Political agency and public healthcare

The development of institutions of self-governance in India, and specifically the 2005 reform—the National Rural Health Mission that introduced village health and sanitation committees—provide a unique opportunity to study the effects of the strengthening of the political agency on collective healthcare decision-making in rural areas. We use data from the District Level Household Survey and take advantage of the heterogeneity of maternal and child healthcare use, before and after the introduction of village health and sanitation committees. Specifically, we examine the effect of village health and sanitation committees on use of both public and preventive healthcare among children. Our results suggest that local democracy has increased access to preventive child healthcare services. Part of the effect is driven by an increase in the utilization of the public healthcare network. We find some evidence of an effect of village residence heads of a Panchayat on preventive healthcare use

A BeppoSAX observation of the super-soft source CAL87

We report on a BeppoSAX Concentrator Spectrometer observation of the super-soft source (SSS) CAL87. The X-ray emission in SSS is believed to arise from nuclear burning of accreted material on the surface of a white dwarf (WD). An absorbed blackbody spectral model gives a chi^2_v of 1.18 and a temperature of 42 +/- ^13 _11 eV. However, the derived luminosity and radius are greater than the Eddington limit and radius of a WD. Including an O viii edge at 0.871 keV gives a significantly better fit (at > 95% confidence) and results in more realistic values of the source luminosity and radius. We also fit WD atmosphere models to the CAL87 spectrum. These also give reasonable bolometric luminosities and radii in the ranges 2.7-4.8 10^{36} erg/s and 8-20 10^7 cm, respectively. These results support the view that the X-ray emission from CAL87 results from nuclear burning in the atmosphere of a WD.Comment: 4 pages. Accepted for publication in A&A (Letters

Health outcomes during the 2008 financial crisis in Europe: systematic literature review

OBJECTIVE:  To systematically identify, critically appraise, and synthesise empirical studies about the impact of the 2008 financial crisis in Europe on health outcomes. DESIGN:  Systematic literature review. DATA SOURCES:  Structural searches of key databases, healthcare journals, and organisation based websites. REVIEW METHODS:  Empirical studies reporting on the impact of the financial crisis on health outcomes in Europe, published from January 2008 to December 2015, were included. All selected studies were assessed for risk of bias. Owing to the heterogeneity of studies in terms of study design and analysis and the use of overlapping datasets across studies, studies were analysed thematically per outcome, and the evidence was synthesised on different health outcomes without formal meta-analysis. RESULTS:  41 studies met the inclusion criteria, and focused on suicide, mental health, self rated health, mortality, and other health outcomes. Of those studies, 30 (73%) were deemed to be at high risk of bias, nine (22%) at moderate risk of bias, and only two (5%) at low risk of bias, limiting the conclusions that can be drawn. Although there were differences across countries and groups, there was some indication that suicides increased and mental health deteriorated during the crisis. The crisis did not seem to reverse the trend of decreasing overall mortality. Evidence on self rated health and other indicators was mixed. CONCLUSIONS:  Most published studies on the impact of financial crisis on health in Europe had a substantial risk of bias; therefore, results need to be cautiously interpreted. Overall, the financial crisis in Europe seemed to have had heterogeneous effects on health outcomes, with the evidence being most consistent for suicides and mental health. There is a need for better empirical studies, especially those focused on identifying mechanisms that can mitigate the adverse effects of the crisis

Disrespectful intrapartum care during facility-based delivery in sub-Saharan Africa: A qualitative systematic review and thematic synthesis of women's perceptions and experiences

The psycho-social elements of labour and delivery are central to any woman's birth experience, but international efforts to reduce maternal mortality in low-income contexts have neglected these aspects and focused on technological birth. In many contexts, maternity care is seen as dehumanised and disrespectful, which can have a negative impact on utilisation of services. We undertook a systematic review and meta-synthesis of the growing literature on women's experiences of facility-based delivery in sub-Saharan Africa to examine the drivers of disrespectful intrapartum care. Using PRISMA guidelines, databases were searched from 1990 to 06 May 2015, and 25 original studies were included for thematic synthesis. Analytical themes, that were theoretically informed and cognisant of the cultural and social context in which the dynamics of disrespectful care occur, enabled a fresh interpretation of the factors driving midwives' behaviour. A conceptual framework was developed to show how macro-, meso- and micro-level drivers of disrespectful care interact. The synthesis revealed a prevailing model of maternity care that is institution-centred, rather than woman-centred. Women's experiences illuminate midwives' efforts to maintain power and control by situating birth as a medical event and to secure status by focusing on the technical elements of care, including controlling bodies and knowledge. Midwives and women are caught between medical and social models of birth. Global policies encouraging facility-based delivery are forcing women to swap the psycho-emotional care they would receive from traditional midwives for the technical care that professional midwives are currently offering. Any action to change the current performance and dynamic of birth relies on the participation of midwives, but their voices are largely missing from the discourse. Future research should explore their perceptions of the value and practice of interpersonal aspects of maternity care and the impact of disrespectful care on their sense of professionalism and personal ethics

Midwives’ perspectives on (dis)respectful intrapartum care during facility-based delivery in sub-Saharan Africa: a qualitative systematic review and meta-synthesis

Background In the past decade, the negative impact of disrespectful maternity care on women’s utilisation and experiences of facility-based delivery has been well documented. Less is known about midwives’ perspectives on these labour ward dynamics. Yet efforts to provide care that satisfies women’s psycho-socio-cultural needs rest on midwives’ capacity and willingness to provide it. We performed a systematic review of the emerging literature documenting midwives’ perspectives to explore the broader drivers of (dis)respectful care during facility-based delivery in the sub-Saharan African context. Methods Seven databases (CINAHL, PsychINFO, PsychArticles, Embase, Global Health, Maternity and Infant Care and PubMed) were systematically searched from 1990 to May 2018. Primary qualitative studies with a substantial focus on the interpersonal aspects of care were eligible if they captured midwives’ voices and perspectives. Study quality was independently assessed by two reviewers and PRISMA guidelines were followed. The results and findings from each study were synthesised using an existing conceptual framework of the drivers of disrespectful care. Results Eleven papers from six countries were included and six main themes were identified. ‘Power and control’ and ‘Maintaining midwives’ status’ reflected midwives’ focus on the micro-level interactions of the mother-midwife dyad. Meso-level drivers of disrespectful care were: the constraints of the ‘Work environment and resources’; concerns about ‘Midwives’ position in the health systems hierarchy’; and the impact of ‘Midwives’ conceptualisations of respectful maternity care’. An emerging theme outlined the ‘Impact on midwives’ of (dis)respectful care. Conclusion We used a theoretically informed conceptual framework to move beyond the micro-level and interrogate the social, cultural and historical factors that underpin (dis)respectful care. Controlling women was a key theme, echoing women’s experiences, but midwives paid less attention to the social inequalities that distress women. The synthesis highlighted midwives’ low status in the health system hierarchy, while organisational cultures of blame and a lack of consideration for them as professionals effectively constitute disrespect and abuse of these health workers. Broader, interdisciplinary perspectives on the wider drivers of midwives’ disrespectful attitudes and behaviours are crucial if efforts to improve the maternity care environment - for women and midwives - are to succeed

Prevalence and pattern of self-medication in elderly individuals

Background: Self-medication that is taking medicines without prescription by the doctor is highly prevalence in the community. Elderly population is more likely to self-medicate due to multiple morbidities. This study was undertaken to evaluate the prevalence and pattern of use of self-medication among elderly individuals.Methods: Study was carried out at tertiary care hospital. The questionnaire which was used in our earlier studies regarding self-medication was utilized. After obtaining consent, the elderly individuals (≥60 years) reporting for health check-up were requested to fill up the questionnaire themselves or were asked to respond to questions verbally in the case of illiterate. Questionnaire mainly contained demographic and clinical data and self-medication details - frequency, symptoms/disease for self-medication, drugs, reasons for self-medication, sources of information, awareness regarding the risk of self-medication.Results: Out of 200 elderly included in the study, 177(88.5%) reported self-medication in 6-month recall period. About 60% were male and mean age - 69.64±6.21 (60-85) years. About 21% reported frequent self-medication. Abdominal pain (16%) and headache (14%) were the most common symptoms, and diabetes (7%) was the most common disease for self-medication. Allopathic medicines (55%) mainly paracetamol (13.5%) were most frequently used followed by home remedies (23%) and ayurvedic (17%). Previous experience with the drug (50%) followed by advertisements (23.2%) were common source of information. Most common reasons for self-medication were convenience (69.5%) and cost (56%). None of respondents were aware of risks of self-medicationConclusion: Self-medication is highly prevalent in elderly people who are unaware of risks involved

BeppoSAX LECS background subtraction techniques

We present 3 methods for the subtraction of non-cosmic and unresolved cosmic backgrounds observed by the Low-Energy Concentrator Spectrometer (LECS) on-board BeppoSAX. Removal of these backgrounds allows a more accurate modeling of the spectral data from point and small-scale extended sources. At high (>|25| degree) galactic latitudes, subtraction using a standard background spectrum works well. At low galactic latitudes, or in complex regions of the X-ray sky, two alternative methods are presented. The first uses counts obtained from two semi-annuli near the outside of the LECS field of view to estimate the background at the source location. The second method uses ROSAT Position Sensitive Proportional Counter (PSPC) all-sky survey data to estimate the LECS background spectrum for a given pointing position. A comparison of the results from these methods provides an estimate of the systematic uncertainties. For high galactic latitude fields, all 3 methods give 3 sigma confidence uncertainties of <0.9 10^-3 count/s (0.1-10 keV), or <1.5 10^-3 count/s (0.1-2 keV). These correspond to 0.1-2.0 keV fluxes of 0.7-1.8 and 0.5-1.1 10^-13 erg/cm2/s for a power-law spectrum with a photon index of 2 and photoelectric absorption of 3 10^20 and 3 10^21 atom/cm2, respectively. At low galactic latitudes, or in complex regions of the X-ray sky, the uncertainties are a factor ~2.5 higher.Comment: 13 pages. Accepted for publication in A&A

Explaining the Better Prognosis of ScreeningExposed Breast Cancers: Influence of Tumor Characteristics and Treatment

This study was funded by a grant from the UK Department of Health (no. 106/0001). The grant was awarded to Prof Stephen W Duffy

A comparison of match demands using ball-in-play versus whole match data in professional soccer players of the English Championship

This is the first study to report the Whole Match, ball-in-play (BiP), ball-out-of-play (BoP), and Max BiP (worst case scenario phases of play) demands of professional soccer players competing in the English Championship. Effective playing time per soccer game is typically 90 s) providing precise peak match demands. Whole-match demands recorded were compared to BiP and Max BiP, and BiP data excluded data from all match stoppages, providing a more precise analysis of match demands. Whole-match metrics were significantly lower than BiP metrics (p 90 s. No significant differences were found between positions. Ball-in-play analysis allows an accurate representation of the game and physical demands imposed on professional soccer players. Through having a clearer understanding of maximum game demands in professional soccer, will enable practitioners to design highly specific training methods