Safety and acceptability of tubal ligation procedures performed by trained clinical officers in rural Uganda.

OBJECTIVE: To assess safety associated with tubal ligation performed by trained clinical officers (COs) in rural Uganda. METHODS: Between March and June 2012, 518 women in 4 regions of Uganda were recruited into a prospective cohort study and followed at days 3, 7, and 45 after undergoing tubal ligation performed by a trained CO. Intraoperative and postoperative adverse events (minor, moderate, or major), and acceptability were assessed. RESULTS: Mean age was 36 years (range, 20-49 years) and mean number of living children was 6.7 (range, 0-15). The overall rate of major adverse events was 1.5%: 0.4% intraoperatively; 1.9% at day 3; and 0.2% at day 7. The majority of women who underwent tubal ligation reported a good/very good experience at the facility (range, 94%-99%) and would recommend the health services to a friend (range, 93%-98%). CONCLUSION: In the present study, task sharing of tubal ligation to trained COs in private facilities was safe. Women reported high levels of satisfaction with the procedure. Training COs could be an effective strategy for expanding family-planning services to rural Uganda

A Systematic Review of the Treatment of Borderline Personality Disorder using Fluoxetine and Olanzapine

BACKGROUND: Borderline personality disorder (BPD) is prevalent among the general population (2%). Treatment of BPD is with the use of psychotherapy and pharmacotherapy. The use of psychotherapy for treatment of BPD has been well established, the effectiveness of pharmacotherapy remains less clear. OBJECTIVES: To evaluate the effectiveness of olanzapine and fluoxetine on outcomes (including depression, anxiety, anger/impulsivity/aggression and global assessment of functioning) of BPD patients. SEARCH STRATEGY: Searched PubMed for the terms fluoxetine and borderline personality disorder and olanzapine and borderline personality disorder. SELECTION CRITERIA: Only included randomized controlled trials in the English language that focused primarily on objective as stated above. MAIN RESULTS: Two fluoxetine studies included in this review, only one study showed significant improvement in depression and anger in BPD patients receiving fluoxetine but this was small (approximately 20% ). Both studies showed significant improvement in global assessment of functioning (GAF) in fluoxetine groups. Four olanzapine studies included in this review, 3 compared olanzapine to placebo and 1 compared olanzapine to a mixed olanzapine-fluoxetine combination (OFC) to fluoxetine. In 2 of the 3 olanzapine studies, there was significant improvement in depression, anxiety and GAF, improvements ranged from 21%-39% for depression and anxiety. All 3 olanzapine studies show improvement in anger/impulsivity/aggression (highest improvement was 49%). In the mixed study, OFC and olanzapine group showed significant improvement in depression and anger but this improvement was mild. Anxiety and GAF were not measured in the mixed study. CONCLUSIONS: Overall, fluoxetine leads to mild improvement in depression, anger and GAF. Olanzapine treatment of BPD patients leads to mild-moderate improvement in depression, anxiety, anger/impulsivity/aggression and GAF.Master of Public Healt

Retired, Unmarried, Male Baby Boomer Attitudes and Behaviors Toward Disease Prevention

Preventive health care is effective in reducing both infectious diseases and chronic conditions among the elderly. Despite efforts to prevent or decrease the risk of illness, unmarried men are less likely to receive selected preventive services compared to married men. The purpose of this cross-sectional survey was to describe disease prevention attitudes and behaviors of retired, unmarried, male baby boomers residing in Harlingen, Texas. Further, the study examined the effects of socioeconomic status on disease prevention attitudes and behaviors. The health belief theory framed the study. A validated questionnaire collected disease prevention attitudes, behaviors, and sociodemographic characteristics data. Data inquiry included ANOVA, multiple regression and moderation analysis. The findings did not show any differences in disease prevention attitudes and behaviors among retired, unmarried male boomers. Multiple linear regression indicated that the socioeconomic factors explained 24% of the variance in disease prevention behaviors (p = .001). Moderation analysis showed that 29% of the variability in the dependent variable could be explained by the independent variables and interaction terms. The only significant predictor was education, p= .002); none of the interaction terms were significant. Positive social change from the study is the possible increase in disease prevention behavior among the retired, unmarried male baby with a low level of education. The study results may help in developing policies that would target education barriers and raise awareness of disease prevention behavior among the retired, unmarried male baby boomers

Assessing the quality of record keeping for cesarean deliveries: results from a multicenter retrospective record review in five low-income countries

BACKGROUND: Reliable, timely information is the foundation of decision making for functioning health systems; the quality of decision making rests on quality data. Routine monitoring, reporting, and review of cesarean section (CS) indications, decision-to-delivery intervals, and partograph use are important elements of quality improvement for maternity services. METHODS: In 2009 and 2010, a sample of CS records from calendar year 2008 was reviewed at nine facilities in Bangladesh, Guinea, Mali, Niger, and Uganda. Data from patient records and hospital registers were collected on key aspects of care such as timing of key events, indications, partograph use, maternal and fetal outcomes. Qualitative interviews were conducted with key informants at all study sites to provide contextual background about CS services and record keeping practices. RESULTS: A total of 2,941 records were reviewed and 57 key informant interviews were conducted. Patient record-keeping systems were of varying quality across study sites: at five sites, more than 20% of records could not be located. Across all sites, patient files were missing key aspects of CS care: timing of key events (e.g., examination, decision to perform CS), administration of prophylactic antibiotics, maternal complications, and maternal and fetal outcomes. Rates of partograph use were low at six sites: 0 to 23.9% of patient files at these sites had a completed partograph on file, and among those found, 2.1% to 65.1% were completed correctly. Information on fetal outcomes was missing in up to 40% of patient files. CONCLUSIONS: Deficits in the quality of CS patient records across a broad range of health facilities in low-resource settings in four sub-Saharan Africa countries and Bangladesh indicate an urgent need to improve record keeping

PAIN RELIEF USING PARACERVICAL BLOCK IN PATIENTS UNDERGOING MANUAL VACUUM ASPIRATION OF UTERUS

Objective: To evaluate pain relief using paracervical nerve block with 1% lignocaineinjection in patients undergoing uterine evacuation by Manual Vacuum Aspiration(MVA) for the treatment of incomplete abortion.Design: A randomized double blind clinical trial.Setting: Marie Stopes Health Centre, Nairobi.Methods: One hundred and forty two patients were recruited between September andOctober 1997. The intervention was random assignment to the study group (paracervicalblock with 1% lignocaine) or the placebo group (paracervical block with sterile waterfor injection). Intra and post operative assessment of pain was made using McGills andfacial expression scales.Results: The untreated group experienced significantly more pain than the treated group,especially lower abdominal pain and backache. The pain was especially marked intraoperatively,less so 30 minutes post-operatively.Conclusion: Based on the findings of this study, any patient going for manual vacuumaspiration for the treatment of incomplete abortion should be given Paracervical blockas it is cost effective, easy to perform and with less side effects

Current practices in treatment of female genital fistula: a cross sectional study

Abstract Background Maternal outcomes in most countries of the developed world are good. However, in many developing/resource-poor countries, maternal outcomes are bleaker: Every year, more than 500,000 women die in childbirth, mostly in resource-poor countries. Those who survive often suffer from severe and long-term morbidities. One of the most devastating injuries is obstetric fistula, occurring most often in south Asia and sub-Saharan Africa. Fistula treatment and care are available in many countries across Africa and Asia, but there is a lack of reliable data around clinical factors associated with the success of fistula repair surgery. Most published research has been retrospective. While these studies have provided useful information about the care and treatment of fistula, they are limited by the design. This study was designed to identify practices in care that could lead to the design of prospective and randomized controlled trials. Methods Self-administered questionnaires were completed by 40 surgeons known to provide fistula treatment services in Africa and Asia at private and government hospitals. The questionnaire was divided into three parts to address the following issues: prophylactic use of antibiotics before, during, and after fistula surgery; urethral catheter management; and management practices for patients with urinary incontinence following fistula repair. Results The results provide a glimpse into current practices in fistula treatment and care across a wide swath of geographic, economic, and organizational considerations. There is consensus in treatment in some areas (routine use of prophylactic antibiotics, limited bed rest until the catheter is removed, nonsurgical treatment for postsurgical incontinence), while there are wide variations in practice in other areas (duration of catheter use, surgical treatments for postsurgical incontinence). These findings are based on a small sample and do not allow for recommending changes in clinical care, but they point to issues for possible clinical trial research that would contribute to more efficient and effective fistula care. Conclusions The findings from the survey allowed us to consider clinical practices most influential in the cost, efficacy, and safety of fistula treatment. These considerations led us to formulate recommendations for eight randomized controlled trials on the following subjects: 1) Efficacy/safety of short-term catheterization; 2) efficacy of surgical and nonsurgical therapies for urinary incontinence; 3) technical measures during fistula repair to reduce the incidence of post-surgery incontinence; 4) identification of predictive factors for "incurable fistula"; 5) usefulness of urodynamic studies in the management of urinary incontinence; 6) incidence and significance of multi-drug resistant bacteria in the fistula population; 7) primary management of small, new fistulas by catheter drainage; and 8) antibiotic prophylaxis in fistula repair.</p

Pain relief using paraceevical block in patients undergoing manual vacuum aspiration of uterus

Objective: To evaluate pain relief using paracervical nerve block with 1% lignocaine injection in patients undergoing uterine evacuation by Manual Vacuum Aspiration (MVA) for the treatment of incomplete abortion. Design: A randomized double blind clinical trial. Setting: Marie Stopes Health Centre, Nairobi. Methods: One hundred and forty two patients were recruited between September and October 1997. The intervention was random assignment to the study group (paracervical block with 1% lignocaine) or the placebo group (paracervical block with sterile water for injection). Intra and post operative assessment of pain was made using McGills and facial expression scales. Results: The untreated group experienced significantly more pain than the treated group, especially lower abdominal pain and backache. The pain was especially marked intraoperatively, less so 30 minutes post-operatively. Conclusion: Based on the findings of this study, any patient going for manual vacuum aspiration for the treatment of incomplete abortion should be given Paracervical block as it is cost effective, easy to perform and with less side effects. (East African Medical Journal: 2002 79(10): 530-534