Oxygen saturation as a predictor of adverse maternal outcomes in women with preeclampsia.

OBJECTIVE: We sought to determine the role of respiratory assessment by cardiorespiratory symptoms and/or oxygen saturation by pulse oximetry (SpO2) in predicting adverse maternal outcomes in women admitted to hospital with preeclampsia. METHODS: These data derive from an international, prospective multicentre cohort study, PIERS (Pre-eclampsia Integrated Estimate of RiSk), which assesses predictors of adverse outcomes in women admitted to tertiary perinatal units with preeclampsia. Univariate and multivariate analyses of cardiorespiratory symptoms and pulse oximetry were performed to assess their ability to predict a combined adverse maternal outcome developed through international Delphi consensus. RESULTS: SpO2 successfully predicted adverse maternal outcomes; the area under the receiver-operator characteristic curve (AUC ROC) was 0.71 (95% CI 0.65 to 0.77). Combining the symptoms of chest pain and/or dyspnea with pulse oximetry improved this predictive ability (AUC ROC 0.73; 95% CI 0.67 to 0.78). When SpO2 was stratified into risk groups using inflection points on the ROC curve, the highest risk group (SpO2 90% to 93%) had an odds ratio of 18.1 (95% CI 8.2 to 40.2) for all outcomes within 48 hours when compared with the baseline group (SpO2 98% to 100%). CONCLUSION: Assessing SpO2 aids in the assessment of maternal risk in women admitted to hospital with preeclampsia. An SpO2 value of ≤ 93% confers particular risk. The symptom complex of chest pain and/or dyspnea adds to the association

Spatio-temporal analyses of impacts of multiple climatic hazards in a savannah ecosystem of Ghana

Ghana’s savannah ecosystem has been subjected to a number of climatic hazards of varying severity. This paper presents a spatial, time-series analysis of the impacts of multiple hazards on the ecosystem and human livelihoods over the period 1983-2012, using the Upper East Region of Ghana as a case study. Our aim is to understand the nature of hazards (their frequency, magnitude and duration) and how they cumulatively affect humans. Primary data were collected using questionnaires, focus group discussions, in-depth interviews and personal observations. Secondary data were collected from documents and reports. Calculations of the standard precipitation index (SPI) and crop failure index used rainfall data from 4 weather stations (Manga, Binduri, Vea and Navrongo) and crop yield data of 5 major crops (maize, sorghum, millet, rice and groundnuts) respectively. Temperature and windstorms were analysed from the observed weather data. We found that temperatures were consistently high and increasing. From the SPI, drought frequency varied spatially from 9 at Binduri to 13 occurrences at Vea; dry spells occurred at least twice every year and floods occurred about 6 times on average, with slight spatial variations, during 1988-2012, a period with consistent data from all stations. Impacts from each hazard varied spatio-temporally. Within the study period, more 70% of years recorded severe crop losses with greater impacts when droughts and floods occur in the same year, especially in low lying areas. The effects of crop losses were higher in districts with no/little irrigation (Talensi, Nabdam, Garu-Tempane, Kassena-Nankana East). Frequency and severity of diseases and sicknesses such as cerebrospinal meningitis, heat rashes, headaches and malaria related to both dry and wet conditions have increased steadily over time. Other impacts recorded with spatio-temporal variations included destruction to housing, displacement, injury and death of people. These impacts also interacted. For example, sicknesses affected labour output; crop losses were blamed for high malnutrition; and reconstruction of properties demanded financial resources largely from sale of agricultural produce. These frequent impacts and their interactions greatly explain the persistent poverty in the area

Cost-effectiveness of HIV prevention interventions in Andhra Pradesh state of India

<p>Abstract</p> <p>Background</p> <p>Information on cost-effectiveness of the range of HIV prevention interventions is a useful contributor to decisions on the best use of resources to prevent HIV. We conducted this assessment for the state of Andhra Pradesh that has the highest HIV burden in India.</p> <p>Methods</p> <p>Based on data from a representative sample of 128 public-funded HIV prevention programs of 14 types in Andhra Pradesh, we have recently reported the number of HIV infections averted by each type of HIV prevention intervention and their cost. Using estimates of the age of onset of HIV infection, we used standard methods to calculate the cost per Disability Adjusted Life Year (DALY) saved as a measure of cost-effectiveness of each type of HIV prevention intervention.</p> <p>Results</p> <p>The point estimates of the cost per DALY saved were less than US $50 for blood banks, men who have sex with men programmes, voluntary counselling and testing centres, prevention of parent to child transmission clinics, sexually transmitted infection clinics, and women sex worker programmes; between US$50 and 100 for truckers and migrant labourer programmes; more than US $100 and up to US$410 for composite, street children, condom promotion, prisoners and workplace programmes and mass media campaign for the general public. The uncertainty range around these estimates was very wide for several interventions, with the ratio of the high to the low estimates infinite for five interventions.</p> <p>Conclusions</p> <p>The point estimates for the cost per DALY saved from the averted HIV infections for all interventions was much lower than the per capita gross domestic product in this Indian state. While these indicative cost-effectiveness estimates can inform HIV control planning currently, the wide uncertainty range around estimates for several interventions suggest the need for more firm data for estimating cost-effectiveness of HIV prevention interventions in India.</p

Feminist health psychology and abortion : towards a politics of transversal relations of commonality

In 1992 Speckhard and Rue argued in the Journal of Social Issues for the recognition of a diagnostic category, post-abortion syndrome (PAS). This term was first used in 1981 by Vincent Rue in testimony to the American Congress, but was only formalised in a published paper a decade later. Speckhard and Rue (1992) posit that abortion is a psychosocial stressor that may cause mild distress through to severe trauma, creating the need for a continuum of categories, these being post-abortion distress, post-abortion syndrome and post-abortion psychosis. PAS, which is the main focus of their paper, and which has taken root in some professional language as well as lay anti-abortion discourse, is described as a type of post-traumatic stress disorder

Solar hydrogen system for cooking applications: Experimental and numerical study

This paper describes the development of a semi-empirical numerical model for a solar hydrogen system consisting of a proton exchange membrane electrolyser (PEM) powered by photovoltaic panels to produce hydrogen as fuel for cooking applications, focussing on Jamaica as a suitable case-study. The model was developed in TRNSYS and includes a novel numerical component based on FORTRAN to model the operation of the PEM electrolyser. The numerical component was developed based on operational data from a purpose constructed small-scale experimental rig. The numerical model was calibrated using data from the experimental rig powered by operational data from a photovoltaic panel system in the UK and predicted photovoltaic panel power data from Jamaica. For the test conditions, experiments indicated an electrolysis maximum efficiency of 63.6%. The calibrated model was used to develop a case study analysis for a small community in Jamaica with a daily cooking demand of 39.6kWh or 1.7kg of H2 gas. Simulations indicate that the H2 production plan is sufficient for the cooking needs of the case-study.This project is partly funded by ACP Caribbean & Pacific Research Programme for Sustainable Development of the European Union (EuropeAid/130381/D/ACT/ACP)

Is the onset of disabling chronic conditions in later childhood associated with exposure to social disadvantage in earlier childhood? a prospective cohort study using the ONS Longitudinal Study for England and Wales

Background: The aetiology of disabling chronic conditions in childhood in high income countries is not fully understood, particularly the association with socio-economic status (SES). Very few studies have used longitudinal datasets to examine whether exposure to social disadvantage in early childhood increases the risk of developing chronic conditions in later childhood. Here we examine this association, and its temporal ordering, with onset of all-cause disabling chronic later childhood in children reported as free from disability in early childhood. Methods: The study comprised a prospective cohort study, using data from the Office for National Statistics Longitudinal Study (ONSLS) for England and Wales. The study sample included 52,839 children with complete data born between 1981–1991 with no disabling chronic condition/s in 1991. Index cases were children with disability recorded in 2001. Comparison cases were children with no recorded disability in 1991. A socio-economic disadvantage index (SDI) was constructed from data on social class, housing tenure and car/van access. Associations were explored with logistic regression modelling controlling sequentially for potentially confounding factors; age, gender, ethnicity and lone parenthood. Results: By 2001, 2049 (4%) had at least one disability. Socio-economic disadvantage, age, gender and lone parenthood but not ethnicity were significantly associated with onset of disabling chronic conditions. The SDI showed a finely graded association with onset of disabling chronic conditions in the index group (most disadvantaged OR 2·11 [CI 1·76 to 2·53]; disadvantaged in two domains OR 1·45 [CI 1·20 to 1·75]; disadvantaged in one domain OR 1·14 [CI 0·93 to 1·39] that was unaffected by age, gender and ethnicity and slightly attenuated by lone parenthood. Conclusion: To our knowledge, this is the first study to identify socio-economic disadvantage in earlier childhood as a predisposing factor for onset of all-cause disabling chronic conditions in later childhood. Temporal ordering and gradation of the response indicate socio-economic disadvantage may play a causal role. This suggests that targeting preventative efforts to reduce socio-economic disadvantage in early childhood is likely to be an important public health strategy to decease health inequalities in later childhood and early adulthood