Development and use of a scale to assess gender differences in appraisal of mistreatment during childbirth among Ethiopian midwifery students

Mistreatment during childbirth occurs across the globe and endangers the well-being of pregnant women and their newborns. A gender-sensitive approach to mistreatment during childbirth seems relevant in Ethiopia, given previous research among Ethiopian midwives and patients suggesting that male midwives provide more respectful maternity care, which is possibly mediated by self-esteem and stress. This study aimed a) to develop a tool that assesses mistreatment appraisal from a provider's perspective and b) to assess gender differences in mistreatment appraisal among Ethiopian final-year midwifery students and to analyze possible mediating roles of self-esteem and stress. First, we developed a research tool (i.e. a quantitative scale) to assess mistreatment appraisal from a provider's perspective, on the basis of scientific literature and the review of seven experts regarding its relevance and comprehensiveness. Second, we utilized this scale, the so-called Mistreatment Appraisal Scale, among 390 Ethiopian final-year midwifery students to assess their mistreatment appraisal, self-esteem (using the Rosenberg Self-Esteem Scale), stress (using the Perceived Stress Scale) and various background characteristics. The scale's internal consistency was acceptable (α = .75), corrected item-total correlations were acceptable (.24 - .56) and inter-item correlations were mostly acceptable (.07 - .63). Univariable (B = 3.084, 95% CI [-.005, 6.173]) and multivariable (B = 1.867, 95% CI [-1.472, 5.205]) regression analyses did not show significant gender differences regarding mistreatment appraisal. Mediation analyses showed that self-esteem (a1b1 = -.030, p = .677) and stress (a2b2 = -.443, p = .186) did not mediate the effect of gender on mistreatment appraisal. The scale to assess mistreatment appraisal appears to be feasible and reliable. No significant association between gender and mistreatment appraisal was observed and self-esteem and stress were not found to be mediators. Future research is needed to evaluate the scale's criterion validity and to assess determinants and consequences of mistreatment during childbirth from various perspectives

Risk Factors for Positive Appraisal of Mistreatment during Childbirth among Ethiopian Midwifery Students

The maternal mortality ratio and neonatal mortality rate remain high in Ethiopia, where few births are attended by qualified healthcare sta. This is partly due to care providers’ mistreatment of women during childbirth, which creates a culture of anxiety that decreases the use of healthcare services. This study employed a cross-sectional design to identify risk factors for positive appraisal of mistreatment during childbirth. We asked 391 Ethiopian final year midwifery students to complete a paper-and-pen questionnaire assessing background characteristics, prior observation of mistreatment during education, self-esteem, stress, and mistreatment appraisal. A multivariable linear regression analysis indicated age (p = 0.005), stress (p = 0.019), and previous observation of mistreatment during education (p 0.001) to be significantly associated with mistreatment appraisal. Younger students, stressed students, and students that had observed more mistreatment during their education reported more positive mistreatment appraisal. No significant association was observed for origin (p = 0.373) and self-esteem (p = 0.445). Findings can be utilized to develop educational interventions that counteract mistreatment during childbirth in the Ethiopian context

Characterizing contributions of glacier melt and groundwater during the dry season in a poorly gauged catchment of the Cordillera Blanca (Peru)

The retreat of glaciers in the tropics will have a significant impact on water resources. In order to overcome limitations with discontinuous to nonexistent hydrologic measurements in remote mountain watersheds, a hydrochemical and isotopic mass balance model is used to identify and characterize dry season water origins at the glacier fed Querococha basin located in southern Cordillera Blanca, Peru. Dry season water samples, collected intermittently between 1998 and 2007, were analyzed for major ions and the stable isotopes of water (δ<sup>18</sup>O and δ<sup>2</sup>H). The hydrochemical and isotopic data are analysed using conservative characteristics of selected tracers and relative contributions are calculated based on pre-identified contributing sources at mixing points sampled across the basin. The results show that during the dry-season, groundwater is the largest contributor to basin outflow and that the flux of groundwater is temporally variable. The groundwater contribution significantly correlates (P-value=0.004 to 0.044) to the antecedent precipitation regime at 3 and 18–36 months. Assuming this indicates a maximum of 4 years of precipitation accumulation in groundwater reserves, the Querococha watershed outflows are potentially vulnerable to multi-year droughts and climate related changes in the precipitation regime. The results show that the use of hydrochemical and isotopic data can contribute to hydrologic studies in remote, data poor regions, and that groundwater contribution to tropical proglacial hydrologic systems is a critical component of dry season discharge

Polio Outbreak Response in Ethiopia

Background: Ethiopia had been polio-free for almost four years until December 2004. However, between December 2004 and February 2006, 24 children were paralysed as a result of infection with wild poliovirus imported from the neighbouring country of Sudan. In response, the country has attempted to document the impact of various response measures on the containment of wild poliovirus transmission. Objectives: This study aims at systematic and epidemiological assessment of the extent of the outbreak, its determinants, and the lessons learned as well as the implications for future control strategies to interrupt wild poliovirus transmission. Design: A cross-sectional study design with qualitative and quantitative data collection approaches was used to conduct the epidemiologic assessment. Subjects: All confirmed wild poliovirus cases, and reported acute flaccid paralysis cases in close proximity to the confirmed polio cases were the study subjects. Child caretakers and health service providers were interviewed as part of the investigation. Results: Between December 2004 and February 2006, eight children from Tigray Regional State, nine children from Amhara Regional State and seven children from Oromia Regional State were paralysed as a result of infection with wild poliovirus type 1. Genetic sequencing demonstrated two separate importations to Ethiopia. Risk factors that may have facilitated spread of the outbreak within the country included gaps in vaccination coverage and interruption of the cold chain system, gaps in acute flaccid paralysis surveillance performance, high population mobility, poor environmental sanitation, crowded living conditions and unsafe drinking water. In response to the outbreak, Ethiopia conducted detailed outbreak investigations within two days of confirmation of the index cases. Large-scale, house-to-house vaccination campaigns were also implemented. As a result, the three regions interrupted the wild poliovirus transmission within the regions within one year of confirmation of the index case. Conclusion: Outbreak response activities were successful in interrupting the imported wild poliovirus transmission in Tigray, Amhara and Oromia Regional States of Ethiopia within a oneyear period of time. In Ethiopia, programme strategies should be intensified to contain further spread and prevent future importation of wild poliovirus. Large-scale immunisation campaigns should reach every child, including those isolated by geography, poverty and security. East African Medical Journla Vol. 85 (5) 2008: pp. 222-23

A Secure Cloud-based Platform to Host Healthcare Applications

Digital technologies, such as Big Data analytics, artificial intelligence, cloud and high-performance computing are presenting new opportunities to transform healthcare systems, increase connectivity of hospitals and other providers, and therefore potentially and significantly improve patient care. However, such networked computing infrastructures also raise significant cybersecurity risks, especially in the healthcare domain, where protecting sensitive personal information is of paramount importance. Project ASCLEPIOS aims at strengthening the trust of users in cloud-based healthcare services by utilizing trusted execution environment and several modern cryptographic approaches such as attribute based encryption, searchable encryption, functional encryption to build a cloud-based e-health framework that protects users’ privacy, prevents both internal and external attacks, verifies the integrity of medical devices before application, and runs privacy-preserving data analytics on encrypted data. The project investigates modern encryption techniques and their combination in order to provide increased security of e-health applications that are then presented towards end-users utilizing a cloud-based platform. Although some topics such as security and privacy are already investigated through block-chain related technologies, it has been decided that the selected approaches would be more suitable for these particular challenges. In order to prototype its security services, ASCLEPIOS develops and deploys three large-scale healthcare demonstrators, provided by three leading hospitals from Europe. These demonstrators are rooted in the practice-based problems and applications provided by the project’s healthcare partners. The Amsterdam University Centers, University of Amsterdam, plans to improve stroke hyper-acute care through secure information sharing on a cloud computing platform to improve patient management. Additionally, they are also building prediction models to enable earlier discharge of patients from hospitals with lower risk factors. Charité Berlin plans to improve inpatient and outpatient sleep medication by remotely controlling the quality of the collected data and transferring it on-line for further analysis. Finally, the Norwegian Centre for e-health Research, University Hospital of North Norway is developing a system for privacy-preserving monitoring and benchmarking of antibiotics prescription of general practitioners. The common characteristics of these three scenarios are the increased demand for high levels of security in data transfer, storage and privacy preserving analytics on cloud infrastructures. In order deploy, operate and further develop these applications to increase their security with the ASCLEPIOS framework, a cloud computing testbed is being setup. The testbed uses state-of-the-art technologies for cloud application deployment and run-time orchestration in order to ensure the optimized deployment and execution of the demonstrator applications. As the data sources do not require the local execution (albeit in one case data may remain on the data source) of processing, there is no need for fog or edge computing, but the testbed is based on private OpenStack cloud computing infrastructures and utilizes the MiCADO framework which is compatible with different containers such as Docker and Kubernetes. The project started only recently, and currently it is in the early stages of systems design and specification. This presentation will provide a short introduction to the ASCLEPIOS project and its demonstrators and will present early results of the currently ongoing requirements specification and platform design processes

Sprouty2 mediated tuning of signalling is essential for somite myogenesis

Background: Negative regulators of signal transduction cascades play critical roles in controlling different aspects of normal embryonic development. Sprouty2 (Spry2) negatively regulates receptor tyrosine kinases (RTK) and FGF signalling and is important in differentiation, cell migration and proliferation. In vertebrate embryos, Spry2 is expressed in paraxial mesoderm and in forming somites. Expression is maintained in the myotome until late stages of somite differentiation. However, its role and mode of action during somite myogenesis is still unclear. Results: Here, we analysed chick Spry2 expression and showed that it overlaps with that of myogenic regulatory factors MyoD and Mgn. Targeted mis-expression of Spry2 led to inhibition of myogenesis, whilst its C-terminal domain led to an increased number of myogenic cells by stimulating cell proliferation. Conclusions: Spry2 is expressed in somite myotomes and its expression overlaps with myogenic regulatory factors. Overexpression and dominant-negative interference showed that Spry2 plays a crucial role in regulating chick myogenesis by fine tuning of FGF signaling through a negative feedback loop. We also propose that mir-23, mir-27 and mir-128 could be part of the negative feedback loop mechanism. Our analysis is the first to shed some light on in vivo Spry2 function during chick somite myogenesis

Iron deficiency was not the major cause of anemia in rural women of reproductive age in Sidama zone, southern Ethiopia: A cross-sectional study

Background Anemia, which has many etiologies, is a moderate/severe public health problem in young children and women of reproductive age in many developing countries. The aim of this study was to investigate prevalence of iron deficiency, anemia, and iron deficiency anemia using multiple biomarkers and to evaluate their association with food insecurity and food consumption patterns in non-pregnant women from a rural area of southern Ethiopia. Methods A cross-sectional study was conducted in 202 rural women of reproductive age in southern Ethiopia. Anthropometrics and socio-demographic data were collected. A venipuncture blood sample was analyzed for hemoglobin (Hb) and for biomarkers of iron status. Biomarkers were skewed and were log transformed before analysis. Mean, median, Pearson\u27s correlations and ordinary least-squares regressions were calculated. Results Median (IQR) Hb was 138 (127, 151) g/L. Based on an altitude-adjusted (1708 m) cutoff of 125 g/L for Hb, 21.3% were anemic. Plasma ferritin was \u3c15 μg/L in 18.6% of the women. Only one woman had α-1-acid glycoprotein (AGP) \u3e1.0 g/L; four women (2%) had \u3e 5 mg/L of C-reactive protein (CRP). Of the 43 women who were anemic, 23.3% (10 women) had depleted iron stores based on plasma ferritin. Three of these had elevated soluble transferring receptors (sTfR). Hemoglobin (Hb) concentration was negatively correlated with sTfR (r = -0.24, p = 0.001), and positively correlated with ferritin (r = 0.17, p = 0.018), plasma iron (r = 0.15, p = 0.046), transferrin saturation (TfS) (r = 0.15, p = 0.04) and body iron (r = 0.14, p = 0.05). Overall prevalence of iron deficiency anemia was only 5%. Conclusion Iron deficiency anemia was not prevalent in the study population, despite the fact that anemia would be classified as a moderate public health problem

Secure and scalable deduplication of horizontally partitioned health data for privacy-preserving distributed statistical computation

Background Techniques have been developed to compute statistics on distributed datasets without revealing private information except the statistical results. However, duplicate records in a distributed dataset may lead to incorrect statistical results. Therefore, to increase the accuracy of the statistical analysis of a distributed dataset, secure deduplication is an important preprocessing step. Methods We designed a secure protocol for the deduplication of horizontally partitioned datasets with deterministic record linkage algorithms. We provided a formal security analysis of the protocol in the presence of semi-honest adversaries. The protocol was implemented and deployed across three microbiology laboratories located in Norway, and we ran experiments on the datasets in which the number of records for each laboratory varied. Experiments were also performed on simulated microbiology datasets and data custodians connected through a local area network. Results The security analysis demonstrated that the protocol protects the privacy of individuals and data custodians under a semi-honest adversarial model. More precisely, the protocol remains secure with the collusion of up to N − 2 corrupt data custodians. The total runtime for the protocol scales linearly with the addition of data custodians and records. One million simulated records distributed across 20 data custodians were deduplicated within 45 s. The experimental results showed that the protocol is more efficient and scalable than previous protocols for the same problem. Conclusions The proposed deduplication protocol is efficient and scalable for practical uses while protecting the privacy of patients and data custodians