Management and prognosis of uterine rupture during labor in an under-medicalized country: about 513 cases collected at the Cocody University Hospital Center (Abidjan-Cote d'Ivoire)

Background: Even today, uterine rupture is necessary as an indicator of health status in developing countries, like Cote d’Ivoire. The objective of this study was to describe the factors influencing the management and the prognosis of this pathology in a level III maternity of a third world country.Methods: The study was made in Cocody University Hospital Center (Abidjan-Cote d’Ivoire). A retrospective descriptive study of all women with ruptured uterus during labor managed between January 2002 and December 2014 was conducted. It covered 513 cases of uterine ruptures collected in 13 years.Results: The overall incidence of uterine ruptures was 0.95% or 1 in 105 deliveries. Most cases occurred in women with unscarred uterus (76.8%) and 23.2% of women had a scarred uterus. Surgical treatment was radical by hysterectomy in 35.3% of all women. Treatment was more conservative by uterine suture in women from the communes of Abidjan and its suburbs (71%) versus 25% of women who came from inland towns (p=0.000). Maternal mortality rate was 5.8% and was significantly influenced by the type of surgery (p=0.000), by the time of uterine rupture (p=0.000) and by the transportation distance (p=0.000). Fetal mortality was 94.1% for all women.Conclusions: Uterine rupture still poses a major public health problem in under-developed countries. The multiplication of obstetric surgical units but also the availability of blood products and the effectiveness of free care will be a vital contribution to effectively and sustainably improve the prognosis of this serious pathology when just constituted

Evaluation of Needle Exchange Programs

Needle exchange programs exist in every major population area in the United States and in many other countries. Some operate legally under emergency health decrees issued by local departments of health, with the stated intention of risk reduction through the removal of used injection equipment from use by injection drug users. It is theorized that this results in a reduced transmission of human immunodeficiency virus, hepatitis, and, possibly, other blood-borne diseases. Needle exchange programs also offer access to drug treatment programs for the participants. It is a difficult but necessary task to evaluate these programs. This article examines examples of evaluations attempted in the past and discusses the challenges of such evaluations. Experimental evaluations, economic program analysis, legal aspects, and risk–benefit assessment along with ethical aspects are considered. An outline of program evaluation is proposed. Needle exchange programs offer an opportunity to encourage risk reduction and to offer counseling and access to health care for individuals at high risk. It is essential that such programs demonstrate their effectiveness. Assumptions of efficacy are insufficient for health care in the twenty-first century

Observation of η′→ωe+e−\eta^{\prime}\to\omega e^{+} e^{-}

Based on a sample of \etapr mesons produced in the radiative decay $J/\psi\to\gamma\eta^{\prime}$ in $1.31\times 10^9$ $J/\psi$ events collected with the BESIII detector, the decay $\eta^{\prime}\to\omega e^{+} e^{-}$ is observed for the first time, with a statistical significance of $8\sigma$. The branching fraction is measured to be $\mathcal{B}(\eta^{\prime}\to\omega e^{+} e^{-})=(1.97\pm0.34(\text{stat})\pm0.17(\text{syst}))\times10^{-4}$, which is in agreement with theoretical predictions. The branching fraction of $\eta^{\prime}\to\omega\gamma$ is also measured to be $(2.55\pm0.03(\text{stat})\pm0.16(\text{syst}))\times10^{-2}$, which is the most precise measurement to date, and the relative branching fraction $\frac{\mathcal{B}(\eta^{\prime}\to \omega e^{+}e^{-})}{\mathcal{B}(\eta^{\prime}\to \omega \gamma)}$ is determined to be $(7.71\pm1.34(\text{stat})\pm0.54(\text{syst}))\times10^{-3}$.Comment: 8 pages, 10 figure

Relationship of aerobic fitness and motor skills with memory and attention in preschoolers (Ballabeina): A cross-sectional and longitudinal study

BACKGROUND: The debate about a possible relationship between aerobic fitness and motor skills with cognitive development in children has recently re-emerged, because of the decrease in children's aerobic fitness and the concomitant pressure of schools to enhance cognitive performance. As the literature in young children is scarce, we examined the cross-sectional and longitudinal relationship of aerobic fitness and motor skills with spatial working memory and attention in preschool children. METHODS: Data from 245 ethnically diverse preschool children (mean age: 5.2 (0.6) years, girls: 49.4%) analyzed at baseline and 9 months later. Assessments included aerobic fitness (20 m shuttle run) and motor skills with agility (obstacle course) and dynamic balance (balance beam). Cognitive parameters included spatial working memory (IDS) and attention (KHV-VK). All analyses were adjusted for age, sex, BMI, migration status, parental education, native language and linguistic region. Longitudinal analyses were additionally adjusted for the respective baseline value. RESULTS: In the cross-sectional analysis, aerobic fitness was associated with better attention (r=0.16, p=0.03). A shorter time in the agility test was independently associated with a better performance both in working memory (r=-0.17, p=0.01) and in attention (r=-0.20, p=0.01). In the longitudinal analyses, baseline aerobic fitness was independently related to improvements in attention (r=0.16, p=0.03), while baseline dynamic balance was associated with improvements in working memory (r=0.15, p=0.04). CONCLUSIONS: In young children, higher baseline aerobic fitness and motor skills were related to a better spatial working memory and/or attention at baseline, and to some extent also to their future improvements over the following 9 months. TRIAL REGISTRATION: clinicaltrials.gov NCT0067454

Barriers to participation in mental health research: are there specific gender, ethnicity and age related barriers?

<p>Abstract</p> <p>Background</p> <p>It is well established that the incidence, prevalence and presentation of mental disorders differ by gender, ethnicity and age, and there is evidence that there is also differential representation in mental health research by these characteristics. The aim of this paper is to a) review the current literature on the nature of barriers to participation in mental health research, with particular reference to gender, age and ethnicity; b) review the evidence on the effectiveness of strategies used to overcome these barriers.</p> <p>Method</p> <p>Studies published up to December 2008 were identified using MEDLINE, PsycINFO and EMBASE using relevant mesh headings and keywords.</p> <p>Results</p> <p>Forty-nine papers were identified. There was evidence of a wide range of barriers including transportation difficulties, distrust and suspicion of researchers, and the stigma attached to mental illness. Strategies to overcome these barriers included the use of bilingual staff, assistance with travel, avoiding the use of stigmatising language in marketing material and a focus on education about the disorder under investigation. There were very few evaluations of such strategies, but there was evidence that ethnically matching recruiters to potential participants did not improve recruitment rates. Educational strategies were helpful and increased recruitment.</p> <p>Conclusion</p> <p>Mental health researchers should consider including caregivers in recruitment procedures where possible, provide clear descriptions of study aims and describe the representativeness of their sample when reporting study results. Studies that systematically investigate strategies to overcome barriers to recruitment are needed.</p

Negative and positive childhood experiences across developmental periods in psychiatric patients with different diagnoses – an explorative study

BACKGROUND: A high frequency of childhood abuse has often been reported in adult psychiatric patients. The present survey explores the relationship between psychiatric diagnoses and positive and negative life events during childhood and adulthood in psychiatric samples. METHODS: A total of 192 patients with diagnoses of alcohol-related disorders (n = 45), schizophrenic disorders (n = 52), affective disorders (n = 54), and personality disorders (n = 41) completed a 42-item self-rating scale (Traumatic Antecedents Questionnaire, TAQ). The TAQ assesses personal positive experiences (competence and safety) and negative experiences (neglect, separation, secrets, emotional, physical and sexual abuse, trauma witnessing, other traumas, and alcohol and drugs abuse) during four developmental periods, beginning from early childhood to adulthood. Patients were recruited from four Psychiatric hospitals in Germany, Switzerland, and Romania; 63 subjects without any history of mental illness served as controls. RESULTS: The amount of positive experiences did not differ significantly among groups, except for safety scores that were lower in patients with personality disorders as compared to the other groups. On the other side, negative experiences appeared more frequently in patients than in controls. Emotional neglect and abuse were reported in patients more frequently than physical and sexual abuse, with negative experiences encountered more often in late childhood and adolescence than in early childhood. The patients with alcohol-related and personality disorders reported more negative events than the ones with schizophrenic and affective disorders. CONCLUSIONS: The present findings add evidence to the relationship between retrospectively reported childhood experiences and psychiatric diagnoses, and emphasize the fact that a) emotional neglect and abuse are the most prominent negative experiences, b) adolescence is a more 'sensitive' period for negative experiences as compared to early childhood, and c) a high amount of reported emotional and physical abuse occurs in patients with alcohol-related and personality disorders respectively