affect memory, thinking or brain function.

The study, highlighted by The Menopause Society, involved nearly 700 people, roughly half of whom had been diagnosed with primary infertility.

It found that women with a history of primary infertility underwent natural menopause about one year earlier than those without such a history.

Researchers found no association between infertility and premature menopause.

Infertility affects around one in six people globally and can have consequences beyond family planning.

Previous research has linked infertility with higher rates of cancer and cardiovascular disease, although causes vary and may involve genetic, hormonal, in-utero or lifestyle factors.

In-utero factors are influences that occur while a baby is developing in the womb.

Earlier studies looking at links between infertility and early or premature menopause have produced mixed results, with some not accounting for different types of infertility.

The new study suggested that women with unexplained infertility or a history of endometriosis may have an increased risk of early menopause.

Endometriosis is a condition where tissue similar to the lining of the womb grows elsewhere in the body. It can cause pain, heavy periods and fertility problems.

Known risk factors for early or premature menopause include tobacco use, low body mass index, not having given birth and starting periods at a younger age.

Women who have had more childbirths and those with a history of oral contraceptive use have previously been linked to later menopause.

The researchers said women with primary infertility may benefit from additional counselling because of the systemic and long-term health effects of early menopause.

They also said women should be encouraged to seek evaluation and treatment if they experience a new loss of menstrual cycles.

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