Maternity waiting home as a potential intervention for reducing the maternal mortality ratio in El Salvador: an observational case study

Abstract Background El Salvador is recognized as a country that has effectively reduced its Maternal Mortality Ratio (MMR). While health indicators, such as total fertility rate, adolescent fertility rate, skilled birth attendance, and health expenditures, have improved in El Salvador, this improvement was unremarkable compared to advancements in other developing countries. How El Salvador could achieve an outstanding decrease in MMR despite unexceptional improvements in health and non-health indicators is a question that deserves deep research. We used quantitative methods and an observational case study to show that El Salvador could reduce its MMR more than expected by instituting health policies that not only aimed to reduce the (adolescent) fertility rate, but also provide safe birthing conditions and medical services to pregnant women through maternity waiting homes. Methods We ran pooled ordinary least squares regression and panel regression with fixed effects using MMR as the dependent variable and health and non-health factors as the independent variables. We conducted residual analysis, calculated the predicted value of MMR, and compared it with the observed value in El Salvador. To explain the change in MMR in El Salvador, we carried out an observational case study of maternity waiting homes in that country. Results El Salvador could reduce MMR by improving health factors such as fertility rate skilled birth attendance and non-health factors, such as gross domestic product (GDP) per capita and female empowerment. However, even while considering these factors, the MMR of El Salvador decreased by more than expected. We confirmed this by analyzing the residuals of the regression model. This improvement in MMR, which is larger than expected from the regression results, can be attributed partly to government measures such as maternity waiting homes. Conclusions The reason for the unexplained reduction in El Salvadors MMR seems to be attributed in part to health policies that not only aim to reduce the fertility rate but also to provide safe birthing conditions and medical services to pregnant women through maternity waiting homes

Health-Care Networks and the Impact of Maternal Health Care Projects – the Cases of Peru and Bolivia

This paper shows that the evaluation of health projects can be inaccurate when it only considers the direct health-care services provided by health facilities, and that the effects on the entire healthcare network must be considered. In Peru's case, we found that an important effect of a new health facility is the improved service quality in the neighbouring facilities. In Bolivia's case, we found that an improvement of maternal health care service in one hospital may just reduce the demand for medical services in other primary health facilities without significantly affecting the overall performance of the health-care network

Comparison of the characteristic features of bonghan ducts, blood and lymphatic capillaries

Objective: To show that the characteristic morphological and ultrastructural features of a Bonghan corpuscle and duct presented here are consistent with the description given in the early reports of Bonghan Kim. Materials and Methods: We compared the morphological aspects of Bonghan ducts with those of blood and lymphatic capillaries on the ultrastructural level to display the manifestly distinctive nature of the Bonghan system. Results: The walls of the ductules were observed to be composed of a single layer of endothelial cells with characteristic rod-shaped nuclei and were not surrounded by a basal lamina or by accessory cells, such as pericytes or smooth muscle cells. The abluminal cell membranes of Bonghan ductules were not attached by anchoring filaments to the fibers of extracellular matrices as observed in lymphatic capillaries

Dihydrotestosterone-Inducible IL-6 Inhibits Elongation of Human Hair Shafts by Suppressing Matrix Cell Proliferation and Promotes Regression of Hair Follicles in Mice

Autocrine and paracrine factors are produced by balding dermal papilla (DP) cells following dihydrotestosterone (DHT)-driven alterations and are believed to be key factors involved in male pattern baldness. Herein we report that the IL-6 is upregulated in balding DP cells compared with non-balding DP cells. IL-6 was upregulated 3hours after 10–100nM DHT treatment, and ELISA showed that IL-6 was secreted from balding DP cells in response to DHT. IL-6 receptor (IL-6R) and glycoprotein 130 (gp130) were expressed in follicular keratinocytes, including matrix cells. Recombinant human IL-6 (rhIL-6) inhibited hair shaft elongation and suppressed proliferation of matrix cells in cultured human hair follicles. Moreover, rhIL-6 injection into the hypodermis of mice during anagen caused premature onset of catagen. Taken together, our data strongly suggest that DHT-inducible IL-6 inhibits hair growth as a paracrine mediator from the DP

Development of carbon-based adsorbent for separation of impurities such as siloxane and ammonia from land-fill gas

Land-fill gas or bio-gas is composed of large portion of methane and carbon dioxide, and small amount of impurities such as nitrogen, oxygen, hydrogen sulfide, siloxane and ammonia. These gases can be used as a gas-fuel after upgrading treatment. For the application of the land-fill gas and bio-gas as a fuel, we developed highly-performing carbon-based adsorbent which can separate siloxane and ammonia residue from these gases. It was quite necessary to consider the chemical properties of siloxane and ammonia for development of suitable adsorbent of each component. The siloxane can be polymerized in acidic or basic condition to form bulkier species which causes adsorbent deactivation and difficult regeneration. The ammonia gas is well known as basic molecules which have strong affinity to acidic species. In these reasons, we prepared neutral carbon materials by various methods for siloxane adsorption. In addition, we developed carbon-based basic ammonia-adsorbent by simple methods such as the chemical treatment of commercial activated carbon or the impregnation of organic molecules into the activated carbon. And then, adsorption-desorption isotherms and breakthrough curve of siloxane and ammonia were measured for thus synthesized adsorbents. Detail results for synthesis and the adsorption measurement of the studied adsorbents will be presented in the conference

Observation of Coiled Blood Plexus in Rat Skin with Diffusive Light Illumination

AbstractBlood plexuses are characteristic anatomical features of acupuncture points (APs). We developed an optical technique using diffusive light illumination to increase the brightened area of skin for observation of the blood plexuses in skin. We found that the blood plexuses were coiled blood vessels which came out of the perforations in the fascia of muscle. The coiled vessels could be straightened by stretching the skin. We observed a series of blood plexuses at the putative APs along the left and right kidney meridian lines in the abdominal skin of rats. In addition, the locations of the plexuses on the muscle fascia were just above the putative acupuncture muscle channels along the kidney meridians. Furthermore, immunohistochemical analysis of the skin specimens of the plexuses revealed its neurovascular bundle nature as expected from known anatomical features of the APs

Possible association of norepinephrine transporter -3081(A/T) polymorphism with methylphenidate response in attention deficit hyperactivity disorder

Background Attention-deficit/hyperactivity disorder (ADHD) is a heritable disorder characterized by symptoms of inattention and/or hyperactivity/impulsivity. Methylphenidate (MPH) has been shown to block the norepinephrine transporter (NET), and genetic investigations have demonstrated that the norepinephrine transporter gene (SLC6A2) is associated with ADHD. The aims of this study were to examine the association of the SLC6A2 -3081(A/T) and G1287A polymorphisms with MPH response in ADHD. Methods This study enrolled 112 children and adolescents with ADHD. A response criterion was defined based on the Clinical Global Impression-Improvement (CGI-I) score, and the ADHD Rating Scale-IV (ARS) score was also assessed at baseline and 8 weeks after MPH treatment. Results We found that the subjects who had the T allele as one of the alleles (A/T or T/T genotypes) at the -3081(A/T) polymorphism showed a better response to MPH treatment than those with the A/A genotype as measured by the CGI-I. We also found a trend towards a difference in the change of the total ARS scores and hyperactivity/impulsivity subscores between subjects with and without the T allele. No significant association was found between the genotypes of the SLC6A2 G1287A polymorphism and response to ADHD treatment. Conclusion Our findings provide evidence for the involvement of the -3081(A/T) polymorphism of SLC6A2 in the modulation of the effectiveness of MPH treatment in ADHD

Associations between maternal stress during pregnancy and offspring internalizing and externalizing problems in childhood

BACKGROUND: Maternal psychological health during pregnancy has been associated with offspring psychopathology. However, it is uncertain whether these associations are mediated by the postpartum depression and related child-rearing factors. Therefore, we examined the associations between prenatal and postnatal factors and internalizing and externalizing behavioral problems in childhood, focusing on maternal psychological health in school-aged children in Korea. FINDINGS: The current study included 1,003 children (580 boys, 423 girls, mean age 9.05 ± 0.70 years, age range 8–11 years) recruited from schools in five Korean cities. Children’s internalizing and externalizing problems were assessed by the Child Behavior Checklist (CBCL). The parents of the children completed structured questionnaires on perinatal factors. Among 1,003 children, 44 had internalizing problems (IP) and 30 had externalizing problems (EP). When comparing children with IP (n = 44) and without IP (n = 959), severe maternal stress during pregnancy (OR3.36, 95% CI 1.80-6.25) and postpartum depression (OR3.19, 95% CI 1.36-7.53) showed a significant association with the IP. When comparing children with EP (n = 30) and without EP (n = 973), low family income (OR2.19, 95% CI 1.05-4.56), unwanted pregnancy (OR2.76, 95% CI 1.28-5.95) and severe maternal stress during pregnancy (OR2.69, 95% CI 1.29-5.61) with the EP. Only maternal stress during pregnancy was significantly associated with the IP after controlling for postpartum depression and with the EP after controlling for family income and unwanted pregnancy. CONCLUSION: This study suggests the importance of maternal psychological health during perinatal period on children’s mental health. Further prospective studies in a larger sample are required to confirm our findings