A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt.

BACKGROUND: The levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care. METHODS: Data from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private). RESULTS: While 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources. CONCLUSIONS: Socio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term

The provocative lumbar facet joint

Low back pain is the most common pain symptom experienced by American adults and is the second most common reason for primary care physician visits. There are many structures in the lumbar spine that can serve as pain generators and often the etiology of low back pain is multifactorial. However, the facet joint has been increasingly recognized as an important cause of low back pain. Facet joint pain can be diagnosed with local anesthetic blocks of the medial branches or of the facet joints themselves. Subsequent radiofrequency lesioning of the medial branches can provide more long-term pain relief. Despite some of the pitfalls associated with facet joint blocks, they have been shown to be valid, safe, and reliable as a diagnostic tool. Medial branch denervation has shown some promise for the sustained control of lumbar facet joint-mediated pain, but at this time, there is insufficient evidence that it is a wholly efficacious treatment option. Developing a universal algorithm for evaluating facet joint-mediated pain and standard procedural techniques may facilitate the performance of larger outcome studies. This review article provides an overview of the anatomy, pathophysiology, diagnosis, and treatment of facet joint-mediated pain

A comparative study on the efficacy of first vs second blood culture set in the diagnosis of bacteraemia in Central Referral Hospital, Sikkim, India

Background: An important but controversial subject is the number of blood culture sets required for the diagnosis of blood stream infection (BSI) and also the use of appropriate antibiotics to treat bacteremia. This paper focuses on the need of two blood culture set in comparison to one blood culture in the diagnosis of bacteraemia. Methods: First and second sets were collected aseptically from two different sites at an interval of about one hour from all clinically suspect patients of bacteremia. The samples were processed in Bact/ALERT3D system and further identified in VITEK 2 compact. Results: Second blood culture set yielded higher rates of positive cultures (63%) than first set (37%). The common bacterial isolates were Coagulase negative Staphylococcus (CoNS) 29 (28%), followed by Staphylococcus aureus 20 (20%), Escherichia coli 13 (13%) and Klebsiella pneumonia 11(11%). Methicillin resistance was observed in 90% of S. aureus isolates. All Gram positive bacteria were found sensitive to vancomycin. In Gram-negative organisms, extended spectrum β-lactamases (ESBL) was observed in 40.5% isolates and resistance to carbapenems was found to be 37.8%. Discussion/Conclusion: In India, most hospitals routinely use single aerobic blood culture. The isolation of CoNS in blood is difficult to interpret hence, proper collection, processing, and relevant clinical information can significantly reduced the chances of contamination. Automated blood culture system can significantly shorten the length of time for isolation and identification compared to the manual techniques which takes about seven days. Resistance to antibiotics is a matter of concern that can result in ineffective treatment

Preliminary studies on antiinflammatory and analgesic activities of Spilanthes acmella in experimental animal models

OBJECTIVE: To evaluate the antiinflammatory and analgesic activities of the aqueous extract of Spilanthes acmella (SPA) in experimental animal models. MATERIAL AND METHODS: SPA was evaluated for antiinflammatory action by carrageenan-induced rat paw edema. The analgesic activity was tested by acetic acid-induced writhing response in albino mice and tail flick method in albino rats. RESULTS: The aqueous extract of SPA in doses of 100, 200 and 400 mg/kg showed 52.6, 54.4 and 56.1% inhibition of paw edema respectively at the end of three hours and the percentage of protection from writhing was 46.9, 51.0 and 65.6 respectively. In the tail flick model, the aqueous extract of SPA in the above doses increased the pain threshold significantly after 30 min, 1, 2 and 4 h of administration. SPA showed dose-dependent action in all the experimental models. CONCLUSION: The present study indicates that SPA has significant antiinflammatory and analgesic properties

The effect of heat transfer on the nonlinear peristaltic transport of a Jeffrey fluid through a finite vertical porous channel

In this paper we analyze the influence of free convection on nonlinear peristaltic transport of a Jeffrey fluid in a finite vertical porous stratum using the Brinkman model. Heat is generated within the fluid by both viscous and Darcy dissipations. The coupled nonlinear governing equations are solved analytically. The expressions for the temperature, the axial velocity, the local wall shear stress and the pressure gradient are obtained. The effects of various physical parameters such as the Jeffrey parameter λ1, the permeability parameter σ and the heat source/sink parameter β are analyzed through graphs, and the results are discussed in detail. It is observed that the velocity field increases with increasing values of the Jeffrey parameter but it decreases with increasing values of the permeability parameter. It is found that the pressure rise increases with decreasing Jeffrey parameter and increasing permeability parameter. We notice that the effect of the permeability parameter σ is the strongest on the bolus trapping phenomenon. For λ1 = 0, N = 0, the results of the present study reduce to the results of Tripathi [Math. Comput. Modelling 57 (2013) 1270-1283]. Further the effect of viscous and Darcy dissipations is to reduce the rate of heat transfer in the finite vertical porous channel under peristalsis