Quality of life of post-menopausal women residing in rural and urban areas of Sikkim, India

Background: Menopause is an inevitable reproductive phase during midlife when various physical and mental changes may impair the quality of life of women. The presence and severity of symptoms vary tremendously from woman to woman and can last from months to years during this transitional period. This study was conducted to assess the quality of life and menopause related problems among post-menopausal women residing rural and urban areas of Sikkim.Methods: Descriptive explorative study was done in East Sikkim among 120 rural and urban post-menopausal women who were in the age group of 45 years and above, had attained natural menopause and didn’t have menstruation from last one year, were selected through purposive sampling technique. Women with induced menopause, hysterectomy, receiving hormonal treatment were excluded. Along with collection of socio-demographic data, the Menopause Specific Quality of Life Questionnaire was used to assess the Quality of life based on experience of the symptoms through interview technique.Results: The mean menopausal age was 48±3.649 years in rural area and 47±3.831 years for urban area. The mean scores in quality of life between post-menopausal women in rural areas (M=136.6, SD=28.78) were found significantly impaired and the difference was found statistically significant (t=5.75 p<0.001) which shows that rural women were having impaired quality of life as compared to urban women during post-menopausal period. The findings also revealed that factors affecting the quality of life of postmenopausal women were the history of menopause, occupation of women, in urban women and time of attending menopause, in rural women.Conclusions: The present study shows that menopause related symptoms had a negative effect on the quality of life of the post-menopausal women. Such studies can help in creating awareness and in educating women on the early identification of the common menopausal symptoms

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

The NeoRoo mobile app: Initial design and prototyping of an Android-based digital health tool to support Kangaroo Mother Care in low/middle-income countries (LMICs).

Premature birth and neonatal mortality are significant global health challenges, with 15 million premature births annually and an estimated 2.5 million neonatal deaths. Approximately 90% of preterm births occur in low/middle income countries, particularly within the global regions of sub-Saharan Africa and South Asia. Neonatal hypothermia is a common and significant cause of morbidity and mortality among premature and low birth weight infants, particularly in low/middle-income countries where rates of premature delivery are high, and access to health workers, medical commodities, and other resources is limited. Kangaroo Mother Care/Skin-to-Skin care has been shown to significantly reduce the incidence of neonatal hypothermia and improve survival rates among premature infants, but there are significant barriers to its implementation, especially in low/middle-income countries (LMICs). The paper proposes the use of a multidisciplinary approach to develop an integrated mHealth solution to overcome the barriers and challenges to the implementation of Kangaroo Mother Care/Skin-to-skin care (KMC/STS) in LMICs. The innovation is an integrated mHealth platform that features a wearable biomedical device (NeoWarm) and an Android-based mobile application (NeoRoo) with customized user interfaces that are targeted specifically to parents/family stakeholders and healthcare providers, respectively. This publication describes the iterative, human-centered design and participatory development of a high-fidelity prototype of the NeoRoo mobile application. The aim of this study was to design and develop an initial ("A") version of the Android-based NeoRoo mobile app specifically to support the use case of KMC/STS in health facilities in Kenya. Key functions and features are highlighted. The proposed solution leverages the promise of digital health to overcome identified barriers and challenges to the implementation of KMC/STS in LMICs and aims to equip parents and healthcare providers of prematurely born infants with the tools and resources needed to improve the care provided to premature and low birthweight babies. It is hoped that, when implemented and scaled as part of a thoughtful, strategic, cross-disciplinary approach to reduction of global rates of neonatal mortality, NeoRoo will prove to be a useful tool within the toolkit of parents, health workers, and program implementors

A study to assess etiology and prevalence of signs and symptoms of temporomandibular disorder

Aim: The purpose of this epidemiological research was to determine how common temporomandibular disorder (TMD) symptoms are. Materials and Methods: Among the outpatient population, a sample of 100 people was chosen at random. A patient survey was presented to each person, and points were allotted based on their responses. Participants were categorized as having no symptoms of TMD, mild TMD, moderate TMD, or severe TMD based on their total score. Results: One hundred adults aged 18 and above were selected from the general public to take part in the research. Temporomandibular disorder was present in no more than 30% of those studied, in the mild range in 50%, in the moderate range in 15%, and in the severe range in 5%. 0.602 was determined to be the dependability of Fonseca's questionnaire. Conclusion: The Fonseca questionnaire is a useful instrument for gauging the extent to which TMD symptoms are present in a given population. The screening questionnaire may be received in a short amount of time and for little money, making it a good option for public health services

Barrier distribution from 28Si+154Sm quasielastic scattering: Coupling effects in the fusion process

Barrier distribution for the 28Si+154Sm system has been extracted from large angle quasielastic scattering measurement to investigate the role of various channel couplings on fusion dynamics. The coupled channel calculations, including the collective excitation of the target and projectile, are observed to reproduce the experimental BD rather well. It seems that the role of neutron transfer, relative to collective excitation, is in fact weak in the 28Si+154Sm system even though it has positive Q-value for neutron transfer channels

Barrier distribution from 28Si^{28}Si+154Sm^{154}Sm quasielastic scattering: Coupling effects in the fusion process

International audienceBarrier distribution for the ^28Si+^154Sm system has been extracted from large angle quasielastic scattering measurement to investigate the role of various channel couplings on fusion dynamics. The coupled channel calculations, including the collective excitation of the target and projectile, are observed to reproduce the experimental BD rather well. It seems that the role of neutron transfer, relative to collective excitation, is in fact weak in the ^28Si+^154Sm system even though it has positive Q-value for neutron transfer channels

Influence of Positive QQ-value Neutron Transfer Coupling on Fusion Enhancement in 28^{28}Si+154+^{154}Sm Reaction

International audienceRecently, the barrier distribution (BD) for the 28Si+154Sm system has been measured by our group using the quasi-elastic scattering technique. Here, we present the results of coupled-channel calculations performed to reproduce the measured BD. The inelastic excitation of target and projectile alone explains the experimentally observed BD very well, even though the system studied has large positive Q-value for neutron transfer channels. Hence, the results reveal no significant influence of positive Q-value neutron transfer channels on fusion enhancement for the 28Si+154Sm system

Effect of coupling in the Si 28 + Sm 154 reaction studied by quasi-elastic scattering

International audienceThe study of the coupling to collective states of the Si28 projectile and Sm154 target in fusion mechanism is reported. Understanding such couplings is important as they influence the barrier height and the formation probability of the compound nuclei, which in turn may be related to the synthesis of superheavy elements in heavier systems. In the present work, before performing the coupled-channel calculations, we wish to obtain an experimental signature of coupling to projectile and target excitation through barrier distribution (BD) study. To this end, the BDs of the Si28+Sm154 and O16+Sm154 systems have been compared using existing fusion data, scaled to compensate for the differences between the nominal Coulomb barriers and the respective coupling strengths. However, the large error bars on the high-energy side of the fusion BD prevent any definite identification of such signatures. We have, therefore, performed a quasi-elastic (QE) scattering experiment for the heavier Si28+Sm154 system and compared its results with existing QE data for the O16 projectile. Since QE BDs are precise at higher energies, the comparison has shown that the BD of Si28+Sm154 is similar to that of O16+Sm154 to a large extent except for a peaklike structure on the higher energy side. The similarity shows that the Sm154 deformation plays a major role in the fusion mechanism of Si28+Sm154 system. The peaklike structure is attributed to Si28 excitation. In contrast with previous studies, it is found that a coupled-channel calculation with vibrational coupling to the first 2+ state of Si28 reproduces this structure rather well. However, an almost identical result is found with the rotational coupling scheme if one considers the large positive hexadecapole deformation of the projectile. A value around that given by Möller and Nix (β4≈0.25) leads to a strong cancellation in the re-orientation term that couples the 2+ state back to itself, making that state look vibrational in this process. Thus, unlike the existing fusion data, our new QE results contain subtle details about the fusion mechanism of Si28+Sm154 system. They even show a sensitivity to the Si28 hexadecapole deformation and hence may be capable of giving a physically reasonable estimate for β4 in an indirect way

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

BackgroundTranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding.MethodsWe did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.FindingsBetween July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98).InterpretationWe found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial.</div