Development of integration indexes to determine the extent of family planning and child immunization services integration in health facilities in urban areas of Nigeria.

BACKGROUND: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. METHODS: This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). RESULTS: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. CONCLUSION: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

Gabapentin dose and the 30-day risk of altered mental status in older adults: A retrospective population-based study.

Gabapentin is an effective treatment for chronic neuropathic pain but may cause dizziness, drowsiness, and confusion in some older adults. The goal of this study was to assess the association between gabapentin dosing and adverse outcomes by obtaining estimates of the 30-day risk of hospitalization with altered mental status and mortality in older adults (mean age 76 years) in Ontario, Canada initiated on high dose (>600 mg/day; n = 34,159) compared to low dose (≤600 mg/day; n = 76,025) oral gabapentin in routine outpatient care. A population-based, retrospective cohort study assessing new gabapentin use between 2002 to 2014 was conducted. The primary outcome was 30-day hospitalization with an urgent head computed tomography (CT) scan in the absence of evidence of stroke (a proxy for altered mental status). The secondary outcome was 30-day all-cause mortality. The baseline characteristics measured in the two dose groups were similar. Initiation of a high versus low dose of gabapentin was associated with a higher risk of hospitalization with head CT scan (1.27% vs. 1.06%, absolute risk difference 0.21%, adjusted relative risk 1.29 [95% CI 1.14 to 1.46], number needed to treat 477) but not a statistically significant higher risk of mortality (1.25% vs. 1.16%, absolute risk difference of 0.09%, adjusted relative risk of 1.01 [95% CI 0.89 to 1.14]). Overall, the risk of being hospitalized with altered mental status after initiating gabapentin remains low, but may be reduced through the judicious use of gabapentin, use of the lowest dose to control pain, and vigilance for early signs of altered mental status.

Quantitative Analysis of Dammarane-type Ginsenosides in Different Ginseng Products

Ginseng products available in different forms and preparations are reported to have varied bioactivities and chemical compositions. In our previous study, four new dammarane-type ginsenosides were isolated from Panax ginseng, which are ginsenoside Rg18 (1), 6-acetyl ginsenoside Rg3 (2), ginsenoside Rs11 (3), and ginsenoside Re7 (4). Accordingly, the goal of this study was to determine the distribution and content of these newly characterized ginsenosides in different ginseng products. The content of compounds 1 – 4 in different ginseng products was determined via HPLC-UV. The samples included ginseng roots from different ginseng species, roots harvested from different localities in Korea, and samples harvested at different cultivation ages and processed under different manufacturing methods. The four ginsenosides were present at varying concentrations in the different ginseng samples examined. The variations in their content could be attributed to species variation, and differences in cultivation conditions and manufacturing methods. The total concentration of compounds 1 – 4 were highest in ginseng obtained from Geumsan (185 µg/g), white-6 yr ginseng (150 µg/g), and P. quinquefolius (186 µg/g). The results of this study provide a basis for the optimization of cultivation conditions and manufacturing methods to maximize the yield of the four new ginsenosides in ginseng.

Green synthesis of gold nanoparticles reduced and stabilized by sodium glutamate and sodium dodecyl sulfate.

The Turkevich method has been used for many years in the synthesis of gold nanoparticles. Lately, the use of plant extracts and amino acids has been reported, which is valuable in the field of biotechnology and biomedicine. The AuNPs was synthesized from the reduction of HAuCl4 3H2O by sodium glutamate and stabilized with sodium dodecyl sulfate. The optimum concentrations for sodium glutamate and sodium dodecyl sulfate in the synthesis process were determined. The characteristics of the synthesized AuNPs was analysed through UV-Vis Spectroscopy and SEM. The AuNPs have spherical shape with a mean diameter of approximately 21.62 ± 4.39 nm and is well dispersed. FTIR analysis of the AuNPs reflected that the sulfate head group of sodium dodecyl sulfate is adsorbed at the surface of the AuNPs. Thus, we report herein the synthesis of AuNPs using sodium glutamate and sodium dodecyl sulfate.

Effect of village midwife program on contraceptive prevalence and method choice in Indonesia.

Indonesia established its Village Midwife Program in 1989 to combat high rates of maternal mortality. The program's goals were to address gaps in access to reproductive health care for rural women, increase access to and use of family planning services, and broaden the mix of available contraceptive methods. In this study, we use longitudinal data from the Indonesia Family Life Survey to examine the program's effect on contraceptive practice. We find that the program did not affect overall contraceptive prevalence but did affect method choice. Over time, for women using contraceptives, midwives were associated with increased odds of injectable contraceptive use and decreased odds of oral contraceptive and implant use. Although the Indonesian government had hoped that the Village Midwife Program would channel women into using longer-lasting methods, the women's "switching behavior" indicates that the program succeeded in providing additional outlets for and promoting the use of injectable contraceptives.

A synoptic climatology of pollen concentrations during the six warmest months in Sydney, Australia.

This paper takes an air mass approach to investigating the influence of weather on pollen concentrations in the atmosphere in Sydney, Australia, by producing a synoptic classification of pollen concentrations measured in the Sydney Basin. This synoptic classification has been produced using multivariate statistical techniques including principal component analysis and cluster analysis, to assign days into meteorologically homogenous categories. Surface and upper air meteorological data for warm months (October-March) over a 10-year period were used as input into the statistical analyses. Eleven synoptic categories were found in Sydney during the warm months. Pollen concentrations for the total pollen load and five individual families measured over a 3.5-year period have been investigated for each of the synoptic categories. High pollen concentrations during the warm months in Sydney are found to be influenced by the presence of a region of low surface pressure located to the south of the continent, bringing fast dry westerly gradient winds to Sydney. It is envisaged that these results will be important from a pollen forecast and associated public health perspective.

Antidepressant treatment and rodent aggressive behaviour.

This review examines two 'ethologically relevant' rodent models, the resident-intruder and social hierarchy paradigms, that are sensitive to chronic antidepressant treatment (including repeated electroconvulsive shock). These models of rodent social and agonistic behaviour demonstrate that acute and chronic treatment with antidepressant drugs (regardless of their acute pharmacological activity) induce diametrically opposite changes in rodent aggressive behaviour. The common ability of chronic antidepressant treatment to increase rodent aggression (which in turn results in increased hierarchical status in closed social groups) most likely reflects the increased assertiveness and associated externalization of emotions (indicative of increased extrapunitive aggression) expressed during recovery from depressive illness. Finally, findings that relate observed behavioural changes to underlying neurochemical changes are briefly reviewed in terms of adaptive mechanisms in the rodent central nervous system induced by antidepressants, and also with respect to suicide ideation and panicogenic responses observed in some patients at the onset of treatment with selective serotonin reuptake inhibitors for affective disorders.

Is the global rise of asthma an early impact of anthropogenic climate change?

The increase in asthma incidence, prevalence, and morbidity over recent decades presents a significant challenge to public health. Pollen is an important trigger of some types of asthma, and both pollen quantity and season depend on climatic and meteorologic variables. Over the same period as the global rise in asthma, there have been considerable increases in atmospheric carbon dioxide concentration and global average surface temperature. We hypothesize anthropogenic climate change as a plausible contributor to the rise in asthma. Greater concentrations of carbon dioxide and higher temperatures may increase pollen quantity and induce longer pollen seasons. Pollen allergenicity can also increase as a result of these changes in climate. Exposure in early life to a more allergenic environment may also provoke the development of other atopic conditions, such as eczema and allergic rhinitis. Although the etiology of asthma is complex, the recent global rise in asthma could be an early health effect of anthropogenic climate change.

The effect of independent practice of motor tasks by stroke patients: a pilot randomized controlled trial.

OBJECTIVE: To investigate the effect of independent practice of sitting balance as an addition to standard physiotherapy treatment for patients with stroke. DESIGN: Randomized controlled trial, using blocked randomization procedure with 2:1 ratio. SUBJECTS: Inpatients with diagnosis of stroke, having achieved one minute of independent sitting balance but not yet achieved 10 independent steps, and with no known previous disabilities, pathology or neurological deficit affecting mobility prior to stroke. INTERVENTION: A four-week regime of independent practice aimed at improving aspects of balance, as an addition to standard physiotherapy treatment based on the Bobath Approach. MAIN OUTCOME MEASURE: Proportion of patients achieving 'normal' symmetry of weight distribution during sitting, standing, rising to stand, sitting down, and reaching. RESULTS: Nineteen subjects were randomized to the control group; nine to the intervention group. There were no clinically significant differences in measured outcome between the groups. CONCLUSIONS: The regime of independent practice had no measured beneficial effect on the balance ability of patients with recently acquired stroke.