Factors Affecting Contraceptive Use in Pakistan

Using data from the Pakistan Demographic and Health Survey of 1990-91, this study examines the effect of selected socio-cultural and supply factors on contraceptive use as reported by married women of reproductive ages. In addition to the expected positive relationship of woman’s age, number of living children, education, and place of residence with contraceptive use, it is theorised that there are five factors potentially affecting fertility regulation in the socio-structural context of Pakistan. These include the extend of communication between husbands and wives, religious beliefs, female autonomy, son preference, and the family planning service and supply variables. Using logistic regression analysis, the results of the study indicate that the explanatory power of these five factors is significant in affecting the use of contraception in both urban and rural areas. While knowledge of a source for family planning is the strongest predictor of contraceptive use, husband-wife communication and religious attitudes are also significant. The fact that the inclusion of the theoretical variables dampens the predictive effect of the primary and secondary education for women leads to the speculation that while the extremely low levels of literacy among women must be addressed through government commitment to universal education, scarce family planning programme resources can be focused more effectively on promoting spousal communication, about family size and contraceptive use, and on soliciting the support of religious leaders to counteract the misperceptions about Islamic teachings on family planning and reliance on fate. With high quality and accessible services, these measures could go a long way towards providing couples with the means to meet their reproductive goals.

Factors Affecting Contraceptive Use in Pakistan

Using data from the Pakistan Demographic and Health Survey of 1990-91, this study examines the effect of selected socio-cultural and supply factors on contraceptive use as reported by married women of reproductive ages. In addition to the expected positive relationship of woman’s age, number of living children, education, and place of residence with contraceptive use, it is theorised that there are five factors potentially affecting fertility regulation in the socio-structural context of Pakistan. These include the extend of communication between husbands and wives, religious beliefs, female autonomy, son preference, and the family planning service and supply variables. Using logistic regression analysis, the results of the study indicate that the explanatory power of these five factors is significant in affecting the use of contraception in both urban and rural areas. While knowledge of a source for family planning is the strongest predictor of contraceptive use, husband-wife communication and religious attitudes are also significant. The fact that the inclusion of the theoretical variables dampens the predictive effect of the primary and secondary education for women leads to the speculation that while the extremely low levels of literacy among women must be addressed through government commitment to universal education, scarce family planning programme resources can be focused more effectively on promoting spousal communication, about family size and contraceptive use, and on soliciting the support of religious leaders to counteract the misperceptions about Islamic teachings on family planning and reliance on fate. With high quality and accessible services, these measures could go a long way towards providing couples with the means to meet their reproductive goals

“We Are Here for You All the Way”—Patients’ and Relatives’ Experiences of Receiving Advanced Home Care

Background: It is of great importance to understand how patients and their close relatives experience the pros and cons of advanced home care so as to further develop this quickly growing choice of care. Objective: The aim of this study was to explore the experiences of receiving advanced home care among patients affected by life-threatening illness and their close relatives. Design: The study was an interview study conducted with patients in their homes. Some patient interviews were conducted together with a close relative participating. Setting/Participants: Patients registered in advanced home care in 2017 were offered the opportunity to participate in the study. The selection criteria were that the patient was within grade 3 of the Eastern Cooperative Oncology Group’s Performance Status, older than 18 years, able to orient to time and place, and not newly registered. Analysis: The interviews were recorded and transcribed verbatim and analyzed with qualitative content analysis. Results: A total of 11 interviews were conducted: 8 with patients and 1 or 2 close relatives together; and 3 with the patient alone. It resulted in 3 main categories: create a safe environment, see the person, and better to manage care at home. Conclusion: The results of this study show that patients and close relatives perceived that advanced home care was a safe and secure form of caring during advanced as well as end-of-life care

Bli en bedre utgave av seg selv

Å bli en bedre utgave av seg selv undersøker mulighetene for egenutvikling av lederskap gjennom bruk av refleksjon i endringsarbeid. Statlig styrte krav til roller og oppgaver en skoleleder skal besitte og ønske om kvalitetsutvikling i tjenestetilbud danner konteksten hvor undersøkelsen foregår. Evner skoleledere å ta i bruk refleksjon som hjelpemiddel i stedet for mer formelle tiltak som utdanning og lederutviklingsprogram? Gjennom et kvalitativt forskningsopplegg er fem ledere spurt om sine erfaringer fra et strukturert endringsarbeid i skolen. Funnene er analysert og diskutert opp mot eksisterende teorier om refleksjon og perspektiver på læring. Flere forhold stimulerer til og påvirker til lederens refleksjon. Utdanningsnivå og erfaring bidra på ulike måter til muligheten for refleksjon og lederne griper de mulighetene på ulikt vis. Studien viser til forskjeller på bevisst refleksjon og bevisst bruk av refleksjon for et mer strukturert læringsutbytte. Erfaringene gjennom handlingene til lederne befester seg som ulik læring og settes sammen til ny atferd i nye sammenhenger. Studien kan bidra til å synliggjøre muligheter for hvordan bevisst og strukturert refleksjon kan bidra i landskapet av lederutvikling og lederlæring

Sexually transmitted infections: progress and challenges since the 1994 International Conference on Population and Development (ICPD)

AbstractBackgroundDespite being recognized as an important challenge at the 1994 International Conference on Population and Development (ICPD), sexually transmitted ınfections (STIs) other than HIV are one of the most neglected dimensions of sexual and reproductive health. STIs, often undiagnosed and untreated, have especially harmful consequences for women and their neonates.Progress since ICPDDuring the last two decades, substantial knowledge and experience have accumulated in behavior change programming during the global response to the HIV epidemic which can also be used for prevention of STIs. There has been progress in development and implementation of vaccines against certain STIs such as hepatitis B and the human papilloma virus. Development of a rapid, point-of-care test for syphilis has opened the door to control this infection.ChallengesThe estimated annual incidence of non-HIV STIs has increased by nearly 50% during the period 1995–2008. The growth in STIs has been aggrevated by a combination of factors: lack of accurate, inexpensive diagnostic tests, particularly for chlamydia and gonorrhea; lack of investment to strengthen health systems that can deliver services for diagnosis and management of STIs; absence of surveillance and reporting systems in the majority of countries; political, socioeconomic and cultural barriers that limit recognition of STIs as an important public health problem; and failure to implement policies that are known to work.RecommendationsGovernments, donors and the international community should give higher priority to preventing STIs and HIV; fully implementing behavior change interventions that are known to work; ensuring access of young people to information and services; investing in development of inexpensive technologies for STI diagnosis,treatment and vaccines; and strengthening STI surveillance, including of microbial resistance

Hera and the Sea. Decoding Dedications at the Samian Heraion

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Effect of infectious salmon anemia virus (ISAV) infection and poly I:C treatment on expression of different stress related genes in Atlantic salmon (Salmo salar L.) cells

2 ABSTRACT Infectious salmon anemia virus (ISAV) is a virus causing severe disease in Atlantic salmon (Salmo salar L.). Although its structure and pathogenesis is well described, little is known about its effects on the expression of genes related to different stress responses in the host cell. ISAV is a virus that is probably causing apoptosis in Atlantic salmon, but the mechanisms are not yet fully understood. Interferons (IFN) and interferon induced genes (ISG), which is important of the host control of virus infections, is highly expressed after ISAV infection. But it looks like that ISAV has developed mechanisms that help it evade the host immune response. In this study we analyzed the relative expression of different stress related genes after ISAV infection and poly I:C stimulation in Atlantic salmon kidney cell line (ASK). Poly I:C is widely used as synthetic dsRNA analog in vivo and in vitro and has also demonstrated to induce antiviral responses in Atlantic salmon. When we compare these two stress situations with each other we may better understand the innate immune responses during viral infections in this commercially important fish species. As measured by quantitative real-time PCR, both ISAV and poly I:C stimulated cells induced a high up-regulation of interferon-á and interferon induced genes as expected. In confocal immunofluorescence microscopy it was detected that ISAV still replicates at day 5 post infection, and that it induces a cytophatic effect in ASK cells, indicating that interferons have little antiviral effect on ISAV. Furthermore, there was observed an up-regulation of different cytokines, stress related genes and even apoptotic related genes, like IAP, both in ISAV infected and poly I:C stimulated ASK cells. Galectin-9, that may be involved in T-cell apoptosis, was up-regulated in both ISAV infected and poly I:C stimulated cell. The protein expression of galectin-9 was analysed using immunofluorescence microscopy. The result of this study strongly indicates that different stress related genes, which may be involved in the host immune response is induced after ISAV infection. These results can lead to a better understanding of the pathogenesis of ISAV in Atlantic salmon

Modeling superior predictors for crude oil prices

A common perception in the literature is that oil price dynamics are most adequately explained by fundamental supply-and-demand factors. We use a general-to-specific approach and find that financial indicators are even more significant at modeling and predicting oil prices. We demonstrate empirically that the futures spreads level, high-yield bond spreads and PHLX Oil Service Sector (OSX) index are the best predictors of oil prices in the period February 2000–June 2013. (The OSX index is designed to track the performance of a set of companies involved in the oil services sector.) The OSX index is particularly interesting, as no study has analyzed its predictive power prior to our analysis. The relationship is intuitively meaningful, as stock prices, which strongly depend on the oil price, are determined in a market with well-informed investors that have strong incentives to gather correct market information. Moreover, the share prices serve as strong proxies or price signals, as they reflect future oil price expectations at any point of time. Furthermore, we demonstrate through an out-of-sample analysis that our most parsimonious model is superior to relevant benchmarks at forecasting oil price changes (two benchmarks were used: (1) a random walk and (2) ARIMA.2; 0; 2/, which was optimized in-sample by minimizing the Akaike information criterion). Our findings do not necessarily imply that the financial sector determines oil prices. On the contrary, we take the view that fundamental information is traceable from financial markets, and, hence, financial predictors serve as indicators for oil price fundamentals.publishedVersio

Consultations and antibiotic treatment for urinary tract infections in Norwegian primary care 2006–2015, a registry-based study

Background Extensive use of antibiotics and the resulting emergence of antimicrobial resistance is a major health concern globally. In Norway, 82% of antibiotics is prescribed in primary care and one in four prescriptions are issued for the treatment of urinary tract infections (UTI). The aim of this study was to investigate time trends in antibiotic treatment following a consultation for UTI in primary care. Methods For the period 2006–2015 we linked data from the Norwegian Registry for Control and Payment of Health Reimbursements on all patient consultations for cystitis and pyelonephritis in general practice and out-of-hours (OOH) services, and data from the Norwegian Prescription Database on all dispensed prescriptions of antibiotics. Results Altogether 2,426,643 consultations by attendance for UTI took place in the study period, of these 94.5% for cystitis and 5.5% for pyelonephritis. Of all UTI consultations, 79.4% were conducted in general practice and 20.6% in OOH services. From 2006 to 2015, annual numbers of cystitis and pyelonephritis consultations increased by 33.9 and 14.0%, respectively. The proportion of UTI consultations resulting in an antibiotic prescription increased from 36.6 to 65.7% for cystitis, and from 35.3 to 50.7% for pyelonephritis. These observed changes occurred gradually over the years. Cystitis was mainly treated with pivmecillinam (53.9%), followed by trimethoprim (20.8%). For pyelonephritis, pivmecillinam was most frequently used (43.0%), followed by ciprofloxacin (20.5%) and sulfamethoxazole-trimethoprim (16.3%). For cystitis, the use of pivmecillinam increased the most during the study period (from 46.1 to 56.6%), and for pyelonephritis, the use of sulfamethoxazole-trimethoprim (from 11.4 to 25.5%) followed by ciprofloxacin (from 18.2 to 23.1%). Conclusions During the 10-year study period there was a considerable increase in the proportion of UTI consultations resulting in antibiotic treatment. Cystitis was most often treated with pivmecillinam, and this proportion increased during the study period. Treatment of pyelonephritis was characterized by more use of broader-spectrum antibiotics, use of both sulfamethoxazole-trimethoprim and ciprofloxacin increased during the study period. These trends, indicative of enduring changes in consultation and treatment patterns for UTIs, will have implications for future antibiotic stewardship measures and policy.publishedVersio