The effect of the community midwifery model on maternal and newborn health service utilization and outcomes in Busia County of Kenya: a quasi-experimental study.

BACKGROUND: Poor women in hard-to-reach areas are least likely to receive healthcare and thus carry the burden of maternal and perinatal mortality from complications of childbirth. This study evaluated the effect of an enhanced community midwifery model on skilled attendance during pregnancy/childbirth as well as on maternal and perinatal outcomes against the backdrop of protracted healthcare workers' strikes in rural Kenya. METHODS: The study used a quasi-experimental (one-group pretest-posttest) design. The study spanned three time periods: December 2016-February 2017 when doctors were on strike (P1), March-May 2017 when no healthcare providers were on strike (P2), and June-October 2017 when nurses/midwives were on strike (P3), which was also the period when the project enhanced the capacity of community midwives (CMs) to provide services at the community level. Analysis entailed comparison of frequencies/means of maternal and newborn health service utilization data across the three periods. RESULTS: The monthly average number of clients obtaining services from CMs across the three time periods was: first antenatal care (ANC) (P1-1.8, P2-2.3, P3-9.9), fourth ANC (P1-1.4, P2-1.0, P3-7.1), skilled birth (P1-1.5, P2-1.7, P3-13.1) and the differences in means were statistically significant (p < 0.05). Over the period, the monthly average number of clients obtaining services from health facilities was: first ANC (P1-55.7, P2-70.8, P3-4.0), fourth ANC (P1-29.6, P2-38.1, P3-1.2) and skilled birth (P1-63.1, P2-87.4, P3-5.6), p < 0.05. There were no statistically significant differences in the average number of clients obtaining services from CMs or health facilities between P1 and P2 (p > 0.05). There was, however, a statistically significant increase in the average number of clients obtaining services from CMs in P3 accompanied by a statistically significant decline in the average number of clients obtaining services from health facilities (p < 0.05). First ANC increased by 68%, fourth ANC by 75%, skilled births by 68%, and postnatal care by 33% in P3 (p < 0.0001). There was a non-significant decline in macerated stillbirths and neonatal deaths in P3. CONCLUSIONS: The findings underscore the importance of integrating community-level health service providers (CMs and health volunteers) into the primary health care system to complement service delivery according to their level of expertise, especially in low-resource settings.

The Establishment of Wonsan Laborers' Hospital during the Japanese Occupation and Its Significance / 의사학

On July 3, 1928, the Wonsan Labor Union established the Wonsan Laborers' Hospital in Seoku-dong, Wonsan for the purpose of reducing medical consultation fees for its members. The union's efforts to improve the welfare of its members include the establishment of an educational institute, a consumers union, a barbershop, and a relief department. The Laborers' Hospital, which began with ten wards, was led by a team of two doctors, one midwife, two pharmacists, and four nurses. The two doctors were Cheol-sun Cha and Jeong-kwon Lee, and the midwife/nurse was Sun-jeong Kim. Union members received a 40% discount on medicine, and this was utilized by a daily average of 60 to 70 workers, or 21,000 workers annually. The Laborers' Hospital was clearly distinct from medical facilities founded as charity institutions in that funds were raised by the recipients themselves, and that the recipients formed a community based on their common status as laborers. However, the Wonsan Laborers' Hospital was shut down in roughly April 1929 due to the breaking of the general strike, and the heightened suppression of union activities prevented any additional opening of laborers' hospitals until Korea's liberation from Japan. Nevertheless, the history of the Wonsan Laborers' Hospital represents a key development in Korea's health coverage. It is not adequate to declare, as was the case in past research, Korea's health coverage to be simply an imitation of the Western system and lacking its own history. Despite some differences in scale and operation, the development of health coverage in the Korean peninsula is in line with the history of health coverage development in the West. The Wonsan Laborers' Hospital, founded and operated by the laborers themselves, thus holds great significance in the history of Korea's health coverage, The findings of this study are expected to stimulate new and more diverse discussions on the history of health coverage in Korea.

Louis XIV's Ginseng: Shaping of Knowledge on an Herbal Medicine in the Late 17th and the Early 18th Century France / 의사학

This article aims to investigate the shaping of knowledge and discourse on ginseng, especially among physicians and botanists, since its introduction to France from the 17th century until the early 18th century. In France, knowledge on herbal medicine, including that of ginseng, was shaped under the influence of the modern state's policy and institution: mercantilism and the Académie royale des sciences. The knowledge of herbal medicine developed as an important part of the mercantilist policy supported systematically by the Académie. The East Asian ginseng, renowned as a panacea, was first introduced into France in the 17th century, initially in a roundabout way through transportation and English and Dutch publications of travel tales from various foreign countries. The publication activity was mainly conducted by Thévenot company with the intention to meet the needs of French mercantilism promoted by Colbert. It also implied interests on medicine in order to bolster the people's health. The Thévenot company's activity thus offered vital information on plants and herbs abroad, one of which was ginseng. Furthermore, with Louis XIV's dispatching of the Jesuit missionaries to East Asia, the Frenchmen were able to directly gather information on ginseng. These information became a basis for research of the Académie. In the Académie, founded in 1666 by Colbert, the king's physicians and botanists systematically and collectively studied on exotic plants and medical herbs including ginseng. They were also key figures of the Jardin du Roi. These institutions bore a striking contrast to the faculty of medicine at the University of Paris which has been a center of the traditional Galenic medicine. The research of the Académie on ginseng was greatly advanced, owing much to the reports and samples sent from China and Canada by Jartoux, Sarrazin, and Lapitau. From the early 18th century, the conservative attitude of the University of Paris, which was a stronghold of conservative Galenic Medicine, began to change with its new interest on foreign medicine herbs, including Chinese medicine. In our opinion, this change is exemplified in a paper, that is to say in a thése de licence or thése quolibétique in French, submitted to the Faculty of Medicine in 1736 by Folliot de Saint-Vast under the direction of Jacques-François Vendermonde. During this period, the knowledge of Chinese Materia Medica was introduced, despite of textual adaptation and interpolation, through the "translation" of Chinese medicale books such as Bencao Gangmu. The Chinese medical books were presented to the French academic public by doctors and Jesuit missionaries active in China. The assessment of the ginseng was generally favorable yet, although physicians and doctors began to take more caution on considering it as a panacea.

Second pay strike set to be bigger as further action adds to pressure.

Thousands of nurses and midwives in England are preparing to strike for the second time in six weeks in protest at the government's refusal to give all NHS staff a 1 per cent cost of living pay rise.

Hunt's 'sincere' words only strike a false note.

The first strike by NHS staff over pay in more than 30 years - and the first by members of the Royal College of Midwives in its history - will hopefully force ministers to rethink their decision to freeze pay rates for 1.3 million health service staff. Those taking part in Monday's four-hour stoppage and this week's 'work-to-rule' deserve great credit for making a sacrifice so that everyone in the NHS may benefit.

Striking nurses and midwives stand united against Hunt's pay freeze.

Thousands of nurses and midwives in England and Northern Ireland went on strike in protest at the government's decision to deny 70 per cent of NHS nurses a 1 per cent cost of living pay rise.

Should doctors strike?

Last year in June, British doctors went on strike for the first time since 1975. Amidst a global economic downturn and with many health systems struggling with reduced finances, around the world the issue of public health workers going on strike is a very real one. Almost all doctors will agree that we should always follow the law, but often the law is unclear or does not cover a particular case. Here we must appeal to ethical discussion. The General Medical Council, in its key guidance document for practising doctors, Good Medical Practice, claims that 'Good doctors make the care of their patients their first concern'. Is this true? And if so, how is this relevant to the issue of striking? One year on since the events, we carefully reflect and argue whether it was right for doctors to pursue strike action, and call for greater discussion of ethical issues such as the recent strikes, particularly among younger members of the profession.

Brazilian physicians hold national strike against medical insurance companies.

The Brazilian Health System has two different forms of access, public and private. The purpose of the public health system is to provide universal, complete access, free of charge, for the entire population. The private sector is composed by people who have private insurance. Nowadays, about 43 million Brazilians, or 26.3% of the population, have private health insurance. The main motivations of the physicians for the strike were the low payment for medical services and the constant interference of the private health insurance companies in medical autonomy. For this reason, Brazilian physicians held a 24-hour strike against the Medical Insurance Companies that did not accept to negotiate new fees in almost all Brazilian states. At least 120,000 physicians from all specialties stopped elective activities during that day, only providing urgent or emergency care. It is estimated that the strike affected 25 to 35 million Brazilians, about 76% of the total number of medical insurance users.

Effects of isoflavone supplementation on the bone mineral density of growing female rats

This study was focused on whether or not isoflavones affect the increase in bone mineral density of growing females. Female Sprague-Dawley rats (60 +/- 5 g) were randomly assigned to two groups and provided control diets (control group) or isoflavone-supplemented diet (IF group, 57.8 mg isoflavones/100 g diet) for 9 weeks in growing female rats. Measurements of Bone Mineral Density (BMD) and Bone Mineral Content (BMC) on the experimental animals were executed in the 3rd, 6th, 9th weeks. In result, there was no significant difference in spine BMD between the isoflavones supplemented group and the control group. But, the IF group tended to have higher BMD than the control group in between 3 and 9 experimental weeks, and the striking difference could be shown in the 6th week of feeding. In case of femur BMD, the effects of added isoflavones appeared in the 6th week of feeding, and it became intensified in the 9th week of feeding to the extent that the BMD in the IF group was significantly higher than that of the control group (p<0.05). In conclusion, isoflavone supplementation increased spine BMD per weight in the 6th week of feeding, and affected the increase of femur BMD in the 9th week. The result of the experiment implies that it affects positively the formation of spine and femur BMD of growing female rats. The study also suggests that the effects of isoflavone on the pattern of BMD formation might differ from the parts of bones.