Disrespect and abuse during childbirth in Western Ethiopia: Should women continue to tolerate?

BACKGROUND: Healthcare coverage in Ethiopia has improved dramatically in recent decades. However, facility-based delivery remains persistently low, while maternal mortality remains high. This paper presents the prevalence and associated factors of disrespect and abuse (D&A) during childbirth in public health facilities of western Oromia, Ethiopia. METHOD: A facility-based cross-sectional study was conducted among 612 women from February 2017 to May 2017. Exit interview with the mothers were conducted upon discharge from the maternity ward. We measured D&A during childbirth using seven dimensions. Multivariable logistic regression model was used to assess the association between experience of D&A and client characteristics and institutional factors. RESULT: Three quarters (74.8%) of women reported experiencing at least one form of D&A during their facility childbirth. The types of D&A experienced by the women were; physical abuse (37.1%), non-dignified care (34.6%), non-consented care (54.1%), non-confidential care (40.4%), neglect (25.2%), detention (2.9%), and discrimination (13.2%). Experiences of D&A were 1.6 times more likely to be reported by women delivering at hospitals than health centers (OR: 1.64, 95% CI: 1.01, 2.66). Women without a companion throughout their delivery were almost 10 times more likely than women who had a companion to encounter D&A (OR: 9.94, 95% CI: 5.72, 17.28). On the other hand, women with more than 1,368-birr (USD 57) monthly income were less likely to experience any type of D&A (OR: 0.36, 95% CI: .21, .65). CONCLUSION: Three in four women reported experiencing at least one form of D&A during labor and delivery. This demonstrates a real disconnect between what the health system intends to achieve and what is practiced and calls for fundamental solutions in terms of both improving quality of facility-based delivery and ensuring women's right to receive health care with dignity

Complication rare de la coloscopie chez un patient sous anticoagulant: hemopéritoine par rupture d’un hématome sous capsulaire de la rate, cas clinique

La coloscopie à visée diagnostique et/ou thérapeutique est un examen invasif fréquemment pratiquée de nos jours. La perforation colique et l'hémorragie digestive en sont les principales complications. La survenue d'un  hémopéritoine par rupture d'un hématome sous-capsulaire splénique est une complication extrêmement rare et potentiellement mortelle de la coloscopie. Un traumatisme splénique minime passé inaperçu et la prised'anticoagulant en sont des facteurs favorisants. Nous présentons le cas d'une rupture d'un hématome sous-capsulaire de la rate après une coloscopie, survenue chez un patient de 70 ans porteur d'une valve mitrale mécanique sous acénocoumarol à dose hypocaogulante. La nécessité d'obtention d'une anti coagulation rapidement efficace et l'instabilité hémodynamique avaient justifiée la réalisation d'une splénectomie. L'évolution était favorable. A travers cette observation clinique nous discutons les mécanismes et les modalités de prise en charge devant cette complication

Diagnosing Capnocytophaga canimorsus Infections

We reviewed clinical and epidemiologic features of 56 human Capnocytophaga canimorsus isolates submitted during a 32-year period to California's Microbial Diseases Laboratory for identification. An increasing number of isolates identified as C. canimorsus have been submitted since 1990. Many laboratories still have difficulty correctly identifying this species

Nonlinear fiber-optic strain sensor based on four-wave mixing in microstructured optical fiber

We demonstrate a nonlinear fiber-optic strain sensor, which uses the shifts of four-wave mixing Stokes and anti-Stokes peaks caused by the strain-induced changes in the structure and refractive index of a microstructured optical fiber. The sensor thus uses the inherent nonlinearity of the fiber and does not require any advanced post-processing of the fiber. Strain sensitivity of -0.23 pm/mu epsilon is achieved experimentally and numerical simulations reveal that for the present fiber the sensitivity can be increased to -4.46 pm/mu epsilon by optimizing the pump wavelength and power. (C) 2012 Optical Society of Americ

Bi-directional association between depression and HF: An electronic health records-based cohort study.

To determine whether a bi-directional relationship exists between depression and HF within a single population of individuals receiving primary care services, using longitudinal electronic health records (EHRs). This retrospective cohort study utilized EHRs for adults who received primary care services within a large healthcare system in 2006. Validated EHR-based algorithms identified 10,649 people with depression (depression cohort) and 5,911 people with HF (HF cohort) between January 1, 2006 and December 31, 2018. Each person with depression or HF was matched 1:1 with an unaffected referent on age, sex, and outpatient service use. Each cohort (with their matched referents) was followed up electronically to identify newly diagnosed HF (in the depression cohort) and depression (in the HF cohort) that occurred after the index diagnosis of depression or HF, respectively. The risks of these outcomes were compared (vs. referents) using marginal Cox proportional hazard models adjusted for 16 comorbid chronic conditions. 2,024 occurrences of newly diagnosed HF were observed in the depression cohort and 944 occurrences of newly diagnosed depression were observed in the HF cohort over approximately 4-6 years of follow-up. People with depression had significantly increased risk for developing newly diagnosed HF (HR 2.08, 95% CI 1.89-2.28) and people with HF had a significantly increased risk of newly diagnosed depression (HR 1.34, 95% CI 1.17-1.54) after adjusting for all 16 comorbid chronic conditions. These results provide evidence of a bi-directional relationship between depression and HF independently of age, sex, and multimorbidity from chronic illnesses

Mapk-activated protein kinase 2 contributes to Clostridium difficile-associated inflammation

Clostridium difficile infection (CDI) results in toxin-induced epithelial injury and marked intestinal inflammation. Fecal markers of intestinal inflammation correlate with CDI disease severity, but regulation of the inflammatory response is poorly understood. Previous studies demonstrated that C. difficile toxin TcdA activates p38 kinase in tissue culture cells and mouse ilium, resulting in interleukin-8 (IL-8) release. Here, we investigated the role of phosphorylated mitogen-activated protein kinase (MAPK)-activated protein kinase (MK2 kinase, pMK2), a key mediator of p38-dependent inflammation, in CDI. Exposure of cultured intestinal epithelial cells to the C. difficile toxins TcdA and TcdB resulted in p38-dependent MK2 activation. Toxin-induced IL-8 and GROα release required MK2 activity. We found that p38 and MK2 are activated in response to other actin-disrupting agents, suggesting that toxin-induced cytoskeleton disruption is the trigger for kinase-dependent cytokine response. Phosphorylated MK2 was detected in the intestines of C. difficile-infected hamsters and mice, demonstrating for the first time that the pathway is activated in infected animals. Furthermore, we found that elevated pMK2 correlated with the presence of toxigenic C. difficile among 100 patient stool samples submitted for C. difficile testing. In conclusion, we find that MK2 kinase is activated by TcdA and TcdB and regulates the expression of proinflammatory cytokines. Activation of p38-MK2 in infected animals and humans suggests that this pathway is a key driver of intestinal inflammation in patients with CDI

Theory of interlayer exchange interactions in magnetic multilayers

This paper presents a review of the phenomenon of interlayer exchange coupling in magnetic multilayers. The emphasis is put on a pedagogical presentation of the mechanism of the phenomenon, which has been successfully explained in terms of a spin-dependent quantum confinement effect. The theoretical predictions are discussed in connection with corresponding experimental investigations.Comment: 18 pages, 4 PS figures, LaTeX with IOP package; v2: ref. added. Further (p)reprints available from http://www.mpi-halle.de/~theory

Imaging of Convection Enhanced Delivery of Toxins in Humans

Drug delivery of immunotoxins to brain tumors circumventing the blood brain barrier is a significant challenge. Convection-enhanced delivery (CED) circumvents the blood brain barrier through direct intracerebral application using a hydrostatic pressure gradient to percolate therapeutic compounds throughout the interstitial spaces of infiltrated brain and tumors. The efficacy of CED is determined through the distribution of the therapeutic agent to the targeted region. The vast majority of patients fail to receive a significant amount of coverage of the area at risk for tumor recurrence. Understanding this challenge, it is surprising that so little work has been done to monitor the delivery of therapeutic agents using this novel approach. Here we present a review of imaging in convection enhanced delivery monitoring of toxins in humans, and discuss future challenges in the field

Polynomial Growth Harmonic Functions on Finitely Generated Abelian Groups

In the present paper, we develop geometric analytic techniques on Cayley graphs of finitely generated abelian groups to study the polynomial growth harmonic functions. We develop a geometric analytic proof of the classical Heilbronn theorem and the recent Nayar theorem on polynomial growth harmonic functions on lattices \mathds{Z}^n that does not use a representation formula for harmonic functions. We also calculate the precise dimension of the space of polynomial growth harmonic functions on finitely generated abelian groups. While the Cayley graph not only depends on the abelian group, but also on the choice of a generating set, we find that this dimension depends only on the group itself.Comment: 15 pages, to appear in Ann. Global Anal. Geo