The associations between physical activity and antepartum and postpartum depression

Background: Depression is a disease of great public health concern as it is responsible for a significant amount of disability and morbidity, and millions of Americans are depressed in any given year. Antepartum and postpartum depression confer health risks for the mother and her family. Research has indicated that physically active individuals may be less likely to experience depression, however, few studies have used pregnancy and postpartum samples. Methods: Data from the third and postpartum phases of the Pregnancy, Infection, and Nutrition (PIN) Study were used to determine the association between moderate-to-vigorous physical activity (MVPA) and depressive symptoms among pregnant and postpartum women. The PIN3 Study was a prospective cohort of 2006 pregnant women in North Carolina enrolled between January 2001 and June 2005. The PIN Postpartum Study followed a subset of the PIN3 women with in-home visits at 3 and 12 months postpartum. Physical activity recall was assessed by telephone at 17-22 and 27-30 weeks' gestation of pregnancy and at 3 months postpartum. Self-reported depressive symptoms were assessed by the Center for Epidemiologic Studies-Depression Scale at <20 and 24-29 weeks' gestation, while postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale at both home visits. Results: Active women with <=2.67 hours/week of total MVPA at 17-22 weeks' gestation had almost half the odds of having high depressive symptoms at 24-29 weeks' gestation as compared to women with no MVPA. However, total MVPA at 3 months postpartum was associated with a doubling of the odds of elevated depressive symptoms at 12 months postpartum. Adult and child care and indoor household MVPA were associated with increased odds of elevated depressive symptoms in both pregnancy and postpartum. No benefit from recreational activity on depressive symptoms was found at any time point. No significant associations were found between MVPA and depressive symptoms when examining the association between MVPA during pregnancy and 3-month depressive symptoms. Conclusion: Associations between physical activity and depressive symptoms differ by domain of MVPA. Future studies with higher statistical power should explore potential differences by domain of physical activity

Racial Differences in Social Support and Coping Among Family Caregivers of Patients with Prostate Cancer

More than 60 million Americans are informal caregivers to adults, which can negatively affect their health. Data from 126 White and 62 African American female caregivers in North Carolina were analyzed to describe social support and coping among family caregivers of patients with prostate cancer and to assess for racial differences. Social support amount and some coping methods differed by race. There was no racial difference in social support satisfaction. Borderline significant difference in social support by health status was found and this differed by race. These racial differences should be explored further to better understand the availability of caregiving resources and their health effects

Breast milk intake measured by deuterium kinetics in mother-infant pairs in Addis Ababa

Abstract: The accurate determination of breast-milk intake of infants is essential in order to estimate energy intake and nutrient requirement during infancy and lactation. The deuterium dilution technique was employed for measuring breast-milk intake in exclusively breast-fed Ethiopian infants. This method is convenient for field conditions rather than the commonly used test-weighing procedure. In addition, the feasibility of using the less specialised, more efficient and considerably cheaper instrument, Fourier Transform Infrared (FTIR), was evaluated in the Ethiopian setting. The results obtained were compared to that of Isotope Ratio Mass Spectrometer (IRMS). Ten mother-infant pairs were recruited from two government subsidised health centres, namely Ledeta and Semen. Mothers received a pre-weighed 30g oral dose of D2O. Maternal and infant saliva samples, and breast milk samples were collected over a 14-day period following dose administration. Anthropometric data were also collected. Saliva and deffated milk samples were analysed for deuterium enrichment by Infrared Spectroscopy and Mass Spectrometry and the data were fitted into two-compartment model. Infant weights were compared with a 12 months breastfed infant-pooled data set. Comparison of these infants with 12 months breast-fed pooled data set showed that weight for age Z-scores were below the mean. There was no significant difference between initial and final Z-scores (p>0.05) during the experimental period although all of the infants showed some catch-up growth. Mean ± SD breast milk intake was 850±120ml/day and 880±120ml/day measured using FTIR and IRMS, respectively. The study has demonstrated that it is feasible to measure breast milk intake using deuterium dilution technique in the Ethiopian setting and Infrared spectroscopy could be used for the purpose. It also confirmed that Ethiopian mothers have comparable or higher milk output than privileged communities. These findings have important implications for future research. [Ethiopia. J. Health Dev. 1999; 13(3): 271-279

Magnitude and Predisposing Factors of Difficult Airway during Induction of General Anaesthesia

Objective. To assess magnitude and predisposing factors of difficult airway during induction of general anaesthesia. Methods. Hospital based cross sectional study carried out to determine the incidence of difficult mask ventilation, difficult laryngoscopy (Cormack and Lehane III and IV), difficult intubation (IDS ≥ 5), and failed intubation. The association between each predisposing factor and airway parameters with components of difficult airway is investigated with binary logistic regression. Sensitivity, specificity, positive and negative predictive value of the test, and odds ratio with 95% confidence interval were calculated to determine the association between independent and dependent variable. Result. The incidence of difficult laryngoscopy, difficult intubation, and failed intubation are 12.3%, 9%, and 0.005%, respectively. Mouth opening 3, and ineffective alternative technique have increased predictability value of difficult airway

Efficacy of Bilateral Transversus Abdominis Plane and Ilioinguinal-Iliohypogastric Nerve Blocks for Postcaesarean Delivery Pain Relief under Spinal Anesthesia

Background. Caesarean delivery can be associated with considerable postoperative pain. While the benefits of transversus abdominis plane (TAP) and ilioinguinal-iliohypogastric (II-IH) nerve blocks on pain after caesarean delivery via Pfannenstiel incision have been demonstrated, no enough investigations on the comparison of these blocks on pain after caesarean delivery have been conducted in our setup. Method. An institutional-based prospective observational cohort study was conducted to compare the analgesic efficacy of those blocks. We observed 102 postoperative parturients. The outcome measure was the severity of pain measured using a numeric rating scale. Result. Twenty-four hours after surgery, the NRS score at rest was (0.90 ± 0.80) versus (0.67 ± 0.58) and at movement (1.2 ± 1.07) versus (0.88 ± 0.76) for the TAP and II-IH groups, respectively. Twenty-four hours after surgery, the mean tramadol consumption was (55.45 ± 30.51) versus (37.27 ± 27.09) mg in TAP and II-IH groups, respectively (p = 0.009). The mean first analgesic requirement time was also prolonged in the II-IH group. Conclusion and Recommendations. There was no statically significant difference between TAP and II-IH blocks regarding postoperative pain score, but the II-IH block significantly reduced the total tramadol consumption and prolonged the time to first analgesic request than TAP. Thus, we recommend the II-IH nerve block

The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia.

BACKGROUND: Basic emergency obstetric and newborn care (BEmONC) is a primary health care level initiative promoted in low- and middle-income countries to reduce maternal and newborn mortality. Tailored support, including BEmONC training to providers, mentoring and monitoring through supportive supervision, provision of equipment and supplies, strengthening referral linkages, and improving infection-prevention practice, was provided in a package of interventions to 134 health centers, covering 91 rural districts of Ethiopia to ensure timely BEmONC care. In recent years, there has been a growing interest in measuring program implementation strength to evaluate public health gains. To assess the effectiveness of the BEmONC initiative, this study measures its implementation strength and examines the effect of its variability across intervention health centers on the rate of facility deliveries and the met need for BEmONC. METHODS: Before and after data from 134 intervention health centers were collected in April 2013 and July 2015. A BEmONC implementation strength index was constructed from seven input and five process indicators measured through observation, record review, and provider interview; while facility delivery rate and the met need for expected obstetric complications were measured from service statistics and patient records. We estimated the dose-response relationships between outcome and explanatory variables of interest using regression methods. RESULTS: The BEmONC implementation strength index score, which ranged between zero and 10, increased statistically significantly from 4.3 at baseline to 6.7 at follow-up (p < .05). Correspondingly, the health center delivery rate significantly increased from 24% to 56% (p < .05). There was a dose-response relationship between the explanatory and outcome variables. For every unit increase in BEmONC implementation strength score there was a corresponding average of 4.5 percentage points (95% confidence interval: 2.1-6.9) increase in facility-based deliveries; while a higher score for BEmONC implementation strength of a health facility at follow-up was associated with a higher met need. CONCLUSION: The BEmONC initiative was effective in improving institutional deliveries and may have also improved the met need for BEmONC services. The BEmONC implementation strength index can be potentially used to monitor the implementation of BEmONC interventions

Physical activity and depressive symptoms among pregnant women: the PIN3 study

Prenatal depression confers health risks for both mother and family. Physical activity may promote better mental health; however, few studies have examined the influence of physical activity on prenatal depression. Data from 1,220 women enrolled in the third Pregnancy, Infection, and Nutrition Study (2001-2005) were used to examine the associations between overall and domain-specific moderate-to-vigorous physical activity (MVPA) and depressive symptoms during pregnancy. Self-reported, past week physical activity assessed at 17-22 weeks' gestation was modeled in logistic regression with self-reported depressive symptoms assessed by the Center for Epidemiologic Studies-Depression Scale at 24-29 weeks' gestation. Active women with ≤2.67 h/week of total MVPA had almost half the odds of having high depressive symptoms as compared to women with no MVPA (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.38, 0.83). Increased odds of elevated depressive symptoms were found for women participating in some but ≤2.25 h/week of adult and child care MVPA (OR = 1.84; 95% CI = 1.08, 3.11) and >1 h of indoor household MVPA (OR = 1.63, 95% CI = 0.99, 2.70) when compared to women with no MVPA. While overall MVPA may play a role in reducing the odds of developing elevated depressive symptoms, adult and child care and indoor household activities may increase it

Physical activity during pregnancy and postpartum depressive symptoms

to examine the associations between total and domain-specific moderate-to-vigorous physical activity (MVPA) during pregnancy and postpartum depressive symptoms

Cervicovaginal Microbiota Profiles in Precancerous Lesions and Cervical Cancer among Ethiopian Women

Although high-risk human papillomavirus infection is a well-established risk factor for cervical cancer, other co-factors within the local microenvironment may play an important role in the development of cervical cancer. The current study aimed to characterize the cervicovaginal microbiota in women with premalignant dysplasia or invasive cervical cancer compared with that of healthy women. The study comprised 120 Ethiopian women (60 cervical cancer patients who had not received any treatment, 25 patients with premalignant dysplasia, and 35 healthy women). Cervicovaginal specimens were collected using either an Isohelix DNA buccal swab or an Evalyn brush, and ribosomal RNA sequencing was used to characterize the cervicovaginal microbiota. Shannon and Simpson diversity indices were used to evaluate alpha diversity. Beta diversity was examined using principal coordinate analysis of weighted UniFrac distances. Alpha diversity was significantly higher in patients with cervical cancer than in patients with dysplasia and in healthy women

Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study.

BACKGROUND: Antenatal care (ANC) is a principal component of safe motherhood and reproductive health strategies across the continuum of care. Although the coverage of antenatal care visits has increased in Ethiopia, there needs to be more evidence of effective coverage of antenatal care. The 'effective coverage' concept can pinpoint where action is required to improve high-quality coverage in Ethiopia. Effective coverage indicates a health system's performance by incorporating need, utilization, and quality into a single measurement. The concept includes the number of contacts, facility readiness, interventions received, and components of services received. This study aimed to measure effective antenatal care coverage in Ethiopia. METHODS: A two-stage cluster sampling method was used and included 2714 women aged 15-49 years and 462 health facilities from six Ethiopian regions from October 2019 to January 2020. The effective coverage cascade was analyzed among the targeted women by computing the proportion who received four or more antenatal care visits where the necessary inputs were available, received iron-folate supplementation and two doses of tetanus vaccination according to process quality components of antenatal care services. RESULTS: Of all women, 40% (95%CI; 38, 43) had four or more visits, ranging from 3% in Afar to 74% in Addis Ababa. The overall mean health facility readiness score of the facilities serving these women was 70%, the vaccination and iron-folate supplementation coverage was 26%, and the ANC process quality was 64%. As reported by women, the least score was given to the quality component of discussing birth preparedness and complication readiness with providers. In the effective coverage cascade, the input-adjusted, intervention-adjusted, and quality-adjusted antenatal coverage estimates were 28%, 18%, and 12%, respectively. CONCLUSION: The overall effective ANC coverage was low, primarily due to a considerable drop in the proportion of women who completed four or more ANC visits. Improving quality of services is crucial to increase ANC up take and completion of the recommended visits along with interventions increasing women's awareness