Maternal deaths in Pakistan : intersection of gender, class and social exclusion.

Background: A key aim of countries with high maternal mortality rates is to increase availability of competent maternal health care during pregnancy and childbirth. Yet, despite significant investment, countries with the highest burdens have not reduced their rates to the expected levels. We argue, taking Pakistan as a case study, that improving physical availability of services is necessary but not sufficient for reducing maternal mortality because gender inequities interact with caste and poverty to socially exclude certain groups of women from health services that are otherwise physically available. Methods: Using a critical ethnographic approach, two case studies of women who died during childbirth were pieced together from information gathered during the first six months of fieldwork in a village in Northern Punjab, Pakistan. Findings: Shida did not receive the necessary medical care because her heavily indebted family could not afford it. Zainab, a victim of domestic violence, did not receive any medical care because her martial family could not afford it, nor did they think she deserved it. Both women belonged to lower caste households, which are materially poor households and socially constructed as inferior. Conclusions: The stories of Shida and Zainab illustrate how a rigidly structured caste hierarchy, the gendered devaluing of females, and the reinforced lack of control that many impoverished women experience conspire to keep women from lifesaving health services that are physically available and should be at their disposal

The impact of elbow and knee joint lesions on abnormal gait and posture of sows

<p>Abstract</p> <p>Background</p> <p>Joint lesions occur widespread in the Danish sow population and they are the most frequent cause for euthanasia. Clinically, it is generally impossible to differentiate between various types of non-inflammatory joint lesions. Consequently, it is often necessary to perform a post mortem examination in order to diagnose these lesions. A study was performed in order to examine the relation of abnormal gait and posture in sows with specific joint lesions, and thereby obtaining a clinical diagnostic tool, to be used by farmers and veterinarians for the evaluation of sows with joint problems.</p> <p>Methods</p> <p>The gait, posture and lesions in elbow- and knee joints of 60 randomly selected sows from one herd were scored clinically and pathologically. Associations between the scorings were estimated.</p> <p>Results</p> <p>The variables 'fore- and hind legs turned out' and 'stiff in front and rear' were associated with lesions in the elbow joint, and the variables 'hind legs turned out' and 'stiff in rear' were associated with lesions in the knee joint.</p> <p>Conclusion</p> <p>It was shown that specified gait and posture variables reflected certain joint lesions. However, further studies are needed to strengthen and optimize the diagnostic tool.</p

Binary and Millisecond Pulsars at the New Millennium

We review the properties and applications of binary and millisecond pulsars. Our knowledge of these exciting objects has greatly increased in recent years, mainly due to successful surveys which have brought the known pulsar population to over 1300. There are now 56 binary and millisecond pulsars in the Galactic disk and a further 47 in globular clusters. This review is concerned primarily with the results and spin-offs from these surveys which are of particular interest to the relativity community.Comment: 59 pages, 26 figures, 5 tables. Accepted for publication in Living Reviews in Relativity (http://www.livingreviews.org

Use of varenicline for smoking cessation treatment in UK primary care: an association rule mining analysis

BACKGROUND: Varenicline is probably the most effective smoking cessation pharmacotherapy, but is less widely used than nicotine replacement therapy. We therefore set out to identify the characteristics of numerically important groups of patients who typically do, or do not, receive varenicline in the UK. METHODS: We used association rule mining to analyse data on prescribing of smoking cessation pharmacotherapy in relation to age, sex, comorbidity and other variables from 477,620 people aged 16 years and over, registered as patients throughout 2011 with one of 559 UK general practices in The Health Improvement Network (THIN) database, and recorded to be current smokers. RESULTS: 46,685 participants (9.8% of all current smokers) were prescribed any smoking cessation treatment during 2011, and 19,316 of these (4% of current smokers, 41% of those who received any therapy) were prescribed varenicline. Prescription of varenicline was most common among heavy smokers aged 31–60, and in those with a diagnosis of COPD. Varenicline was rarely used among smokers who were otherwise in good health, or were aged over 60, were lighter smokers, or had psychotic disorders or dementia. CONCLUSIONS: Varenicline is being underused in healthy smokers, or in older smokers, and in those with psychotic disorders or dementia. Since varenicline is probably the most effective available single cessation therapy, this study identifies under-treatment of substantial public health significance

Epidemiology of Streptococcus pneumoniae and Staphylococcus aureus colonization in healthy Venezuelan children

Streptococcus pneumoniae and Staphylococcus aureus cause significant morbidity and mortality worldwide. We investigated both the colonization and co-colonization characteristics for these pathogens among 250 healthy children from 2 to 5 years of age in Merida, Venezuela, in 2007. The prevalence of S. pneumoniae colonization, S. aureus colonization, and S. pneumoniae–S. aureus co-colonization was 28%, 56%, and 16%, respectively. Pneumococcal serotypes 6B (14%), 19F (12%), 23F (12%), 15 (9%), 6A (8%), 11 (8%), 23A (6%), and 34 (6%) were the most prevalent. Non-respiratory atopy was a risk factor for S. aureus colonization (p = 0.017). Vaccine serotypes were negatively associated with preceding respiratory infection (p = 0.02) and with S. aureus colonization (p = 0.03). We observed a high prevalence of pneumococcal resistance against trimethoprim–sulfamethoxazole (40%), erythromycin (38%), and penicillin (14%). Semi-quantitative measurement of pneumococcal colonization density showed that children with young siblings and low socioeconomic status were more densely colonized (p = 0.02 and p = 0.02, respectively). In contrast, trimethoprim–sulfamethoxazole- and multidrug-resistant-pneumococci colonized children sparsely (p = 0.03 and p = 0.01, respectively). Our data form an important basis to monitor the future impact of pneumococcal vaccination on bacterial colonization, as well as to recommend a rationalized and restrictive antimicrobial use in our community

A New Measure of Binge Drinking: Prevalence and Correlates in a Probability Sample of Undergraduates

A standard measure defines binge drinking as the consumption of 5 or more drinks in a row for men (4 or more drinks for women) on at least 1 occasion during the past 2 weeks. A revised operational definition of binge drinking was developed by the National Institute on Alcohol Abuse and Alcoholism in 2004 and incorporated the duration of the drinking episode in addition to the quantity of alcohol consumed. This study compares the standard and new binge measures for overall and subgroup prevalence rates; associations with gender, race/ethnicity, and age of drinking onset; and associations with negative drinking consequences. Methods : A probability sample of 4,580 randomly selected college students (50.3% female, M age=19.9, SD =2.0) at a large Midwestern university in the United States completed a Web-based survey of alcohol and other drug use. Participants reported on past 2-week binge drinking using the standard measure and past-year binge drinking using the new measure. Results : The longer past-year time frame of the new measure yielded a higher prevalence estimate of binge drinking (63.6%) compared with the 2-week standard measure (53.2%). Approximately 9.9% of those who were classified as binge drinkers using the 2-week standard measure were classified as non–binge drinkers using the new measure specification of a 2-hour duration for the drinking episode. The past-year new binge measure was positively associated with negative drinking consequences even when the 2-week measure was statistically controlled. Conclusions : Using a longer time frame and incorporating the duration of the drinking episode, the new measure of binge drinking appears to capture an important element of risky alcohol involvement in college students that is not fully assessed by the standard measure.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65718/1/j.1530-0277.2006.00234.x.pd

Alcohol, tobacco and illicit drug use amongst same-sex attracted women: results from the Western Australian Lesbian and Bisexual Women's Health and Well-Being Survey

Background: The prevalence of alcohol, tobacco and illicit drug use has been reported to be higheramongst lesbian and bisexual women (LBW) than their heterosexual counterparts. However, few studieshave been conducted with this population in Australia and rates that have been reported vary considerably.Methods: A self-completed questionnaire exploring a range of health issues was administered to 917women aged 15-65 years (median 34 years) living in Western Australia, who identified as lesbian orbisexual, or reported having sex with another woman. Participants were recruited from a range of settings,including Perth Pride Festival events (67.0%, n = 615), online (13.2%, n = 121), at gay bars and nightclubs(12.9%, n = 118), and through community groups (6.9%, n = 63). Results were compared against availablestate and national surveillance data.Results: LBW reported consuming alcohol more frequently and in greater quantities than women in thegeneral population. A quarter of LBW (25.7%, n = 236) exceeded national alcohol guidelines by consumingmore than four standard drinks on a single occasion, once a week or more. However, only 6.8% (n = 62)described themselves as a heavy drinker, suggesting that exceeding national alcohol guidelines may be anormalised behaviour amongst LBW. Of the 876 women who provided data on tobacco use, 28.1% (n =246) were smokers, nearly double the rate in the female population as a whole. One third of the sample(33.6%, n = 308) reported use of an illicit drug in the previous six months. The illicit drugs most commonlyreported were cannabis (26.4%, n = 242), meth/amphetamine (18.6%, n = 171), and ecstasy (17.9%, n =164). Injecting drug use was reported by 3.5% (n = 32) of participants.Conclusion: LBW appear to use alcohol, tobacco and illicit drugs at higher rates than women generally,indicating that mainstream health promotion messages are not reaching this group or are not perceivedas relevant. There is an urgent need for public health practitioners working in the area of substance useto recognise that drug consumption and use patterns of LBW are likely to be different to the widerpopulation and that special considerations and strategies are required to address the unique and complexneeds of this population

Perspectives on the chemical etiology of breast cancer.

Multiple factors, known and unknown, contribute to human breast cancer. Hereditary, hormonal, and reproductive factors are associated with risk of breast cancer. Environmental agents, including chemical carcinogens, are modifiable risk factors to which over 70% of breast cancers have been attributed. Polymorphisms of drug-metabolizing enzymes may influence risk of breast cancer from environmental chemicals, dietary agents, and endogenous steroids. The environmental factors discussed in this review include pollutants, occupational exposures, tobacco smoke, alcohol, and diet. Aromatic amines are discussed as potential mammary carcinogens, with a focus on heterocyclic amine food pyrolysis products. These compounds are excreted into the urine after consumption of meals containing cooked meats and have recently been detected in the breast milk of lactating women