Fertility intentions and use of contraception among monogamous couples in northern Malawi in the context of HIV testing: a cross-sectional analysis.

CONTEXT: Knowledge of HIV status may influence fertility desires of married men and women. There is little knowledge about the importance of this influence among monogamously married couples and how knowledge of HIV status influences use of contraception among these couples. METHODOLOGY: We carried out a cross-sectional analysis of interview data collected between October 2008 and September 2009 on men aged 15-59 years and women aged 15-49 years who formed 1766 monogamously married couples within the Karonga Prevention Study demographic surveillance study in northern Malawi. RESULTS: 5% of men and 4% of women knew that they were HIV positive at the time of interview and 81% of men and 89% of women knew that they were HIV negative. 73% of men and 83% of women who knew that they were HIV positive stated that they did not want more children, compared to 35% of men and 38% of women who knew they were HIV negative. Concordant HIV positive couples were more likely than concordant negative couples to desire to stop child bearing (odds ratio 11.5, 95%CI 4.3-30.7, after adjusting for other factors) but only slightly more likely to use contraceptives (adjusted odds ratio 1.5 (95%CI 0.8-3.3). CONCLUSION: Knowledge of HIV positive status is associated with an increase in the reported desire to cease childbearing but there was limited evidence that this desire led to higher use of contraception. More efforts directed towards assisting HIV positive couples to access and use reproductive health services and limit HIV transmission among couples are recommended

UCANP: Urinary Catheter Alleviation Navigation Protocol Quality Improvement Project

Introduction: Catheter associated urinary tract infections (CAUTI) can place significant financial burden on healthcare facilities, decrease quality of care and increase length of stay. Reducing indwelling urinary catheter days reduces the risk of a CAUTI. Current practice after catheter removal includes the reinsertion of the catheter if the patient demonstrates three episodes of urinary retention that requires intermittent urinary catheterization. Intermittent urinary catheterization, when implemented appropriately, has proven to be safe and decreases risk for urinary infection. Background: Several initiatives have been introduced to decrease hospital CAUTI rates, including nursing education on appropriate urine culture collection, use of root cause analysis (RCA) tools to identify problem areas, and nurse driven removal protocols when catheters are no longer indicated. Despite some decreased catheter utilization rates, CAUTIs continued to occur. Data obtained through RCAs revealed a trend of catheter re-insertions due to urinary retention. A nurse driven pathway was developed using bladder scan and straight catheterization protocols with emphasis on not re-inserting catheters. Study Aim: By utilizing an algorithm for monitoring patients after catheter References removal, which includes routine bladder scan assessment and intermittent urinary catheterization if applicable, this study aimed to reduce the incidence of reinsertion of an indwelling catheter. Decreased re-insertion rates contribute to decreased urinary catheter utilization days and decreased risk for CAUTIs. Results: Metrics utilized to determine improvement included indwelling catheter utilization days and CAUTI count. Catheter days is defined as the number of days an indwelling catheter is in place. Each unit was compared to the previous year for the months of September, October, and November. The combined decrease of catheter days for all units was 17%, 23%, and 34% for September, October, and November, respectively. Discussion: Reducing the use of urinary catheters can reduce rates of catheter-associated urinary tract infections and their associated morbidities. Development of one standard protocol, in collaboration with urology provider input, and applying it across a variety of patient populations led to increased utilization of the protocol by the nursing staff. Improvement was also seen in nurses’ awareness and understanding of urinary retention post catheter removal and using bladder scanning and intermittent catheterization appropriately when needed. Due to the initial success of this project, the UCANP initiative is currently being implemented on additional units and will continue until all patient-care areas of the hospital are included.https://scholarlycommons.henryford.com/nursresconf2021/1006/thumbnail.jp

Toward Adaptation of fNIRS Instrumentation to Airborne Environments

The paper reviews potential applications of functional Near-Infrared Spectroscopy (fNIRS), a well-known medical diagnostic technique, to monitoring the cognitive state of pilots with a focus on identifying ways to adopt this technique to airborne environments. We also discuss various fNIRS techniques and the direction of technology maturation of associated hardware in view of their potential for miniaturization, maximization of data collection capabilities, and user friendliness

Math in Motion

Everything we know about the universe rests on the foundation of mathematics. Somehow, though, the magic of mathematics – the true power of numbers and their beautiful wildness – gets lost in math class. Children, our most magical thinkers, get turned off math in grade school and miss out on a language through which they could learn to read and change the world. VCU Math In Motion will generate a creative, dynamic STEM education initiative within the Richmond community using an innovative curriculum and a customized mobile unit to bring the beauty of math to Richmond region school children in grades 5-9, through partnerships across VCU and within the local school system

Effects of Varying Gravity Levels on fNIRS Headgear Performance and Signal Recovery

This paper reviews the effects of varying gravitational levels on functional Near-Infrared Spectroscopy (fNIRS) headgear. The fNIRS systems quantify neural activations in the cortex by measuring hemoglobin concentration changes via optical intensity. Such activation measurement allows for the detection of cognitive state, which can be important for emotional stability, human performance and vigilance optimization, and the detection of hazardous operator state. The technique depends on coupling between the fNIRS probe and users skin. Such coupling may be highly susceptible to motion if probe-containing headgear designs are not adequately tested. The lack of reliable and self-applicable headgear robust to the influence of motion artifact currently inhibits its operational use in aerospace environments. Both NASAs Aviation Safety and Human Research Programs are interested in this technology as a method of monitoring cognitive state of pilots and crew

Unintended Childbearing and Child Growth in Northern Malawi

Objective The study aims to assess whether unintended children experience slower growth than intended children. Methods We analysed longitudinal data linked to the Karonga Health and Demographic Surveillance Site collected over three rounds between 2008 and 2011 on women's fertility intentions and anthropometric data of children. Using the prospective information on fertility intention we assessed whether unintended children are more likely to be stunted than intended children. We applied Propensity Score Matching technique to control for endogenous factors affecting both the probability that a family has an unwanted birth and a child with poor health outcomes. Results We found that 24 % of children from unwanted pregnancies were stunted compared with 18 % of mistimed pregnancies and 17 % of those from wanted pregnancies. However, these differences in probability of children being stunted, though in the expected direction, were not significant either for large or small families, after controlling for age. The number of children in the household was associated with stunting and boys were substantially more likely to be stunted than girls. Conclusion We found no significance difference in probability of being stunted by mother's fertility intention

The role of perceived benefits and costs in patients’ medical decisions

Background  Many decisions can be understood in terms of actors’ valuations of benefits and costs. The article investigates whether this is also true of patient medical decision making. It aims to investigate (i) the importance patients attach to various reasons for and against nine medical decisions; (ii) how well the importance attached to benefits and costs predicts action or inaction; and (iii) how such valuations are related to decision confidence. Methods  In a national random digit dial telephone survey of U.S. adults, patients rated the importance of various reasons for and against medical decisions they had made or talked to a health‐care provider about during the past 2 years. Participants were 2575 English‐speaking adults age 40 and older. Data were analysed by means of logistic regressions predicting action/inaction and linear regressions predicting confidence. Results  Aggregating individual reasons into those that may be regarded as benefits and those that may be regarded as costs, and weighting them by their importance to the patient, shows the expected relationship to action. Perceived benefits and costs are also significantly related to the confidence patients report about their decision. Conclusion  The factors patients say are important in their medical decisions reflect a subjective weighing of benefits and costs and predict action/inaction although they do not necessarily indicate that patients are well informed. The greater the difference between the importance attached to benefits and costs, the greater patients’ confidence in their decision.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102701/1/hex739.pd

Profile: the Karonga Health and Demographic Surveillance System

The Karonga Health and Demographic Surveillance System (Karonga HDSS) in northern Malawi currently has a population of more than 35 000 individuals under continuous demographic surveillance since completion of a baseline census (2002–2004). The surveillance system collects data on vital events and migration for individuals and for households. It also provides data on cause-specific mortality obtained by verbal autopsy for all age groups, and estimates rates of disease for specific presentations via linkage to clinical facility data. The Karonga HDSS provides a structure for surveys of socio-economic status, HIV sero-prevalence and incidence, sexual behaviour, fertility intentions and a sampling frame for other studies, as well as evaluating the impact of interventions, such as antiretroviral therapy and vaccination programmes. Uniquely, it relies on a network of village informants to report vital events and household moves, and furthermore is linked to an archive of biological samples and data from population surveys and other studies dating back three decades

Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial

Objectives To evaluate the clinical effectiveness of group art therapy for people with schizophrenia and to test whether any benefits exceed those of an active control treatment

The ADP receptor P2RY12 regulates osteoclast function and pathologic bone remodeling

The adenosine diphosphate (ADP) receptor P2RY12 (purinergic receptor P2Y, G protein coupled, 12) plays a critical role in platelet aggregation, and P2RY12 inhibitors are used clinically to prevent cardiac and cerebral thrombotic events. Extracellular ADP has also been shown to increase osteoclast (OC) activity, but the role of P2RY12 in OC biology is unknown. Here, we examined the role of mouse P2RY12 in OC function. Mice lacking P2ry12 had decreased OC activity and were partially protected from age-associated bone loss. P2ry12(–/–) OCs exhibited intact differentiation markers, but diminished resorptive function. Extracellular ADP enhanced OC adhesion and resorptive activity of WT, but not P2ry12(–/–), OCs. In platelets, ADP stimulation of P2RY12 resulted in GTPase Ras-related protein (RAP1) activation and subsequent α(IIb)β(3) integrin activation. Likewise, we found that ADP stimulation induced RAP1 activation in WT and integrin β(3) gene knockout (Itgb3(–/–)) OCs, but its effects were substantially blunted in P2ry12(–/–) OCs. In vivo, P2ry12(–/–) mice were partially protected from pathologic bone loss associated with serum transfer arthritis, tumor growth in bone, and ovariectomy-induced osteoporosis: all conditions associated with increased extracellular ADP. Finally, mice treated with the clinical inhibitor of P2RY12, clopidogrel, were protected from pathologic osteolysis. These results demonstrate that P2RY12 is the primary ADP receptor in OCs and suggest that P2RY12 inhibition is a potential therapeutic target for pathologic bone loss