Women with infertility complying with and resisting polygyny : an explorative qualitative study in urban Gambia

Background. In many low-and middle-income countries women with infertility are often in polygynous marriages. From a human and women's rights perspective, the practice of polygyny is commonly understood as harmful. Studies indicate that polygyny aggravates negative life circumstances of women with infertility with respect to their health and social well-being. The purpose of this qualitative study is to explore how women with infertility experience polygyny and to understand their decision-making regarding these marriages.Methods. An explorative qualitative study was conducted among women with infertility in the urban communities of the West Coast region of The Gambia using in-depth interviews (30). Data analysis involved an emergent and partially inductive thematic framework and was carried out using NVivo 11.Results. With the exception of some women with infertility who described positive experiences within polygynous marriages, most women emphasised conflicts that exist within polygynous households and reported financial and emotional difficulties. Thematic analysis identified several strategies of women with infertility to cope with and resist polygynous marriages, including overcoming childlessness, addressing conflict, spending time outside the compound, looking for social support, kanyaleng kafoolu, living separately and initiating divorce. Moreover, the experiences and decision-making power of women with infertility when it comes to polygynous marriages was found to be closely related to their socio-demographic background.Conclusion.This work highlights how women with infertility in polygynous marriages are in a precarious situation in urban Gambia. Women utilize a mix of compliance, coping and resistance strategies to navigate the challenges of polygynous marriages in a structurally constraining context

Involvement of palliative care in euthanasia practice in a context of legalized euthanasia : a population-based mortality follow-back study

Background: In the international debate about assisted dying, it is commonly stated that euthanasia is incompatible with palliative care. In Belgium, where euthanasia was legalized in 2002, the Federation for Palliative Care Flanders has endorsed the viewpoint that euthanasia can be embedded in palliative care. Aim: To examine the involvement of palliative care services in euthanasia practice in a context of legalized euthanasia. Design: Population-based mortality follow-back survey. Setting/participants: Physicians attending a random sample of 6871 deaths in Flanders, Belgium, in 2013. Results: People requesting euthanasia were more likely to have received palliative care (70.9%) than other people dying non-suddenly (45.2%) (odds ratio=2.1 (95% confidence interval, 1.5-2.9)). The most frequently indicated reasons for non-referral to a palliative care service in those requesting euthanasia were that existing care already sufficiently addressed the patient's palliative and supportive care needs (56.5%) and that the patient did not want to be referred (26.1%). The likelihood of a request being granted did not differ between cases with or without palliative care involvement. Palliative care professionals were involved in the decision-making process and/or performance of euthanasia in 59.8% of all euthanasia deaths; this involvement was higher in hospitals (76.0%) than at home (47.0%) or in nursing homes (49.5%). Conclusion: In Flanders, in a context of legalized euthanasia, euthanasia and palliative care do not seem to be contradictory practices. A substantial proportion of people who make a euthanasia request are seen by palliative care services, and for a majority of these, the request is granted

Hot-melt co-extrusion as manufacturing technique for multilayer oral dosage forms

Co-extrusion implies the simultaneous hot-melt extrusion of two or more materials through the same die, creating a multilayered extrudate. This innovative continuous production technology offers numerous advantages over traditional pharmaceutical processing techniques. Moreover co-extrusion provides great potential for the production of fixed-dose combination products which are gaining importance in pharmaceutical industry. Except from an implant (Implanon®) and a vaginal ring (Nuvaring®), there are no co-extruded dosage forms on the market so far. The aim of this work was to evaluate the potential of hot-melt coextrusion for the production of multilayer (core/coat) oral dosage forms. Possible applications are pointed out and polymers which can be combined in co-extruded dosage forms are selected. In the introduction, the equipment and downstream solutions for processing coextrudates into drug products are reviewed. Requirements and challenges in material selection, considering melt viscosity and multilayer adhesion are pointed out. Examples of medical and pharmaceutical applications are presented and some recent findings considering the production of oral drug delivery systems are summarized. Chapter 1 gives a brief overview of the polymer characteristics relevant for hot-melt co-extrusion (including solubility, hygroscopicity, toxicity, thermal stability, melt viscosity and extrudability). In chapter 2, fixed-dose combination dosage forms are developed by means of hot-melt coextrusion, the core providing sustained drug release and the coat immediate drug release. In chapter 3, hot-melt co-extrusion is assessed for the development of multilayered dosage forms characterized by a dual release profile of the same drug. In chapter 4, fixed-dose combination dosage forms are developed characterized by immediate release for both layers, the layers containing different drugs with different water-solubility. Chapter 5 is a critical evaluation of the co-extrusion process. This chapter questions if hot-melt co-extrusion offers an added value over hot-melt extrusion

Muscle herniation : an often-missed pseudotumor

Teaching Point: Dynamic ultrasound and knowledge of a clinical history of a soft-tissue lump that increases in volume upon muscle contraction or weight-bearing are crucial in the diagnosis of muscle herniation