How the internet increases modern contraception uptake: evidence from eight sub-Saharan African countries

Background Sub-Saharan African (SSA) countries have the highest worldwide levels of unmet need for modern contraception. This has led to persistently high fertility rates in the region, rates which have had major adverse repercussions on the development potential there. Family planning programmes play a key role in improving the uptake of modern contraception, both by fostering women’s health and by lowering their fertility. Increasing awareness of contraception benefits is a major component of such programmes. Here, we ask whether internet access can bridge the gap between women’s need for modern contraception and women’s uptake of the same. Methods We use a compendium of data for 125 242 women, aged 15–49, from the Demographic Health Survey, Akamai and International Communication Union data, covering eight SSA countries, for the period 2014–2019. We apply a Two-Stage Least Square model, using as instruments for individual internet exposure the distance to the main server in the country and whether the backbone network in the country has been connected to at least one submarine cable. Results Internet exposure, measured as women access the internet at least monthly (almost daily), is associated with a positive, 11.4% (95% CI 10.6% to 12.2%) (53.8% (95% CI 13.4% to 94.1%)), increase in modern contraception uptake. Education is an important moderator. Poorly educated women benefit the most from internet exposure. Discussion Internet exposure appears to have significantly increased the uptake of modern contraception among sub-Saharan women. The poorly educated appear particularly to benefit. There are two mechanisms at play: the internet increases women’s knowledge of contraception; and, in parallel, fosters their empowerment

Antimicrobial Treatment of Staphylococcus aureus in Patients with Cystic Fibrosis

Staphylococcus aureus is a ubiquitous human commensal pathogen. It is commonly isolated in cystic fibrosis (CF) patients and is considered one of the main causes of the recurrent acute pulmonary infections and progressive decline in lung function that characterize this inherited life-threatening multisystem disorder. However, the true role of S. aureus in CF patients is not completely understood. The main aim of this narrative review is to discuss the present knowledge of the role of S. aureus in CF patients. Literature review showed that despite the fact that the availability and use of drugs effective against S. aureus have coincided with a significant improvement in the prognosis of lung disease in CF patients, clearly evidencing the importance of S. aureus therapy, how to use old and new drugs to obtain the maximal effectiveness has not been precisely defined. The most important problem remains that the high frequency with which S. aureus is carried in healthy subjects prevents the differentiation of simple colonization from infection. Moreover, although experts recommend antibiotic administration in CF patients with symptoms and in those with persistent detection of S. aureus, the best antibiotic approach has not been defined. All these problems are complicated by the evidence that the most effective antibiotic against methicillin-resistant S. aureus (MRSA) cannot be used in patients with CF with the same schedules used in patients without CF. Further studies are needed to solve these problems and to assure CF patients the highest level of care

Does bribery increase maternal mortality? Evidence from 135 Sub-Saharan African regions

About 295,000 women died globally during and following pregnancy and childbirth in 2017. Two-thirds of these deaths occurred in Sub-Saharan Africa. By linking individual and regional data from 135 regions in 17 Sub-Saharan African countries over the period 2002–2018 this study explores how bribery affects maternal mortality in Sub-Saharan Africa. Our results show that the percentage of people who had first-hand experience in bribery is significantly and positively associated with pregnancy related deaths. We find that a 10 p.p. increase in the prevalence of bribery is associated with up to 41 [95% CI: 10–73] additional deaths for every 1,000 pregnancy-related deaths. However, the healthcare system quality appears to be an important moderator. To reduce maternal mortality, policy makers should not only increase investments in healthcare, they need also to implement measures to combat corruption.</jats:p

Impairment of platelet function in both mild and severe COVID-19 patients

Abnormalities of platelet function were reported in patients with severe COVID-19 (severe-C), but few data are available in patients with mild COVID-19 (mild-C) and after COVID-19 recovery. The aim of this study was to investigate platelet parameters in mild-C patients (n = 51), with no evidence of pneumonia, and severe-C patients (n = 49), during the acute phase and after recovery, compared to 43 healthy controls. Both mild-C and severe-C patients displayed increased circulating activated platelets, low d-granule content (ADP, serotonin), impaired platelet activation by collagen (light transmission aggregometry) and impaired platelet thrombus formation on collagen-coated surfaces under controlled flow conditions (300/s shear rate). The observed abnormalities were more marked in severe-C patients than in mild-C patients. Overall, 61% (30/49) of mild-C and 73% (33/45) of severe-C patients displayed at least one abnormal platelet parameter. In a subgroup of just 13 patients who showed no persisting signs/symptoms of COVID-19 and were re-evaluated at least 1 month after recovery, 11 of the 13 subjects exhibited normalization of platelet parameters. In conclusion, mild abnormalities of platelet parameters were present not only in severe-C but also, albeit to a lesser extent, in mild-C patients during the acute phase of COVID-19 and normalized in most tested patients after clinical recovery

Childbearing intentions in a low fertility context: the case of Romania

This paper applies the Theory of Planned Behaviour (TPB) to find out the predictors of fertility intentions in Romania, a low-fertility country. We analyse how attitudes, subjective norms and perceived behavioural control relate to the intention to have a child among childless individuals and one-child parents. Principal axis factor analysis confirms which items proposed by the Generation and Gender Survey (GGS 2005) act as valid and reliable measures of the suggested theoretical socio-psychological factors. Four parity-specific logistic regression models are applied to evaluate the relationship between the socio-psychological factors and childbearing intentions. Social pressure emerges as the most important aspect in fertility decision-making among childless individuals and one-child parents, and positive attitudes towards childbearing are a strong component in planning for a child. This paper also underlines the importance of the region-specific factors when studying childbearing intentions: planning for the second child significantly differs among the development regions, representing the cultural and socio-economic divisions of the Romanian territory

Sarilumab plus standard of care vs standard of care for the treatment of severe COVID-19: a phase 3, randomized, open-labeled, multi-center study (ESCAPE study)

Background Among interleukin-6 inhibitors suggested for use in COVID-19, there are few robust evidences for the efficacy of sarilumab. Herein, we evaluated the efficacy and safety of sarilumab in severe COVID-19.Methods In this phase 3, open-labeled, randomized clinical trial, conducted at 5 Italian hospitals, adults with severe COVID-19 pneumonia (excluding mechanically ventilated) were randomized 2:1 to receive intravenous sarilumab (400 mg, repeatable after 12 h) plus standard of care (SOC) (arm A) or to continue SOC (arm B). Randomization was web-based. As post-hoc analyses, the participants were stratified according to baseline inflammatory parameters. The primary endpoint was analysed on the modified Intention-To-Treat population, including all the randomized patients who received any study treatment (sarilumab or SOC). It was time to clinical improvement of 2 points on a 7-points ordinal scale, from baseline to day 30. We used Kaplan Meier method and log-rank test to compare the primary outcome between two arms, and Cox regression stratified by clinical center and adjusted for severity of illness, to estimate the hazard ratio (HR). The trial was registered with EudraCT (2020-001390-76).Findings Between May 2020 and May 2021, 191 patients were assessed for eligibility, of whom, excluding nine dropouts, 176 were assigned to arm A (121) and B (55). At day 30, no significant differences in the primary endpoint were found (88% [95% CI 81-94] in arm A vs 85% [74-93], HR 1.07 [0.8-1.5] in arm B; log-rank p = 0.50). After stratifying for inflammatory parameters, arm A showed higher probability of improvement than B without statistical significance in the strata with C reactive protein (CRP) &lt; 7 mg/dL (88% [77-96] vs 79% [63-91], HR 1.55 [0.9-2.6]; log-rank p = 0.049) and in the strata with lymphocytes &lt;870/mmc (90% [79-96]) vs (73% [55-89], HR 1.53 [0.9-2.7]; log-rank p = 0.058). Overall, 39/121 (32%) AEs were reported in arm A and 14/55 (23%) in B (p = 0.195), while serious AEs were 22/121 (18%) and 7/55 (11%), respectively (p = 0.244). There were no treatment-related deaths.Interpretation The efficacy of sarilumab in severe COVID-19 was not demonstrated both in the overall and in the stratified for severity analysis population. Exploratory analyses suggested that subsets of patients with lower CRP values or lower lymphocyte counts might have had benefit with sarilumab treatment, but this finding would require replication in other studies. The relatively low rate of concomitant corticosteroid use, could partially explain our results.Funding This study was supported by INMI "Lazzaro Spallanzani" Ricerca Corrente Linea 1 on emerging and ree-merging infections, funded by Italian Ministry of Health.Copyright (c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

MOVING INTO PERI-URBAN MOSAICS. Building resilient relationships along the margins: the Green System Plan of Ravenna for a new liveability

The ongoing process of urbanization and its expression in intensive land exploitation, fragmentation of natural areas and cycles gave shape to our cities. A renewed centrality of the soil guaranteeing essential functions and services for the local communities’ welfare is necessary, particularly in zones of friction and marginality such as urban voids and peri-urban fringes. Bearing in mind the definition of a mosaic where the settlement, the agricultural and the environmental systems interact and coexist together (Kipar, 1994), a formal and functional reconstruction of peri-urban fringes is crucial: they could give back a sense and the identity to the undefined spaces produced by a controversial planning tradition, due to their potential of conversion and transformation. The paper deals with a clarified reciprocity between built environment and open territory, outlining project actions measured to the current challenge – such as climate changes –, setting infrastructural intervention and new energy sources. Focusing on the case study of the Green System Plan of Ravenna (Italy), the attention is given to model planning policies towards design actions able to create physical and ecological connections between the city and the territory. Therefore, the peri-urban fringes become places of experimentation, guaranteeing the interaction between different functional layers and improving the urban resilience: the result is the coexistence of the anthropic development with the preservation and implementation of environmental ecosystems, in a systemic and programmatic vision, throughout landscape ecology design approach for a resilient and ecological city. Within this system, the infrastructures would have a renewed role in building miscellaneous geographies between urban and rural areas and on landscapes vulnerability: the defined resilient factors and spaces could be innervated along the main corridors, grafting onto the obsolete and dismissed urban spaces, in an osmotic process and a wider vision of urban metabolism recovering the elements of the city

Processing Nature, beyond the antinomy of ecological pretence in contemporary planning. A critical understanding

In the still dominant perception of a hierarchical order of nature, humans are disturbing ecosystems factors. We should move away from the one-dimensional dichotomy between natural and human interaction towards a more effective representation without nostalgia. The contact between human and natural habitats is close to the idea of maintaining and conserving a certain state of equilibrium, instead of letting natural habitats evolve into new ecosystems. In other words, energy management and the capacity of a system to self-organize (autopoiesis) defines the difference between human and natural habitats. Where this capacity is not limited, a natural habitat is present. Contemporary landscapes (tourist coasts, reclaimed land, etc.) demonstrate this thesis by highlighting how human intervention is an indispensable factor in their maintenance. It is necessary to provide precise and sophisticated tools capable of synthesizing agents and forces within territorial transformations starting from a global understanding of natural processes. Ecological dynamics must be transformed into project parameters involved within design process. Here a further degree of integration is suggested above the level of simple natural ecosystems, where human is assumed as a key factor in landscape transformation and geography construction. Considering other paradigms that interfere with the same epistemological area, the contribution questions the theoretical and practical implications of rethinking the interaction between natural and artificial ecosystems within the framework of landscape resilience. This perspective allows a territorial update by increasing the level of compatibility between the evolution of human habitat and the maintenance of natural regeneration times. This articulation, however, requires a reconsideration of landscape aesthetics beyond the beautiful and the consolatory, as well as a fundamental shift in landscape thinking from representation to action

Processing Nature, beyond the antinomy of ecological pretence in contemporary planning. A critical understanding

In the still dominant perception of a hierarchical order of nature, humans are disturbing ecosystems factors. We should move away from the one-dimensional dichotomy between natural and human interaction towards a more effective representation without nostalgia. The contact between human and natural habitats is close to the idea of maintaining and conserving a certain state of equilibrium, instead of letting natural habitats evolve into new ecosystems. In other words, energy management and the capacity of a system to self-organize (autopoiesis) defines the difference between human and natural habitats. Where this capacity is not limited, a natural habitat is present. Contemporary landscapes (tourist coasts, reclaimed land, etc.) demonstrate this thesis by highlighting how human intervention is an indispensable factor in their maintenance. It is necessary to provide precise and sophisticated tools capable of synthesizing agents and forces within territorial transformations starting from a global understanding of natural processes. Ecological dynamics must be transformed into project parameters involved within design process. Here a further degree of integration is suggested above the level of simple natural ecosystems, where human is assumed as a key factor in landscape transformation and geography construction. Considering other paradigms that interfere with the same epistemological area, the contribution questions the theoretical and practical implications of rethinking the interaction between natural and artificial ecosystems within landscape design. This perspective allows a territorial update by increasing the level of compatibility between the evolution of human habitat and the maintenance of natural regeneration times. This articulation, however, requires a reconsideration of landscape aesthetics beyond the beautiful and the consolatory, as well as a fundamental shift in landscape thinking from representation to action

Innesti. Tra progetto di paesaggio e gestione dei rischi territoriali nel paesaggio agrario. Il caso studio di Mezzano all'interno del PAESC di Ravenna.

Le aree rurali rappresentano, per estensione, l’ambito che caratterizza maggiormente il territorio di Ravenna. L’alterazione delle caratteristiche idrogeologiche originarie rende i territori agricoli soggetti a rischio idraulico, esondazioni dei canali di scolo e difficoltà di drenaggio superficiale, associati a fenomeni di siccità sempre più prolungati in certi periodi dell’anno. Il cambiamento climatico amplifica tali rischi. Nella visione di adattamento territoriale al cambiamento climatico del Comune di Ravenna, per l’ambito rurale si propongono strategie volte a ridurre i rischi a cui ad oggi il territorio è esposto assieme all’ottimizzazione dell’uso di acqua come fonte irrigua, associandolo ad espedienti progettuali per dare continuità agli habitat presenti oggi frammentati dalla parcellizzazione del terreno e dalla trasfigurazione dell’assetto originario. Questa strategia è illustrata attraverso un focus progettuale situato nella località Mezzano, contenuto all’interno del PAESC redatto dal Comune insieme ad un contributo di ricerca dell’Università di Ferrara e degli autori volto a indagare la trasformazione del paesaggio in un’operazione di adattamento territoriale al cambiamento climatico. La proposta ha l’obiettivo di razionalizzare gli interventi progettuali per renderli efficaci nella gestione dei rischi individuati e delle future criticità da includere nella pianificazione a scala territoriale. Ne deriva un paesaggio rinnovato e performante e capace di evolversi verso diversi scenari futuri di adattamento.Rural areas represent, by extension, the area that most characterizes the Ravenna administrative area. The modification of the original hydrogeological characteristics makes agricultural areas subject to hydraulic risk, flooding of drainage channels and difficulties in surface drainage, associated with increasingly prolonged drought phenomena. Climate change amplifies the risks mentioned. In the vision of territorial adaptation to climate change, the Municipality of Ravenna proposes strategies for the rural area for reducing the risks to which the territory is currently exposed together with the optimization of the use of water as an irrigation source associated with design expedientes envisioned to give continuity to the presence of habitats, presently fragmented by the parcellization of the land and the transfiguration of the original structure. The strategy is illustrated through a design focus located in Mezzano, contained within the SECAP drawn up by the Municipality together with a research contribution from the University of Ferrara and the author, aimed at investigating the transformation of the landscape in relationship to the territorial adaptation to climate change. The aim is to rationalize the interventions making them effective in the management of the identified risks, becoming an integral and performing part of the landscape that continues to evolve with respect to new critical issues to be included in planning on a territorial scale