Factors Influencing the Choice of Place of Delivery of a First Child among Nigerian Women

Among the factors responsible for maternal deaths in developing countries is complications during pregnancy and childbirth, and as such, the choice of place for delivery is vital as the quality of attention received can either aid or reduce the risks attached to child bearing. This study seeks to statistically model factors that determine the place of delivery in Nigeria among women of reproductive age taking into consideration possible nesting structure in the mode of data collection. A two-level hierarchical multilevel logistic model with the individual women as the lower level and the state of residence as the second level was applied to 2018 Nigeria Demographic Health Survey (NDHS) data. Results showed that the odd of choosing a government or private facility reduced by 58.6% and 85.9%, respectively. Women in the rural areas are 12% and 20% less likely to choose either a government or private facility, additional education increases the odd of choosing any of the two facilities against home delivery. Other significant variables were wealth index, religion, assistance during labour and the number of antenatal visits. Keyword: Place of delivery; Nesting; Multilevel Logistic Model; Odds and Antenatal Car

Prevalence and factors associated with suicidal ideation amongst college students in the Nelson Mandela Bay Municipality, South Africa

Background: Suicidal behaviour amongst college students constitutes a significant social and public health problem globally. This study determined the prevalence and associated factors of suicidal ideation amongst students of higher education in the Nelson Mandela Bay Municipality (NMBM), South Africa. Methods: In this institution-based cross-sectional study, a multistage cluster sampling of 826 participants, drawn from a college in NMBM, was conducted from January to March 2020. Data were collected with a standardised self-administered questionnaire. Multivariable logistic regression analysis was used to identify the factors associated with suicidal ideation. Results: Participants’ ages ranged from 18 to 24 years, with a mean age of 20.49 years (standard deviation, 1.88 years). The lifetime prevalence of suicidal ideation and plans in the preceding 12 months were 24.5% and 9.6%, respectively. The odds of suicidal ideation were higher in students who experienced bullying (adjusted odds ratio [AOR], 1.89; 95% confidence interval [CI], 1.35–2.65), mental illness (AOR, 1.89; 95% CI, 1.35–2.65), a history of sexual assault (AOR, 2.50; 95% CI, 1.20–5.21) and experience of sexual assault by or to a close family member (AOR, 1.69; 95% CI, 1.01–2.82). Underlying chronic illness was associated with a twofold risk for suicidal ideation in both sexes. Conclusion: About a quarter of the students sampled at the college had experienced suicidal ideation and some had had suicidal plans in the preceding 12 months. Screening for the identified risk factors amongst the student population coupled with prompt interventions would mitigate the risk of suicide in the study population. Keywords: suicidal behaviour; suicidal plans; higher education; students; South Africa

Predicting swimming performance using state anxiety

Competitive state anxiety is a common response to stressful competitive sports situations that could affect athletic performance. The effects of state anxiety on swimming performance need further inquiry. The aim of the study was to determine the component of state anxiety that best predicts swimming performance. A quantitative, cross-sectional study design that made use of the Competitive State Anxiety Inventory-2 to measure precompetitive state anxiety was used. A total of 61 male high school swimmers whose age ranged between 14 and 19 years (M = 16.16, standard deviation = 1.66 years) completed the Competitive State Anxiety Inventory-2 1 hr before competing in a 50-m individual swimming event. Performance was evaluated using finishing position. Due to the relatively short duration of the 50-m event, the available literature would suggest that Somatic Anxiety would have a greater effect on Performance - there is not enough time to allow cognitive anxiety to have a detrimental impact on performance. Thus, it was hypothesized that somatic rather than cognitive anxiety will best predict swimming performance. It emerged that both cognitive (b =.787; p <.001) and somatic anxieties (b =.840; p <.001) can independently predict swimming performance. However, when both cognitive and somatic anxieties were regressed onto swimming performance, somatic anxiety partially dominated cognitive anxiety (b =.626; p <.001) and became the significant predictor of swimming performance. It is recommended that swimmers and swimming coaches make use of specific intervention strategies that eradicate the detrimental effects of somatic anxiety immediately before competition.IS

The malleable brain: plasticity of neural circuits and behavior: A review from students to students

One of the most intriguing features of the brain is its ability to be malleable, allowing it to adapt continually to changes in the environment. Specific neuronal activity patterns drive long-lasting increases or decreases in the strength of synaptic connections, referred to as long-term potentiation (LTP) and long-term depression (LTD) respectively. Such phenomena have been described in a variety of model organisms, which are used to study molecular, structural, and functional aspects of synaptic plasticity. This review originated from the first International Society for Neurochemistry (ISN) and Journal of Neurochemistry (JNC) Flagship School held in Alpbach, Austria (Sep 2016), and will use its curriculum and discussions as a framework to review some of the current knowledge in the field of synaptic plasticity. First, we describe the role of plasticity during development and the persistent changes of neural circuitry occurring when sensory input is altered during critical developmental stages. We then outline the signaling cascades resulting in the synthesis of new plasticity-related proteins, which ultimately enable sustained changes in synaptic strength. Going beyond the traditional understanding of synaptic plasticity conceptualized by LTP and LTD, we discuss system-wide modifications and recently unveiled homeostatic mechanisms, such as synaptic scaling. Finally, we describe the neural circuits and synaptic plasticity mechanisms driving associative memory and motor learning. Evidence summarized in this review provides a current view of synaptic plasticity in its various forms, offers new insights into the underlying mechanisms and behavioral relevance, and provides directions for future research in the field of synaptic plasticity.Fil: Schaefer, Natascha. University of Wuerzburg; AlemaniaFil: Rotermund, Carola. University of Tuebingen; AlemaniaFil: Blumrich, Eva Maria. Universitat Bremen; AlemaniaFil: Lourenco, Mychael V.. Universidade Federal do Rio de Janeiro; BrasilFil: Joshi, Pooja. Robert Debre Hospital; FranciaFil: Hegemann, Regina U.. University of Otago; Nueva ZelandaFil: Jamwal, Sumit. ISF College of Pharmacy; IndiaFil: Ali, Nilufar. Augusta University; Estados UnidosFil: García Romero, Ezra Michelet. Universidad Veracruzana; MéxicoFil: Sharma, Sorabh. Birla Institute of Technology and Science; IndiaFil: Ghosh, Shampa. Indian Council of Medical Research; IndiaFil: Sinha, Jitendra K.. Indian Council of Medical Research; IndiaFil: Loke, Hannah. Hudson Institute of Medical Research; AustraliaFil: Jain, Vishal. Defence Institute of Physiology and Allied Sciences; IndiaFil: Lepeta, Katarzyna. Polish Academy of Sciences; ArgentinaFil: Salamian, Ahmad. Polish Academy of Sciences; ArgentinaFil: Sharma, Mahima. Polish Academy of Sciences; ArgentinaFil: Golpich, Mojtaba. University Kebangsaan Malaysia Medical Centre; MalasiaFil: Nawrotek, Katarzyna. University Of Lodz; ArgentinaFil: Paid, Ramesh K.. Indian Institute of Chemical Biology; IndiaFil: Shahidzadeh, Sheila M.. Syracuse University; Estados UnidosFil: Piermartiri, Tetsade. Universidade Federal de Santa Catarina; BrasilFil: Amini, Elham. University Kebangsaan Malaysia Medical Centre; MalasiaFil: Pastor, Verónica. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia ; ArgentinaFil: Wilson, Yvette. University of Melbourne; AustraliaFil: Adeniyi, Philip A.. Afe Babalola University; NigeriaFil: Datusalia, Ashok K.. National Brain Research Centre; IndiaFil: Vafadari, Benham. Polish Academy of Sciences; ArgentinaFil: Saini, Vedangana. University of Nebraska; Estados UnidosFil: Suárez Pozos, Edna. Instituto Politécnico Nacional; MéxicoFil: Kushwah, Neetu. Defence Institute of Physiology and Allied Sciences; IndiaFil: Fontanet, Paula. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia ; ArgentinaFil: Turner, Anthony J.. University of Leeds; Reino Unid

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

A qualitative analysis of factors influencing antiretroviral adherence among persons living with <scp>HIV</scp> in Ghana

Adherence to antiretroviral therapy (ART) remains an important factor in HIV prevention and treatment efforts. We explored the individual and environmental factors influencing antiretroviral adherence among PLWH in Ghana. This study used 20 semi-structured in-depth interviews and three focus group discussions (FGD) involving 29 PLWH attending one of three antiretroviral clinics. Thematic analysis covered experiences of PLWH clinic visits, knowledge, attitudes, self-efficacy related to ART adherence, psychological wellbeing and stigma. The findings suggest that both individual and environmental factors including treatment outcome, coping skills, disclosure, self-regulation, healthcare-provider interaction, family and partner support, organization of ART clinics, stigma, and transportation cost influenced treatment adherence. Interventions that empower PLWH and reduce HIV-related stigma in the community will most likely support antiretroviral adherence. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112