Relationship between Challenges Militating against Mortgage Finance and Benefits of Mortgage Acquisition in Ghana: Case of SSNIT

Past studies on the mortgage market of Ghana evidenced that absence of long-term sources of housing funds, low-income levels, macroeconomic instability, inability to assess the creditworthiness of prospective mortgagors among others plague the development of Ghana’s mortgage market. Therefore, this study was conducted to evaluate the relationship between challenges militating against mortgage finance and benefits of mortgage acquisition in Ghana. Questionnaires were used to elicit responses from respondents. Convenience sampling technique was used to select one hundred (100) respondents comprising staff at SSNIT Head Office in Accra, SSNIT contributors, beneficiaries of SSNIT funds, mortgage applicants, owners and occupants of SSNIT flats. Mean score ranking, Cronbach’s Alpha coefficient, one sample t-test and Partial Least Square Structural Equation Modeling (PLS-SEM) were the analytical tools adopted. Dollarization of mortgage markets, access to funding for the scheme, macroeconomic instability and inability to assess creditworthiness of mortgage applicant were the most significant challenges. The most significant benefits were: (1) increase in the rate of house construction; (2) ability to provide a relatively low-interest credit; (3) capacity to mitigate housing deficits; and (4) capability to provide a relatively long-term credit for housing. Structural Equation Model was developed to evaluate the relationship between the challenges and benefits. The study is beneficial to stakeholders such as policymakers, financial institutions, Ghana Real Estate Developers Association (GREDA) and SSNIT contributors. This work is a pioneering study in Ghana on the relationship between challenges SSNIT encounters in mortgage financing and benefits of acquiring mortgage facilities with the assistance of SSNIT

Relationship between Challenges Militating against Mortgage Finance and Benefits of Mortgage Acquisition in Ghana: Case of SSNIT

Past studies on the mortgage market of Ghana evidenced that absence of long-term sources of housing funds, low-income levels, macroeconomic instability, inability to assess the creditworthiness of prospective mortgagors among others plague the development of Ghana’s mortgage market. Therefore, this study was conducted to evaluate the relationship between challenges militating against mortgage finance and benefits of mortgage acquisition in Ghana. Questionnaires were used to elicit responses from respondents. Convenience sampling technique was used to select one hundred (100) respondents comprising staff at SSNIT Head Office in Accra, SSNIT contributors, beneficiaries of SSNIT funds, mortgage applicants, owners and occupants of SSNIT flats. Mean score ranking, Cronbach’s Alpha coefficient, one sample t-test and Partial Least Square Structural Equation Modeling (PLS-SEM) were the analytical tools adopted. Dollarization of mortgage markets, access to funding for the scheme, macroeconomic instability and inability to assess creditworthiness of mortgage applicant were the most significant challenges. The most significant benefits were: (1) increase in the rate of house construction; (2) ability to provide a relatively low-interest credit; (3) capacity to mitigate housing deficits; and (4) capability to provide a relatively long-term credit for housing. Structural Equation Model was developed to evaluate the relationship between the challenges and benefits. The study is beneficial to stakeholders such as policymakers, financial institutions, Ghana Real Estate Developers Association (GREDA) and SSNIT contributors. This work is a pioneering study in Ghana on the relationship between challenges SSNIT encounters in mortgage financing and benefits of acquiring mortgage facilities with the assistance of SSNIT

What do antenatal care providers understand and do about oral health care during pregnancy: a cross-sectional survey in New South Wales, Australia

BACKGROUND: There is mounting evidence to support the lack of awareness among pregnant women about health consequences and long term risks associated with poor oral hygiene during pregnancy. A recognised and important point of influence is their interaction with health professionals, particularly when receiving Antenatal Care. However, there is limited evidence about the perceptions of ANC providers in Australia toward the provision of perinatal oral healthcare. This study was undertaken to explore the knowledge, attitudes and practices of Antenatal Care (ANC) providers in New South Wales (NSW), Australia providing perinatal oral healthcare and to identify barriers to and predictors of their practices in this area. METHODS: A cross sectional survey was undertaken of ANC providers (general practitioners, obstetricians/gynaecologists and midwives) practising in NSW, Australia. Participants were recruited through their professional organisations via email, postal mail, and networking at conferences. The survey addressed the domains of knowledge, attitude, barriers and practices towards oral healthcare, along with demographics. Data was entered into SPSS software and analysed using descriptive and inferential statistics. RESULTS: A total of 393 surveys (17.6% response rate) were completed comprising 124 general practitioners, 74 obstetricians/gynaecologists and 195 midwives. The results showed limited knowledge among ANC providers regarding the impact of poor maternal oral health on pregnancy/infant outcomes. Most (99%) participants agreed that maternal oral health was important yet few were discussing the importance of oral health or advising women to visit a dentist (16.4–21.5%). Further, less than a third felt they had the skills to provide oral health advice during pregnancy. ANC providers who were more knowledgeable about maternal oral health, had training and information in this area and greater experience, were more likely to engage in practices addressing the oral health of pregnant women. CONCLUSION: The findings suggest that ANC providers in NSW are not focussing on oral health with pregnant women. ANC providers seem willing to discuss oral health if they have appropriate education/training and information in this area. Further research at a national level is required to confirm whether these findings are similar in all Australian states

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

Life-threatening `breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS- CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals ( age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto- Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-a2 and IFN-., while two neutralized IFN-omega only. No patient neutralized IFN-ss. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population

Phase 3, Randomized, 20-Month Study of the Efficacy and Safety of Bimatoprost Implant in Patients with Open-Angle Glaucoma and Ocular Hypertension (ARTEMIS 2)

Objective- To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of 10 and 15 µg bimatoprost implant in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). Methods- This randomized, 20-month, multicenter, masked, parallel-group, phase 3 trial enrolled 528 patients with OAG or OHT and an open iridocorneal angle inferiorly in the study eye. Study eyes were administered 10 or 15 µg bimatoprost implant on day 1, week 16, and week 32, or twice-daily topical timolol maleate 0.5%. Primary endpoints were IOP and IOP change from baseline through week 12. Safety measures included treatment-emergent adverse events (TEAEs) and corneal endothelial cell density (CECD). Results- Both 10 and 15 µg bimatoprost implant met the primary endpoint of noninferiority to timolol in IOP lowering through 12 weeks. Mean IOP reductions from baseline ranged from 6.2–7.4, 6.5–7.8, and 6.1–6.7 mmHg through week 12 in the 10 µg implant, 15 µg implant, and timolol groups, respectively. IOP lowering was similar after the second and third implant administrations. Probabilities of requiring no IOP-lowering treatment for 1 year after the third administration were 77.5% (10 µg implant) and 79.0% (15 µg implant). The most common TEAE was conjunctival hyperemia, typically temporally associated with the administration procedure. Corneal TEAEs of interest (primarily corneal endothelial cell loss, corneal edema, and corneal touch) were more frequent with the 15 than the 10 µg implant and generally were reported after repeated administrations. Loss in mean CECD from baseline to month 20 was ~ 5% in 10 µg implant-treated eyes and ~ 1% in topical timolol-treated eyes. Visual field progression (change in the mean deviation from baseline) was reduced in the 10 µg implant group compared with the timolol group. Conclusions- The results corroborated the previous phase 3 study of the bimatoprost implant. The bimatoprost implant met the primary endpoint and effectively lowered IOP. The majority of patients required no additional treatment for 12 months after the third administration. The benefit-risk assessment favored the 10 over the 15 µg implant. Studies evaluating other administration regimens with reduced risk of corneal events are ongoing. The bimatoprost implant has the potential to improve adherence and reduce treatment burden in glaucoma

Where to with treatment of pelvic organ prolapse in 2014?

Pelvic organ prolapse affects many women after childbirth. The decision of whether to have surgery requires consideration of many factors

The incidence of preeclampsia and eclampsia and associated maternal mortality in Australia from population-linked datasets : 2000-2008

Objective: To determine the incidence of preeclampsia and eclampsia and associated mortality in Australia between 2000 and 2008. Study design: Analysis of statutorily collected datasets of singleton births in New South Wales using International Classification of Disease coding. Analyzed using cross tabulation, logistic regression, and means testing, where appropriate. Results: The overall incidence of preeclampsia was 3.3% with a decrease from 4.6% to 2.3%. The overall rate of eclampsia was 8.6/10,000 births or 2.6% of preeclampsia cases, with an increase from 2.3% to 4.2%. The relative risk of eclampsia in preeclamptic women in 2008 was 1.9 (95% confidence interval, 1.28-2.92) when compared with the year 2000. The relative risk of a woman with preeclampsia/eclampsia dying in the first 12 months following birth compared with normotensive women is 5.1 (95% confidence interval, 3.07-8.60). Conclusion: Falling rates of preeclampsia have not equated to a decline in the incidence of eclampsia. An accurate rate of both preeclampsia and eclampsia is vital considering the considerable contribution that these diseases make to maternal mortality. The identification and treatment of eclampsia should remain a priority in the clinical setting

Reply

Refers to Nikolaos Vlachadis, Zoe Iliodromiti, Nikolaos Vrachnis The incidence of preeclampsia and eclampsia in Australia: 2000 through 2008 American Journal of Obstetrics and Gynecology, Volume 210, Issue 2, February 2014, Pages 173-17

A pilot study on surgical reduction of the levator hiatus : the puborectalis sling

Introduction and hypothesis: Female pelvic organ prolapse recurrence has been shown to be associated with levator hiatal distensibility. Reducing hiatal size surgically may reduce recurrence risk. This study aims to demonstrate a novel surgical procedure, the puborectalis sling (PR sling), designed to reduce the levator hiatal area, and to assess the medium-term safety and efficacy of this procedure. Methods: One hundred fifteen women undergoing prolapse repair with a pre-operative hiatal area on Valsalva of ≥ 35 cm2 were recruited into this phase 1 prospective multicentre pilot study. All underwent a PR sling procedure after completion of standard repairs. Primary outcome was levator hiatal area measured on ultrasound. Results: One hundred ten patients were evaluated at least 3 months post-operatively. At 2.5 years average follow-up, there was an average of 12 cm2 (range 6–16 cm2) reduction in hiatal area from a mean pre-operative hiatal area of 43.9 (35–63) cm2. Thirty per cent (28/93) were symptomatic of prolapse, 66% (61/93) had clinical prolapse recurrence whilst 49% (46/93) had sonographic recurrence. Three patients required a return to theatre; one case of infection resulted in mesh removal, one had severe obstructed defecation requiring sling loosening and another had buttock pain with faecal impaction that resolved after manual disimpaction. There were no long-term sequelae. Conclusions: The levator hiatal area can be reduced surgically, with almost 30% reduction in area seen in this pilot study. The reduction was significant and sustained up to 2 years with no major long-term complications