Indigenous women managing pregnancy complications in rural Ecuador

Previous research has explored the potential use of digital health to support maternal health in the Global South highlighting the importance of understanding the socio-cultural context to inform system design. However, the experiences of indigenous women managing pregnancy complications in Latin America remain underexplored in HCI. We present a qualitative study with 25 indigenous pregnant women in an Ecuadorian rural community looking at their experiences during complications, their antenatal care visits and their access and use of technologies. Our findings highlight key barriers that hinder the use of antenatal care services and influence women's experiences managing complications. Based on the findings, we present opportunities for digital health centered on indigenous women to enhance antenatal care in rural Ecuador

Granulocyte-colony stimulating factor for acute-on-chronic liver failure: systematic review and meta-analysis

Acute-on-chronic liver failure (ACLF) is associated with increased short and long-term mortality. Animal models of liver failure have demonstrated that granulocyte-colony stimulating factor (G-CSF) accelerates the liver regeneration process and improves survival. However, clinical evidence regarding the use of G-CSF in ACLF remains scarce. The aim of this study was to assess the benefits and harms of G-CSF in patients with acute-on-chronic liver failure. An electronic search was made in The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS up to November 2013. Randomized clinical trials comparing the use of any regimen of G-CSF against placebo or no intervention in patients with ACLF were included. Primary outcomes included overal mortality, mortality due multi-organ failure, and adverse events. Relative risk (RR) and mean difference (MD) were used. Two trials involving 102 patients were included. A significant reduction in short-term overall mortality was observed in patients receiving G-CSF compared to controls (RR 0.56; 95%CI 0.39,0.80). G-CSF failed to reduce mortality secondary to gastrointestinal bleeding (RR 1.45; 95%CI 0.50, 4.27). Adverse effects reported included: fever, rash, herpes zoster, headache and nausea. In conclusion, the use of G-CSF for the treatment of patients with ACLF significantly reduced short-term mortality. While the evidence is still limited, the apparent benefit observed on short-term mortality, mild adverse effects and lack of an alternative therapy make the use of G-CSF in ACLF patients a reasonable alternative when liver transplantation is contraindicated or unavailable

Passive air sampling of organochlorine pesticides in Mexico.

The spatial and temporal variation of organochlorine pesticides (OCs) in air across Mexico was investigated by deploying passive samplers at eleven stations across the country during 2005−2006. Integrated samples were taken over three-month periods and quantified for DDT compounds,endosulfans, toxaphenes, components of technical chlordane, hexachlorocyclohexanes (HCHs), and dieldrin. Enantiomers of chiral chlordanes and o,p′-DDT were determined on chiral stationary phase columns as an indicator of source and age. Results are discussed in combination with pumped air samples taken at four other stations in southern Mexico during 2002−2004. DDT and its metabolites, endosulfan and toxaphene were the most abundant OCs detected in all sampling sites. Atmospheric concentrations of ΣDDT (p,p′-DDT + o,p′-DDT + p,p′-DDE + o,p′-DDE + p,p′-DDD + o,p′-DDD) ranged from 15 to 2360 pg m−3 with the highest concentrations found in southern Mexico and the lowest found in northern and central Mexico. A fresher DDT residue was observed at sites with greater DDT use and in the southern part of the country, as shown from the higher FDDTe = p,p′-DDT/(p,p′-DDT + p,p′-DDE) and nearly racemic o,p′-DDT. This agrees with the former heavy use of DDT in the endemic malarious area of the country. A local hotspot of endosulfan was identified at an agricultural area in Mazatlan, Sinaloa, with a annual mean concentration of ΣENDO (endosulfans I + II + endosulfan sulfate) = 26,800 pg m−3. At this site, higher concentrations of ΣENDO were recorded during the winter (November to February) and spring (February to May) periods. From back trajectory analysis, this coincides with a shift in the air mass coming from the Pacific Ocean (May to November) to the inland agricultural area (November to May). The elevated ΣENDO observed is likely due to the local agricultural usage. HCHs, chlordanes, trans-nonachlors, and dieldrin were more evenly distributed across the country likely due to them being aged residues and more diffuse in the environment. In contrast, hotspots of endosulfans, DDTs, and toxaphenes were observed as they were heavily used in localized agricultural or malarious regions of Mexico