Optimizing the delivery of contraceptives in low- and middle-income countries through task shifting: a systematic review of effectiveness and safety

Objective: To assess the effectiveness and safety of task shifting for the delivery of injectable contraceptives, contraceptive implants, intrauterine devices (IUDs), tubal ligation and vasectomy in low-and middle-income countries. Methods: Multiple electronic databases were searched up to 25 May 2012 for studies which had assessed the delivery of contraceptives by health workers with lower levels of training, compared to delivery by health workers usually assigned this role, or compared to no organized provision of contraceptives. We included randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series. Data were extracted using a standard form and the certainty of the evidence found was assessed using GRADE. Results: We identified six randomized controlled trials published between 1977 and 1995 that assessed the safety and effectiveness of task shifting for the delivery of long-term contraceptives. Two studies assessed IUD insertion by nurses compared to doctors, two assessed IUD insertion by auxiliary nurse-midwives compared to doctors, one assessed tubal ligation by midwives compared to doctors, and one assessed the delivery of vasectomy by medical students compared to doctors. In general, little or no difference was found in contraceptive outcomes between cadres. Study design limitations and the low number of eligible studies, however, allow only limited conclusions to be drawn. Conclusions: The findings indicate that task shifting for the delivery of long-term contraceptives may be a safe and effective approach to increasing access to contraception. Further research is needed because the certainty of the evidence identified is variable

Optimizing the delivery of contraceptives in low- and middle-income countries through task shifting: a systematic review of effectiveness and safety

Objective: To assess the effectiveness and safety of task shifting for the delivery of injectable contraceptives, contraceptive implants, intrauterine devices (IUDs), tubal ligation and vasectomy in low-and middle-income countries. Methods: Multiple electronic databases were searched up to 25 May 2012 for studies which had assessed the delivery of contraceptives by health workers with lower levels of training, compared to delivery by health workers usually assigned this role, or compared to no organized provision of contraceptives. We included randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series. Data were extracted using a standard form and the certainty of the evidence found was assessed using GRADE. Results: We identified six randomized controlled trials published between 1977 and 1995 that assessed the safety and effectiveness of task shifting for the delivery of long-term contraceptives. Two studies assessed IUD insertion by nurses compared to doctors, two assessed IUD insertion by auxiliary nurse-midwives compared to doctors, one assessed tubal ligation by midwives compared to doctors, and one assessed the delivery of vasectomy by medical students compared to doctors. In general, little or no difference was found in contraceptive outcomes between cadres. Study design limitations and the low number of eligible studies, however, allow only limited conclusions to be drawn. Conclusions: The findings indicate that task shifting for the delivery of long-term contraceptives may be a safe and effective approach to increasing access to contraception. Further research is needed because the certainty of the evidence identified is variable

A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0-6) weeks of gestation

BACKGROUND Caesarean sections often have no urgent indication and are electively planned. Research showed that elective caesarean section should not be performed until 39 + (0-6) weeks of gestation to ensure best neonatal and maternal health if there are no contraindications. This was recommended by various guidelines published in the last two decades. With this systematic review, we are looking for implementation strategies trying to implement these recommendations to reduce elective caesarean section before 39 + (0-6) weeks of gestation. METHODS We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL, and CINAHL on 3rd of March 2021. We included studies that assessed implementation strategies aiming to postpone elective caesarean section to ≥ 39 + (0-6) weeks of gestation. There were no restrictions regarding the type of implementation strategy or reasons for elective caesarean section. Our primary outcome was the rate of elective caesarean sections before 39 + (0-6) weeks of gestation. We used the ROBINS-I Tool for the assessment of risk of bias. We did a narrative analysis of the results. RESULTS We included 10 studies, of which were 2 interrupted time series and 8 before-after studies, covering 205,954 elective caesarean births. All studies included various types of implementation strategies. All implementation strategies showed success in decreasing the rate of elective caesarean sections performed < 39 + (0-6) weeks of gestation. Risk difference differed from - 7 (95% CI - 8; - 7) to - 45 (95% CI - 51; - 31). Three studies reported the rate of neonatal intensive care unit admission and showed little reduction. CONCLUSION This systematic review shows that all presented implementation strategies to reduce elective caesarean section before 39 + (0-6) weeks of gestation are effective. Reduction rates differ widely and it remains unclear which strategy is most successful. Strategies used locally in one hospital seem a little more effective. Included studies are either before-after studies (8) or interrupted time series (2) and the overall quality of the evidence is rather low. However, most of the studies identified specific barriers in the implementation process. For planning an implementation strategy to reduce elective caesarean section before 39 + (0-6) weeks of gestation, it is necessary to consider specific barriers and facilitators and take all obstetric personal into account. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017078231

Prevalence of Vitamin B12 Deficiency in Patients with type 2 Diabetes Mellitus on Metformin

Background: Type 2 diabetes mellitus (T2DM) is a common public health problem in metabolism. Metformin is the oral hypoglycemic agent used as a first line together with life style modification in type 2 diabetes patients worldwide. Continuous metformin therapy increases the risk of vitamin B12 insufficiency, and its medical consequences in T2DM patients. Objective: To detect the prevalence of serum vitamin B12 deficiency in T2DM who has been treated with metformin in Erbil Province. Patients and Methods: The study involved 200 cases (100 patients and 100 controls) that met the study's basic criteria. A completed questionnaire, and a blood test for serum vitamin B12 levels were performed. A deficiency of vitamin B12 is defined as <160 pg/mL in serum vitamin B12. Results: Deficiency of serum vitamin B12 was found in 48% of patients (n=48), while HbA1c levels had no impact on this finding. In T2DM level of serum vitamin B12 that has been on metformin at a dose of ≤ 1 gm/ day shows a significant difference with those patients with no history of metformin use. Conclusion: Low levels of serum vitamin B12  came as a result of the overdosing of metformin for long period of treatment

Modeling Operating Speed and Deceleration on Two-Lane Rural Roads with Global Positioning System Data

[EN] In the road design process, speed variation along the road segment is an important issue to consider in adapting road geometry to drivers' expectations. To achieve this objective, speed criteria are used to evaluate road consistency. Being able to estimate the operating speed in the design phase can lead to safer road alignment. With this objective, several researchers have developed operating speed models. Most of these models are based on collected spot speed data. They assume constant speed on curves and, therefore, deceleration that occurs entirely on the approach tangent. According to these assumptions, spot speed data are collected at the center of the horizontal curve and at the midpoint of the preceding tangent to obtain operating speed models. This paper presents a new methodology based on the use of Global Positioning System devices that allow continuous collecting and processing of speed data. With this new methodology, not only can new and more accurate operating speed models he developed, but cited hypotheses can also be checked. Observed speed continuous profiles allow studies that previously could not be done, especially as related to deceleration and speed variations. This study calibrated new speed models, including three for horizontal curves with a radius curve and the curvature change rate of a single curve as explanatory variables, and one for tangents that incorporates the curve speed model. Tangent-curve speed variations are evaluated, with comparison of Delta(85)V and Delta V(85), analysis of the deceleration length occurring on a curve, and development of two deceleration models.The authors thank the Center for Studies and Experimentation of Public Works of the Spanish Ministry of Public Works, which partially subsidized the research. The authors also thank the Infrastructure and Transportation Department, General Directorate of Public Works, Valencian Government, Spain; the Valencian Provincial Council; and the Ministry of the Interior, General Directorate of Traffic, Spain, for their cooperation in field data gathering.Pérez Zuriaga, AM.; García García, A.; Camacho-Torregrosa, FJ.; D'attoma, P. (2010). Modeling Operating Speed and Deceleration on Two-Lane Rural Roads with Global Positioning System Data. Transportation Research Record. 2171:11-20. doi:10.3141/2171-02S1120217

Environmental Interventions to Reduce the Consumption of Sugar-Sweetened Beverages: Abridged Cochrane Systematic Review

BACKGROUND Regular consumption of sugar-sweetened beverages (SSB) can increase the risk for obesity, type 2 diabetes, cardiovascular disease, and dental caries. Interventions that alter the physical or social environment in which individuals make beverage choices have been proposed to reduce the consumption of SSB. METHODS We included randomised controlled, non-randomised controlled, and interrupted time series studies on environmental interventions, with or without behavioural co-interventions, implemented in real-world settings, lasting at least 12 weeks, and including at least 40 individuals. Studies on the taxation of SSB were not included, as these are subject of a separate Cochrane review. We used standard Cochrane methods for data extraction, risk of bias assessment, and evidence grading and synthesis. Searches were updated to January 24, 2018. RESULTS We identified 14,488 unique records and assessed 1,030 full texts for eligibility. We included 58 studies comprising a total of 1,180,096 participants and a median length of follow-up of 10 months. We found moderate-certainty evidence for consistent associations with decreases in SSB consumption or sales for the following interventions: traffic light labelling, price increases on SSB, in-store promotion of healthier beverages in supermarkets, government food benefit programs with incentives for purchasing fruits and vegetables and restrictions on SSB purchases, multi-component community campaigns focused on SSB, and interventions improving the availability of low-calorie beverages in the home environment. For the remaining interventions we found low- to very-low-certainty evidence for associations showing varying degrees of consistency. CONCLUSIONS With observed benefits outweighing observed harms, we suggest that environmental interventions to reduce the consumption of SSB be considered as part of a wider set of measures to improve population-level nutrition. Implementation should be accompanied by evaluations using appropriate methods. Future studies should examine population-level effects of interventions suitable for large-scale implementation, and interventions and settings not yet studied thoroughly

The Fundamental Diagram of Pedestrian Movement Revisited

The empirical relation between density and velocity of pedestrian movement is not completely analyzed, particularly with regard to the `microscopic' causes which determine the relation at medium and high densities. The simplest system for the investigation of this dependency is the normal movement of pedestrians along a line (single-file movement). This article presents experimental results for this system under laboratory conditions and discusses the following observations: The data show a linear relation between the velocity and the inverse of the density, which can be regarded as the required length of one pedestrian to move. Furthermore we compare the results for the single-file movement with literature data for the movement in a plane. This comparison shows an unexpected conformance between the fundamental diagrams, indicating that lateral interference has negligible influence on the velocity-density relation at the density domain $1 m^{-2}<\rho<5 m^{-2}$. In addition we test a procedure for automatic recording of pedestrian flow characteristics. We present preliminary results on measurement range and accuracy of this method.Comment: 13 pages, 9 figure

Garden varieties: how attractive are recommended garden plants to butterflies?

One way the public can engage in insect conservation is through wildlife gardening, including the growing of insect-friendly flowers as sources of nectar. However, plant varieties differ in the types of insects they attract. To determine which garden plants attracted which butterflies, we counted butterflies nectaring on 11 varieties of summer-flowering garden plants in a rural garden in East Sussex, UK. These plants were all from a list of 100 varieties considered attractive to British butterflies, and included the five varieties specifically listed by the UK charity Butterfly Conservation as best for summer nectar. A total of 2659 flower visits from 14 butterfly and one moth species were observed. We performed a principal components analysis which showed contrasting patterns between the species attracted to Origanum vulgare and Buddleia davidii. The “butterfly bush” Buddleia attracted many nymphalines, such as the peacock, Inachis io, but very few satyrines such as the gatekeeper, Pyronia tithonus, which mostly visited Origanum. Eupatorium cannibinum had the highest Simpson’s Diversity score of 0.75, while Buddleia and Origanum were lower, scoring 0.66 and 0.50 respectively. No one plant was good at attracting all observed butterfly species, as each attracted only a subset of the butterfly community. We conclude that to create a butterfly-friendly garden, a variety of plant species are required as nectar sources for butterflies. Furthermore, garden plant recommendations can probably benefit from being more precise as to the species of butterfly they attract

New consistency index based on inertial operating speed

The occurrence of road crashes depends on several factors, with design consistency (i.e., conformance of highway geometry to drivers' expectations) being one of the most important. A new consistency model for evaluating the performance of tangent-to-curve transitions on two-lane rural roads was developed. This model was based on the inertial consistency index (ICI) defined for each transition. The ICI was calculated at the beginning point of the curve as the difference between the average operating speed on the previous 1-km road segment (inertial operating speed) and the actual operating speed at this point. For the calibration of the ICI and its thresholds, 88 road segments, which included 1,686 tangent-to-curve transitions, were studied. The relationship between those results and the crash rate associated with each transition was analyzed. The results showed that the higher the ICI was, the higher the crash rate; thus, the probability of accidents increased. Similar results were obtained from the study of the relationship between the ICI and the weighted average crash rate of the corresponding group of transitions. A graphical and statistical analysis established that road consistency might be considered good when the ICI was lower than 10 km/h, poor when the ICI was higher than 20 km/h, and fair otherwise. A validation process that considered 20 road segments was performed. The ICI values obtained were highly correlated to the number of crashes that had occurred at the analyzed transitions. Thus, the ICI and its consistency thresholds resulted in a new approach for evaluation of consistency.The authors thank the Center for Studies and Experimentation of Public Works of the Spanish Ministry of Public Works, which partially subsidized the data collection, for obtaining the empirical operating speed profiles used in the validation process. The authors also thank the General Directorate of Public Works of the Infrastructure and Transportation Department of the Valencian government, the Valencian Province Council, and the General Directorate of Traffic of the Ministry of the Interior of the Government of Spain for their cooperation in data gathering.García García, A.; Llopis Castelló, D.; Camacho Torregrosa, FJ.; Pérez Zuriaga, AM. (2013). New consistency index based on inertial operating speed. Transportation Research Record. (2391):105-112. doi:10.3141/2391-10S1051122391Ng, J. C. ., & Sayed, T. (2004). Effect of geometric design consistency on road safety. Canadian Journal of Civil Engineering, 31(2), 218-227. doi:10.1139/l03-090Gibreel, G. M., Easa, S. M., Hassan, Y., & El-Dimeery, I. A. (1999). State of the Art of Highway Geometric Design Consistency. Journal of Transportation Engineering, 125(4), 305-313. doi:10.1061/(asce)0733-947x(1999)125:4(305)Hassan, Y. (2004). Highway Design Consistency: Refining the State of Knowledge and Practice. Transportation Research Record: Journal of the Transportation Research Board, 1881(1), 63-71. doi:10.3141/1881-08Polus, A., & Mattar-Habib, C. (2004). New Consistency Model for Rural Highways and Its Relationship to Safety. Journal of Transportation Engineering, 130(3), 286-293. doi:10.1061/(asce)0733-947x(2004)130:3(286)Cafiso, S., Di Graziano, A., Di Silvestro, G., La Cava, G., & Persaud, B. (2010). Development of comprehensive accident models for two-lane rural highways using exposure, geometry, consistency and context variables. Accident Analysis & Prevention, 42(4), 1072-1079. doi:10.1016/j.aap.2009.12.015Zuriaga, A. M. P., García, A. G., Torregrosa, F. J. C., & D’Attoma, P. (2010). Modeling Operating Speed and Deceleration on Two-Lane Rural Roads with Global Positioning System Data. Transportation Research Record: Journal of the Transportation Research Board, 2171(1), 11-20. doi:10.3141/2171-0

Sight Distance Standards Based On Observational Data Risk Evaluation Of Passing

The paper presents an application of a reliability analysis for evaluating the risk associated with passing sight distance (PSD) standards in terms of the expected probability of noncompliance. Calculation of PSD is required to determine where drivers can safely execute passing maneuvers. Traditional PSD standards are based on deterministic, theoretical models, which are calibrated with conservative percentile values for uncertain design inputs to account for uncertainty. The PSD standards do not provide information about the risk of deviation from them. Reliability analysis is a technique that is based on limit state design and that accounts for the propagation of variability from input random parameters to the design outputs. A total of 1,098 passing maneuvers were observed on several two-lane highways in Spain; two data collection methodologies were used: external observations and an instrumented vehicle. The most significant factors affecting PSD were impeding-vehicle speed, passing-vehicle acceleration, and head-ways between impeding and passing vehicles. A uniform acceleration model described the passing-vehicle trajectory. The characterized input parameters and the passing model were used to perform a reliability analysis. The results showed the probability of noncompliance in different scenarios, defined as the proportion of cases in which the required PSD would exceed the available sight distance. American and Spanish PSD standards were evaluated. Geometric design standards presented a probability of noncompliance of about 0.15, whereas some marking standards had a probability of noncompliance exceeding 0.85. These standards may be associated with higher risk levels if they are followed by drivers. As well, PSD risk levels were not consistent for different design speeds, since they underestimated operating speed at some locationsThis paper was developed as a result of a mobility study at the University of British Columbia funded by the Erasmus Mundus Program of the European Commission under the Transatlantic Partnership for Excellence in Engineering project. The authors thank the Spanish Ministry of Economy and Competitiveness, which subsidized the research project, and the Spanish Directorate General of Traffic, Spanish Ministry of Public Works, Valencia Regional Department of Transport, and Valencia province road department for their collaboration during the field study.Llorca Garcia, C.; Moreno Chou, AT.; Sayed, T.; García García, A. (2014). Sight Distance Standards Based On Observational Data Risk Evaluation Of Passing. Transportation research record. 2404:18-26. doi:10.3141/2404-03S18262404Ismail, K., & Sayed, T. (2009). Risk-based framework for accommodating uncertainty in highway geometric design. Canadian Journal of Civil Engineering, 36(5), 743-753. doi:10.1139/l08-146Ismail, K., & Sayed, T. (2010). Risk-Based Highway Design. Transportation Research Record: Journal of the Transportation Research Board, 2195(1), 3-13. doi:10.3141/2195-01Richl, L., & Sayed, T. (2006). Evaluating the Safety Risk of Narrow Medians Using Reliability Analysis. Journal of Transportation Engineering, 132(5), 366-375. doi:10.1061/(asce)0733-947x(2006)132:5(366)Harwood, D. W., Gilmore, D. K., & Richard, K. R. (2010). Criteria for Passing Sight Distance for Roadway Design and Marking. Transportation Research Record: Journal of the Transportation Research Board, 2195(1), 36-46. doi:10.3141/2195-05Wang, Y., & Cartmell, M. P. (1998). New Model for Passing Sight Distance on Two-Lane Highways. Journal of Transportation Engineering, 124(6), 536-545. doi:10.1061/(asce)0733-947x(1998)124:6(536)Polus, A., Livneh, M., & Frischer, B. (2000). Evaluation of the Passing Process on Two-Lane Rural Highways. Transportation Research Record: Journal of the Transportation Research Board, 1701(1), 53-60. doi:10.3141/1701-07Llorca, C., & García, A. (2011). Evaluation of Passing Process on Two-Lane Rural Highways in Spain with New Methodology Based on Video Data. Transportation Research Record: Journal of the Transportation Research Board, 2262(1), 42-51. doi:10.3141/2262-05Carlson, P., Miles, J., & Johnson, P. (2006). Daytime High-Speed Passing Maneuvers Observed on Rural Two-Lane, Two-Way Highway: Findings and Implications. Transportation Research Record: Journal of the Transportation Research Board, 1961, 9-15. doi:10.3141/1961-02Llorca, C., Moreno, A. T., García, A., & Pérez-Zuriaga, A. M. (2013). Daytime and Nighttime Passing Maneuvers on a Two-Lane Rural Road in Spain. Transportation Research Record: Journal of the Transportation Research Board, 2358(1), 3-11. doi:10.3141/2358-01Easa, S. M. (1993). Reliability‐Based Design of Intergreen Interval at Traffic Signals. Journal of Transportation Engineering, 119(2), 255-271. doi:10.1061/(asce)0733-947x(1993)119:2(255)Selvanathan, E. A., & Selvanathan, S. (1994). The demand for transport and communication in the United Kingdom and Australia. Transportation Research Part B: Methodological, 28(1), 1-9. doi:10.1016/0191-2615(94)90027-2Easa, S. M. (2000). Reliability Approach to Intersection Sight Distance Design. Transportation Research Record: Journal of the Transportation Research Board, 1701(1), 42-52. doi:10.3141/1701-06Ibrahim, S. E.-B., & Sayed, T. (2011). Developing safety performance functions incorporating reliability-based risk measures. Accident Analysis & Prevention, 43(6), 2153-2159. doi:10.1016/j.aap.2011.06.006Khoury, J. E., & Hobeika, A. G. (2007). Assessing the Risk in the Design of Passing Sight Distances. Journal of Transportation Engineering, 133(6), 370-377. doi:10.1061/(asce)0733-947x(2007)133:6(370)Khoury, J. E., & Hobeika, A. G. (2012). Integrated Stochastic Approach for Risk and Service Estimation: Passing Sight Distance Application. Journal of Transportation Engineering, 138(5), 571-579. doi:10.1061/(asce)te.1943-5436.0000366Kim, S., & Choi, J. (2013). Effects of preceding geometric conditions on operating speed consistency of multilane highways. Canadian Journal of Civil Engineering, 40(6), 528-536. doi:10.1139/cjce-2012-005