An analysis of the quality of maternity services in Nampula, Mozambique: implementation research.

Introduction: the quality of maternity services is an essential factor in reducing maternal and newborn morbidity and mortality, which remains extremely high in Africa. In Mozambique, maternal mortality rate is 451.6 deaths per 100,000 live births (2017). The reasons for this are complex, but one important factor to reduce this burden is to provide effective and efficient care, to improve institutional deliveries. To reduce maternal and newborn mortality rates in Nampula, researchers from Lúrio University and the University of Saskatchewan, carried out an implementation research program, including various interventions such as training activities for health professionals in maternal and child health care. We planned a mid-project evaluation, to assess the trainings´ impact on the quality of services at Marrere Hospital Maternity. Methods: quantitative pre-post study, carrying out two cross-sectional surveys about maternity service quality, one being conducted after five health professionals´ trainings and the other after six more trainings. The two surveys included samples of post-partum women in the maternity, calculated with a 10% margin error and 90% confidence interval for the first survey, and with a 7% margin error and 95% confidence interval for the second. The surveys were entered into REDCap and analysed to assess frequencies, percentages, mean and standard deviations. This research was approved by the Institutional Committees of Bioethics at Lúrio University and at the University of Saskatchewan. Results: one hundred and sixteen post-partum women were surveyed at the maternity, assessing standards of patient centred care during delivery labour. Most areas showed no improvement. Some positive improvements were delivering women were given the option to have a person of their choice accompany them during labour (75%), notably a traditional birth attendant (34%), and they had continuous support from a health professional (68%). But many shortcomings persisted in areas of privacy (33%) and confidentiality (57%). Conclusion: the quality of patient centred care at Marrere Hospital Maternity did not improve much with health professionals´ trainings. Decreasing the large turnover rate of such staff, reviewing their learning styles, and promoting continuous professional capacity building would be the next steps to improve quality of care.

Covid-19 pandemic impact on maternal and child health services access in Nampula, Mozambique: a mixed methods research.

BACKGROUND: The Covid-19 pandemic has so far infected more than 30 million people in the world, having major impact on global health with collateral damage. In Mozambique, a public state of emergency was declared at the end of March 2020. This has limited people's movements and reduced public services, leading to a decrease in the number of people accessing health care facilities. An implementation research project, The Alert Community for a Prepared Hospital, has been promoting access to maternal and child health care, in Natikiri, Nampula, for the last four years. Nampula has the second highest incidence of Covid-19. The purpose of this study is to assess the impact of Covid-19 pandemic Government restrictions on access to maternal and child healthcare services. We compared health centres in Nampula city with healthcare centres in our research catchment area. We wanted to see if our previous research interventions have led to a more resilient response from the community. METHODS: Mixed-methods research, descriptive, cross-sectional, retrospective, using a review of patient visit documentation. We compared maternal and child health care unit statistical indicators from March-May 2019 to the same time-period in 2020. We tested for significant changes in access to maternal and child health services, using KrushKall Wallis, One-way Anova and mean and standard deviation tests. We compared interviews with health professionals, traditional birth attendants and patients in the two areas. We gathered data from a comparable city health centre and the main city referral hospital. The Marrere health centre and Marrere General Hospital were the two Alert Community for a Prepared Hospital intervention sites. RESULTS: Comparing 2019 quantitative maternal health services access indicators with those from 2020, showed decreases in most important indicators: family planning visits and elective C-sections dropped 28%; first antenatal visit occurring in the first trimester dropped 26%; hospital deliveries dropped a statistically significant 4% (p = 0.046), while home deliveries rose 74%; children vaccinated down 20%. CONCLUSION: Our results demonstrated the negative collateral effects of Covid-19 pandemic Government restrictions, on access to maternal and child healthcare services, and highlighted the need to improve the health information system in Mozambique.

Influence of smartphone use on the median frequency of mastigatory and trapezius muscles in women - a Pilot study.

INTRODUCTION: The use of smartphones is growing every year, and their excessive use can cause adverse physical and mental effects. AIM: This study aimed to evaluate the influence of smartphone use on the median frequency of the masticatory muscles and upper trapezius muscles in healthy women. METHOD: Six healthy young women were evaluated. All the volunteers underwent a submaximal bite test to evaluate their masticatory muscles. In addition, the volunteers underwent a test for bilateral shoulder elevation to a submaximal load to evaluate their upper trapezius muscles. Both protocols were performed before and after a task using the smartphone for 30 min. Median frequency (MF) values were collected during the submaximal bite and submaximal shoulder elevation tests. RESULTS: Data were analyzed using specific statistical tests. A statistically significant reduction in the MF for all the masticatory muscles was observed in the bilateral bite task when comparing pre and post smartphone use (p < 0.005). A significant reduction in the MF was also found for the right upper trapezius when comparing pre and post smartphone use in the shoulder elevation task (p = 0.001). CONCLUSION: It appears that prolonged smartphone use may contribute to fatigue in the masticatory and upper trapezius muscles. Therefore, guidelines for smartphone users should include advice on the moderate use of this device.

Fatty Acid Profile of Pacific Oyster, Crassostrea gigas, Fed Different Ratios of Dietary Seaweed and Microalgae during Broodstock Conditioning.

The fatty acid (FA) profile of oysters generally reflects the dietary FA composition. Moreover, incorporation of FA into tissues is modulated by various metabolic factors, and final composition will depend upon the dietary sources, cumulative intake, and oysters' development stage. Thus, the aim of this study was to assess the impact of dietary incorporation of seaweed (SW) Ulva rigida, in replacement of traditional microalgae diet, on the FA composition of Pacific oysters Crassostrea gigas, during broodstock conditioning. The dietary conditioning consisted of direct replacement of microalgae (33% Tisochrysis lutea, 50.25% Skeletonema costatum, and 16.75% Chaetoceros calcitrans) by SW at four different substitution levels (0%, 25%, 50%, and 100% diet). The dietary docosahexaenoic acid (DHA) (22:6n-3) and eicosapentaenoic acid (EPA) (20:5n-3) contents showed a positive correlation with the dietary microalgae level. During the trial, oysters fed with higher percentages of microalgae revealed a depletion of DHA and accumulation of EPA. The 100% SW caused a significant reduction in oxygen consumption and, consequently, in the standard metabolic rate. Based on these results, a partial substitution of up to 25% of dietary microalgae seems to be a suitable alternative, because it elicited similar results to the commercial 100% microalgae diet.

Contributions des tradipraticiens de santé au traitement antirétroviral : Étude de cas à Nampula, Mozambique.

Contexte: L'épidémie du virus de l'immunodéficience humaine au Mozambique est un problème grave de santé publique et le Ministère de la Santé a étendu le traitement antirétroviral à tous les districts du pays. Cependant, on constate un nombre élevé d'abandon du traitement encore insuffisamment évalué. L'Organisation Mondiale de la Santé recommande que les tradipraticiens de santé collaborent avec les systèmes nationaux de santé dans les pays en développement, pour combattre cette épidémie, mais il existe peu d'actions dans ce domaine à ce jour.Objectif: Évaluer la connaissance des tradipraticiens sur l'infection et leur disponibilité à coopérer avec les services de santé dans la Province de Nampula au Mozambique, pour améliorer les résultats du traitement antirétroviral.Lieux: Cinq centres de santé des districts de la Province de Nampula, au Nord du Mozambique, avec des taux élevés d'incidence du virus d'immunodéficience humaine et d'abandon du traitement.Méthodes: Une étude mixte transversale, utilisant des interviews ciblés et des discussions de groupes focaux. Les données quantitatives étaient traitées par fréquence et les données qualitatives par analyse de discours et ethnographie locale.Résultats: Nous avons interviewé 79 tradipraticiens de santé. La perte de poids était souvent considérée comme le signal principal de suspicion d'infection par le virus d'immunodéficience humaine et certains tradipraticiens ne pas les signes de la maladie ; la majorité pensait que les antirétroviraux améliorent la qualité de vie des patients, ne prétendait pas traiter l'infection, savait qu'elle n'est pas curable, avait une idée sur le concept de bonne adhésion au traitement et référait les cas compliqués au centre de santé. En ce qui concerne l'alimentation, la moitié considérait exclusivement les céréales comme l'aliment principal ; les fruits étaient importants pour un quart ; l'eau potable est ignorée. La majorité était prête à collaborer avec le système de santé et avait des propositions de coopération pratique : la qualification et la reconnaissance individuelle et la formation intégrée avec les professionnels de santé.Conclusion: Les tradipraticiens connaissaient l'infection par le virus d'immunodéficience humaine et les facteurs associés, mais il y a des lacunes. Ils ont signalé qu'ils utilisaient principalement les plantes médicinales, ce qui peut contribuer au traitement des infections opportunistes et la majorité référait déjà des patients au centre de santé ; mais la collaboration nécessite une procédure éducative et une articulation structurée. Les lacunes de connaissance empêchent une coopération efficace dans le combat contre l'épidémie. Le groupe est disponible pour coopérer avec le système de santé pour améliorer les résultats du traitement antirétroviral, mais pour ça il est nécessaire d'informer et former les tradipraticiens dans un processus intégré de collaboration avec les professionnels de santé conventionnels.

Evaluation of integral electromyographic values and median power frequency values in women with myogenous temporomandibular disorder and asymptomatic controls.

BACKGROUND: Surface electromyography (EMG) has been used as a reliable tool for the evaluation of electrical muscle activity. OBJECTIVE: The purpose of this study was to evaluate the EMG indices of the masticatory muscles (masseter, anterior temporalis and suprahyoid) in women with temporomandibular disorder (TMD) and asymptomatic controls in the time domain, by the integrated EMG signal (IEMG) and in the frequency domain, using the median power frequency (MPF). METHODS: An observational, cross-sectional study was conducted involving 30 asymptomatic women as the control (mean age: 25.85 ± 2.57 years) and 74 women with myogenous TMD (mean age: 26.54 ± 2.45 years) diagnosed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Three EMG readings were taken during maximum voluntary clenching (MVC) of the molars on parafilm for five seconds with a three-minute rest interval between readings. The mixed-model analysis of variance test followed by the Bonferroni correction or the Student-t test was used for the analyses, with the level of significance set to 5% (p < 0.05). RESULTS: IEMG values were significantly higher in the masseter muscles than the anterior temporalis muscles in the control group (p < 0.01). IEMG values were significantly higher in the masseter muscles of the control group than the group with myogenous TMD (p < 0.05). MPF values of the suprahyoid muscles were significantly higher in the myogenous TMD group than the control group. CONCLUSIONS: These significant findings show that women with myogenous TMD have reduction of electrical activity of their masseter muscles and increased firing rate of the motor units of the suprahyoid muscles. These findings may help the treatment of myogenous TMD in women.

Efeito da mobilização das raízes nervosas lombares sobre a força e flexibilidade dos músculos do membro inferior / Effect of the mobilization in lumbar nerve roots on muscle strength and flexibility of the lower limb

Introdução: A mobilização neural é bastante aplicada na pratica clínica. Objetivo: Avaliar o efeito da mobilização neural das raízes lombares na força e flexibilidade dos músculos flexores e extensores do joelho. Métodos: Foram selecionados 14 homens (22,4±2,87 anos) saudáveis. A flexibilidade foi avaliada para flexão de joelho (FJD e FJE), extensão de quadril (EQD e EQE) e coluna lombar (FL). A força muscular foi avaliada para flexão e extensão do joelho. As avaliações foram realizadas antes da técnica (PRÉ), imediatamente após (PÓS1) e uma semana após (PÓS2). Resultados: Nas avaliações PÓS1 e PÓS2 foi observado aumento significativo da força muscular na FJE. Para a flexibilidade, na avaliação PÓS1, observou-se aumento significativo na FJE, EQD e EQE. Conclusão: A técnica de mobilização neural promoveu aumento da força dos músculos flexores de joelho esquerdo e da flexibilidade no movimento de flexão de joelho esquerdo, extensão de quadril direito e esquerdo em homens sedentários saudáveis.

Introduction: Neural mobilization is widely applied in clinical practice. Aim: To evaluate the effect of neural mobilization of the lumbar roots on the strength and flexibility of the knee and hip muscles. Methods: We selected 14 men (22.4 ± 2.87 years) healthy. Flexibility was evaluated during knee flexion movements (KFR and KFL), extension of the hip (HER and HEL) and for the lumbar spine (LS). Assessment of muscle strength was performed for the knee movements. The evaluations were performed before the neural mobilization (PRE), immediately after (POST1) and one week after (POST2). Results: In the POST1 and POST2 was a significant increase in muscle strength in KFL. For flexibility, the POST1 evaluation, it was observed significant increase in KFL, HER, and HEL. In the evaluation POST2, a significant increase flexibility in LS and reduction in KFL. Conclusion: The neural mobilization promoted increased strength of the flexor muscles of the left knee, increased flexibility in the KFL, HER, HEL and LS.

Immediate and Short-Term Effects of Upper Thoracic Manipulation on Myoelectric Activity of Sternocleidomastoid Muscles in Young Women With Chronic Neck Pain: A Randomized Blind Clinical Trial.

OBJECTIVE: The aim of this study was to assess the immediate and short-term effects of upper thoracic spine manipulation on pain intensity and myoelectric activity of the sternocleidomastoid muscles in young women with chronic neck pain. METHODS: A randomized clinical trial was carried out involving 32 women with chronic neck pain (mean age, 24.8 ± 5.4 years) allocated to an experimental group and a placebo group. Three evaluations were carried out: baseline, immediate postintervention, and short-term postintervention (48-72 hours after intervention). Myoelectric activity of the right and left sternocleidomastoid muscles was assessed at rest and during isometric contractions for cervical flexion and elevation of the shoulder girdle. Neck pain intensity was assessed at rest using a visual analog scale. Comparisons of the data were performed using 2-way repeated-measures analysis of variance with the Bonferroni correction. The level of significance was set at P < .05. RESULTS: A moderate treatment effect on myoelectric activity of the right and left sternocleidomastoid muscles during isometric elevation of the shoulder girdle was found in the experimental group only on the short-term postintervention evaluation (d > 0.40). No statistically significant differences were found for any of the variables analyzed in the intergroup comparisons at the different evaluation times (P > .05). CONCLUSION: No statistically significant differences were found in the intragroup or intergroup analyses of the experimental and placebo groups regarding myoelectric activity of the cervical muscles or the intensity of neck pain at rest in the immediate or short-term postintervention evaluations.

Effect of upper thoracic manipulation on mouth opening and electromyographic activity of masticatory muscles in women with temporomandibular disorder: a randomized clinical trial.

OBJECTIVE: The purpose of this study was to assess the effect of upper thoracic manipulation on vertical mouth opening (VMO) and electromyographic activity of the masticatory muscles in women with temporomandibular disorder (TMD). METHODS: A randomized, controlled, blinded study involving 32 women (mean age of 24.78 ± 5.41 years) diagnosed with TMD was performed. Subjects were randomly allocated to an experimental group (n = 16) or a sham manipulation (placebo) group (n = 16). A single session of manipulation was administered to the T1 vertebral area. Electromyography was used to determine activity of masticatory muscles with the mandible at rest and during isometric contraction. Vertical mouth opening was measured using a ruler. Measurements were made before manipulation, immediately after manipulation, and at the short-term follow-up (2 to 4 days after manipulation). RESULTS: No significant differences were found in any of the comparisons of mandibular VMO or electromyographic activity of the masticatory muscles at rest or during isometric contraction of mandibular elevator muscles (P > .05). Regarding isometric contraction of the mandibular depressors, an immediate increase in muscle activity was found in the suprahyoid (P = .014) and left masseter (P = .005) muscles. CONCLUSION: In the present study, no significant differences were found regarding VMO between the experimental and placebo groups or among the different evaluations times in each group. Moreover, Cohen d test revealed no clinical effect of the technique. Therefore, based upon the findings of this study, manipulation administered to the T1 vertebral area appears to have no effect on VMO and electromyographic activity of the masticatory muscles in women with TMD.

High prevalence of multidrug-resistant Escherichia coli and Enterococcus spp. in river water, upstream and downstream of a wastewater treatment plant.

In this study, microbial quality and antimicrobial resistance of faecal bacteria from a Portuguese river were assessed. River water samples collected upstream and downstream of a wastewater treatment plant, throughout a 3-month period, were used for the enumeration of Escherichia coli and Enterococcus spp. The highest numbers found for E. coli and enterococci were 1.1 × 104 and 1.2 × 104 colony forming units (CFU)/100 ml, respectively. In total, 144 isolates of E. coli and 144 of enterococci were recovered and tested for antimicrobial susceptibility; 104 E. coli and 78 Enterococcus spp. showed resistance to one or more antimicrobial drugs. Overall, 70 and 32 different resistance patterns were found for E. coli and enterococci, respectively. One E. coli showed resistance to imipenem and 29 isolates were extended spectrum ß-lactamase-producers. Multidrug-resistant E. coli belonged mostly to groups A, B1 and group D. Enterococcus spp. were mostly resistant to rifampicin, tetracycline, azithromycin and erythromycin; six isolates showed resistance to vancomycin, presenting the VanA phenotype. The high levels of E. coli and enterococci and the remarkable variety of antimicrobial resistance profiles, reinforces the theory that these river waters can be a pool of antimicrobial resistance determinants, which can be easily spread among different bacteria and reach other environments and hosts.

HIV/AIDS-related attitudes and practices among traditional healers in Zambézia Province, Mozambique.

OBJECTIVES: To document HIV knowledge, treatment practices, and the willingness of traditional healers to engage with the health system in Zambézia Province, Mozambique. SETTINGS/LOCATION: Traditional healers offer culturally acceptable services and are more numerous in Mozambique than are allopathic providers. Late presentation of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) is reported among persons who have first sought care from traditional healers. DESIGN: One hundred and thirty-nine (139) traditional healers were interviewed in their native languages (Chuabo or Lomwe) in Zambézia Province. Furthermore, 24 traditional healers were observed during patient encounters. Healers answered a semistructured questionnaire regarding their knowledge of HIV/AIDS, general treatment practices, attitudes toward the allopathic health system, and their beliefs in their abilities to cure AIDS. RESULTS: Traditional healers were older and had less formal education than the general population. Razor cutting in order to rub herbs into blooded skin was observed, and healers reported razor cutting as a routine practice. Healers stated that they did not refer HIV patients to clinics for two principal reasons: (1) patient symptoms/signs of HIV were unrecognized, and (2) practitioners believed they could treat the illness effectively themselves. Traditional healers were far more likely to believe in a spiritual than an infectious origin of HIV disease. Prior HIV/AIDS training was not associated with better knowledge or referral practices, though 81% of healers were interested in engaging allopathic providers. CONCLUSIONS: It was found that the HIV-related practices of traditional healers probably increase risk for both HIV-infected and uninfected persons through delayed care and reuse of razors. Mozambican traditional healers attribute HIV pathogenesis to spiritual, not infectious, etiologies. Healers who had received prior HIV training were no more knowledgeable, nor did they have better practices. The willingness expressed by 4 in 5 healers to engage local formal health providers in HIV/AIDS care suggests a productive way forward, though educational efforts must be effective and income concerns considered.

Nutritional quality of the edible tissues of European lobster Homarus gammarus and American lobster Homarus americanus.

The clawed lobsters Homarus gammarus and Homarus americanus are high-priced and appreciated food items in southern Europe. From a nutritional point of view there is still limited information on the chemical composition of edible tissues (muscle, hepatopancreas, and gonads) of both species. Therefore, the aims of the present work were to study the proximate chemical composition, energy, fatty acid and amino acid profiles, and cholesterol content in each edible tissue of both species and to evaluate their nutritional quality. Differences were observed between tissues, sexes, and species. Muscle and gonads were rich in protein, whereas hepatopancreas had high fat, cholesterol, and energy contents. All edible tissues were valuable sources of essential amino acids. Contrary to the common belief that shellfish consumption should be reduced in a low-fat and -cholesterol diet, all edible tissues of clawed lobsters have a nutritious value perfectly compatible with nutritious and healthy diets.

Effects of antimicrobial treatment on selection of resistant Escherichia coli in broiler fecal flora.

Under field conditions, three commercial antimicrobials were sequentially prescribed to 16,000 broiler chickens during their rearing period, via drinking water using subtherapeutic levels for 3 days. A control group of 16,000 broilers was placed in the same controlled environment poultry house. Feed diet and fecal samples from both groups were collected periodically. One sample of the drinking water along with samples from the broiler house environment was also collected 1 day before bird placement. Samples were plated onto Tergitol BCIG Agar media; a maximum of 26 Escherichia coli were isolated per sample, and their susceptibility was tested to 12 antimicrobials by disk diffusion agar method. We have observed that day-old chicks were rapidly colonized by new antibiotic-resistant patterns shortly after treatment with lincomycin associated with spectinomycin. After medication with the second (sulfadiazine with trimethoprim) and third (tylosin) antimicrobials, a more radical displacement was observed, and, concurrently, antimicrobial resistance phenotypes have become more complex. In contrast, more than 70% of the strains isolated in control group during the experiment displayed exactly the same resistance pattern found in the day-old chicks. This study provides clear evidence that a sequential medication of a broiler flock, with different antimicrobial classes during short periods of time for prophylactic objectives, was accompanied by a dramatic increase in both antimicrobial resistance rates and phenotype diversity of E. coli strains.

Antimicrobial resistance in Enterococcus spp. isolated in inflow, effluent and sludge from municipal sewage water treatment plants.

Antimicrobial resistance of enterococci was investigated in 42 samples of crude inflow, treated effluent and sludge collected in 14 municipal sewage treatment plants of Portugal. A total of 983 enterococci were recovered and tested, using the diffusion agar method, regarding their sensitivity to 10 different antimicrobial drugs. Multidrug resistance was present in 49.4% of the isolates. Only 3.3% and 0.6% of the investigated strains were resistant to ampicillin and vancomycin, respectively. Resistances found against rifampicin (51.5%), tetracycline (34.6%), erythromycin (24.8%) and nitrofurantoin (22.5%), are causes for substantial concern. Almost 14% of isolates were resistant to ciprofloxacin. Wastewater treatment resulted in enterococci decrease between 0.5 and 4log; nevertheless, more than 4.4 x 10(5)CFU/100ml were present in the outflow of the plants. Our data indicate that the use of antimicrobials had created a large pool of resistance genes and that sewage treatment processes are unable to avoid the dissemination of resistant enterococci into the environment.