Expanding Use of Magnesium Sulfate for Treatment of Pre-eclampsia and Eclampsia

Pre-eclampsia/eclampsia is a serious condition that can develop during pregnancy, even in women with no risk factors. Although there is little understanding of what causes pre-eclampsia/eclampsia, there is an effective treatment for this condition which, if left untreated, can progress to coma and death. In 1994, the World Health Organization (WHO) recommended magnesium sulfate as the standard treatment for pre-eclampsia and eclampsia and within two years it was placed on WHO's Essential Medicines List. Despite its known efficacy, this inexpensive drug is often underutilized, in part because the diffusion of innovation takes time but also because of the service delivery challenges inherent to the use of magnesium sulfate—it requires a strong and effective referral system, often a challenge in under-resourced health systems. The underutilization of magnesium sulfate has been a recognized problem in Nigeria for some time; prior to 2007 there was almost no magnesium sulfate in the country.The significant contribution of pre-eclampsia/eclampsia to maternal mortality in Nigeria—along with the promise of magnesium sulfate as a solution—caught the attention of the John D. and Catherine T. MacArthur Foundation in 2005 when a program officer overheard a conversation between two Nigerian doctors who were lamenting the failure of a piece of equipment in their hospital laboratory that was used for manufacturing magnesium sulfate. Without it, one was saying to the other, they would have no supply of the drug to treat pre-eclampsia/eclampsia and no way to save women's lives. The Foundation decided to fund a series of grants to expand the use of magnesium sulfate for pre-eclampsia/eclampsia in Nigeria and, in 2014, commissioned an evaluation of that work. This case study describes the findings of the evaluation, including the challenges encountered while implementing the projects, the successes achieved, and existing opportunities for future scaling up of the services across the country

DEVELOPMENT OF A COMMUNITY-BASED PLAN FOR AN EFFECTIVE BEHAVIORAL INTERVENTION TO REDUCE CHILDHOOD OBESITY IN A RURAL APPALACHIAN COMMUNITY

Rural children experience increased rates of obesity and reduced access to specialized weight management facilities, which makes receiving the recommended frequency of care difficult. Clinical-community partnerships, recommended by the American Academy of Pediatrics (AAP) to expand access, have been shown to be a feasible strategy of care delivery. Examination of literature and stakeholder interviews were used to inform the development of a collaborative pediatric weight management program in a rural, Appalachian community. Screening articles as well as intervention articles were reviewed. Outcomes of screening articles reviewed included BMI measures (3), screening practices (7), and referral practices (4). Common outcomes of intervention articles included BMI (24), parent BMI (7), diet (17), physical activity (16), quality of life (9), and sleep/sleep quality (7). Key results from these outcomes varied in each article. Clinical referral was seen in 23 studies and family-centeredness was seen in 25 of the 32 intervention articles reviewed. The majority of intervention studies that reported improved outcomes included both clinical referral and family-centered interventions. Interview guides were developed using the Consolidated Framework for Implementation Research (CFIR). Structured stakeholder interviews were conducted among implementation partners (n=4), community partners (n=1), and individuals (parents/caregivers) (n=1). Interviews were transcribed and a thematic analysis was conducted. Themes that emerged during thematic analysis included Barriers, Facilitators, Need for Intervention, Incentives, Receptivity, Setting Characteristics, and Implementation Considerations. Barrier sub-themes included transportation, childcare, adherence, time, and financial barriers. Facilitators sub-theme included complementary programs and processes. Incentives were grouped into monetary and non-monetary incentives sub-themes. Receptivity included community and organizational receptivity sub-themes. Setting characteristics included community and organizational setting characteristics sub-themes. Community site considerations (spaciousness, access, and familiarity); overlapping financial and adherence barriers; provision of program-specific incentives; and positive program framing to improve receptivity and participation were notable characteristics examined among themes and should be considered in future program development. Preliminary research, establishing factors that may influence implementation within the specified community, is of great importance to ensure efficacy; thus, the findings of this study will present critical information for program development and delivery

Field Evaluation of Herbicides on Small Fruit, Vegetable, and Ornamental Crops, 1997

Growers generally use herbicides to efficiently produce high-quality fruit and vegetables for processing or fresh market sales. Due to the smaller acreage of these crops compared to major field crops, fewer herbicides are registered for use in fruit and vegetable crops than for field crops. Each year, new herbicides are evaluated under Arkansas growing conditions with the objective of improving the herbicide technology for the grower, processor, and ultimately the consumer. This report includes studies on the control of many of the more serious weed problems in important crops of this region, including snapbeans, spinach, southern pea, watermelon, cantaloupe, tomato, blackberry, and grape. In addition, the report includes information on the tolerance of selected bedding plants to some effective herbicides