Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis.

BACKGROUND: What constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable. OBJECTIVES: To develop a conceptualisation of RMC. SEARCH STRATEGY: Key databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies. SELECTION CRITERIA: Primary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date. DATA COLLECTION AND ANALYSIS: A combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings. MAIN RESULTS: Sixty-seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent. CONCLUSIONS: This review presents an evidence-based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes. TWEETABLE ABSTRACT: Understanding respectful maternity care - synthesis of evidence from 67 qualitative studies.

Prevalence of child malnutrition at a university hospital using the World Health Organization criteria and bioelectrical impedance data

Malnutrition constitutes a major public health concern worldwide and serves as an indicator of hospitalized patients’ prognosis. Although various methods with which to conduct nutritional assessments exist, large hospitals seldom employ them to diagnose malnutrition. The aim of this study was to understand the prevalence of child malnutrition at the University Hospital of the Ribeirão Preto Medical School, University of São, Brazil. A cross-sectional descriptive study was conducted to compare the nutritional status of 292 hospitalized children with that of a healthy control group (n=234). Information regarding patients’ weight, height, and bioelectrical impedance (i.e., bioelectrical impedance vector analysis) was obtained, and the phase angle was calculated. Using the World Health Organization (WHO) criteria, 35.27% of the patients presented with malnutrition; specifically, 16.10% had undernutrition and 19.17% were overweight. Classification according to the bioelectrical impedance results of nutritional status was more sensitive than the WHO criteria: of the 55.45% of patients with malnutrition, 51.25% exhibited undernutrition and 4.20% were overweight. After applying the WHO criteria in the unpaired control group (n=234), we observed that 100.00% of the subjects were eutrophic; however, 23.34% of the controls were malnourished according to impedance analysis. The phase angle was significantly lower in the hospitalized group than in the control group (P<0.05). Therefore, this study suggests that a protocol to obtain patients’ weight and height must be followed, and bioimpedance data must be examined upon hospital admission of all children.

Prevalence of child malnutrition at a university hospital using the World Health Organization criteria and bioelectrical impedance data.

Malnutrition constitutes a major public health concern worldwide and serves as an indicator of hospitalized patients' prognosis. Although various methods with which to conduct nutritional assessments exist, large hospitals seldom employ them to diagnose malnutrition. The aim of this study was to understand the prevalence of child malnutrition at the University Hospital of the Ribeirão Preto Medical School, University of São, Brazil. A cross-sectional descriptive study was conducted to compare the nutritional status of 292 hospitalized children with that of a healthy control group (n=234). Information regarding patients' weight, height, and bioelectrical impedance (i.e., bioelectrical impedance vector analysis) was obtained, and the phase angle was calculated. Using the World Health Organization (WHO) criteria, 35.27% of the patients presented with malnutrition; specifically, 16.10% had undernutrition and 19.17% were overweight. Classification according to the bioelectrical impedance results of nutritional status was more sensitive than the WHO criteria: of the 55.45% of patients with malnutrition, 51.25% exhibited undernutrition and 4.20% were overweight. After applying the WHO criteria in the unpaired control group (n=234), we observed that 100.00% of the subjects were eutrophic; however, 23.34% of the controls were malnourished according to impedance analysis. The phase angle was significantly lower in the hospitalized group than in the control group (P<0.05). Therefore, this study suggests that a protocol to obtain patients' weight and height must be followed, and bioimpedance data must be examined upon hospital admission of all children.

Impact of activated sludge configuration and operating conditions on in vitro and in vivo responses and trace organic compound removal.

This study tested municipal sewage effluents generated at the pilot scale using conventional activated sludge (CAS), nitrifying activated sludge (CAS-N) and biological nutrient removal (BNR) in terms of the removal of trace organic compounds (TrOCs) and final effluent quality as indicated by yeast estrogenicity screening (YES), short term zebrafish reproduction and fathead minnow life-cycle tests. Under cold weather conditions (extended SRTs), the BNR configuration reduced the concentrations of the largest number of TrOCs while under warm weather conditions (reduced SRTs) the CAS-N was most effective. By comparison, YES test results indicated statistically lower responses in the BNR effluent in the warm weather tests and no difference between the effluents of CAS-N and BNR in the cold weather tests. Short term tests with adult zebrafish revealed no impact of the BNR and CAS-N effluents on egg production. By contrast egg production and gene expression in the CAS-exposed zebrafish were substantially less than that of control exposures and were similar to that of exposures to ammonia at similar concentrations as the CAS exposures. In fathead minnow life-cycle tests, exposures to CAS effluent (70-50% v/v) resulted in considerable mortality, reduced growth and reduced egg production that was likely due to the elevated ammonia concentrations. The CAS-N effluent (100% v/v) also resulted in some mortality and reduced growth and egg production in the fathead minnows. By contrast, the BNR effluent (100% v/v) had no effect on mortality, growth or egg production. The results suggest that enhancements to wastewater treatment plants that are associated with improved nitrogen removal can result in enhanced removal of TrOCs and can reduce the harmful effects of the effluents on aquatic biota.

UV disinfection of wastewater flocs: the effect of secondary treatment conditions.

Activated sludge flocs that are carried to the final effluent can significantly decrease the effectiveness of ultraviolet (UV) disinfection of wastewater. This effect is detected in a typical UV dose-response curve, where at higher UV doses there is a decrease in the inactivation rate (tailing). In this study, the effect of activated sludge process conditions on the UV inactivation kinetics of flocs was investigated. The conditions compared were nitrifying vs. non-nitrifying vs. an enhanced biological nutrient removal-University of Cape Town (BNR-UCT) system. The results showed that the flocs generated in the BNR-UCT process were easier to disinfect. The final effluent from the BNR-UCT process also showed improved kinetics of inactivation and reached higher levels of disinfection. The nitrifying system's final effluent had a lower number of initial fecal coliforms, which contributed to reaching higher disinfection levels compared to the non-nitrifying system.

Specific immunotherapy downregulates peripheral blood CD4 and CD8 T-lymphocyte activation in grass pollen-sensitive asthma.

Several lines of evidence indicate that specific immunotherapy may act by modifying the immune responses of T-lymphocytes to the antigen. To evaluate the effect of specific immunotherapy on the activation of T-lymphocytes by cluster of differentiation cells (CD4+ and CD8+) in peripheral blood, the expression of two surface activation markers, the p55 interleukin-2 receptor (CD25) and human leucocyte antigen (HLA)-DR, was studied prospectively on circulating CD4+ and CD8+ T-cell subsets in subjects with grass-pollen sensitive asthma before and after 1 yr of treatment with specific immunotherapy. Twenty five asthmatic patients with pollen sensitivity other than grass, studied out of their pollen season, served as the control group. Specific immunotherapy improved clinical indices of disease activity including symptom scores and medication use during the pollen season of the treatment year. It had a marked effect in reducing the expression of the two activation markers, CD25 and HLA-DR, in both CD4+ (p=0.002 and p=0.005, respectively) and CD8+ (p=0.01 and p=0.01, respectively) T-cell subsets, in parallel with a significant decrease in CD23 expression on B-cells (p=0.008) and in grass-specific immunoglobulin E levels (p=0.01) in the peripheral blood of subjects with grass pollen-sensitive asthma. The decreased T-lymphocyte activation observed in immunotherapy-treated subjects after the treatment year was significant (p=0.05) in comparison with the control group. These data add to the view that the efficacy of specific immunotherapy may be attributed to the downregulation of T-cell responses.

Lymphocyte activation markers in peripheral blood before and after natural exposure to allergen in asthmatic patients.

Activated T cells and their cytokine products are involved in the pathogenesis of asthma. However, little is known about changes in circulating T cell subsets in allergic asthma during natural exposure to allergens. We examined whether natural allergen exposure of patients with atopic asthma is associated, in vivo, with changes of lymphocyte subtypes and activation markers in peripheral blood. Ten patients with atopic mild asthma sensitized only to grass pollen had peripheral venous blood lymphocyte analyses before and during the pollen season. No significant changes were observed. There was an inversion in the CD4/CD8 ratio in the peripheral blood both before (p < 0.05) and during (p < 0.01) seasonal exposure when compared to a group of healthy, age-matched control subjects. Evaluation of T cells expressing CD25 activation marker also demonstrated a significant reduction of CD4+25+ cells and a significant increase of CD+25+ cells compared to the controls. CD23+ cells (B lymphocytes with low affinity Fc IgE receptor) in the asthmatic group out of the pollen season correlated negatively with hyperreactivity to methacholine (p < 0.05). We conclude that in mild allergic asthmatic patients sensitized to grass pollen, blood lymphocyte subsets and their activation markers do not reflect seasonal exposure. Moreover, our findings show that these patients have higher proportions of CD8+ cells expressing higher levels of CD25 in their blood compared to normal subjects both before and during the pollen season.