Implications for school nurses using simulator dolls to manage unplanned teen pregnancy.

Background: School nurses are key professionals in the promotion of sexual and reproductive health which should include using high fidelity baby simulator dolls. Aim: To explore teenager’s perceptions of their practical parenting skills and their attitudes towards experiential learning from using high fidelity baby simulators. Methods: Virtual baby simulator dolls were used as part of sex and relationship education with school pupils (aged 15-16 years) to look after over a weekend. Pupils were recruited from a UK Academy and completed a diary of their experiences while parenting, received quantitative feedback simulator reports and completed a post-study evaluation questionnaire. Findings: Pupils saw the virtual baby project as beneficial and important in schools and perceived an improvement in their understanding of practical parenting skills, sexual health and contraception. Conclusion: The implications of this paper are towards involving school nurses more actively in sexual health education in schools via the use of high fidelity simulators as creative pedagogy in Personal Sexual Health Education (PSHCE)

Trench layering using indole-3-butyric acid and local organic substrate mixtures to enhance rooting and survival of apple rootstocks

Apples ( Malus domestica ) were introduced to enhance nutrition and improve livelihoods of famers in highlands of Uganda. However, adoption and commercialisation of apples is largely constrained by low quality rootstocks due to poor rooting and low survivability. This study determined the effect of organic substrate mixtures (OSM) and indole-3-butyric acid (IBA) on rooting, sprouting and survival characteristics of apple rootstocks propagated by trench layering. Four apple rootstock varieties (M106, M109, MM793 and bitten-felder) were planted in OSM (Site soil as control, TsaOm and TsdOm) then treated with IBA concentrations (IBA-0 ppm, IBA-4000 ppm and IBA-8000 ppm) in a factorial randomised block design with three replications. Results showed significant (P<0.001) variability among rootstocks for all characters. OSM significantly (P<0.01) increased rooting, root numbers and root length while IBA significantly (P<0.01) increased all traits, except rooting. The highest rooting (46.7%), root numbers (23.1) and root length (14.9cm), and sprout length (59.5cm) were obtained in bitten felder under TsaOm + IBA-4000ppm, TsaOm, and TsdOm, respectively. For M106, maximum rooting (28.1%) and root numbers (22.3) were obtained under TsaOm + IBA-8000ppm while root (14.3cm) and sprout (35.2cm) lengths under TsdOm. TsaOm gave the highest root numbers (14.2), root (12.8cm) and sprout (30.7cm) lengths in M109 likewise root (7.8cm) and sprout (38.3cm) lengths in MM793. Logistic regression revealed that rooting, sprout length, and IBA-4000ppm significantly (P<0.01) increased survival of apple rootstocks. The highest survival rates in bitten felder and M106 were 52.4% and 51.7% under TsdOm + IBA-4000 ppm and TsdOm + IBA-8000 ppm respectively; likewise 49.5% in M109 and 51.7% in MM793 both treated with IBA-8000 ppm. The results demonstrate that trench layering with OSM and IBA improves rooting and survival of apple rootstocks which might improve farmers\u2019 access to quality apple planting material.Les pommes ( Malus domestica ) \ue9taient introduites pour renforcer la nutrition et am\ue9liorer le niveau de vie des producteurs dans les r\ue9gions montagneuses d\u2019Ouganda. Toutefois, l\u2019adoption et la commercialisation des pommes sont largement limit\ue9es par la faible qualit\ue9 des porte-greffes \ue0 cause du pauvre enracinement et la faible capacit\ue9 de survie. Cette \ue9tude visait \ue0 d\ue9terminer l\u2019effet des m\ue9langes du substrat organique (OSM) et l\u2019acide indole-3-butyrique (IBA) sur l\u2019enracinement, la germination et les caract\ue9ristiques de survie des porte-greffes de la pomme propag\ue9e par le marcottage de tranch\ue9e. Quatre portes greffes des vari\ue9t\ue9s de pomme (M106, M109, MM793 et bitten-felder) \ue9taient plant\ue9es dans l\u2019OSM (site de sol servant de contr\uf4le, TsaOm et TSdOm) et trait\ue9e avec diff\ue9rentes concentrations de l\u2019IBA (IBA-0 ppm, IBA-4000 ppm et IBA-8000 ppm) dans un design factoriel \ue0 blocks compl\ue8tement al\ue9atoires avec trois r\ue9plications. Les r\ue9sultats ont montr\ue9 de variabilit\ue9 significative (P<0,001) entre les porte-greffes des vari\ue9t\ue9s pour tous les caract\ue8res. OSM significativement (P<0.01) a fait accro\ueetre l\u2019enracinement, le nombre de racines et la longueur de la racine; alors que IBA a augment\ue9 significativement (P<0.001) tous les traits, sauf l\u2019enracinement. Les plus grandes valeurs des caract\ue8res \ue0 savoir\ua0; l\u2019enracinement (46,7%), le nombre de racines (23,1), la longueur des racines (14,9 cm), et la longueur des pousses (59,5cm) \ue9taient obtenues sur bitten felder sous TsaOm + IBA-4000ppm, TsaOm, et TsdOm, respectivement. Pour M106, les valeurs maximales de l\u2019enracinement (28,1%) et de nombre de racines (22.3) \ue9taient obtenues sous TsaOm + IBA-8000ppm alors que les valeurs maximales de la longueur des racines (14,3 cm) et des pousses (35,2 cm) sous TsdOM. TsaOm ont donn\ue9 le plus grand nombre de racines (14,2), la plus grande longueur des racines (12,8 cm) et de pousses (30,7 cm) dans M109 pareillement \ue0 la longueur des racines (7,8 cm) et de pousses (38,3 cm) dans MM793. La r\ue9gression logistique a r\ue9v\ue9l\ue9 que l\u2019enracinement, la longueur de la pousse et IBA-400ppm ont augment\ue9 significativement (P<0,01) la survie des porte-greffes de la pomme. Les plus forts taux de survies sur le bitten felder et M106 \ue9taient 52,4% et 51,7% sous TsdOm+IBA-4000 ppm et TsdOm+IBA-8000 ppm, respectivement\ua0; de m\ueame 49,5% ont \ue9t\ue9 obtenus sur M109 et 51,7% sur MM793 tous trait\ue9s avec IBA-8000 ppm. Les r\ue9sultats ont d\ue9montr\ue9 que le marcottage de tranch\ue9e avec OSM et IBA am\ue9liore l\u2019racinement et la survie des porte-greffes qui pourrait am\ue9liorer l\u2019acc\ue8s des producteurs \ue0 des mat\ue9riels de plantation de pomme de qualit\ue9

Crossing cultural divides: a qualitative systematic review of factors influencing the provision of healthcare related to female genital mutilation from the perspective of health professionals

Introduction As a result of global migration, health professionals in destination countries are increasingly being called upon to provide care for women and girls who have experienced female genital mutilation/cutting (FGM/C). There is considerable evidence to suggest that their care experiences are sub-optimal. This systematic review sought to illuminate possible reasons for this by exploring the views, experiences, barriers and facilitators to providing FGM-related healthcare in high income countries, from health professionals’ perspectives. Methods Sixteen electronic databases/resources were searched from inception to December 2017, supplemented by reference list searching and suggestions from experts. Inclusion criteria were: qualitative studies (including grey literature) of any design, any cadre of health worker, from OECD countries, of any date and any language. Two reviewers undertook screening, selection, quality appraisal and data extraction using tools from the Joanna Briggs Institute (JBI). Synthesis involved an inductive thematic approach to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using GRADE-CERQual. The review protocol was registered with PROSPERO (CRD420150300042015). Results Thirty papers (representing 28 distinct studies) from nine different countries were included. The majority of studies focused on maternity contexts. No studies specifically examined health professionals’ role in FGM/C prevention/safeguarding. There were 20 descriptive themes summarised into six analytical themes that highlighted factors perceived to influence care: knowledge and training, communication, cultural (mis)understandings, identification of FGM/C, clinical management practices and service configuration. Together, these inter-linked themes illuminate the ways in which confidence, communication and competence at provider level and the existence and enactment of pathways, protocols and specialist support at service/system level facilitate or hinder care. Conclusions FGM/C is a complex and culturally shaped phenomenon. In order to work effectively across cultural divides, there is a need for provider training, clear guidelines, care pathways and specialist FGM/C centres to support mainstream services

Seeking culturally safe care: a qualitative systematic review of the healthcare experiences of women and girls who have undergone female genital mutilation/cutting

Objective: To explore the experiences of accessing and receiving healthcare related to female genital mutilation/cutting (FGM/C) across the life course from the perspective of women and girls who have undergone FGM/C. Design: A systematic review of qualitative research studies using a thematic synthesis approach. Methods: Inclusion criteria were qualitative studies (including grey literature) of any design, from Organisation for Economic Co-operation and Development (OECD) countries, of any date and any language. Sixteen electronic databases were searched from inception to December 2017, supplemented by reference list searching. Papers were screened, selected and quality-appraised by two reviewers using established tools from the Joanna Briggs Institute. NVivo software was used to extract study characteristics and code study findings. An inductive thematic synthesis approach was undertaken to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using Grading of Recommendations, Assessment, Development and Evaluations-Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual). Results: Fifty-seven papers (from 55 distinct studies) from 14 different OECD countries were included (50% published within the last 8 years). One-third of studies focused exclusively on maternity care experiences, whereas others covered a range of foci. No studies reported explicitly on girls’ experiences or on experiences of health service-led safeguarding interventions. Only three studies addressed psychological care. The synthesis developed 17 descriptive themes, organised into 5 analytical constructs. These related to communication, access to care, experiences of cultural dissonance/integrity, disempowering care experiences and positive care encounters. The themes illuminate significant challenges to obtaining timely and holistic care (especially for deinfibulation), and highlight different ways in which women may experience care as disrespectful, unsafe and disempowering. Key elements of ‘culturally safe care’ are identified. Conclusions: This review has highlighted key knowledge gaps, especially around (1) girls’/unmarried women’s experiences and (2) the impact of recent safeguarding interventions. There is an ongoing need for community engagement, service development and staff training. PROSPERO registration number: CRD420150300012015

Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda

Background: Community capacities and resources must be harnessed to complement supply side initiatives addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda. Methods: A participatory action research project was supported from 2012 to 2015 in three eastern districts. This project involved working with households, saving groups, sub county and district leaders, transporters and village health teams in diagnosing causes of maternal and neonatal mortality and morbidity, developing action plans to address these issues, taking action and learning from action in a cyclical manner. This paper draws from project experience and documentation, as well as thematic analysis of 20 interviews with community and district stakeholders and 12 focus group discussions with women who had recently delivered and men whose wives had recently delivered. Results: Women and men reported increased awareness about birth preparedness, improved newborn care practices and more male involvement in maternal and newborn health. However, additional direct communication strategies were required to reach more men beyond the minority who attended community dialogues and home visits. Saving groups and other saving modalities were strengthened, with money saved used to meet transport costs, purchase other items needed for birth and other routine household needs. However saving groups required significant support to improve income generation, management and trust among members. Linkages between savings groups and transport providers improved women’s access to health facilities at reduced cost. Although village health teams were a key resource for providing information, their efforts were constrained by low levels of education, inadequate financial compensation and transportation challenges. Ensuring that the village health teams and savings groups functioned required regular supervision, review meetings and payment for supervisors to visit. Conclusions: This participatory program, which focused on building the capacity of community stakeholders, was able to improve local awareness of maternal and newborn health practices and instigate local action to improve access to healthcare. Collaborative problem solving among diverse stakeholders, continuous support and a participatory approach that allowed flexibility were essential project characteristics that enabled overcoming of challenges faced

Male involvement in birth preparedness and complication readiness for emergency obstetric referrals in rural Uganda

<p>Abstract</p> <p>Background</p> <p>Every pregnant woman faces risk of life-threatening obstetric complications. A birth-preparedness package promotes active preparation and assists in decision-making for healthcare seeking in case of such complications. The aim was to assess factors associated with birth preparedness and complication-readiness as well as the level of male participation in the birth plan among emergency obstetric referrals in rural Uganda.</p> <p>Methods</p> <p>This was a cross-sectional study conducted at Kabale regional hospital maternity ward among 140 women admitted as emergency obstetric referrals in antenatal, labor or the postpartum period. Data was collected on socio-demographics and birth preparedness and what roles spouses were involved in during developing the birth plan. Any woman who attended antenatal care at least 4 times, received health education on pregnancy and childbirth danger signs, saved money for emergencies, made a plan of where to deliver from and made preparations for a birth companion, was deemed as having made a birth plan. Multivariate logistic regression analysis was conducted to analyze factors that were independently associated with having a birth plan.</p> <p>Results</p> <p>The mean age was 26.8 ± 6.6 years, while mean age of the spouse was 32.8 ± 8.3 years. Over 100 (73.8%) women and 75 (55.2%) of their spouses had no formal education or only primary level of education respectively. On multivariable analysis, Primigravidae compared to multigravidae, OR 1.8 95%CI (1.0-3.0), education level of spouse of secondary or higher versus primary level or none, OR 3.8 95%CI (1.2-11.0), formal occupation versus informal occupation of spouse, OR 1.6 95%CI (1.1-2.5), presence of pregnancy complications OR 1.4 95%CI (1.1-2.0) and the anticipated mode of delivery of caesarean section versus vaginal delivery, OR 1.6 95%CI (1.0-2.4) were associated with having a birth plan.</p> <p>Conclusion</p> <p>Individual women, families and communities need to be empowered to contribute positively to making pregnancy safer by making a birth plan.</p

Influence of Birth Preparedness, Decision-Making on Location of Birth and Assistance by Skilled Birth Attendants among Women in South-Western Uganda

Introduction: Assistance by skilled birth attendants (SBAs) during childbirth is one of the strategies aimed at reducing maternal morbidity and mortality in low-income countries. However, the relationship between birth preparedness and decision-making on location of birth and assistance by skilled birth attendants in this context is not well studied. The aim of this study was to assess the influence of birth preparedness practices and decision-making and assistance by SBAs among women in south-western Uganda

Strategies for the Use of Fallback Foods in Apes

Researchers have suggested that fallback foods (FBFs) shape primate food processing adaptations, whereas preferred foods drive harvesting adaptations, and that the dietary importance of FBFs is central in determining the expression of a variety of traits. We examine these hypotheses in extant apes. First, we compare the nature and dietary importance of FBFs used by each taxon. FBF importance appears greatest in gorillas, followed by chimpanzees and siamangs, and least in orangutans and gibbons (bonobos are difficult to place). Next, we compare 20 traits among taxa to assess whether the relative expression of traits expected for consumption of FBFs matches their observed dietary importance. Trait manifestation generally conforms to predictions based on dietary importance of FBFs. However, some departures from predictions exist, particularly for orang-utans, which express relatively more food harvesting and processing traits predicted for consuming large amounts of FBFs than expected based on observed dietary importance. This is probably due to the chemical, mechanical, and phenological properties of the apes’ main FBFs, in particular high importance of figs for chimpanzees and hylobatids, compared to use of bark and leaves—plus figs in at least some Sumatran populations—by orang-utans. This may have permitted more specialized harvesting adaptations in chimpanzees and hylobatids, and required enhanced processing adaptations in orang-utans. Possible intercontinental differences in the availability and quality of preferred and FBFs may also be important. Our analysis supports previous hypotheses suggesting a critical influence of the dietary importance and quality of FBFs on ape ecology and, consequently, evolution