Phytochemical Profile, Safety and Efficacy of a Herbal Mixture Used for Contraception by Traditional Health Practitioners in Ngaka Modiri Molema District Municipality, South Africa

The use of medicinal plants for contraception remains a common practice among South African ethnic groups. The present study assessed the phytochemical profile, cytotoxicity, acute oral toxicity and efficacy of a herbal mixture used for contraception by the Batswana of South Africa. An aqueous extract was prepared from equal quantities (in terms of weight) of Bulbine frutescens (roots), Helichrysum caespititium (leaves) and Teucrium trifidum (leaves) based on a recipe used by traditional health practitioners. The phytochemical profiles of the freeze-dried herbal mixture were analyzed using gas chromatography–mass spectrometry (GC-MS). In addition, cytotoxicity was determined using an MTT assay on Vero cells and in vivo contraceptive efficacy was evaluated using seven Sprague Dawley rats per control and treatment groups. The control group received distilled water while test groups received 5, 50 and 300 mg/kg of the herbal mixture, which was administered orally once a day for three consecutive days. Subsequently, female rats were paired 1:1 with males for 3 days. Their weights were measured weekly and incidence of pregnancy was recorded. The GC-MS chromatogram revealed the presence of 12 identified and 9 unidentified compounds. In terms of safety, the herbal mixture had an IC50 value of 755.2 μg/mL and 2000 mg/kg, which was the highest tested dose that caused no mortality or morbidity in the rats. A contraceptive efficacy of 14.5% was exerted with 50 mg/kg herbal mixture extract while other doses had no effects given that all the rats were pregnant. Based on a chi-square test (p < 0.05), there was no correlation between the tested herbal mixture doses and contraception, nor on the weight of the rats. Overall, the herbal mixture extract was found to be safe but had limited contraceptive efficacy at the tested doses. In future studies, exploring increased dose range, solvent extract types and hormonal analysis will be pertinent.

CrowdMed-II: a blockchain-based framework for efficient consent management in health data sharing

The healthcare industry faces serious problems with health data. Firstly, health data is fragmented and its quality needs to be improved. Data fragmentation means that it is difficult to integrate the patient data stored by multiple health service providers. The quality of these heterogeneous data also needs to be improved for better utilization. Secondly, data sharing among patients, healthcare service providers and medical researchers is inadequate. Thirdly, while sharing health data, patients’ right to privacy must be protected, and patients should have authority over who can access their data. In traditional health data sharing system, because of centralized management, data can easily be stolen, manipulated. These systems also ignore patient’s authority and privacy. Researchers have proposed some blockchain-based health data sharing solutions where blockchain is used for consensus management. Blockchain enables multiple parties who do not fully trust each other to exchange their data. However, the practice of smart contracts supporting these solutions has not been studied in detail. We propose CrowdMed-II, a health data management framework based on blockchain, which could address the above-mentioned problems of health data. We study the design of major smart contracts in our framework and propose two smart contract structures. We also introduce a novel search contract for searching patients in the framework. We evaluate their efficiency based on the execution costs on Ethereum. Our design improves on those previously proposed, lowering the computational costs of the framework. This allows the framework to operate at scale and is more feasible for widespread adoption.

Use of new technologies and promotion of breastfeeding: integrative literature review

ABSTRACT Objective: To identify the most used social networks and the most consumed contents by women seeking support and further understanding of breastfeeding/breast milk. Data source: An integrative literature review was performed using the Psychology & Behavioral Sciences Collection, MEDLINE Complete, CINAHL Complete, MedicLatina, Academic Search Complete and ERIC databases. The search was conducted in April, 2020. The inclusion criteria were: publications in Portuguese, English or Spanish with several keywords, such as “Breastfeeding”, “Social Networking”, “Social Media”, “Breastfeeding Promotion”, in the title and in the abstract, with the combination of the Boolean operators “AND” and “OR”, in original articles of primary source, which were available in full text and were published between 2015 and 2020. Data synthesis: Out of the 93 articles that were first examined, 10 were used in the descriptive summary. Studies from the United States, Sweden, New Zealand, Brazil, Australia, Indonesia, and Switzerland were included in the review. Women were found to use several social networks, which is facilitated by an easy access to the Internet and to its content through several electronic resources, often using more than one device simultaneously. Most issues were universally recognized as some of the most common reasons for interrupting breastfeeding. Conclusions: The analyzed studies show that women seek to clarify their doubts outside the traditional health services’ environment, using Facebook, apps, websites, online videos, podcasts and e-mail. We stress the importance of these support groups for promoting breastfeeding and the need for health professionals to introduce themselves in social networks to reach mothers.

Indigenous Communication and Traditional Health Practices Among the Yoruba During Pregnancy, Child Delivery, and Baby Caring

Communication is a vital aspect of human existence. It pervades man's existence and society, forming an integral part of human life. Communication is the means through which human beings express their feelings. Indigenous communication serves as the traditional means of conveying messages, all social and value exchanges of indigenous practice like the health practices. Traditional health practices include the use of knowledge skills, practices based on indigenous belief, experiences of culture used in maintenance of health-prevention, treatment and diagnosis in traditional health practices. This chapter examines and documents traditional health practices on how Yorùbás care for pregnancy, child delivery, and their babies. Such traditional health practices have existed since before the advent of modern health practices, thereby using indigenous communication for preservation and dissemination of valuable information that is significant for Yorùbá generations.

The Effects of Teach Back Method on Caregivers’ Strain in Handling Patients with Prolonged Immobilization

Background: Caregivers’ strain mainly comes from lack of relevant care knowledge and nursing skills. Traditional health education is just a one-way information transmission mode without evaluation and feedback. Objective: To help caregivers’ memory, the researcher utilized a quasi-experimental design to measure the effectiveness of the teach-back method on caregivers’ strain in handling patients with prolonged immobilization. Method: A total of forty caregivers were averagely assigned into treatment (Teach-Back) and comparison group (traditional). Participant’s Data Sheet, The Zarit Burden Interview and Teach Back Assessment Tool was used to gather data. Results: There was a significant difference in caregivers’ strain before and after the Teach-Back Method in treatment (p<0.001) and comparison group (p <0.001). Likewise, a significant difference existed after the Teach-Back Method in the treatment group (p <0.001). Conclusion: The Teach-Back Method is an effective intervention in reducing caregivers’ strain in handling patients with prolonged immobilization.

Time to Align: A Call for Consensus on the Assessment of Genetic Testing

In this paper, we updated our 2018 systematic review aimed to identify and compare ad hoc designed frameworks for genetic testing evaluation. Overall, we identified 30 frameworks (29 in the first systematic review and one in the update): they were mainly based on the ACCE model, whereas a minority were adjustments of the more traditional Health Technology Assessment (HTA) approach. After discussing the strengths and weaknesses of the retrieved frameworks, this perspective calls for consensus on the assessment of genetic testing. In line with the recent European recommendations that encouraged the generation of comparable evidence across Member States, we believe that the time has come to align all the ideas that have emerged over the last few decades and find a sustainable and sharable tool for the evaluation of genetic and genomic applications. Therefore, we suggest stopping the evaluation of such technologies using ad hoc strategies–affected by validation, implementation, and adoption issues–and we propose to use a general HTA approach, particularly the European reference tool for the assessment of health technologies, the EUnetHTA HTA core model, that is built on solid theoretical and methodological principles and provides a comprehensive assessment of the technologies value.

The Middle–Out Perspective — an approach to formalise 'normal practice' in public health advocacy

Background: The Middle–Out Perspective (MOP) provides a lens to examine how actors positioned between government (top) and individuals (bottom) act to promote broader societal changes from the middle–out (rather than the top–down or bottom–up). The MOP has been used in recent years in the fields of energy, climate change, and development studies. Public health practitioners involved with advocacy activities and creating alliances to amplify health promotion actions will be familiar with the general MOP concept if not the formal name. Methods: This paper introduces the MOP conceptual framework and customises it for a public health audience by positioning it among existing concepts and theories for actions within public health. Using two UK case studies (increasing signalised crossing times for pedestrians and the campaign for smoke–free legislation), we illustrate who middle actors are and what they can do to result in better public health outcomes. Results: These cases studies show that involving a wider range of middle actors, including those not traditionally involved in improving the public's health, can broaden the range and reach of organisations and individuals involving in advocating for public health measures. They also demonstrate that middle actors are not neutral. They can be recruited to improve public health outcomes, but they may also be exploited by commercial interests to block healthy policies or even promote a health-diminishing agenda. Conclusions: Using the MOP as a formal approach can help public health organisations and practitioners consider potential 'allies' from outside traditional health-related bodies or professions. Formal mapping can expand the range of who are considered potential middle actors for a particular public health issue. By applying the MOP, public health organisations and staff can enlist the additional leverage that is brought to bear by involving additional middle actors in improving the public's health.

Association of pre-ESRD care education with patient outcomes in a 10-year longitudinal study of patients with CKD stages 3–5 in Taiwan

There is little comprehensive education for people with end-stage renal disease (ESRD) progress. We investigated the differences in terms of outcomes between patients with CKD stages 3–5 who enrolled and did not enroll in the pre-ESRD care education in Taiwan. This retrospective cohort study was conducted using data from the National Health Insurance Research Database (NHIRD). All patients diagnosed with CKD stages 3–5 who received the pre-ESRD care education through the pay for performance (P4P) program were enrolled. Based on whether or not they participated in the program, they were categorized into P4P or non-P4P groups. All analyses were performed from January 2006 through December 2015. Study outcomes were risk of hemodialysis dependency, hospitalization, and all-cause mortality. In this study of 29,337 patients, those with CKD stages 3–5 in the P4P group had lower events of hemodialysis, hospitalization, and all-cause mortality compared to patients in the non-P4P group. This study suggested that pre-ESRD care education is associated with increased patient outcomes, resulting in lower hemodialysis and hospitalization events and a higher overall survival rate in patients with CKD stages 3–5. Patient education could raise opportunities to improve pre-ESRD care by reaching patients outside the traditional health care setting.

Undoing disaster colonialism: a pilot map of the pandemic's first wave in the Mapuche territories of Southern Chile

PurposeThe authors use media research and crowdsourced mapping to document how the first wave of the pandemic (April–August 2020) affected the Mapuche, focussing on seven categories of events: territorial control, spiritual defence, food sovereignty, traditional health practices, political violence, territorial needs and solidarity, and extractivist expansion.Design/methodology/approachResearch on the effects of the pandemic on the Mapuche and their territories is lacking; the few existing studies focus on death and infection rates but overlook how the pandemic interacts with ongoing processes of extractivism, state violence and community resistance. The authors’ pilot study addresses this gap through a map developed collaboratively by disaster scholars and Mapuche journalists.FindingsThe map provides a spatial and chronological overview of this period, highlighting the interconnections between the pandemic and neocolonialism. As examples, the authors focus on two phenomena: the creation of “health barriers” to ensure local territorial control and the state-supported expansion of extractive industries during the first months of the lockdown.Research limitations/implicationsThe authors intersperse our account of the project with reflections on its limitations and, specifically, on how colonial formations shape the research. Decolonising disaster studies and disaster risk reduction practice, the authors argue, is an ongoing process, bound to be flawed and incomplete but nevertheless an urgent pursuit.Originality/valueIn making this argument, the paper responds to the Disaster Studies Manifesto that inspires this special issue, taking up its invitation to scholars to be more reflexive about their research practice and to frame their investigations through grounded perspectives.

Common Health Problems and Health-seeking Behavior Among the Tribals of Odisha, India

The present study aims to explore the common health problems and the health-seeking behavior among the tribal population in Koraput district of Odisha. In order to assess the common health problems and the treatment-seeking behavior, 300 tribal individuals from 173 households in the age group of 18–64 years and 24 health care staff were recruited for the study. Information regarding health facilities, their affordability, and morbidity status were obtained through pre-structured questionnaires. Data analysis was carried out using SPSS-20 and Microsoft Excel software tools. Anemia, diarrheal problems, cold, pneumonia, vaginal problems, skin infection, fever, malnutrition, and sickle cell anemia were the common health problems reported by the respondents. In addition, the study found that the majority of the respondents relied on traditional health care practices. The initiation of proper awareness can help in reducing traditional health care practices among the tribal communities. Furthermore, the involvement of modern health care practitioners would help to reduce the disease burden in tribal communities.