Provision of medical abortion by midlevel healthcare providers in Kyrgyzstan : testing an intervention to expand safe abortion services to underserved rural and periurban areas

Publisher Copyright: © 2017 World Health OrganizationObjective: To demonstrate the feasibility and safety of training midlevel healthcare providers (midwives and family nurses) to provide medical abortion and postabortion contraception in underserved areas in Kyrgyzstan. Study design: This was an implementation study at four referral facilities and 28 Felsher Obstetric Points in two districts to train their midwives and family nurses to deliver safe and effective abortion care with co-packaged mifepristone–misoprostol and provide contraceptives postabortion. The outcome of abortion — complete abortion, incomplete abortion or o-going pregnancy — was the primary end point measured. An international consultant trained 18 midwives and 14 family nurses (with midwifery diplomas) to provide medical abortion care. Supervising gynecologists based in the referral centers and study investigators based in Bishkek provided monthly monitoring of services and collection of patient management forms. A voluntary self-administered questionnaire at the follow-up visit documented women's acceptability of medical abortion services. All study data were cross-checked and entered into an online data management system for descriptive analysis. Results: Between August 2014 and September 2015, midwives provided medical abortion to 554 women with a complete abortion rate of 97.8%, of whom 62% chose to use misoprostol at home. No women were lost to follow-up. Nearly all women (99.5%) chose a contraceptive method postabortion; 61% of women receiving services completed the acceptability form, of whom more than 99% indicated a high level of satisfaction with the service and would recommend it to a friend. Conclusion: This study demonstrates that trained Kyrgyz midwives and nurses can provide medical abortion safely and effectively. This locally generated evidence can be used by the Kyrgyz Ministry of Health to reduce unintended pregnancy and expand safe abortion care to women in underserved periurban and rural settings. Implications: Success in scaling up midwife/nurse provision of medical abortion in Kyrgyzstan will require registration of mifepristone–misoprostol, regulations permanently allowing midwife/nurse provision, strengthened procurement and distribution systems to prevent stockouts of supplies, preservice training of midwives/nurses and their involvement in district level supervision, monitoring and reporting, and support from supervisors.publishersversionPeer reviewe

Need for closure effect on collective action intentions and behavior toward immigrants in Italy:The mediation of binding foundations and political conservatism

Why are people (de)motivated to mobilize in favor of immigrants? Addressing this question, we investigated the role of individuals' epistemic motivation (i.e., need for closure) in influencing the process of becoming motivated to participate in collective action in favor of immigrants in Italy. Specifically, the mediational role of binding moral foundations and political conservatism in explaining the relationship between need for closure and collective action in favor of immigrants was examined in three studies. It was hypothesized that a heightened need for closure would be indirectly and negatively associated with collective action in favor of immigrants, sequentially mediated first through binding moral foundations and then political conservatism. We found support for this prediction when either dispositional measure (Study 1 and Study 2) or an experimental induction (Study 3) of need for closure were used, and when both collective action intentions (Study 1 and Study 3) and behavior (Study 2) were assessed. The results suggest that need for closure constitutes a powerful motivational force that leads individuals to engage in uncertainty‐reducing evaluations and actions. We discuss these results regarding how they are related with previous work and their implications for research and practice

Making geology relevant for infrastructure and planning

The urban population is projected to rise to 66% in 2050 to 7.6 billion. This has had, and will have, a profound effect on the geological and geomorphological character of the Earth’s shallow geosphere. It is important to know the character and geometries of the geological deposits so that infrastructure is planned sensibly and sustainably, and urban areas can be reused responsibly to ensure that they help facilitate economic and social development. This brings major challenges for our cities, where there is increased pressure on resources, space and services. The geosciences have an important part to play in securing sustainable global cities - they can support urban innovation and city performance, reduce our environmental footprint and ensure greater resilience to natural hazards such as flooding and ground instability. For more than 30 years the British Geological Survey has advanced the geoscientific understanding and 3D characterisation of urban environments, producing multi-themed spatial datasets for geohazards and ground investigation used across the environmental, planning and insurance sectors. The BGS have collaborated with the University of Cambridge to better integrate geological data with landuse and infrastructure to look at the long-term impact on these types of activities at surface and subsurface. A 3D GeoLanduse layer was produced from the geological framework model of London. This vector-based grid means that many soil and rock properties (e.g. foundation conditions, groundwater levels, volume change potential), can be represented alongside landuse statistics and infrastructure type and correlated in the XYZ domain. Focus has been at geothermal potential of the ground surrounding residential basements and the broader correlation between geology, energy consumption and landuse at city scale using principle component analysis and cluster recognition

Rural to Urban Migration and Changes in Cardiovascular risk Factors in Tanzania: A Prospective Cohort Study.

High levels of rural to urban migration are a feature of most African countries. Our aim was to investigate changes, and their determinants, in cardiovascular risk factors on rural to urban migration in Tanzania. Men and women (15 to 59 years) intending to migrate from Morogoro rural region to Dar es Salaam for at least 6 months were identified. Measurements were made at least one week but no more than one month prior to migration, and 1 to 3 monthly after migration. Outcome measures included body mass index, blood pressure, fasting lipids, and self reported physical activity and diet. One hundred and three men, 106 women, mean age 29 years, were recruited and 132 (63.2%) followed to 12 months. All the figures presented here refer to the difference between baseline and 12 months in these 132 individuals. Vigorous physical activity declined (79.4% to 26.5% in men, 37.8% to 15.6% in women, p < 0.001), and weight increased (2.30 kg men, 2.35 kg women, p < 0.001). Intake of red meat increased, but so did the intake of fresh fruit and vegetables. HDL cholesterol increased in men and women (0.24, 0.25 mmoll-1 respectively, p < 0.001); and in men, not women, total cholesterol increased (0.42 mmoll-1, p = 0.01), and triglycerides fell (0.31 mmoll-1, p = 0.034). Blood pressure appeared to fall in both men and women. For example, in men systolic blood pressure fell by 5.4 mmHg, p = 0.007, and in women by 8.6 mmHg, p = 0.001. The lower level of physical activity and increasing weight will increase the risk of diabetes and cardiovascular disease. However, changes in diet were mixed, and may have contributed to mixed changes in lipid profiles and a lack of rise in blood pressure. A better understanding of the changes occurring on rural to urban migration is needed to guide preventive measures

Urbanization and international trade and investment policies as determinants of noncommunicable diseases in Sub-Saharan Africa

There are three dominant globalization pathways affecting noncommunicable diseases in Sub-Saharan Africa (SSA): urbanization, trade liberalization, and investment liberalization. Urbanization carries potential health benefits due to improved access to an increased variety of food imports, although for the growing number of urban poor, this has often meant increased reliance on cheap, highly processed food commodities. Reduced barriers to trade have eased the importation of such commodities, while investment liberalization has increased corporate consolidation over global and domestic food chains. Higher profit margins on processed foods have promoted the creation of ‘obesogenic’ environments, which through progressively integrated global food systems have been increasingly ‘exported’ to developing nations. This article explores globalization processes, the food environment, and dietary health outcomes in SSA through the use of trend analyses and structural equation modelling. The findings are considered in the context of global barriers and facilitators for healthy public policy.Department of HE and Training approved lis

Evaluating quality of contraceptive counseling: An analysis of the method information index

The Method Information Index (MII) is calculated from contraceptive users\u27 responses to questions regarding counseling content-whether they were informed about methods other than the one they received, told about method-specific side effects, and advised what to do if they experienced side effects. The MII is increasingly reported in national surveys and used to track program performance, but little is known about its properties. Using additional questions, we assessed the consistency between responses and the method received in a prospective, multicountry study. We employed two definitions of consistency: (1) presence of any concordant response, and (2) absence of discordant responses. Consistency was high when asking whether users were informed about other methods and what to do about side effects. Responses were least consistent when asking whether side effects were mentioned. Adjusting for inconsistency, scores were up to 50 percent and 30 percent lower in Pakistan and Uganda, respectively, compared to unadjusted MII scores. Additional questions facilitated better understanding of counseling quality

Segregation in the twenty first century: Processes, complexities and future directions

Economic inequality, international migration and urban transformation have generated fresh interest in segregation and given new social significance to questions of socio‐spatial separation and interaction. At the same time, advances in data, methods and theory are opening up new avenues of inquiry that push the focus beyond simple measures of unevenness of residential patterns towards more nuanced analysis of spatial asymmetry, structure and scale. There is also a drive towards considering spaces and activities outside the neighbourhood, bringing new richness to our understanding of how various social groups interact in the various aspects of their lives. These processes and complexities form the backdrop for our special issue and we reflect on the implications for future priorities in research on segregation in the twenty first century

Within-Neighborhood Patterns and Sources of Particle Pollution: Mobile Monitoring and Geographic Information System Analysis in Four Communities in Accra, Ghana

BACKGROUND: Sources of air pollution in developing country cities include transportation and industrial pollution, biomass and coal fuel use, and resuspended dust from unpaved roads. OBJECTIVES: Our goal was to understand within-neighborhood spatial variability of particulate matter (PM) in communities of varying socioeconomic status (SES) in Accra, Ghana, and to quantify the effects of nearby sources on local PM concentration. METHODS: We conducted 1 week of morning and afternoon mobile and stationary air pollution measurements in four study neighborhoods. PM with aerodynamic diameters RESULTS: In our measurement campaign, the geometric means of PM2.5 and PM10 along the mobile monitoring path were 21 and 49 microg/m3, respectively, in the neighborhood with highest SES and 39 and 96 microg/m3, respectively, in the neighborhood with lowest SES and highest population density. PM2.5 and PM10 were as high as 200 and 400 microg/m3, respectively, in some segments of the path. After adjusting for other factors, the factors that had the largest effects on local PM pollution were nearby wood and charcoal stoves, congested and heavy traffic, loose dirt road surface, and trash burning. CONCLUSIONS: Biomass fuels, transportation, and unpaved roads may be important determinants of local PM variation in Accra neighborhoods. If confirmed by additional or supporting data, the results demonstrate the need for effective and equitable interventions and policies that reduce the impacts of traffic and biomass pollution

Analyzing the relationship between urbanization, food supply and demand, and irrigation requirements in Jordan

The landscape surrounding urban areas is often used as farmland. With the observed expansion of urban areas over the last decades and a projected continuation of this trend, our objective was to analyze how urbanization affects food supply and demand in The Hashemite Kingdom of Jordan. We used a chain of simulation models covering components of the atmosphere (climate simulations), biosphere (crop yield calculations), and anthroposphere (simulations of urban expansion and land-use change) to calculate the effect of farmland displacement on land and water resources (hydrosphere). Our simulations show that the displacement of farmland itself has hardly any effect on cropland demand, crop yields, or irrigation water requirements. These results indicate that Jordan has sufficient productive areas available to buffer effects of urban expansion on food production for the next decades. However, this picture changes dramatically once we include changes in socioeconomy and climate in our simulations. The isolated effect of climate change results in an expected increase in irrigation water requirements of 19 MCM by 2025 and 64 MCM by 2050. It furthermore leads to an increase in cropland area of 147 km2 by 2025 and 265 km2 by 2050. While the combined analysis of urban expansion, climate change, and socioeconomic change makes optimistic assumptions on the increase in crop yields by 2050, the results still indicate a pronounced effect on cropland demands (2700 km2) and a steep increase in irrigation water requirements (439 MCM). Our simulation results highlight the importance of high resolution, spatially explicit projections of future land changes as well as the importance of spatiotemporal scenario studies at the regional level to help improving water planning strategies.The research presented in this manuscript was funded by the German Federal Ministry of Education and Research [contract 01LW0502]. We would like to thank our colleagues from IMK-559 IFU for providing the climate data without which this study would not have been possible. The authors thank the anonymous reviewers for their constructive comments that helped improve the quality of this manuscript.YesThis journal operates a single blind review process. All contributions will be initially assessed by the editor for suitability for the journal. Papers deemed suitable are then typically sent to a minimum of two independent expert reviewers to assess the scientific quality of the paper. The Editor is responsible for the final decision regarding acceptance or rejection of articles. The Editor's decision is final