Go With the (Milk) Flow. Infant feeding practices and premature introduction of solids in rural Eastern Cape South Africa

This study uses an intersectional approach to examine and understand how different social and cultural norms impact women’s agency when choosing infant feeding practice. The study wishes to broaden the debate on how women can succeed with breastfeeding or the infant feeding practice of her choice and decrease harmful premature introduction of solids such as Nestum®. Data was collected via group and individual interviews in Ginyitsimbi, Eastern Cape, South Africa and focuses on understanding women’s lived experiences.Particular attention was given to how power relations and demographic hierarchies intersect on women’s choice of feeding practice and the premature introduction of solids as well as social and cultural viewings of motherhood. The theoretical framework was constructed by the work of Bourdieu as well as Kabeer and helped to analyze the findings. These suggest that women’s choice of infant feeding practice is affected by broader contextual factors that through normative expectations on motherhood and demographic hierarchies impact on women’s agency and decision-making power. The study stresses the importance of community support and information as it aspires to inform and improve attitudes and practices for infant feeding support. These are key elements for enabling the acceptance of breastfeeding and improving infant feeding knowledge

Lively and safe urban squares : a case study of Rådhustorget in Umeå

Till följd av dagens kraftigt växande städer och förtätning som stadsideal blir de offentliga ytorna extra viktiga för människors välmående. Social hållbarhet handlar om att utforma städer där människors mående sätts i fokus. En viktig del av den socialt hållbara staden är de offentliga platserna som ska vara till för alla och skapa möjligheter för möten. Torgen är ett av de viktigaste offentliga rummen då de oftast är placerade i stadens mest centrala delar och har historiskt sett alltid fungerat som en plats där stadens medborgare kan mötas. En grundförutsättning för att människor ska trivas och vilja använda ett torg är att det inbringar trygghet. Därav kan tomma torg resultera i en upplevelse av otrygghet. Syftet med den här uppsatsen är att få en större förståelse för hur livfulla och trygga torg kan uppnås för att bidra till att skapa socialt hållbara städer. För att besvara uppsatsens frågeställning har Rådhustorget undersökts genom platsanalyser som utgått från olika teoretiska ramverk. I analysen har Jan Gehls kriterier för Bekvämlighet och kategorisering av aktiviteter i det offentliga rummet använts för att bedöma vilka aspekter som bidrar till ett livfullt torg. För att bedöma tryggheten på Rådhustorget har Boverkets utgångspunkter analyserats. Det har även skett en dokumentgranskning av Rådhustorgets gestaltningsprogram och planer för kommunens arbete för social hållbarhet på offentliga platser. Det gav en ökad förståelse för arkitekternas utgångspunkter vid renoveringen av torget samt en övergripande uppfattning för kommunens visioner. Genom att notera torgets aspekter utifrån ramverken gavs en insikt i hur utformningen påverkade användningen och upplevelsen av trygghet på torget. Några aspekter som noterades bidra till ökad användning och trygghet på torget var bland annat att det var enkelt att få en överblick på torget och dess omgivning. Den huvudsakliga bristande kvaliteten på torget var att det fanns få faktorer som bjöd in till att stanna upp och utföra olika aktiviteter.As a result of today's rapidly growing cities and densification as an ideal in city planning, public places become extra important for people's well-being. Social sustainability is about designing cities where people's wellbeing is the top priority. An important part of a socially sustainable city is that the public places should be accessible for everybody while also creating opportunities for social encounters. The urban square is one of the most important public spaces since they usually are situated in the most central part of the city. Historically, the squares have always functioned as a meeting place for the citizens. A basic requirement for people to enjoy and use an urban square is that it brings a feeling of safety. Hence an empty square can lead to people experiencing a feeling of lack of safety. The intention of this essay is to get a broader understanding of how to achieve lively and safe urban squares to contribute to a socially sustainable city. In order to answer the essay's research question, Rådhustorget has been investigated through a case study based on various theoretical frameworks. The analysis is based on Jan Gehl's criteria for Comfort and categorization of activities in the public space and Boverkets criteria on the experience of safety in public environments. There has also been a document review of Rådhustorget's designprogram and planning for the township’s work for social sustainability in public places. This gave an increased understanding of the architects' main focus for the renovation as well as an overall understanding of the township’s goals. By analysing the square's different aspects based on the theoretical frameworks, a broader understanding was given about how the design influenced the usage and safety on Rådhustorget. Some aspects that were noted to contribute to increasing liveliness and safety in the square were, among other things, that it was easy to get an overview of the square and its surroundings. The main lack of quality of the square was that there were few factors that made people want to stay for a longer time and participate in different activities

Improved postpartum care after a participatory facilitation intervention in Dar es Salaam, Tanzania: a mixed method evaluation

Background: In order to improve the health and survival of mothers/newborns, the quality and attendance rates of postpartum care (PPC) must be increased, particularly in low-resource settings. Objective: To describe outcomes of a collegial facilitation intervention to improve PPC in government-owned health institutions in a low-resource suburb in Dar es Salaam, Tanzania. Methods: A before-and-after evaluation of an intervention and comparison group was conducted using mixed methods (focus group discussions, questionnaires, observations, interviews, and field-notes) at health institutions. Maternal and child health aiders, enrolled nurse midwives, registered nurse midwives, and medical and clinical officers participated. A collegial facilitation intervention was conducted and healthcare providers were organized in teams to improve PPC at their workplaces. Facilitators defined areas of improvement with colleagues and met regularly with a supervisor for support. Results: The number of mothers visiting the institution for PPC increased in the intervention group. Some care actions were noted in more than 80% of the observations and mothers reported high satisfaction with care. In the comparison group, PPC continued to be next to non-existent. The healthcare providers’ knowledge increased in both groups but was higher in the intervention group. The t-test showed a significant difference in knowledge between the intervention and comparison groups and between before and after the intervention in both groups. The difference of differences for knowledge was 1.3. The providers perceived the intervention outcomes to include growing professional confidence/knowledge, improved PPC quality, and mothers’ positive response. The quality grading was based on the national guidelines and involved nine experts and showed that none of the providers reached the level of good quality of care. Conclusions: The participatory facilitation intervention contributed to improved quality of PPC, healthcare providers’ knowledge and professional confidence, awareness of PPC among mothers, and increased PPC attendance

Mechanical chest compression for out of hospital cardiac arrest: Systematic review and meta-analysis

Aim: To summarise the evidence from randomised controlled trials of mechanical chest compression devices used during resuscitation after out of hospital cardiac arrest. Methods: Systematic review of studies evaluating the effectiveness of mechanical chest compression. We included randomised controlled trials or cluster randomised trials that compared mechanical chest compression (using any device) with manual chest compression for adult patients following out-of-hospital cardiac arrest. Outcome measures were return of spontaneous circulation, survival of event, overall survival, survival with good neurological outcome. Results were combined using random-effects meta-analysis. Data sources: Studies were identified by searches of electronic databases, reference lists of other studies and review articles. Results: Five trials were included, of which three evaluated the LUCAS or LUCAS-2 device and two evaluated the AutoPulse device. The results did not show an advantage to the use of mechanical chest compression devices for survival to discharge/30 days (average OR 0.89, 95% CI 0.77, 1.02) and survival with good neurological outcome (average OR 0.76, 95% CI 0.53, 1.11). Conclusions: Existing studies do not suggest that mechanical chest compression devices are superior to manual chest compression, when used during resuscitation after out of hospital cardiac arrest

Hypothermic cardiac arrest far away from the center providing rewarming with extracorporeal circulation

A 41-year-old man suffered hypothermic cardiac arrest after water immersion and was transported to our university hospital by ambulance helicopter for rewarming on cardiopulmonary bypass. He resumed spontaneous cardiac activity 6 h 52 min after cardiac arrest and recovered completely

The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation

BACKGROUND: The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO(2,) compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS™ device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. METHODS/DESIGN: This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1). RESULTS: Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. CONCLUSION: This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS™ device when used in association with defibrillation during on-going CPR

Risk Stratification Among Survivors of Cardiac Arrest Considered for Coronary Angiography.

BACKGROUND: The American College of Cardiology Interventional Council published consensus-based recommendations to help identify resuscitated cardiac arrest patients with unfavorable clinical features in whom invasive procedures are unlikely to improve survival. OBJECTIVES: This study sought to identify how many unfavorable features are required before prognosis is significantly worsened and which features are most impactful in predicting prognosis. METHODS: Using the INTCAR (International Cardiac Arrest Registry), the impact of each proposed unfavorable feature on survival to hospital discharge was individually analyzed. Logistic regression was performed to assess the association of such unfavorable features with poor outcomes. RESULTS: Seven unfavorable features (of 10 total) were captured in 2,508 patients successfully resuscitated after cardiac arrest (ongoing cardiopulmonary resuscitation and noncardiac etiology were exclusion criteria in our registry). Chronic kidney disease was used in lieu of end-stage renal disease. In total, 39% survived to hospital discharge. The odds ratio (OR) of survival to hospital discharge for each unfavorable feature was as follows: age \u3e85 years OR: 0.30 (95% CI: 0.15 to 0.61), time-to-ROSC \u3e30 min OR: 0.30 (95% CI: 0.23 to 0.39), nonshockable rhythm OR: 0.39 (95% CI: 0.29 to 0.54), no bystander cardiopulmonary resuscitation OR: 0.49 (95% CI: 0.38 to 0.64), lactate \u3e7 mmol/l OR: 0.50 (95% CI: 0.40 to 0.63), unwitnessed arrest OR: 0.58 (95% CI: 0.44 to 0.78), pH85 years, time-to-ROSC \u3e30 min, and non-ventricular tachycardia/ventricular fibrillation) together or ≥6 unfavorable features predicted a ≤10% chance of survival to discharge. CONCLUSIONS: Patients successfully resuscitated from cardiac arrest with 6 or more unfavorable features have a poor long-term prognosis. Delaying or even forgoing invasive procedures in such patients is reasonable

Mechanical chest compression devices at in-hospital cardiac arrest: A systematic review and meta-analysis

AIM: To summarise the evidence in relation to the routine use of mechanical chest compression devices during resuscitation from in-hospital cardiac arrest. METHODS: We conducted a systematic review of studies which compared the effect of the use of a mechanical chest compression device with manual chest compressions in adults that sustained an in-hospital cardiac arrest. Critical outcomes were survival with good neurological outcome, survival at hospital discharge or 30-days, and short-term survival (ROSC/1-h survival). Important outcomes included physiological outcomes. We synthesised results in a random-effects meta-analysis or narrative synthesis, as appropriate. Evidence quality in relation to each outcome was assessed using the GRADE system. DATA SOURCES: Studies were identified using electronic databases searches (Cochrane Central, MEDLINE, EMBASE, CINAHL), forward and backward citation searching, and review of reference lists of manufacturer documentation. RESULTS: Eight papers, containing nine studies [689 participants], were included. Three studies were randomised controlled trials. Meta-analyses showed an association between use of mechanical chest compression device and improved hospital or 30-day survival (odds ratio 2.34, 95% CI 1.42-3.85) and short-term survival (odds ratio 2.14, 95% CI 1.11-4.13). There was also evidence of improvements in physiological outcomes. Overall evidence quality in relation to all outcomes was very low. CONCLUSIONS: Mechanical chest compression devices may improve patient outcome, when used at in-hospital cardiac arrest. However, the quality of current evidence is very low. There is a need for randomised trials to evaluate the effect of mechanical chest compression devices on survival for in-hospital cardiac arrest

Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC) : a pragmatic, cluster randomised controlled trial

BACKGROUND: Mechanical chest compression devices have the potential to help maintain high-quality cardiopulmonary resuscitation (CPR), but despite their increasing use, little evidence exists for their effectiveness. We aimed to study whether the introduction of LUCAS-2 mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest. METHODS: The pre-hospital randomised assessment of a mechanical compression device in cardiac arrest (PARAMEDIC) trial was a pragmatic, cluster-randomised open-label trial including adults with non-traumatic, out-of-hospital cardiac arrest from four UK Ambulance Services (West Midlands, North East England, Wales, South Central). 91 urban and semi-urban ambulance stations were selected for participation. Clusters were ambulance service vehicles, which were randomly assigned (1:2) to LUCAS-2 or manual CPR. Patients received LUCAS-2 mechanical chest compression or manual chest compressions according to the first trial vehicle to arrive on scene. The primary outcome was survival at 30 days following cardiac arrest and was analysed by intention to treat. Ambulance dispatch staff and those collecting the primary outcome were masked to treatment allocation. Masking of the ambulance staff who delivered the interventions and reported initial response to treatment was not possible. The study is registered with Current Controlled Trials, number ISRCTN08233942. FINDINGS: We enrolled 4471 eligible patients (1652 assigned to the LUCAS-2 group, 2819 assigned to the control group) between April 15, 2010 and June 10, 2013. 985 (60%) patients in the LUCAS-2 group received mechanical chest compression, and 11 (<1%) patients in the control group received LUCAS-2. In the intention-to-treat analysis, 30 day survival was similar in the LUCAS-2 group (104 [6%] of 1652 patients) and in the manual CPR group (193 [7%] of 2819 patients; adjusted odds ratio [OR] 0·86, 95% CI 0·64-1·15). No serious adverse events were noted. Seven clinical adverse events were reported in the LUCAS-2 group (three patients with chest bruising, two with chest lacerations, and two with blood in mouth). 15 device incidents occurred during operational use. No adverse or serious adverse events were reported in the manual group. INTERPRETATION: We noted no evidence of improvement in 30 day survival with LUCAS-2 compared with manual compressions. On the basis of ours and other recent randomised trials, widespread adoption of mechanical CPR devices for routine use does not improve survival