Impact of an in-built monitoring system on family planning performance in rural Bangladesh

<p>Abstract</p> <p>Background</p> <p>During 1982–1992, the Maternal and Child Health Family Planning (MCH-FP) Extension Project (Rural) of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), in partnership with the Ministry of Health and Family Welfare (MoHFW) of the Government of Bangladesh (GoB), implemented a series of interventions in Sirajganj Sadar sub-district of Sirajganj district. These interventions were aimed at improving the planning mechanisms and for reviewing the problem-solving processes to build an effective monitoring system of the interventions at the local level of the overall system of the MOHFW, GoB.</p> <p>Methods</p> <p>The interventions included development and testing of innovative solutions in service-delivery, provision of door-step injectables, and strengthening of the management information system (MIS). The impact of an in-built monitoring system on the overall performance was assessed during the period from June 1995 to December 1996, after the withdrawal of the interventions in 1992.</p> <p>Results</p> <p>The results of the assessment showed that Family Welfare Assistants (FWAs) increased household-visits within the last two months, and there was a higher use of service-delivery points even after the withdrawal of the interventions. The results of the cluster surveys, conducted in 1996, showed that the selected indicators of health and family-planning services were higher than those reported by the Bangladesh Demographic and Health Survey (BDHS) 1996–1997. During June 1995-December, 1996, the contraceptive prevalence rate (CPR) increased by 13 percentage points (i.e. from 40% to 53%). Compared to the national CPR (49%), this increase was statistically significant (p < 0.05).</p> <p>Conclusion</p> <p>The in-built monitoring systems, including effective MIS, accompanied by rapid assessments and review of performance by the programme managers, have potentials to improve family planning performance in low-performing areas.</p

Racial disparities in infant mortality: what has birth weight got to do with it and how large is it?

<p>Abstract</p> <p>Background</p> <p>It has been hypothesized that birth weight is not on the causal pathway to infant mortality, at least among "normal" births (i.e. those located in the central part of the birth weight distribution), and that US racial disparities (African American versus European American) may be underestimated. Here these hypotheses are tested by examining the role of birth weight on racial disparities in infant mortality.</p> <p>Methods</p> <p>A two-component Covariate Density Defined mixture of logistic regressions model is used to decompose racial disparities, 1) into disparities due to "normal" versus "compromised" components of the birth cohort, and 2) further decompose these components into indirect effects, which are associated with birth weight, versus direct effects, which are independent of birth weight.</p> <p>Results</p> <p>The results indicate that a direct effect is responsible for the racial disparity in mortality among "normal" births. No indirect effect of birth weight is observed despite significant disparities in birth weight. Among "compromised" births, an indirect effect is responsible for the disparity, which is consistent with disparities in birth weight. However, there is also a direct effect among "compromised" births that reduces the racial disparity in mortality. This direct effect is responsible for the "pediatric paradox" and maybe due to differential fetal loss. Model-based adjustment for this effect indicates that racial disparities corrected for fetal loss could be as high as 3 or 4 fold. This estimate is higher than the observed racial disparities in infant mortality (2.1 for both sexes).</p> <p>Conclusions</p> <p>The results support the hypothesis that birth weight is not on the causal pathway to infant mortality among "normal" births, although birth weight could play a role among "compromised" births. The overall size of the US racial disparities in infant mortality maybe considerably underestimated in the observed data possibly due to racial disparities in fetal loss.</p

A nicotina atua como fator deletério na reparação da parede abdominal The nicotine has a deleterious effect on the healing of abdominal wall

OBJETIVO: Avaliar o efeito da nicotina na cicatrização da camada musculoaponeurótica da parede abdominal. MÉTODOS: Estudo experimental em que foram usados 16 ratos da raça Wistar pesando em média 210&plusmn; 8g, separados aleatoriamente em 2 grupos de 8. Nos animais do grupo A foi implantado disco de nicotina (Nicotinel Ò) na dose de 5mg/Kg de peso/dia no subcutâneo da região dorsal, trocado a cada dois dias, a partir do 5&ordm; dia antes da operação em que foi feita laparotomia mediana de 5 cm, até o 10º dia de observação. No grupo B (controle) foram usados discos de celulose com o mesmo diâmetro. Tubo de silicone multiperfurado foi implantado no subcutâneo a 1cm da lesão da parede abdominal. A camada musculoaponeurótica e a pele foram suturadas com fio de nylon 5-0. No 10&ordm; dia pós-operatório foi colhido 1ml de líquido seroso do tubo de silicone por punção percutânea para dosagem de pO2 e os animais receberam dose letal de anestésico. Foi ressecado um segmento da camada musculoaponeurótica com 2cm de largura para tensiometria, em seguida processado e corado em HE e tricrômico de Masson para análise quantitativa dos dados histopatológicos em sistema digitalizado. A análise estatística foi feita pelo ANOVA e teste Newman-Keuls, com significância 0,05. RESULTADOS: No grupo A a pO2 do líquido tecidual atingiu o valor 17,75&plusmn; 3,4 mmHg e no grupo B (controle) a pO2 = 40,75&plusmn; 6,4 mmHg (p<0,01). A resistência à tensão apresentou o valor de 728,5&plusmn; 161,75gf no grupo A e 1241,6&plusmn; 232gf no grupo de controle (p<0,01), coincidindo com os achados da pO2. A densidade média dos elementos histopatológicos estudados foi de 105&plusmn; 17,1 nos animais do grupo A e 146,2&plusmn; 8,8 no grupo B (p<0,01). CONCLUSÃO: após avaliação da pO2 tecidual, tensiometria e histopatologia, concluiu-se que a nicotina por via subcutânea exerce efeito deletério sobre a cicatrização de lesões da parede abdominal de ratos.<br>OBJETIVE: An experimental study was done to evaluate the effect of nicotine on the healing of abdominal wall. METHODS: Sexteen Wistar rats weighing 210&plusmn; 8g were randomly separated into two groups of eight rats each. In the group A Nicotine (Nicotinel Ò) was implanted in the back subcutaneous 5mg/Kg each two days, begining at the fifth preoperative day. A 5cm median laparotomy was done, sutured with nylon 5-0 and the rats were observed in individual cages. The group B (control) didn&rsquo;t use nicotine. A multiperfurated silicone tube was implanted subcutaneously near the abdominal sutured lesion. In the tenth postoperative day 1ml of serous liquid was harvested from the silicone tube and a pO2 dosage was done. The rats were killed with overdose of anesthetic. A 2cm width transversal segment of abdominal wall was submited to tensile strength test by a tensiometer. A biopsy of the sutured area including muscle, aporeurosis and peritoneum was processed for histopatologic analysis by a digitalised system. The data were processed by the ANOVA and Newman-Keuls tests, considering significant the differences when p<0,05. RESULTS: In the group A the pO2 on the tissue serous liquid reached 17,75&plusmn; 3,4 mmHg and in the group B (control) the pO2 = 40,75&plusmn; 6,4 mmHg (p<0,01). The tensile strength reached 728,5&plusmn; 161,75gf in the group A and 1241,6&plusmn; 232gf in the control one (p<0,01).The mean density of the histopatologic elements was 105&plusmn; 17,1 in group A and 146,2&plusmn; 8,8 in group B (p<0,01). CONCLUSION: after evaluation of tissue pO2 , tensiometry and histopatology, the data permited to conclude that the nicotine has a deleterious effect on the healing the abdominal wall of rats

Social stigma in diabetes : a framework to understand a growing problem for an increasing epidemic

A comprehensive understanding of the social and psychological impact of diabetes mellitus is important for informing policy and practice. One potentially significant, yet under-researched, issue is the social stigma surrounding diabetes. This narrative review draws on literature about health-related stigma in diabetes and other chronic conditions in order to develop a framework for understanding diabetes-related stigma. Our review of the literature found that people who do not have diabetes assume that diabetes is not a stigmatized condition. In contrast, people with diabetes report that stigma is a significant concern to them, experienced across many life domains, e.g., in the workplace, in relationships. The experience of diabetes-related stigma has a significant negative impact on many aspects of psychological well-being and may also result in sub-optimal clinical outcomes for people with diabetes. We propose a framework that highlights the causes (attitudes of blame, feelings of fear and disgust, and the felt need to enforce social norms and avoid disease), experiences (being judged, rejected, and discriminated against), and consequences (e.g., distress, poorer psychological well-being, and sub-optimal self-care) of diabetes-related stigma and also identifies potential mitigating strategies to reduce diabetes-related stigma and/or enhance coping and resilience amongst people with diabetes. The systematic investigation of the experiences, causes, and consequences of diabetes-related stigma is an urgent research priority.<br /