scholarly journals Estimating abortion incidence and unintended pregnancy among adolescents in Zimbabwe, 2016: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e034736
Author(s):  
Taylor Riley ◽  
Mugove G. Madziyire ◽  
Tsungai Chipato ◽  
Elizabeth A. Sully
Keyword(s):  
Unintended Pregnancy ◽  
Urban Areas ◽  
Outcome Measure ◽  
Age Groups ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Adolescent Women ◽  
Unintended Pregnancies ◽  
Abortion Ratio ◽  
Abortion Incidence

ObjectiveTo estimate age-specific abortion incidence and unintended pregnancy in Zimbabwe, and to examine differences among adolescents by marital status and residence.DesignWe used a variant of the Abortion Incidence Complications Methodology, an indirect estimation approach, to estimate age-specific abortion incidence. We used three surveys: the Health Facility Survey, a census of 227 facilities that provide postabortion care (PAC); the Health Professional Survey, a purposive sample of key informants knowledgeable about abortion (n=118) and the Prospective Morbidity Survey of PAC patients (n=1002).SettingPAC-providing health facilities in Zimbabwe.ParticipantsHealthcare providers in PAC-providing facilities and women presenting to facilities with postabortion complications.Primary and secondary outcome measuresThe primary outcome measure was abortion incidence (in rates and ratios). The secondary outcome measure was the proportion of unintended pregnancies that end in abortion.ResultsAdolescent women aged 15–19 years had the lowest abortion rate at five abortions per 1000 women aged 15–19 years compared with other age groups. Adolescents living in urban areas had a higher abortion ratio compared with adolescents in rural areas, and unmarried adolescent women had a higher abortion ratio compared with married adolescents. Unintended pregnancy levels were similar across age groups, and adolescent women had the lowest proportion of unintended pregnancies that ended in induced abortion (9%) compared with other age groups.ConclusionsThis paper provides the first estimates of age-specific abortion and unintended pregnancy in Zimbabwe. Despite similar levels of unintended pregnancy across age groups, these findings suggest that adolescent women have abortions at lower rates and carry a higher proportion of unintended pregnancies to term than older women. Adolescent women are also not a homogeneous group, and youth-focused reproductive health programmes should consider the differences in experiences and barriers to care among young people that affect their ability to decide whether and when to parent.

scholarly journals Silver diamine fluoride as a minimally invasive and aerosol free approach in pediatric dentistry: An extensive case series

2021 ◽  
Vol 2 (2) ◽  
pp. 42-54
Author(s):  
Abhishek Soni ◽  
Sanchit Paul ◽  
Priyanka Sachdeva
Keyword(s):  
Minimally Invasive ◽  
Outcome Measure ◽  
Age Groups ◽  
Case Series ◽  
Pediatric Dentistry ◽  
Permanent Teeth ◽  
Secondary Outcome ◽  
Clinical Approach ◽  
Secondary Outcome Measure ◽  
Silver Diamine Fluoride

The current pandemic of COVID-19 warrants a repeal from conventional dentistry to an aerosol free, minimally invasive yet maximally effective clinical approach. Silver diamine fluoride (SDF) is an established modality for caries arrest in children fulfilling all the above. This extensive 25 case series highlights various clinical situations in which SDF was successfully used in children between 1-12 years of age with asymptomatic carious lesions of ICDAS score 2 or more in primary and permanent teeth. Primary outcome measure was caries arrest in the form of the hard and shiny lesion with no/minimal sensitivity. The secondary outcome measure was the zombie effect which was the residual staining on other tooth surfaces and indications of substantivity. SDF can be effectively and efficaciously used across different behaviour patterns and age groups of children in a various clinical scenario for both primary and permanent teeth routinely experienced in a paediatric dental office especially during these pandemic times with minimal aerosol generation.

Risk factors for mortality in landslide- and flood-affected populations in Uganda

2013 ◽  
Vol 8 (2) ◽  
pp. 113-122
Author(s):  
Shreya Agrawal, MSPH, MPA, ◽  
Yuri Gorokhovich, MA, PhD ◽  
Shannon Doocy, PhD
Keyword(s):  
Risk Factors ◽  
Medical Care ◽  
Outcome Measure ◽  
Age Groups ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Risk Of Death ◽  
Time Period ◽  
Younger Age

Objective: Assess mortality risk factors including age, sex, and disaster type, in the March 2010 floods and landslides in Eastern Uganda and to compare time period, cause, location, and receipt of medical care among landslide and flood fatalities.Design: A stratified cluster survey was conducted of 802 affected households in community and camp locations.Setting: Flood and landslide affected populations in the East Uganda the districts of Baduda and Butaleja.Respondents: Adult household members in 802 households were surveyed regarding household member deaths in the floods and landslides areas.Main Outcome Measures: The primary outcome measure was the odds of death associated with age, sex, and disaster type (flood or landslide). The secondary outcome measure was the odds of event (landslide or flood) among fatalities associated with sex, age, time period of death, and cause of death.Results: The odds of death were significantly higher in landslide affected populations than in flood affected populations (OR 3.06, 95% CI 2.20-4.25, p 0.001). Time period of death (p = 0.016), type of death (p 0.001), death after seeking medical care (p = 0.033), month of death (p 0.001), and cause of death (p 0.001) were significantly associated with increased odds of death due to landslides as compared to floods.Conclusion: More deaths occurred due to landslides than floods, and landslide deaths were more immediate, with a majority occurring on the day of the event. Females and younger age groups faced a greater risk of death from the landslide than the flood.

scholarly journals Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes

2018 ◽  
Vol 103 (10) ◽  
pp. 1395-1400 ◽  
Author(s):  
Rashmi G Mathew ◽  
Sahar Parvizi ◽  
Ian E Murdoch
Keyword(s):  
Cataract Surgery ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Risk Of Failure ◽  
Increased Risk ◽  
Significant Difference ◽  
Measure Change ◽  
Group 2

AimsTo compare success proportions at 5 years in three surgical groups: group 1, trabeculectomy alone; group 2, trabeculectomy followed by cataract surgery within 2 years; and group 3, trabeculectomy performed on a pseudophakic eye.MethodsA retrospective cohort study. 194 eyes of 194 patients were identified with at least 5 years’ follow-up post trabeculectomy (N=85, 60 and 49 in groups 1, 2 and 3, respectively).Main outcome measures1. Primary outcome measure: intraocular pressure (IOP) at 5 years post-trabeculectomy surgery, 2.Secondary outcome measure: change in visual acuity at 5 years.ResultsAt 5 years, the mean IOP (SD) was 12.9 (3.5), 12.5 (4.8) and 12.7 (4.8) mm Hg in groups 1, 2 and 3, respectively. Overall success was almost identical, 58%, 57% and 59% in groups 1, 2 and 3, respectively. There was no significant difference between the groups in terms of percentage IOP reduction, number of medications, proportion restarting medication and reoperation rates at 5 years. Logistic regression for an outcome of failure showed men to be at increased risk of failure OR 1.97 (95% CI 1.10 to 3.52, p=0.02). Nearly 80% of patients retained or improved their vision following their initial trabeculectomy.ConclusionsThe sequence in which surgery is carried out does not appear to affect trabeculectomy function at 5 years, success being similar to trabeculectomy alone. In our study, men may be at increased risk of failure.

scholarly journals Determinants of Sports Injury in Young Female Swedish Competitive Figure Skaters

2021 ◽  
Vol 3 ◽  
Author(s):  
Moa Jederström ◽  
Sara Agnafors ◽  
Christina Ekegren ◽  
Kristina Fagher ◽  
Håkan Gauffin ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Sports Injury ◽  
Young Female ◽  
Older Age ◽  
Point Prevalence ◽  
Severe Injury ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Multiple Model ◽  
Figure Skaters

Introduction: Although figure skating attracts several hundred thousand participants worldwide, there is little knowledge about physical health and sports injuries among young skaters. The present study aimed to describe the health status of a geographically defined Swedish population of licensed competitive figure skaters and to examine injury determinants.Methods: All licensed competitive skaters in the southeastern region of Sweden were in April 2019 invited to participate in a cross-sectional study using an online questionnaire. Multiple binary logistic regression was used for the examination of injury determinants. The primary outcome measure was the 1-year prevalence of a severe sports injury episode (time loss >21 days). The secondary outcome measure was the point prevalence of an ongoing injury. The determinants analyzed were age, skating level, relative energy deficiency indicators, and training habits.Results: In total, 142 (36%) skaters participated, 137 (96%) girls [mean (SD) age: 12.9 (SD 3.0) years]. Participating boys (n = 5) were excluded from further analysis. The 1-year prevalence of a severe sports injury episode was 31%. The most common injury locations for these injuries were the knee (25%), ankle (20%), and hip/groin (15%). In the multiple model, having sustained a severe injury episode was associated with older age (OR 1.2, 95% CI 1.1–1.4; p = 0.002) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.014). The point prevalence of an ongoing injury episode was 19%. The most common locations were the knee (24%), ankle (24%), and foot (24%). Having an ongoing injury episode was associated with older age (OR 1.4, 95% CI 1.2–1.7; p < 0.001) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.049).Conclusion: One-third of young female Swedish competitive figure skaters had sustained a severe injury episode during the past year, and a fifth reported an ongoing episode. Older age and an increased number of skipped meals per week were associated with a sports injury episode. Long-term monotonous physical loads with increasing intensity and insufficient energy intake appear to predispose for injury in young female figure skaters. Further examination of injury determinants among competitive figure skaters is highly warranted.

The importance of perioperative optimisation to facilitate safe regional anaesthesia and their improved outcomes in fracture neck of femur patients

2021 ◽  
pp. 175045892110640
Author(s):  
Benjamin Thomas Vincent Gowers ◽  
Michael Sean Greenhalgh ◽  
Kathryn Dyson ◽  
Karthikeyan P Iyengar ◽  
Vijay K Jain ◽  
...  
Keyword(s):  
Hip Fracture ◽  
General Anaesthesia ◽  
Regional Anaesthesia ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
General Anaesthetic ◽  
Secondary Outcome Measure ◽  
Neck Of Femur ◽  
One Year ◽  
To Receive

Background: Hip fractures are common presentations to orthopaedic departments, and their surgical management often results in blood transfusions. Compared with general anaesthesia, regional anaesthesia reduces the need for transfusions and mortality in the wider surgical population. Aims: In hip fracture patients, our primary outcome measure was to examine any relationship between anaesthetic modality and transfusion rates. The secondary outcome measure was to assess the relationship between anaesthetic modality and one-year mortality. Methods: A retrospective cohort study of 280 patients was carried out in 2017 and 2018. Data were collected from patient records, local transfusion laboratory and the national hip fracture database. Results: A total of 59.6% had regional and 40.4% general anaesthesia. Regional anaesthesia patients were younger with fewer comorbidities (p < .05). About 19.8% regional and 34.5% general anaesthesia patients received transfusions (odds ratio (OR) = 0.47, p < .05); 13.6% were taking anticoagulants and were less likely to receive a regional anaesthetic (31.6% versus 64%, OR = 0.26, p < .05). One-year mortality was 27% for regional and 37% for general anaesthetic patients (OR = 0.64, p = .09). Conclusion: Regional anaesthesia halved the risk of blood transfusion. Anticoagulated patients were 74% less likely to receive regional anaesthetics, but had no additional transfusion risk. With optimisation, a larger proportion of patients could have regional anaesthesia.

scholarly journals Impact of blood group on survival following critical illness: a single-centre retrospective observational study

2019 ◽  
Vol 6 (1) ◽  
pp. e000426
Author(s):  
Robert Slade ◽  
Raza Alikhan ◽  
Matt P Wise ◽  
Lam Germain ◽  
Simon Stanworth ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Blood Group ◽  
Outcome Measure ◽  
Tertiary Hospital ◽  
Current Data ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Transfusion Requirements ◽  
Significant Difference

BackgroundPredicting patient outcomes following critical illness is challenging. Recent evidence has suggested that patients with blood group AB are more likely to survive following major cardiac surgery, and this is associated with a reduced number of blood transfusions. However, there are no current data to indicate whether a patient’s blood group affects general intensive care outcomes.ObjectiveThe objective of this study was to determine if ABO blood group affects survival in intensive care. The primary outcome measure was 90-day mortality with a secondary outcome measure of the percentage of patients receiving a blood transfusion.DesignRetrospective analysis of electronically collected intensive care data, blood group and transfusion data.SettingGeneral intensive care unit (ICU) of a major tertiary hospital with both medical and surgical patients.PatientsAll patients admitted to ICU between 2006 and 2016 who had blood group data available.InterventionNone.Measurements and main results7340 patients were included in the study, blood group AB accounted for 3% (221), A 41% (3008), B 10.6% (775) and O 45.4% (3336). These values are similar to UK averages. Baseline characteristics between the groups were similar. Blood group AB had the greatest survival benefit (blood group AB 90-day survival estimate 76.75, 95% CI 72.89 to 80.61 with the overall estimate 72.07, 95% CI 71.31 to 72.82) (log-rank χ2 16.128, p=0.001). Transfusion requirements were similar in all groups with no significant difference between the percentages of patients transfused (AB 23.1%, A 21.5%, B 18.7%, O 19.9%, Pearson χ2 5.060 p=0.167).ConclusionAlthough this is primarily a hypothesis generating study, intensive care patients with blood group AB appeared to have a higher 90-day survival compared with other blood groups. There was no correlation between blood group and percentage of patients receiving transfusion.

Stratification of chronic and complex wounds according to healing characteristics: a retrospective study

2019 ◽  
Vol 28 (7) ◽  
pp. 446-452
Author(s):  
Nicole E. Spruijt ◽  
Maarten M. Hoogbergen ◽  
Servaas J.E. Buijs ◽  
Marcel J.W. Grosveld ◽  
Jaap Buth
Keyword(s):  
Wound Healing ◽  
Retrospective Study ◽  
Outcome Measure ◽  
Treatment Time ◽  
Wound Dehiscence ◽  
Lower Percentage ◽  
Secondary Outcome ◽  
Study Cohort ◽  
Secondary Outcome Measure ◽  
Risk Categories

Objective: Wound risk-stratified analyses are clinically relevant as they can assist in identifying hard-to-heal wounds. The aim of the study is to develop risk categories for wound healing based on a limited number of reliably recordable clinical data. Method: This retrospective study used observational data. The primary outcome measure was wound healing at the end of treatment and the secondary outcome measure was the time to wound healing. A stratification model using regression analyses was developed to assign the patients to risk categories for wound healing and the time-to-heal. Results: The study cohort comprised of 540 patients. The most common wound diagnoses were diabetic ulcers, wounds in irradiated areas and wound dehiscence after surgery. Average wound duration before starting treatment at the wound centre was 11.7 months. Healing was achieved in 382 (71%) wounds, after an average treatment time of 4.4 months. A total of four risk categories for wound healing were developed by combining wound diagnosis (favourable versus unfavourable) and duration (<3 months versus >3 months). These risk categories demonstrated healing percentages ranging from 69–97% (p=0.0004) and mean time-to-healing varying from 2.7–5.9 months (p=0.01). Conclusion: Using two clinical wound variables, diagnosis and duration, stratification categories were identified with significant associations with wound healing outcomes. Longer wound duration and unfavourable diagnoses, when combined into unfavourable risk categories, were associated with a lower percentage of wound healing and a longer treatment time until healing.

Reliability of clinical tests for prediction of occult scaphoid fractures and cost benefit analysis of a dedicated scaphoid pathway

2020 ◽  
pp. 175319342097946
Author(s):  
Preetham Kodumuri ◽  
Andrew McDonough ◽  
Victoria Lyle ◽  
Zaf Naqui ◽  
Lindsay Muir
Keyword(s):  
Outcome Measure ◽  
Cost Benefit Analysis ◽  
Scaphoid Fracture ◽  
Cost Benefit ◽  
Clinical Suspicion ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Post Injury ◽  
Level Of Evidence ◽  
Scaphoid Fractures

We reviewed the outcomes of our dedicated clinic for suspected scaphoid fractures. The primary outcome measure was to test the reliability of accurately diagnosing an occult scaphoid fracture with a combination of anatomical snuff box, scaphoid tubercle, longitudinal compression tenderness, ulnar deviation and the pinch test. Cost savings of the new patient pathway was our secondary outcome measure. Between December 2016 and March 2020, 922 patients were recruited at a mean of 12 days post-injury. Sixty-five per cent ( n = 602) with a low clinical suspicion were discharged and 35% ( n = 320) with a high clinical suspicion had same day MRI scan. Fifty-eight scaphoid fractures were diagnosed and treated with no nonunions reported. Anatomical snuff box tenderness was the most sensitive test (90%). A combination of five tests better excluded an occult fracture (80% accuracy). The dedicated scaphoid clinic pathway resulted in 350 fewer follow-up visits and an overall saving of £59,666. Level of evidence: III

scholarly journals Effects of standard v. very long Roux limb Roux-en-Y gastric bypass on nutrient status: a 1-year follow-up report from the Dutch Common Channel Trial (DUCATI) Study

2020 ◽  
Vol 123 (12) ◽  
pp. 1434-1440 ◽  
Author(s):  
M. Leeman ◽  
R. P. M. Gadiot ◽  
J. M. A. Wijnand ◽  
E. Birnie ◽  
J. A. Apers ◽  
...  
Keyword(s):  
Vitamin D ◽  
Gastric Bypass ◽  
Folic Acid ◽  
Outcome Measure ◽  
Roux Limb ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Close Monitoring ◽  
Common Channel ◽  
Reoperation Rates

AbstractLaparoscopic Roux-en-Y gastric bypass (RYGB) is considered the ‘gold standard’ for surgical treatment of morbid obesity. It is hypothesised that reducing the length of the common limb positively affects the magnitude and preservation of weight loss but may also impose a risk of malnutrition. The aim of this study was to compare patients’ nutrient and vitamin deficiencies in standard RYGB with a very long Roux limb RYGB (VLRL-RYGB). This study was part of the multicentre randomised controlled trial (Dutch Common Channel Trial), including 444 patients undergoing an RYGB or a VLRL-RYGB. Laboratory results, use of multivitamin supplements and reoperations were collected at baseline and 1 year postoperative. Primary outcome measure was nutrient deficiency after 1 year postoperative. Secondary outcome measure was the reoperation rate due to malabsorption. In total, 227 patients underwent RYGB and 196 patients underwent VLRL-RYGB. Most common deficiencies at 1 year postoperative were ferritin (17·2–18·2 %), Fe (23·4–35·6 %), K (7·4–15·2 %), vitamin B12 (9·0–9·9 %) and vitamin D (22·7–34·5 %). Patients undergoing VLRL-RYGB had slightly but significantly lower levels of Ca, Fe and vitamin D compared with those undergoing RYGB at 1 year postoperative, but significantly higher levels of folic acid and Na. Reoperation rates due to malabsorption were not significantly different between RYGB (2/227, 0·9 %) and VLRL-RYGB (7/196, 3·6 %) (P = 0·088). We concluded that patients undergoing VLRL-RYGB had significantly lower levels of Ca, Fe and vitamin D compared with those undergoing RYGB at 1 year postoperative, but higher levels of folic acid and Na. Reoperation rates did not differ. Close monitoring on nutrient deficiencies should be performed in patients undergoing VLRL-RYGB.

scholarly journals Factors Influencing Unintended Pregnancies amongst Adolescent Girls and Young Women in Cambodia

2019 ◽  
Vol 16 (20) ◽  
pp. 4006 ◽  
Author(s):  
Farwa Rizvi ◽  
Joanne Williams ◽  
Elizabeth Hoban
Keyword(s):  
Unintended Pregnancy ◽  
Ecological Model ◽  
Age Groups ◽  
Sociodemographic Factors ◽  
Health Concern ◽  
Modern Contraceptive ◽  
Unintended Pregnancies ◽  
Younger Age ◽  
History Of ◽  
Socioeconomic Consequences

Background: Unintended pregnancies in Cambodian youth are a major reproductive health concern with detrimental personal and socioeconomic consequences. A social ecological model was used to identify sociodemographic factors potentially associated with unintended pregnancies, and an analysis of data from the 2014 Cambodian Demographic and Health Survey was used to determine associations. Methods: Weighted data were analysed using multiple logistic regression analyses for 3406 Cambodian sexually active single, in union or married females aged 15–29 years. Results: The prevalence of unintended pregnancy was 12.3%. Unintended pregnancy was significantly associated with younger age groups (15–24 years), multiparity, history of abortion, and current use of modern contraceptive methods. All women had an increased likelihood of unintended pregnancy when the husband alone or someone else in the household made decisions about their access to healthcare. Conclusion: The burden of unintended pregnancies is associated with young age, multiparity, history of abortions, unemployment, and low autonomy for accessing healthcare. Multi-pronged, holistic reproductive and sexual health program interventions are needed to increase literacy and accessibility to modern contraception and to raise awareness about women’s health and status in Cambodia.

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