Women's Empowerment and Reproductive Choices

The 1994 Cairo International Conference on Population and Development (ICPD) in their Programme of Action calls for promoting gender equality and equity and the empowerment of women. Furthermore, the conference also recognises the basic rights of all couples and individuals to decide freely and responsibly the number, spacing, and timing of their children, as well as the right to the information and the means to do so [Sadik (1994)]. The need for such a programme of action arose in view of the fact that in many countries, including Pakistan, women are generally least empowered and hence they have negligible rights to decide about the number of their children. According to the 1990-91 Pakistan Demographic and Health Survey, over 54 percent women either wanted to stop having children or wanted to wait at least two years before having another child [Ali and Rukanuddin (1992)]. However, in practice, all of these women were not protected; instead, only 12 percent were practising contraception [Shah and Ali (1992)]. The low incidence of family planning practice on the part of the women is not so much due to the dearth of family planning services; rather it is due to resistance by husbands, in-laws, and other peer pressures. Demographers like Caldwell (1982) and Cain et al. (1979) also contend that in patriarchal societies it is the patriarchy which militates against the fertility decline.

Integration of mental health into primary healthcare: Perceptions of stakeholders in Pakistan

Background: In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC).Objectives: This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan.Methods: A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out.Results: Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services.Conclusions: The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan

Age and site of Colonic Neoplastic Lesions: Implications of screening in South Asia.

Objective : To evaluate the Age of patients and the site of Colonic Neoplastic Lesions (CNL) and to determine the appropriate screening strategy for Colorectal Carcinoma (CRC) (sigmoidoscopy versus colonoscopy) in our population. Methods : This is a cross sectional study. Data of all patients more than 16 years of age who underwent full colonoscopic examination at the Aga Khan University hospital between January 2011 till December 2013 and were diagnosed to have CRC or advanced adenomas (defined as polyp more than 1 cm and/or having villous morphology on histology) was recorded. Lesions found distal to the splenic flexure were characterized as distal lesions and while lesions found between the splenic flexure and the cecum were characterized as proximal lesions. RESULTS: During the study period colonic neoplastic lesions were found in 217 patients; 186 (85.7%) patients had CRC and 31(14.3%) patients had advanced adenomatous polyps. Mean age was 55.8±14 years and amongst them 72 (33.2%) patients were less than 50 years of age while 145 (66.8%) were more than 50 years. In 144 (66.4%) patients lesions were located in the distal colon, 65 (30%) had lesions in the proximal colon while in 8 (3.7%) patients the neoplastic lesions were found both in the proximal and distal colon. The predominant symptoms were bleeding per rectum in 39.6% of patients followed by weight loss in 31.8% of patients. Only 3 patients had familial syndromes with multiple polyps. When patients younger than 50 years of age were compared with patients more than 50 years there was no statistically significant difference between the site of neoplastic lesion as well as the presenting symptoms. (p value 0.85). CONCLUSION: Colonic Neoplastic Lesions presented at younger age in our study population and one third of the lesions were found in the right sided colon. Hence screening for CNLs should be implied at an earlier age preferably with colonoscopy. More population based data is required to further validate our results

The Impact of Lameness on Dairy Cattle Welfare: Growing Need for Objective Methods of Detecting Lame Cows and Assessment of Associated Pain

Dairy cows are the major animals reared for milk production worldwide. Lameness is a manifestation of painful condition due to injury or disease in the foot, regarded as a major welfare problem in dairy cows. An effective lameness management requires prompt identification of lame cows. The objectives of this systematic review were to discuss the various techniques of detecting lameness, assessment of the associated pain, and the impact of lameness on dairy cow welfare. Results from the literature search yielded 534 papers, with 102 papers meeting the inclusion criteria. The eligible studies were discussed in two sections which were; (1) lameness detection systems and their application in pain assessment using four methods: gait and behavioral variables, physiological parameters, pressure nociceptive threshold and blood biomarkers; (2) impact of lameness on animal-based welfare measures. Despite the limitations in the use of automated locomotion scoring systems, results showed the technique remains a promising tool for the prompt detection of lame cows compared with manual systems (MLSS). More investigation of such systems could aid the validation of pain in cows with various degree of lameness. Further studies are required for early lameness detection and minimizing the welfare implications in dairy herds

Wavelength tunable soliton rains in a nanotube-mode locked Tm-doped fiber laser

We report soliton rains in a tunable Tm-doped fiber laser mode locked by carbon nanotubes. We also detect their second- and third-harmonics. We achieve a tunability of over 56 nm, from 1877 to 1933 nm, by introducing a polarization-maintaining isolator and two in-line polarization controllers. This makes our system promising as a tunable filter for ultrafast spectroscopy.We acknowledge funding from ERC Grant Hetero2D, EPSRC Grants Nos. EP/L016087/1, EP/K017144/1, EP/K01711X/1 and the China Scholarship Council

Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan: Evidence from two longitudinal cohort studies 15 years apart

Background: Oshikhandass is a rural village in northern Pakistan where a 1989-1991 verbal autopsy study showed that diarrhea and pneumonia were the top causes of under-5 mortality. Intensive surveillance, active community health education and child health interventions were delivered in 1989-1996; here we assess improvements in under-5 mortality, diarrhea, and pneumonia over this period and 15 years later.Methods: Two prospective open-cohort studies in Oshikhandass from 1989 to 1996 (Study 1) and 2011-2014 (Study 2) enrolled all children under age 60 months. Study staff trained using WHO guidelines, conducted weekly household surveillance and promoted knowledge on causes and management of diarrhea and pneumonia. Information about household characteristics and socioeconomic status was collected. Hurdle models were constructed to examine putative risk factors for diarrhea and pneumonia.Results: Against a backdrop of considerable change in the socioeconomic status of the community, under-5 mortality, which declined over the course of Study 1 (from 114.3 to 79.5 deaths/1000 live births (LB) between 1989 and 1996), exceeded Sustainable Development Goal 3 by Study 2 (19.8 deaths/ 1000 LB). Reductions in diarrhea prevalence (20.3 to 2.2 days/ Child Year [CY]), incidence (2.1 to 0.5 episodes/ CY), and number of bloody diarrhea episodes (18.6 to 5.2%) seen during Study 1, were sustained in Study 2. Pneumonia incidence was 0.5 episodes /CY in Study 1 and 0.2/CY in Study 2; only 5% of episodes were categorized as severe or very severe in both studies. While no individual factors predicted a statistically significant difference in diarrhea or pneumonia episodes, the combined effect of water, toilet and housing materials was associated with a significant decrease in diarrhea; higher household income was the most protective factor for pneumonia in Study 1.Conclusions: We report a 4-fold decrease in overall childhood mortality, and a 2-fold decrease in childhood morbidity from diarrhea and pneumonia in a remote rural village in Pakistan between 1989 and 2014. We conclude that significant, sustainable improvements in child health may be achieved through improved socioeconomic status and promoting interactions between locally engaged health workers and the community, but that continued efforts are needed to improve health worker training, supervision, and the rational use of medications

Efficient design in building construction with rubber bearing in medium risk seismicity: case study and assessment

Earthquakes pose tremendous threats to life, property and a country's economy, not least due to their capability of destroying buildings and causing enormous structural damage. The hazard from ground excitations should be properly assessed to mitigate their action on building structures. This study is concerned with medium risk seismic regions. Specifically, the heavily populated capital city Dhaka in Bangladesh has been considered. Recent earthquakes that occurred inside and very close to the city have manifested the city's earthquake sources and vulnerability. Micro-seismicity data supports the existence of at least four earthquake source points in and around Dhaka. The effects of the earthquakes on buildings are studied for this region. Rubber base isolation is selected as an innovative option to lessen seismic loads on buildings. Case studies have been carried out for fixed and isolated based multi-storey buildings. Lead rubber bearing and high damping rubber bearing have been designed and incorporated in building bases. Structural response behaviours have been evaluated through static and dynamic analyses. For the probable severe earthquake, rubber bearing isolation can be a suitable alternative as it mitigates seismic effects, reduces structural responses and provides structural and economic benefits

Preventive Hoof Trimming and Animal-Based Welfare Measures Influence the Time to First Lameness Event and Hoof Lesion Prevalence in Dairy Cows

Background: The objectives of this study were to, (1) investigate the impact of the Dutch five-step hoof trimming (HT) technique on time to lameness and hoof lesion prevalence in grazing (GR) and non-grazing (NGR) dairy cows, and (2) determine the association between potential benefits of HT and animal-based welfare measures during lactation. A total of 520 non-lame cows without hoof lesions from 5 dairy farms (GR = 2, NGR = 3) were enrolled at early (within 30 days in milk; DIM) and late lactation (above 200 DIM), and randomly allocated to either trimmed (HGR or HNGR) or control groups (CON-GR and CON-NGR). Locomotion scores, body condition, hock condition, leg hygiene, and hoof health were assessed at monthly intervals until the following 270 days in milk. The data were analyzed using Kaplan-Meier survival analysis, multivariable Cox, and logistic regression models. The overall incidence rate of lameness was 36.2 cases/100 cows/month, with corresponding rates of 27.4, 31.9, 48.4, and 45.8 cases/100 cows/month in HGR, HNGR, CON-GR, and CON-NGR, respectively. Time to first lameness event was significantly higher in HGR (mean ± S.E; 8.12 ± 0.15) compared to CON-GR (7.36 ± 0.26), and in HNGR (8.05 ± 0.16) compared to CON-NGR (7.39 ± 0.23). The prevalence of hoof lesions in the enrolled cows was 36.9%, with a higher occurrence in CON-GR (48.8%) than HGR (23.2%), and in CON-NGR (52.6%) compared to HNGR (32.2%). The majority of hoof lesions were non-infectious in grazing (HGR vs. CON-GR; 21.3 vs. 33.3%) and non-grazing herds (HNGR vs. CON-NGR; 25.0 vs. 40.4%). The risk of lameness was higher in underconditioned cows (Hazard ratio; HR = 3.1, 95% CI 1.2–7.4), presence of hoof lesion (HR = 33.1, 95% CI 17.6–62.5), and there was variation between farms. Aside HT, lower parity (OR = 0.4, 95% CI 0.2–0.8), normal hock condition (OR = 0.06; 95% 0.01–0.29), and absence of overgrown hoof (OR = 0.4; 95% 0.2–0.7) were protective against non-infectious hoof lesions. Functional HT is beneficial as a lameness preventive strategy during lactation; however, ensuring older cows are in good body condition and free from hock injuries are equally important