Staff experiences of Providing Maternity Services in Rural Southern Tanzania -- A Focus on Equipment, Drug and Supply Issues.

The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse maternal outcomes through delaying care provision. We aim to describe staff experiences of providing maternal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items. The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures that carried potential health risks to themselves as a result. Inadequately stocked and equipped facilities compromise the health system's ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions

Analysis of Heat-Exercise Cross Adaptation in Hot Dry Sauna

熱帯地非スポーツマン(タンザニア)と日本人スポーツマン(短距離走者)を環境制御実験装置(気温28℃,湿度60%)に安静にさせた後,低温サウナ(60-70℃)で30分間暑熱負荷を加え(n=4 period),体重,皮膚温,心拍数,血圧,呼吸数,代謝量の変化を連続記録解析した.暑熱負荷中の熱帯地非スポーツマンの心拍数・代謝量の増加率は日本人スポーツマンの増加率より低かった.しかし熱帯地非スポーツマンでは,かなりの呼吸数増加が観察され,特に深呼吸後に見られた浅速呼吸は,ヒトに熱放散現象であるパンディング現象の残存が示唆された.この熱帯地非スポーツマンから得られた結果は遺伝的に獲得された熱耐性であり,日本人スポーツマンのそれは暑熱と運動の協調による体温調節反応量の増加によると考えられる.A tropical resident (non-sportsman) and a Japanese sportsman (sprinter) were the subjects in this study. The changes in metabolic rate, respiratory rate, pulse rate, blood pressure, skin temperature and body weight during 30 minutes sauna heat load (60-70℃) were measured after 30 minutes resting in the climate chamber (28℃, 60% r.h.). The mean increase of pulse rate and metabolic rate in the tropical subject were small compared to those of the Japanese sportsman (in both subjects, n=4 period of experiments). But considerable increase of respiratory rate and in a few case the rapid and shallow breathing similar to thermal panting were observed in the tropical subject. The results obtained from the tropical subject may be closely related to his inherent constitutional characteristic and his acquired heat tolerance, and those of the Japanese sportsman may be due to the enhanced ability of heat production and effective heat loss response owing to larger cross adaptability by co-operation of heat and exercise load

Noise induced hearing loss among industrial workers in Dar es Salaam

Objectives: To determine whether sound in the study areas was of sufficient intensity to cause hearing loss and if so whether those exposed have been affected and to determine whether workers/employees in the study areas were aware that sound can cause hearing loss and if so whether they knew that this can be prevented by ear protection. Design: Cross-sectional study Setting: Industrial area A and B randomly selected from among industries in Dar es Salaam. Subjects: One hundred and fifty workers from area A and fifty two employees from area B. Method: A questionnaire was filled and had their hearing thresholds measured by a pure tone audiometer machine. Results: In both study areas the noise levels were above the safe limit of 85dB(A). In area A 28 workers and in area B eight employees had noise induced hearing loss. In area A 81.1% of the workers and in area B 85% of the employees knew that noise causes hearing loss. All workers/employees from both study areas knew that noise induced hearing loss could be prevented by some form of ear protection. Conclusion: Workers/Employees exposed to noise above 85dB(A) will eventually develop hearing loss. Workers/employees are aware of this hazard. There is therefore a need to educate those exposed on how best to protect their ears from the hazard and provide them with protective gear. (East African Medical Journal: 2003 80(6): 298-302

Autonomic Nervous Tones in Chronic Spinal Rats

慢性脊髄動物の自律神経のToneをLin and Horvathの方法で測定評価し,脊髄無傷動物の場合と比較検討した。Wistar系雄ラットの頚髄下端をPentobarbital麻酔下で吸引除去し,室温30℃で飼育したものを慢性脊髄ラットとした.実験は室温30℃において,無麻酔,半拘束状態で約90分放置した後に,硫酸アトロピン1mg/kg又は塩酸プロプラノロール8mg/kgを腹腔内に投与し,その後の心拍数の変化から交感及び副交感神経の活動による心拍の増加及び減少幅を計算し,それらのintrinsicな心拍数(HR(o))(計算で求められた)に対する百分率を求め,各々副交感神経のTone (PT)及び交感神経のTone (ST)とした.30℃に順化した脊髄無傷の対照群では,HR(o): 362 beats/min, PT: 22.5%, ST: 24.4%と計算された.一方脊髄切断後,1週から6週後の34例(アトロピンとプロプラノロールの合計例数)の慢性脊髄ラットでは,HR(o): 350 beats/min, PT: 16.6%, ST: 15.7%と計算された.慢性脊髄動物の交感・副交感神経のToneは,脊髄無傷の対照群に比して低い値を示した.この事から,慢性脊髄動物の体温調節能等の自律機能の回復に,副交感神経のToneの変化も含めた新しい自律神経バランスの形成の関与が示唆された.Sympathetic and parasympathetic nervous tones and ability of temperature regulation were compared in spinal-intact control rats and in chronic spinal rats. The lower cervical cord of male Wistar rats was transected under pentobarbital anesthesia, and the rats were reared in a room of 30℃. For the experiment, each rat was placed in wire-meshed small cage in the climatic chamber (30℃, 60%, r.h). Ninety minutes after the beginning of recording, atropine sulfate (1mg/kg, i.p.) or propranolol hydrochloride (8mg/kg, i.p.) was injected. Cardiac parasympathetic and sympathetic tones were evaluated by heart rate (HR) change after the medication. Rectal temperature (Tre), tail skin temperature (Ttail) and HR were evaluated for 30 min before the medication. Mean Tre (M. ± S.E.) in control was 38.0±0.1℃, and those in the 1st, 2nd and 3rd week after spinalization were 36.1±0.2℃, 37.0±0.3℃ and 37.3±0.3℃, respectively. Resting HR (HR(norm.)) in control was 369±6 beats/min, and those in the 1st, 2nd and 3rd week after spinalization were 330±19 beats/min, 344±10 beats/min and 341±9 beats/min, respectively. The excess temperatures (dT) of the tail skin over the environmental temperature in the 1st to 3rd week were significantly higher (p<0.05) than in the control. In chronic spinal rats, there was a negative correlation between the increase in heart rate by atropine (HR(p)) and HR(norm.), and a positive correlation between the decrease in heart rate by propranolol (HR(s)) and HR(norm.). In control rats, parasympathetic tone (PT) and sympathetic tone (ST) were calculated as 22.5% and 24.4%, while in chronic spinal rats (from 1st to 6th week after spinalization), PT and ST were 16.6% and 15.7%, respectively. From these results it is presumed that the change in parasympathetic tone also may be a contributing factor in the recovery of the autonomic functions in chronic spinal animals

Transcatheter edge-to-edge repair in proportionate versus disproportionate functional mitral regurgitation

Background: Functional mitral regurgitation (FMR) can be subclassified on the basis of its proportionality relative to left ventricular (LV) volume and function, indicating potential differences in underlying etiology. The aim of this study was to evaluate the association of FMR proportionality with FMR reduction, heart failure hospitalization and mortality after transcatheter edge-to-edge mitral valve repair (TEER). Methods: This multicenter registry included 241 patients with symptomatic heart failure with reduced LV ejection fraction treated with TEER for moderate to severe or greater FMR. FMR proportionality was graded on preprocedural transthoracic echocardiography using the ratio of the effective regurgitant orifice area to LV end-diastolic volume. Baseline characteristics, follow-up transthoracic echocardiography, and 2-year clinical outcomes were compared between groups. Results: Median LV ejection fraction, effective regurgitant orifice area and LV end-diastolic volume index were 30% (interquartile range [IQR], 25%–35%), 27 mm2, and 107 mL/m2 (IQR, 90–135 mL/m2), respectively. Median effective regurgitant orifice area/LV end-diastolic volume ratio was 0.13 (IQR, 0.10–0.18). Proportionate FMR (pFMR) and disproportionate FMR (dFMR) was present in 123 and 118 patients, respectively. Compared with patients with pFMR, those with dFMR had higher baseline LV ejection fractions (median, 32% [IQR, 27%–39%] vs 26% [IQR, 22%–33%]; P <.01). Early FMR reduction with TEER was more pronounced in patients with dFMR (odds ratio, 0.45; 95% CI, 0.28–0.74; P <.01) than those with pFMR, but not at 12 months (odds ratio, 0.93; 95% CI, 0.53–1.63; P =.80). Overall, in 35% of patients with initial FMR reduction after TEER, FMR deteriorated again at 1-year follow-up. Rates of 2-year all-cause mortality and heart failure hospitalization were 30% (n = 66) and 37% (n = 76), with no differences between dFMR and pFMR. Conclusions: TEER resulted in more pronounced early FMR reduction in patients with dFMR compared with those with pFMR. Yet after initial improvement, FMR deteriorated in a substantial number of patients, calling into question durable mitral regurgitation reductions with TEER in selected patients. The proportionality framework may not identify durable TEER responders