A study protocol for an mHealth, multi-centre randomized control trial to promote use of postpartum contraception amongst rural women in Punjab, Pakistan

Background: Provision of family planning services during the immediate post-partum phase is considered effective and cost-efficient for promoting healthy timing and spacing of pregnancies. This research aims to test the effectiveness of mobile phone-based interventions in promoting use of postpartum contraception. Moreover, it will also test the non-inferiority of text and voice messages compared to interactive phone-based counselling.Methods: A three-arm, 10-month, multicentre, randomized controlled trial will be conducted at 15 social franchise (SF) health facilities in Punjab province of Pakistan. Pregnant women aged 15-44 years who are in their first or second trimester and have a mobile phone for their own use will be eligible to participate in this study. The participants will be randomly allocated to one of three study arms: a) voice and text messages; b) interactive telephone-based counselling; or c) control arm (no additional phone-based support). The intervention counselling module will be developed based on the Integrated Behaviour Model which was recently adapted, and tested for the family planning context in Pakistan. It will broadly cover birth-preparedness, importance of birth spacing, and postnatal care. The phone-based intervention aims to improve women\u27s ability to use contraception by providing them with information about a range of methods, access to family planning methods through outlets such as Suraj SF providers, connecting them with MSS field health educators to help them reach the centres, motivation by re-enforcing the benefits of contraceptive use on women\u27s quality of life, and dispelling myths and misconceptions about modern contraceptive methods. Risk differences will be used as the measure of effect of the intervention on the outcomes.Discussion: The study findings will highlight effectiveness of mobile phone in raising awareness of maternal health and contraception, which in turn, is expected to be translated into increased proportion of: at least four antenatal visits, skilled birth or institutional delivery, postpartum contraceptive use, postnatal check-up, child immunization, and breastfeeding. Moreover, if the text and voice messages approach is proven to be non-inferior to interactive calls, it will provide evidence to making promotion of healthcare less resource intensive, and thereby contribute in improving the efficiency of the healthcare system.Trial registration: This trial was prospectively registered with the Clinical Trials registry ( NCT03612518 ) on August 2nd, 2018

Endonasal Endoscopic Repair of Cerebrospinal Fluid Leaks

Objective: To assess the outcome of Endonasal Endoscopic Repair of Cerebrospinal Fluid LeaksMethods and Materials: This study was conducted from July 2013 to October 2014 at the department of Neurosurgery, PGMI, Lahore General Hospital, Lahore. A total of 20 patients were included in this study of both gender (male and female) and in the age range of 15 – 65 years. All the patients undergone Endonasal Endoscopic with the use of a Karl Stortz rigid endoscope of 0º and 30º with a 4mm diameter. All of them were followed up for recurrence of CSF leak and any postoperative complication.Results: Out of 20 patients, there were 08 (40%) males and 12 (60%) female patients. Their age ranged from 15 – 65 years. The maximum numbers of patients were in their third and fourth decade of life. The cause of CSF leak was spontaneous in 11(55%), iatrogenic in 5 (25%) and traumatic in 4 (20%) of cases. In 13 (65%) patients, CSF rhinorrhea was from right nostril and in 7 (35%) patients left side was affected. Endonasal Endoscopic CSF repair was done in all patients and was successful in 18 (90%) of patients. Two patients (10%) presented with recurrence of CSF leak in which one was successfully re-operated endoscopically and other undergone transcranial approach. Overall the success rate was 95% in our study. Only one patient complicates with meningitis postoperatively which was resolved with antibiotics.Conclusion: The repair of the CSF rhinorrhea by Endonasal Endoscopic surgery is minimal invasive, safe, effective and is a valid alternative to the cranial approach. Abbreviations: CSF: Cerebrospinal Fluid. MRI: Magnetic Resonance Imaging

Opinto-ohjauksen suunnitelman jalkauttaminen toiminnallisen menetelmän avulla

Artikkelissa tarkastellaan opinto-ohjaussuunnitelman jalkauttamista oppilaitosympäristössä tuoden esiin yhden näkökulman, kuinka jalkauttamista voidaan tehdä käytännössä henkilöstöä osallistaen. Jalkauttaminen liittyy yleisemmin organisaatioissa strategiseen johtamiseen sekä osaamisen kehittämiseen. Opinto-ohjaussuunnitelman jalkauttaminen tähtää opinto-ohjauksen laadun kehittämiseen oppilaitoksissa. Esimerkkitapauksena kuvataan Raahen koulutuskuntayhtymän ammatillisen 2. asteen oppilaitosten (nykyisin Koulutuskeskus Brahe) opinto-ohjauksen suunnitelman jalkauttamista toiminnallisen menetelmän avulla. Opinto-ohjaussuunnitelman jalkauttamisen idea oli tarjota toiminnallisen työskentelytavan avulla mahdollisuus kokea opinto-ohjaus opiskelijan näkökulmasta. Toiminnallisen toteutuksen ohjausteoreettinen viitekehys rakentuu ratkaisu- ja voimavarakeskeiselle sekä sosiodynaamiselle ohjausteorialle. Opinto-ohjausmallina käytetään opintopolkumallia. Työhyvinvointipäivän yhteydessä toteutettu jalkauttaminen toteutui suunnitellusti, osallistujat lähtivät innokkaasti mukaan toimintaan ja antoivat myönteistä palautetta päivän onnistumisesta. Toiminallisuus teki opinto-ohjauksen suunnitelmaan perehtymisestä kevyemmän ja konkreettisemman. Ammatillisen 2. asteen koulutuksen reformin lähtökohtana on siirtyä henkilökohtaistettuun osaamisperusteiseen oppimisprosessiin. Tämä edellyttää osaavan ja oikea-aikaisen ohjauksen ja tuen saatavuutta sekä koko opetus- ja ohjaushenkilöstön sitoutumista ohjaukselliseen ajatteluun ja toimintaan. Tässä valossa oppilaitosten ohjaussuunnitelmien jalkauttaminen nousee tärkeäksi tehtäväksi. Koska ohjaus kuuluu koko henkilöstölle, on oleellista osallistaa henkilöstö ohjauksen kehittämiseen jo suunnitelmien laadintavaiheissa

EFFECTIVENESS OF MANUAL TRACTION AND OTHER PHYSIOTHERAPY TREATMENT IN THE MANAGEMENT OF PAINFUL CERVICAL RADICULOPATHY

Background: Cervical radiculopathy, generally entitle as pinching of the nerves which causes severe shooting pain which mostly pass through the shoulder. Along with it causes muscle weakness and numbness into the arm and hand. In majority of the cases, cervical radiculopathy responds well to conservative mode of treatments which incorporate physical therapy with medical management. The aim of this study is to uncover the effective and evidence based conservative treatment of cervical radiculopathy. Method: Randomized controlled trial study conducted from January 2014 to December 2014. Participants were recruited from physiotherapy OPDs of tertiary care hospitals. A total number of, 100 subjects with a ratio of 50 men and 50 women were recruited between the ages of 25 and 55 years with unilateral cervical radiculopathy. Control group received combination of conventional AROM exercises and modalities including TENS and superficial thermotherapy as a treatment while experimental group received manual cervical traction and combination of conventional AROM exercises, modalities including TENS and superficial thermotherapy. For both groups, treatment was designed for two weeks (6 sessions/ week). Improvement in symptoms was assessed by evaluation of both groups on the basis of visual analogue scale (VAS). Results: After 2 weeks of treatment, patients with neck pain showed marked decreased in pain as compared with the control group (P<.001).For pre and post level a paired sample t-test was used and the results with p-value less than 0.05 were considered as significant. Mean difference of 0.94 (VAS) with a significant p-value (P<0.01) was obtained shows the respective improvements in the numeric pain scale scores. Conclusion: Manual cervical traction when used with conventional AROM exercises and modalities were effective methods for decreasing pain in cervical radiculopathy. Recent literature supports such protocols involving multiple interventions. Results of this study also supported the treatment options in cervical radiculopathy in a multimodal approach

Conceptual framework for women empowerment.

<p>Conceptual framework for women empowerment.</p

Women empowerment in different household decision making (n = 2133).

<p>Women empowerment in different household decision making (n = 2133).</p

Univariable analysis of women's empowerment in decision making and socio-economic and reproductive health characteristics (n = 2133).

<p>Univariable analysis of women's empowerment in decision making and socio-economic and reproductive health characteristics (n = 2133).</p