Community health workers in Kajiado County: an evaluation of the community health strategy in rural Kenya

Between 1980 and 2000, mortality rates of children under the age of five and maternal mortality ratios declined across sub-Saharan Africa. During the same period, Kenya's mortality rates continued to rise until 2005 when the Kenyan Ministry of Health (MOH) introduced the Kenya Essential Package for Health (KEPH) in an effort to reverse its declining health indicators. The KEPH defined six service delivery levels which included the new community level, also known as level one. The Ministry of Health's plan for delivering services at the community level, known as the Community Health Strategy (CHS), called for the creation of Community Health Workers (CHWs) which the MOH hoped would produce the expected outcomes of the CHS. CHWs would be trained volunteers that were both members of the community they would serve, and selected by their community. Their training would allow them to recognize health problems, provide basic first aid, refer patients with serious problems to health facilities, conduct surveys, maintain records, provide education, and distribute supplies. In 2010, the Division of Community Health Services released an evaluation of the relevance, efficiency, and sustainability of the community health strategy. Their results showed that CHWs could produce many of the CHS's expected outcomes. In 2013, researchers from the Boston University School of Public Health and Moi University resolved to conduct a cross-sectional study for the Kenyan Ministry of Public Health and Sanitation to assess the effectiveness of the CHWs in Kajiado County. The county faced numerous health challenges and an overburdened health system. Data collection was completed over a seven-day period in June of 2013 by fourteen teams. Data was collected from 12 communities located in the areas of Rombo, Entonet, and Central Divisions of the Loitokitok sub-county within Kajiado County in rural South Kenya. Six of the selected communities had CHWs mobilized and were the intervention communities. Six communities had no registered CHWs and served as the controls. Eligibility to participate in the study was limited to permanent members of randomly selected households that housed at least one child less than five years of age and no active CHWs. Mothers of children less than five years of age were the preferred respondents. The primary and secondary outcomes were selected to address as many of the CHS's expected outcomes as possible. In an effort to compensate for the study's cross-sectional design, results were analyzed by stratifying them by each community's proximity to a hospital, the time since the CHW's last visit, and the respondent's knowledge of their CHW's name. Data was collected from 316 households, half of which were from intervention communities, and was entered into CSPro 5.0 before being exported to EpiInfo 7.1.1 for analysis. Analysis of the results suggests that the Community Health Strategy has been largely ineffective at producing its expected outcomes in Kajiado County as communities with active community health workers typically did not fare significantly better than non-CHW communities. The CHS was not entirely unsuccessful however, as mothers in CHW communities were significantly more likely to give birth at a health facility (PR: 1.41; CI: 1.15-1.72) than in non-CHW communities. Results also indicated that a community's proximity to a hospital could be a confounder in the relationship between a community's CHW status and health outcomes. The success of CHWs may have been masked by their tendency to visit households with worse health indicators more frequently

The Head Organs of \u3cem\u3eCleidodiscus mirabilis\u3c/em\u3e (TREMATODA MONOGENEA)

Introduction: Little or no detailed description has been heretofore attempted of Cleidodiscus, the work to date having been confined to taxonomy and general morphology (Mueller, 1934 and 1937; Mizelle, 1938; Mizelle and Cronin, 1943). The head organs and cephalic glands were chosen for this study because of their conspicuous nature in the living animal and, at the same time, their confinement to a relatively small anatomical area. Since no minute description of these structures is known, an attempt was made to discover their exact histologic nature. The methods to be used were to include well known techniques of fixation, sectioning, and staining, but, in addition, an attempt was made to try to evaluate the usefulness of the phase-contrast microscope as a supplementary tool especially for examination of living material

The role of hypothalamic progestin receptors in the activation and maintenance of sexual receptivity in female rats and guinea pigs

The role of hypothalamic (HTH) intracellular progestin receptors (PRs) in the activation and termination of sexual receptivity (heat) in female rats and guinea pigs was examined. In the first study, the progestin antagonist, RU 486, was found to inhibit progesterone-facilitated sexual behavior in ovariectomized (OVX) estrogen-treated guinea pigs. RU 486 bound in vitro to neural PRs, and decreased the availability of HTH PRs when administered to estradiol-treated animals. These findings support the hypothesis that intracellular PRs mediate the facilitation of sexual behavior by progesterone. In a second study, OVX rats were treated with daily injections of the pesticide, o,p\u27-DDT (which has estrogenic properties), for 3 days, followed by progesterone on day 4. A dose of 400 mg/kg o,p\u27-DDT resulted in the activation of sexual behavior in 50% of the animals, and increased HTH cytosol PR concentration by 43%. Following progesterone treatment, the concentration of nuclear-bound PRs increased 137%. These findings support the hypothesis that estrogen-induced PRs are required for the facilitation of sexual receptivity by progesterone, and contradict a recent study using DDT that suggested that estrogen induction of PRs is not necessary. The last three studies tested the hypothesis that loss of PRs from the HTH cell nuclei results in heat termination. A supplemental injection of progesterone given 8 h after an initial injection delayed heat termination by more than 2 h, and also delayed the loss of HTH nuclear PRs. In an attempt to further delay heat termination, OVX guinea pigs were treated with capsules containing estradiol and one of several doses of progesterone. Heat termination occurred at about the same time regardless of the dose of progesterone, and despite the continued presence of both hormones. Nuclear PRs were also found to decrease in the presence of continued administration of estradiol and progesterone. As nuclear PR levels decreased, sexual receptivity terminated. In the final study, RU 486 administered to estradiol-progesterone treated guinea pigs accelerated both the loss of nuclear PRs and the termination of sexual receptivity. These studies support the hypothesis that heat termination results from the loss of PRs from HTH cell nuclei, and provide further evidence that intracellular PRs are involved in mediating progesterone\u27s effects on sexual behavior

Studies of the Changes in Cardiovascular Functions during Hypothermia

In the past few years general hypothermia has been investigated as a means of reducing the oxygen requirements of the body sufficiently to allow exclusion of the heart from the circulation and thus permit intracardiac surgery under direct vision. There is also an important group of patients whose poor physical condition precludes radical surgery of any type. If the oxygen demands of the brain and other vital organs can be sufficiently reduced by hypothermia, it is conceivable that these patients would be able to withstand the shock of reduced circulation and even peripheral vascular embarrassment for short periods of time. Hypothermia is capable of significantly reducing metabolism and of producing a “physiologic hypotension.” As such, the use of this modality suggests itself as a potentially valuable technique in a variety of conditions

Greece: Five years after the coup

[Δε διατίθεται περίληψη][No abstract available

3D Spatial Visualization Instruction within an Introductory Constrait-Based CAD Modeling Course

Since the Fall 2010 semester, spatial visualization instruction has been integrated into the Introduction to Technical Drawing and Constraint-Based Modeling course at Illinois State University. In addition to these materials, the course also includes instruction in constraint-based CAD modeling and other engineering graphics topics. During the Fall 2015 semester, students were asked to complete the PSVT:R and the MCT to assess their spatial visualization abilities at the beginning of the course. These two assessments will also be given at the end of the course to determine the impact of the course activities on students’ spatial visualization. This paper describes the activities in the course, gives demographic information on the students, presents descriptive statistics related to the pre-test scores, examines the relationship between the PSVT:R and the MCT, and compares the means on the PSVT:R and MCT between students who took the course as a requirement versus those who took it as an elective