1,226 research outputs found
Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania.
\ud
\ud
Non-adherence to tuberculosis (TB) treatment is the leading contributor to the selection of drug-resistant strains of Mycobacterium tuberculosis and subsequent treatment failure. Tanzania introduced a TB Patient Centred Treatment (PCT) approach which gives new TB patients the choice between home-based treatment supervised by a treatment supporter of their own choice, and health facility-based treatment observed by a medical professional. The aim of this study was to assess the extent and determinants of adherence to anti-TB therapy in patients opting for home-based treatment under the novel PCT approach. In this cross-sectional study, the primary outcome was the percentage of patients adherent to TB therapy as detected by the presence of isoniazid in urine (IsoScreen assay). The primary analysis followed a non-inferiority approach in which adherence could not be lower than 75%. Logistic regression was used to examine the influence of potentially predictive factors. A total of 651 new TB patients were included. Of these, 645 (99.1%) provided urine for testing and 617 patients (95.7%; 90%CI 94.3-96.9) showed a positive result. This result was statistically non-inferior to the postulated adherence level of 75% (p<0.001). Adherence to TB therapy under home-based Directly Observed Treatment can be ensured in programmatic settings. A reliable supply of medication and the careful selection of treatment supporters, who preferably live very close to the patient, are crucial success factors. Finally, we recommend a cohort study to assess the rate of adherence throughout the full course of TB treatment
Existence of a tripled coincidence point in ordered G b -metric spaces and applications to a system of integral equations
"Who am I? Where am I?" Experiences of married young women in a slum in Islamabad, Pakistan
Background: According to the cultural tradition in Pakistan, young women belonging to poor families should
marry shortly after menarche. However, existing data show that young people, especially women, are not
prepared for sexual life and have poor knowledge about sexuality and reproductive health. Many of the
difficulties young women experience are related to beliefs and expectations in the society related to their
reproductive roles making them more vulnerable to reproductive ill health.
Aim: The study explores the preparedness of young women for married life (communicating with spouse,
initiation of sexual activity and child bearing) and ability to negotiate in marriage with spouse on number of
children to have and on contraceptive use.
Methods: In order to obtain an in-depth understanding of young women’s lives qualitative and quantitative
approaches were used. Three qualitative studies using narrative and content analysis were carried out in a slum
setting in the outskirts of Islamabad city in Pakistan. Married young women (I), unmarried young women (II) and
parents (III) were selected with the help of a community worker. Young married women were interviewed three
times at different occasions. Narrative structuring was used to explore how the participants represented their
situation. In addition twenty qualitative interviews and three focus group discussions were conducted with young
unmarried women (II). Twenty-five parents participated in four gender specific focus group discussions (III).
Content analysis was used for analysis of study II and III. For the quantitative study (IV), a subset of 1803
married young women aged 15-24 years was drawn from a nationally representative adolescent and youth survey
conducted in Pakistan in 2001-2002 by the Population Council. Regression models were used for analysing the
following outcomes: reported agreement with spouse on the number of children to have, current use of
contraceptives, intention to use contraceptives in the future and the time elapsed between marriage and the first
contraceptive use. Key co-variates of interest were variables that measure the involvement of young women in
their marriage as having a say in selection of spouse, mobility outside the household, social role and decision
making in their homes.
Results: The main theme in all the qualitative studies was ‘socialisation of young women into submissiveness’.
For the married young women two themes were identified a) submissive-accepting and
b) submissive-victims. The married young women who belonged to the accepting group lived under compromised
conditions but described themselves as satisfied with their situation. Women belonging to the victimized group
experienced physical and verbal abuse for their inability to cope with the duties of a wife, caretaker of the home
and bearer of children. Their situation was compounded by the power dynamics within the household (I). For the
unmarried young women the main theme identified was security lies in obedience. The two sub-themes
contributing to the main theme were socialisation into submissiveness and transition into adulthood in silence
(II). The theme and the sub-themes illustrate the situation of young women in a poor setting in Pakistan. The main
theme identified in the study with the parents was ‘Good parents’ strive to raise ‘innocent daughters’. The three
sub-themes contributing to the main theme were: a daughter - a responsibility and a burden, social and sexual
innocence and parents’ roles in the preparation for marriage. The theme and the sub-themes illustrate how the
parents saw themselves as responsible for raising ‘innocent daughters’ and arranging good marriages (III). The
quantitative study on the married young women showed that having a say in the selection of spouse at the time of
marriage was significantly associated with agreeing with spouse over the number of children to have, intention to
use contraceptives and the time between marriage and first contraceptive use. These relationships existed after
controlling for education, socioeconomic status, mobility outside of house and decision making in the home (IV).
Conclusions: In a culture of silence around sexuality, young women’s socialisation into submissiveness lays the
foundation for the lack of control over their future reproductive health (I and II). The parents realised, though, that
bringing up daughters for marriage requires not only obedience, but also building confidence and knowledge
during their childhood (III). Women who had decision making freedom in their parental home carried this ability
with them into marriage in their new home and were better able to negotiate about their fertility (IV). Knowledge
about reproductive life could prepare young women better for the future life and give them more control of their
fertility. Innovative interventions targeting women need to challenge current societal norms of womanhood to
promote the upbringing of confident and knowledgeable young women
Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy
Background
A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets.
Methods
Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis.
Results
A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001).
Conclusion
We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty
Acute kidney disease and renal recovery : consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup
Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of > 90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process. For patients in whom pathophysiologic processes are ongoing, the term acute kidney disease (AKD) has been proposed to define the course of disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD
Pleosporales
One hundred and five generic types of Pleosporales are described and illustrated. A brief introduction and detailed history with short notes on morphology, molecular phylogeny as well as a general conclusion of each genus are provided. For those genera where the type or a representative specimen is unavailable, a brief note is given. Altogether 174 genera of Pleosporales are treated. Phaeotrichaceae as well as Kriegeriella, Zeuctomorpha and Muroia are excluded from Pleosporales. Based on the multigene phylogenetic analysis, the suborder Massarineae is emended to accommodate five families, viz. Lentitheciaceae, Massarinaceae, Montagnulaceae, Morosphaeriaceae and Trematosphaeriaceae
Effective Rheology of Bubbles Moving in a Capillary Tube
We calculate the average volumetric flux versus pressure drop of bubbles
moving in a single capillary tube with varying diameter, finding a square-root
relation from mapping the flow equations onto that of a driven overdamped
pendulum. The calculation is based on a derivation of the equation of motion of
a bubble train from considering the capillary forces and the entropy production
associated with the viscous flow. We also calculate the configurational
probability of the positions of the bubbles.Comment: 4 pages, 1 figur
- …