How much time do health services spend on antenatal care? Implications for the introduction of the focused antenatal care model in Tanzania

BACKGROUND: Antenatal care (ANC) is a widely used strategy to improve the health of pregnant women and to encourage skilled care during childbirth. In 2002, the Ministry of Health of the United Republic of Tanzania developed a national adaptation plan based on the new model of the World Health Organisation (WHO). In this study we assess the time health workers currently spent on providing ANC services and compare it to the requirements anticipated for the new ANC model in order to identify the implications of Focused ANC on health care providers' workload. METHODS: Health workers in four dispensaries in Mtwara Urban District, Southern Tanzania, were observed while providing routine ANC. The time used for the overall activity as well as for the different, specific components of 71 ANC service provisions was measured in detail; 28 of these were first visits and 43 revisits. Standard time requirements for the provision of focused ANC were assessed through simulated consultations based on the new guidelines. RESULTS: The average time health workers currently spend for providing ANC service to a first visit client was found to be 15 minutes; the provision of ANC according to the focused ANC model was assessed to be 46 minutes. For a revisiting client the difference between current practise and the anticipated standard of the new model was 27 minutes (9 vs. 36 min.). The major discrepancy between the two procedures was related to counselling. On average a first visit client was counselled for 1:30 minutes, while counselling in revisiting clients did hardly take place at all. The simulation of focused ANC revealed that proper counselling would take about 15 minutes per visit. CONCLUSION: While the introduction of focused ANC has the potential to improve the health of pregnant women and to raise the number of births attended by skilled staff in Tanzania, it may need additional investment in human resources. The generally anticipated saving effect of the new model through the reduction of routine consultations may not materialise because the number of consultations is already low in Tanzania with a median of only 4 visits per pregnancy. Special attention needs to be given to counselling attitudes and skills during the training for Focused ANC as this component is identified as the major difference between old practise and the new model. Our estimated requirement of 46 minutes per first visit consultation matches well with the WHO estimate of 40 minutes

A systematic review of the use of quality-of-life instruments in randomized controlled trials for psoriasis

This is the peer reviewed version of the following article: F. M. Ali, A. C. Cueva, J. Vyas, A. A. Atwan, M. S. Salek, A. Y. Finlay, and V. Piguet, ‘A systematic review of the use of quality-of-life instruments in randomized controlled trials for psoriasis’, British Journal of Dermatology, Vol. 176 (3): 577-593, March 2017, which has been published in final form at https://doi.org/10.1111/bjd.14788. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Planners of interventional studies in psoriasis face the dilemma of selecting suitable quality-of-life (QoL) measures. Systematic reviews have the potential of identifying psychometrically sound measures in a given therapeutic area, while guiding the development of practice guidelines. The aim of this systematic review was to generate evidence of the use of QoL instruments in randomized controlled trials (RCTs) for interventions in psoriasis. The methodology followed the PRISMA guidelines. Six databases were searched with 388 search terms. Abstracts of articles were reviewed independently by two assessors, and a third adjudicator resolved any opinion differences. Risk of bias was assessed using the Jadad scale. Of 3646 screened publications, 99 articles (100 trials) met the eligibility criteria for inclusion, describing research on 33 215 patients. Thirty-three trials tested topical therapy, 18 systemic, 39 biologics, nine phototherapy and 10 other interventions. The Dermatology Life Quality Index (DLQI) was the most commonly used QoL instrument (83 studies, 83%), followed by the 36-Item Short Form Survey (SF-36) (31, 31%), EuroQoL-5D (EQ-5D) (15, 15%), Psoriasis Disability Index (14, 14%) and Skindex (five, 5%). There was widespread inconsistency in the way that QoL data were reported. Of the 100 trials identified, 37 reported minimal clinically important difference (MCID): 32 for DLQI, 10 for SF-36 and six for EQ-5D. QoL measurement is increasingly being reported in RCTs of psoriasis. Formal guidelines are needed for assessment and publishing of QoL data. Researchers should consider whether MCID information is available, and development of MCID data should be encouraged.Peer reviewedFinal Accepted Versio

Data from: African departure rather than migration speed determines variation in spring arrival in pied flycatchers

The data package contains three datasets: - return_in_2014 Observed local return in 2014 of pied flycatchers with and without geolocator devices in 2013, based on field observations and catches. This file is used to study potential effects of geolocator deployment and harness types on the survival of pied flycatchers, compared to birds without these devices. - timing_in 2013-2014 Timing of breeding arrival dates (in males and females) and first egg laying dates (females) in 2013 and 2014 in Drenthe (The Netherlands), as shown for pied flycatchers deployed with geolocator devices in 2013 or without such devices. Arrival and egg laying are based on field observations. This file is used to study potential effects of geolocator deployment and harness types on the timing of arrival and egg laying of pied flycatchers, compared to birds without these devices. Timing is expressed as days relative to the sex-specific annual mean of the population. - transitions Contains raw data on sunset and sunrise times (so called 'transitions') used to estimate longitude, movement and stationary periods. The file shows data of 27 solar geolocator-loggers deployed on pied flycatchers, Ficedula hypoleuca, in Drenthe The Netherlands (Longitude: 6.378, Latitude: 52.820) in 2013, using Intigeo-W50 made by Migrate Technology Ltd logger. Data was processed using the program BASTrack

Dataset: Weak effects of geolocators on small birds: A meta-analysis controlled for phylogeny and publication bias

Data set contains formerly published and unpublished data used in the meta-analysis. We quantitatively reviewed 549 records extracted from 74 published and 48 unpublished studies on over 7,800 tagged and 17,800 control individuals to examine the effects of geolocator tagging on small bird species (body mass <100 g). We calculated the effect of tagging on apparent survival, condition, phenology and breeding performance and identified the most important predictors of the magnitude of effect sizes

Replication Data for: Climate change may affect fatal competition between two bird species

This data set consists of eight files providing raw data, R-code to process the data files, and metadata for interpretation of the data file

Data from: Competitor phenology as a social cue in breeding site selection

1. Predicting habitat quality is a major challenge for animals selecting a breeding patch, because it affects reproductive success. Breeding site selection may be based on previous experience, or on social information from the density and success of competitors with an earlier phenology. 2. Variation in animal breeding phenology is often correlated with variation in habitat quality. Generally, animals breed earlier in high quality habitats that allow them to reach a nutritional threshold required for breeding earlier or avoid nest predation. In addition, habitat quality may affect phenological overlap between species and thereby interspecific competition. Therefore, we hypothesized that competitor breeding phenology can be used as social cue by settling migrants to locate high quality breeding sites. 3. To test this hypothesis, we experimentally advanced and delayed hatching phenology of two resident tit species on the level of study plots and studied male and female settlement patterns of migratory pied flycatchers Ficedula hypoleuca. The manipulations were assigned at random in two consecutive years, and treatments were swapped between years in sites that were used in both years. 4. In both years, males settled in equal numbers across treatments, but later arriving females avoided pairing with males in delayed phenology plots. Moreover, male pairing probability declined strongly with arrival date on the breeding grounds. 5. Our results demonstrate that competitor phenology may be used to assess habitat quality by settling migrants, but we cannot pinpoint the exact mechanism (e.g. resource quality, predation pressure, or competition) that has given rise to this pattern. 6. In addition, we show that opposing selection pressures for arrival timing may give rise to different social information availabilities between sexes. We discuss our findings in the context of climate warming, social information use, and the evolution of protandry in migratory animals. The data package contains seven sets: - Contains all the flycatcher arrival data used in the statistical analyses - Data of the 2014 swaps of tit broods - Data of the 2015 tit nests used for swapping - Data of every nest box and which subplot they belonged to - Data of general breeding biology of the four most common nest box breeders in our study - Data of the arrival order of flycatcher males and females in relatively "early" and "late" subplots. Used for figure 4. - R script in which all the results in this study can be checked and replicated, using the data files available