Antenatal care and skilled delivery service utilisation in Somali pastoral communities of Eastern Ethiopia.

OBJECTIVE: To assess maternal health care service utilisation and associated factors in Somali pastoral communities of eastern Ethiopia. METHODS: Community-based cross-sectional study complemented by qualitative assessments in Adadle district, Somali region, eastern Ethiopia, among 450 women in six kebeles from August to September 2016. Logistic regression was used to assess factors associated with antenatal care use and skilled delivery care use, controlling for confounders. RESULTS: About 27% [95%CI 22.8-31.2%] of women used antenatal care, and 22.6% [95%CI 18.7-26.5%] received skilled delivery service. None of the respondents reported post-natal care. About 43% reported that they had no knowledge of antenatal care, and 46% did not perceive delivery at a health facility as important. Pastoral lifestyle, husband's educational status, women's attitude towards health care service and financial support from the husband were significantly associated with antenatal care utilisation. Health professionals' attitudes, perceptions of institutional delivery, antenatal care utilisation and information about exemptions from maternal health care fees were associated with skilled delivery service utilisation. CONCLUSION: Improving community awareness of antenatal care, employing female health professionals and culturally adapted guidelines could improve skilled delivery utilisation. In a patriarchal society, involving male partners in all maternal health issues is essential to increase use of maternal health services and to decrease maternal mortality.

OBJECTIF: Evaluer l'utilisation des services de soins de santé maternelle et les facteurs associés dans les communautés pastorales somaliennes dans l'est de l'Ethiopie. MÉTHODES: Etude transversale basée sur la communauté complétée par des évaluations qualitatives dans le district d'Adadle, région somalienne, dans l'est de l'Ethiopie, portant sur 450 femmes dans six kebeles d'août à septembre 2016. Une régression logistique a été utilisée pour évaluer les facteurs associés à l'utilisation des soins prénatals et à l'accouchement sous soins qualifiés, en ajustant pour les facteurs confusionnels. RÉSULTATS: 27% [IC95%: 22.8-31.2%] des femmes ont utilisé des soins prénatals et 22,6% [IC95%: 18.7-26.5%] ont reçu des services d'accouchement qualifiés. Aucune des répondantes n'a signalé des soins postnatals. 43% ont déclaré qu'elles n'avaient aucune connaissance des soins prénatals et 46% ne percevaient pas l'accouchement dans un établissement de santé comme important. Le mode de vie pastoral, le niveau d'éducation du mari, l'attitude des femmes à l'égard des services de santé et le soutien financier du mari étaient significativement associés à l'utilisation des soins prénatals. Les attitudes des professionnels de la santé, les perceptions de l'accouchement en établissement, l'utilisation des soins prénatals et les informations sur les exemptions des frais de soins de santé maternelle ont été associées à l'utilisation des services d'accouchement qualifiés. CONCLUSION: Améliorer la sensibilisation de la communauté aux soins prénatals, employer des professionnels de la santé féminins et des directives culturellement adaptées pourrait améliorer l'utilisation de l'accouchement qualifié. Dans une société patriarcale, la participation des partenaires masculins à toutes les questions de santé maternelle est essentielle pour accroître l'utilisation des services de santé maternelle et réduire la mortalité maternelle.

Depression and anxiety symptoms in cardiac patients: a cross-sectional hospital-based study in a Palestinian population.

BACKGROUND: Mental health problems have an adverse effect on the course of cardiac disease. The integration of their diagnosis and treatment into cardiology care is generally poor. It is particularly challenging in cultural environments where mental health problems are stigmatized. The objective of the current study was to investigate the proportion of cardiac patients with depression and anxiety as well as factors associated with the presence of these symptoms in a Palestinian population. METHODS: This cross-sectional hospital-based study was conducted on patients consecutively admitted with a new or existing cardiac diagnosis to one of the four main hospitals in Nablus, Palestine over an eight-month period. Data was obtained from hospital medical charts and an in-person interview, using a structured questionnaire with a sequence of validated instruments. All subjects were screened for depression and anxiety using the Cardiac Depression Scale (CDS) and the Depression Anxiety Stress Scale (DASS-42). Multivariate ordered logistic regression analyses were performed to identify factors among four categories (socio-demographic, clinical, psychosocial, lifestyle) independently associated with depression and anxiety. RESULTS: In total, 1053 patients with a confirmed cardiac diagnosis were included in the study with a participation rate of 96%. Based on the CDS and DASS-42, 54% met the criteria for severe depression (CDS > 100) and 19.2% for severe-to-very severe anxiety (DASS-anxiety > 15), respectively. Symptoms of depression and anxiety were more prevalent among females and less educated patients. Factors independently associated with both depressive and anxiety symptoms were post-traumatic stress disorder symptoms, low level of self-esteem, high somatic symptoms, low physical and mental health component scores, active smoking, physical inactivity, and longer disease duration. Patients with depressive and anxiety symptoms also reported poor social support and lower resilience. CONCLUSION: There was a high level of depression and anxiety in this sample of cardiac patients. The results point to characteristics of patients in particular need for mental health screening and suggest possible targets for intervention such as strengthening of social support and of physical activity. The integration of mental health services into cardiac rehabilitation in Palestine and comparable cultural settings is warranted from the time of first diagnosis and onward.

Determinants of change in airway reactivity over 11 years in the SAPALDIA population study.

We investigated determinants of change in bronchial reactivity in the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA), a population-based cohort with wide age range (29-72 yrs at follow-up). The role of sex, age, atopic status, smoking and body mass index (BMI) on percentage change in bronchial reactivity slope from the baseline value was analysed in 3,005 participants with methacholine tests in 1991 and 2002, and complete covariate data. Slope was defined as percentage decline in forced expiratory volume in 1 s from its maximal value per micromole of methacholine. Bronchial hyperreactivity prevalence fell from 14.3 to 12.5% during follow-up. Baseline age was nonlinearly associated with change in reactivity slope: participants aged <50 yrs experienced a decline and those above an increase during follow-up. Atopy was not associated with change, but accentuated the age pattern (p-value for interaction = 0.038). Smoking significantly increased slope by 21.2%, as did weight gain (2.7% increase per BMI unit). Compared with persistent smokers, those who ceased smoking before baseline or during follow-up experienced a significant decrease in slope (-27.7 and -23.9%, respectively). Differing, but not statistically different, age relationships and effect sizes for smoking and BMI between sexes were found. Mean bronchial reactivity increases after 50 yrs of age, possibly due to airway remodelling or ventilation-perfusion disturbances related to cumulative lifetime exposures.

[Sexual health: variability in Switzerland and Europe]. / Sante sexuetle: variabilités en Suisse et en Europe.

Sexual Health is interrelated with both, sex and gender, through its biological dimension, its connection with cultural conventions, and its impact on women's health. Reproductive factors are presented from two cohorts, the Swiss SAPALDIA study and the European Community Respiratory Health Survey. Reproductive characteristics vary considerably across Switzerland and across Europe. A shift is observed towards lower ages at menarche and higher ages at menopause in younger cohorts. Smoking is the most important determinant of an early menopause. These secular trends imply that there will be changes also in the prevalence of diseases associated with age at menopause such as breast cancer and cardiovascular diseases.

Occupational exposure to inhalative irritants and methacholine responsiveness.

OBJECTIVES: Occupational exposures to inhalative irritants have been associated with an increased reporting of respiratory symptoms in previous studies. Methacholine responsiveness represents a continuous measure of airway responsiveness. As such, it may be less subject to recall bias and more sensitive to detecting effects of occupational exposure on airways. Such effects may be stronger among atopic persons. The objective of the study was to examine the relationship between self-reports of occupational exposure to dusts, gases, vapors, aerosols, and fumes and methacholine responsiveness. METHODS: A sample was studied of never smokers (N=3044) chosen randomly from 8 areas in Switzerland. Atopy was defined as any positive skin test to 8 inhalative allergens. Nonspecific bronchial reactivity was tested using methacholine chloride and quantified by calculating the slope of the dose-response. RESULTS: The methacholine slopes were 19% [95% confidence interval (95% CI) 6-32] higher for never smokers with exposure to dusts, fumes, vapors, gases, or aerosols than for the unexposed group. When only atopic never smokers were examined. the increase was larger (37%, 95% CI 7-75), and for persons with >2 positive skin prick tests the effect was still higher (42%, 95% CI -1.5-104). Exposure to vapors and aerosols was strongly associated with increased methacholine slopes among the atopic subjects. CONCLUSIONS: Occupational exposure, particularly to dusts and fumes, was associated with increased bronchial reactivity in never smokers in this study. The magnitude of the effect was larger among atopic subjects.

[Sequelae of venous thrombosis. Incidence in of the post-thrombosis syndrome after 5 years]. / Séquelles de la thrombose veineuse. Incidence en 5 ans du syndrome post-thrombotique.

The authors report on an epidemiological study carried out in Basle, Switzerland, which prospectively included 341 consecutive patients (226 men, 115 women, mean age 52 +/- 16 years) who had developed deep venous thrombosis evidenced by phlebography. The treatment of the acute phase most often consisted in thrombolysis, conventional heparin being reserved for the contra-indications of thrombolysis. A second phlebographic examination allowed dividing up the series into two groups, ie. positive and negative, according to the presence or absence of a complete or partial return of patency. Each group was subdivided according to the location and extension of the thrombosis. Both groups (positive vs. negative) are different as regards the location and extent of the thrombosis. The selective comparison of both groups according to the objective subdivision demonstrated: the absence of post-phlebitis disease in sural phlebitis; the same risk of post-phlebitis disease in thrombosis extending to 4 levels, whether patency was restored or not; lower incidence of post-phlebitis disease in the positive group for single -, two - or three-level phlebitis. Leg ulcers occur within an average of 5.5 +/- 2.1 years after the acute episode in 6.7% of all patients. Complete return of patency is obtained in 23% of cases only.

[Chronic handicaps and social integration in the aged. Results from the Somipops health survey]. / Chronische Behinderungen und soziale Integration im Alter. Ergebnisse aus dem Health Survey Somipops.

Findings of the first Swiss health Survey Somipops are presented. The percentage of long-term disability as well as the number of disabilities per person increases with age. On the other hand social activities decrease with age. For persons aged 65-84 with long-term disability these tendencies are stronger than for those without disability.

[Sex differences in demands made on medical services. Results of the SOMIPOPS health survey]. / Geschlechtsunterschiede in der Inanspruchnahme von medizinischen Dienstleistungen.

Data of the nationwide health survey SOMIPOPS show a higher number of physician visits for females than for males. Females report a total annual rate of 6,6 visits per person while males made 4,8 visits per person. Females have seen a gynecologist once a year. They report higher perceived morbidity than males which is considered to be the principal determinant of use of health services. Visits made for disorders of the female reproductive system accounts for 13,9% of the female visits. Preventive reasons for the last visit are more frequent among females.

[Sex differences in health and health behavior]. / Geschlechtsunterschiede in Gesundheit und Gesundheitsverhalten.

The higher life expectancy of women is contrasting with the higher female morbidity known from health interview surveys and statistics on use of health services. In the Swiss Health Survey SOMIPOPS, women report higher rates of complaints, diagnoses, chronical impairments and psychic illness, more frequent restrictions of their daily activities for health reasons and a worse overall health status. In men, only higher rates of indicators related to respiratory diseases and accidents were found. On the other hand, women have a stronger health orientation in daily life habits, seem to differ from men in health perception, are more willing to treat symptoms and use health services more often for preventive reasons. Comparison of survey and examination data reveal a different health perception and a higher female willingness to treat symptoms. The question is arised whether the different health behaviour have long-term effects, especially on life-expectancy.

[Blood pressure: knowledge and behavior]. / Blutdruck: Wissen und Verhalten.

Knowledge about blood pressure and practice in terms of its measurement are two important indicators for problem areas in cardiovascular disease prevention. This paper analyses these two indicators based on a representative Health Survey (SOMIPOPS) in order to illustrate the potential of such surveys. The results demonstrate that interesting clues to preventive action can indeed be obtained. In addition, time series analyses could potentially be a basis for the continuous evaluation of health services in this area.

The Swiss Health Survey Project (SOMIPOPS): an example of a data collection effort from various sources.

In 1981/82 the first representative health survey (SOMIPOPS "Socio-medical indicators for the population of Switzerland") was conducted 1) to gain representative data on health status (perceived morbidity), use of health services, 2) to analyse the demand for health care, and 3) to develop reliable health and use indicators. In order to validate questionnaire and interview data (primary data sources), two additional (secondary sources) were used: income and wealth data for the whole of the original SOMIPOPS sample (N = 5,860), and health insurance records for 80% consenting members of the interviewed sample. The integration of different data sources on an individual level greatly enhances the analytic potential of health survey.

[Tooth loss, dental restorations and dental attendance in Switzerland]. / Zahnverlust, prothetische Versorgung und zahnärztliche Inanspruchnahme in der Schweiz.

The aim of this study is to report about the dental health situation in Switzerland and to evaluate frequencies of dental visits. Data were obtained from the first and second national Health Survey of the Federal Office for Statistics in 1992/3 and 1997. Based on a random sample of the population aged from 15 to 74 years, 71% participated in an oral interviews and of this group of individuals, 75% later filled in a written questionnaire in 1992/3. Data analysis showed that the proportion of the fully dentate population (28 remaining teeth) is 41%, while almost 50% had some prosthetic treatment. 31% were treated with fixed prostheses, i.e.crowns and/or bridges, and 19% with removable prostheses, i.e. partial and/or full dentures. With increasing age the number of missing teeth and the frequency of prosthetic treatment went up. The population with prosthodontic reconstruction increased mainly in the third and forth decades. In the elderly population (age 65-74 years), a shift was observed from fixed to removable prostheses; two thirds in this groups was restored with removable prostheses. The proportion of subjects visiting the dentist was by 70% in 1992/3 and declined to 65% in 1997. Subjects wearing removable prostheses had apparently lower frequencies (43%) in dental visits than subjects with fixed prostheses (80%). A potential concern exists for the edentulous population who presented a limited need for dental visits of only 22% during the year preceding the study.

[The course of varicose disease. Parallel retrospective study of 2 ethnic groups (Catania-Basel)]. / Curso de la enfermedad varicosa. Estudio retrospectivo en paralelo entre dos diferentes grupos étnicos (Catania-Basilea).

Authors presents a retrospective study with two different ethnic groups, one of them from Catania and the other from Basilea, with varicose veins and subjected to a saphenectomy. They studies the following parameters: age at the entrance, and when varicose veins appeared; correlation between varix appearance date and subjective symptomatology; and rapport between varix complications and its duration. The possible incidence of "ambiental factor" and contrasts between the two groups are considered.

Asthma and the menopause: a systematic review and meta-analysis.

OBJECTIVE: To review the available literature to determine whether the menopausal transition is associated with asthma incidence. METHODS: We performed a systematic review and meta-analysis of cohort and cross-sectional studies providing a definition/assessment of menopausal status, incidence or prevalence of a defined diagnosis of asthma, and providing a measure of the association or of menopausal state and asthma or enough data for a calculation of this association. Where possible these meta-analytic estimates were also stratified by intake of menopausal hormone therapy (MHT). RESULTS: Of 76 potentially relevant articles, 8 studies met the inclusion criteria and were included in the review, and 6 in the meta-analysis. There was heterogeneity across studies: four studies reported slightly increased prevalence rates of asthma in post-menopause, one large cohort yielded a lower asthma incidence and one cross-sectional study a lower prevalence in post-menopause. Overall, the meta-analysis showed no significant association between menopause and asthma rates. When stratifying by use of MHT, the association between menopause and asthma rates was increased in women reporting use of MHT (RR 1.32, 95%CI 1.01-1.74), but not in women not using MHT. CONCLUSION: We found no significant association of menopause with asthma prevalence or incidence except for women reporting use of MHT. However, these findings result from a small number of studies, including only 1 large cohort with incidence rates for pre- as well as post-menopause. Further studies are needed addressing more closely subgroup analyses and a possible modification of the association of menopause and asthma by MHT.

Incidence of asthma and net change in symptoms in relation to changes in obesity.

The incidence of asthma has been reported to be associated with obesity. An alternative analysis, of net change in prevalence, does not require exclusion of those with asthma at baseline. Follow-up data were obtained from 9,552 participants in the European Community Respiratory Health Survey and the Swiss cohort Study on Air Pollution and Lung Disease in Adults. Incidence of asthma was analysed by proportional hazards regression, and net changes in symptoms and asthma status by generalised estimating equations, by obesity group. Incidence and net change in ever having had asthma were greater in females than in males, and in participants who remained obese compared with those who were never obese (hazard ratio 2.00, 95% confidence interval 1.25-3.20; excess net change 2.8%, 0.4-5.3% per 10 yrs). The effect of being obese on net change in diagnosed asthma was greater in females than in males, but for net change in wheeze without a cold it was greater in males. The present results are consistent with asthma being more frequently diagnosed in females, especially obese females. These findings may help to explain the reports of a stronger association between asthma and obesity in females than in males.

[The treatment of deep venous thrombosis of the lower limbs]. / Le traitement de la thrombose veineuse profonde des membres inférieurs.

The various therapeutic modalities in deep venous thrombosis of the lower limbs (surgical thrombectomy, thrombolysis, anticoagulation, bed rest) are discussed with special reference to developments in the last ten years (new generation of thrombolytics, introduction of INR to express prothrombin time). Tentative therapeutic guidelines are proposed.