Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa

The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in a province in South Africa with the possibility of nationwide use

100 years of mortality due to chronic obstructive pulmonary disease in Australia: the role of tobacco consumption

Global studies of the long-term association between tobacco consumption and chronic obstructive pulmonary disease (COPD) have relied upon descriptions of trends.To statistically analyse the relationship of tobacco consumption with data on mortality due to COPD over the past 100 years in Australia.Tobacco consumption was reconstructed back to 1887. Log-linear Poisson regression models were used to analyse cumulative cohort and lagged time-specific smoking data and its relationship with COPD mortality.Age-standardised COPD mortality, although likely misclassified with other diseases, decreased for males and females from 1907 until the start of the Second World War in contrast to steadily rising tobacco consumption. Thereafter, COPD mortality rose sharply in line with trends in smoking, peaking in the early 1970s for males and over 20 years later for females, before falling again. Regression models revealed both cumulative and time-specific tobacco consumption to be strongly predictive of COPD mortality, with a time lag of 15 years for males and 20 years for females.Sharp falls in COPD mortality before the Second World War were unrelated to tobacco consumption. Smoking was the primary driver of post-War trends, and the success of anti-smoking campaigns has sharply reduced COPD mortality levels

Determinants of women's satisfaction with maternal health care: a review of literature from developing countries.

BACKGROUND: Developing countries account for 99 percent of maternal deaths annually. While increasing service availability and maintaining acceptable quality standards, it is important to assess maternal satisfaction with care in order to make it more responsive and culturally acceptable, ultimately leading to enhanced utilization and improved outcomes. At a time when global efforts to reduce maternal mortality have been stepped up, maternal satisfaction and its determinants also need to be addressed by developing country governments. This review seeks to identify determinants of women's satisfaction with maternity care in developing countries. METHODS: The review followed the methodology of systematic reviews. Public health and social science databases were searched. English articles covering antenatal, intrapartum or postpartum care, for either home or institutional deliveries, reporting maternal satisfaction from developing countries (World Bank list) were included, with no year limit. Out of 154 shortlisted abstracts, 54 were included and 100 excluded. Studies were extracted onto structured formats and analyzed using the narrative synthesis approach. RESULTS: Determinants of maternal satisfaction covered all dimensions of care across structure, process and outcome. Structural elements included good physical environment, cleanliness, and availability of adequate human resources, medicines and supplies. Process determinants included interpersonal behavior, privacy, promptness, cognitive care, perceived provider competency and emotional support. Outcome related determinants were health status of the mother and newborn. Access, cost, socio-economic status and reproductive history also influenced perceived maternal satisfaction. Process of care dominated the determinants of maternal satisfaction in developing countries. Interpersonal behavior was the most widely reported determinant, with the largest body of evidence generated around provider behavior in terms of courtesy and non-abuse. Other aspects of interpersonal behavior included therapeutic communication, staff confidence and competence and encouragement to laboring women. CONCLUSIONS: Quality improvement efforts in developing countries could focus on strengthening the process of care. Special attention is needed to improve interpersonal behavior, as evidence from the review points to the importance women attach to being treated respectfully, irrespective of socio-cultural or economic context. Further research on maternal satisfaction is required on home deliveries and relative strength of various determinants in influencing maternal satisfaction

Effects of zonal flows on ion temperature gradient instability in the scrape-off layer of a field-reversed configuration

Abstract Gyrokinetic simulations of long wavelength ion temperature gradient (ITG) turbulence in the scrape-off layer (SOL) of a field-reversed configuration (FRC) find that zonal flows are nonlinearly generated and are the dominant mechanism for the nonlinear saturation of the ITG instability. After the ITG saturation, zonal flows remain undamped and gradually suppress the turbulent transport to a very low level. In the simulations with collisions, collisional damping gradually reduces zonal flow amplitude to a lower level, which allows finite ITG turbulence intensity and ion heat transport in the SOL. The steady state turbulence intensity and ion heat transport are found to be proportional to the collision frequency. This favorable scaling suggests that minimizing collisions (e.g. increasing temperature, reducing impurity content, etc) and preserving toroidal symmetry could improve plasma confinement in the FRC.</jats:p

Effects of equilibrium radial electric field on ion temperature gradient instability in the scrape-off layer of a field-reversed configuration

Abstract Linear and nonlinear effects of the equilibrium radial electric field on the ion temperature gradient (ITG) instability in the scrape-off layer (SOL) of a field-reversed configuration have been studied using gyrokinetic particle simulations for a single toroidal mode. Linear simulations with adiabatic electrons find that the E × B flow shear reduces the growth rate and causes a radial tilting of the mode structure on the toroidal plane. Nonlinear simulations find that the E × B flow shear significantly decreases ITG saturation amplitude and ion heat transport in the SOL by reducing both turbulence intensity and eddy size. The turbulence intensity is determined by fluid eddy rotation, which is the dominant saturation mechanism for the SOL ITG instability with a single toroidal mode number. On the other hand, parallel wave-particle decorrelation is the dominant mechanism for the SOL ITG turbulent transport. A random walk model using the guiding center radial excursion as the characteristic length scale and the eddy turnover time as the characteristic time scale fits very well to the scaling of ion heat conductivity with the E × B flow shear.</jats:p

Suppressed ion-scale turbulence in a hot high-β plasma.

An economic magnetic fusion reactor favours a high ratio of plasma kinetic pressure to magnetic pressure in a well-confined, hot plasma with low thermal losses across the confining magnetic field. Field-reversed configuration (FRC) plasmas are potentially attractive as a reactor concept, achieving high plasma pressure in a simple axisymmetric geometry. Here, we show that FRC plasmas have unique, beneficial microstability properties that differ from typical regimes in toroidal confinement devices. Ion-scale fluctuations are found to be absent or strongly suppressed in the plasma core, mainly due to the large FRC ion orbits, resulting in near-classical thermal ion confinement. In the surrounding boundary layer plasma, ion- and electron-scale turbulence is observed once a critical pressure gradient is exceeded. The critical gradient increases in the presence of sheared plasma flow induced via electrostatic biasing, opening the prospect of active boundary and transport control in view of reactor requirements

Tobacco consumption and pancreatic cancer mortality: what can we conclude from historical data in Australia?

Tobacco consumption is an established risk factor for pancreatic cancer yet studies of long-term mortality trends have not statistically analysed this relationship. We sought evidence for this relationship based on an analysis of long-term population-level data in Australia.Pancreatic cancer mortality data from 1931, tobacco consumption data and fruit and vegetable consumption data for Australia were utilized. Log-linear Poisson regression models were used to analyse pancreatic cancer mortality from 1931 with cumulative cohort and lagged time-specific tobacco consumption data and fruit and vegetable consumption data.Pancreatic cancer mortality rose steadily for males until it began falling from the 1970s, and continued rising for females until 2006. These trends correspond with a long-term rise in male tobacco consumption until the 1960s and a later peak for females. Our models show that cumulative tobacco consumption predicts pancreatic cancer mortality for both sexes but with time lags only being significant for males. Fruit and vegetable consumption provides a protective effect against mortality in some of the models.The success of smoking reduction programmes in Australia has contributed to the decline in pancreatic cancer mortality for males, providing important evidence about the need for tobacco control measures in populations where it is still increasing. Continued declines in female tobacco consumption should lead to a reversal of the long-term rise in female pancreatic cancer mortality