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Exploring the lived experiences of menstrual hygiene management among in-school visually impaired adolescent girls in Rwanda: a phenomenological study
Full text linkBackground In low-income countries, many menstruating persons continue to face numerous challenges regarding menstrual hygiene management. Visual impairment further compounds the difficulties faced by in-school adolescent girls, but little is known about its consequences in Rwanda. Objective To explore the lived experiences of menstrual hygiene management among in-school visually impaired adolescent girls in Rwanda. Design descriptive phenomenology. Methods This study was conducted in four specialized educational institutions for visually impaired students in Rwanda. We conducted four focus group discussions with 25 visually impaired adolescent girls selected purposively. The seven steps of Colaizzi’s method were used to analyze the data. Results Some participants reported double stigma due to both gender norms and menstruation as well as being visually impaired. Due to taboos and misconceptions around menstruation, some participants reported not getting accurate information about menstrual hygiene management from their parents or teachers. Some poor practices related to taboos and misconceptions, such as drying the reusable clothes out of sight of others, were reported. Finally, some participants faced a double burden regarding period poverty. Due to the lack of sanitary pads, some must wear reusable clothes, which are challenging to clean and dry. In case of water outages, participants could not travel to fetch water. Educational materials in three out of four girls’ rooms are visual, making it difficult for visually impaired girls to access accurate information. Conclusions This study reveals the significant challenges visually impaired adolescent girls face in managing menstruation, compounded by societal norms and their disability. The double stigma highlights the need for targeted interventions to reduce discrimination and misconceptions. Addressing inadequate access to MHM education, period products, and infrastructural issues like water shortages is essential for creating an enabling environment for these girls
Newborn screening-a worldwide endeavour to protect
No full textFor more than 60 years, newborn (or neonatal) screening has flourished through global collaboration, demonstrating that collective action is key to success. This unity proved to be especially vital during the COVID-19 pandemic, when, despite severe disruptions, NBS services were largely preserved, reflecting the high value placed on early detection and care for vulnerable newborns. Today, the International Society for Neonatal Screening (ISNS) recognises that NBS programmes face increasing challenges due to global instability. While direct assistance is not always possible, ISNS emphasises the strength of the international NBS community-scientists, clinicians, patient groups, and industry partners-who are committed to mutual support and knowledge-sharing. Building on the proud legacy inspired by pioneers like Bob Guthrie, this community is enriched by diverse voices and is unified by a shared vision: to ensure that all children with rare disorders have access to life-saving screening and care. Safeguarding and advancing this foundation is a responsibility owed to future generations
Simplifying Asthma: Understanding and managing asthma in young children in primary care
No full textAsthma is a common ailment presenting in primary care clinics, but it poses significant challenges in diagnosis and management for children under five years of age. Diagnostic tools like spirometry are not feasible for this age group and symptoms such as wheezing are common in many respiratory conditions. Treatment is equally challenging, as standard asthma medications cannot be administered in the same manner to young children as in adults and memorizing treatment guidelines can be difficult. To address this, we organized a Continuing Medical Education (CME) session featuring case-based discussions following a survey on asthma knowledge. This manuscript provides a concise summary of the activity, aiming to simplify asthma management for primary care physicians worldwide, particularly in children under five
Letter to the editor regarding, Influence of the use of a denture adhesive on salivary cells and candidal activity: A randomized clinical trial by Elsherbini et al
No full textEquity and Agency in Technology-Supported Teacher Professional Development in Tanzania: Research Instruments Pack
Full text linkThis pack contains links to research instruments developed by EdTech Hub, the University of Dodoma, Aga Khan University, and Tanzania Institute of Education for the second phase of a study investigating the scale-up and local contextualisation of a national technology-supported teacher professional development programme known as MEWAKA (Mafunzo Endelevu kwa Walimu Kazini, which translates as ‘teacher continuous professional development’ [TCPD] in English). The instruments draw on previously published research instruments used in Phase 1 of our research, plus examples from other sources that exemplify best practices in education research. We are making these tools available to other researchers and practitioners and hope that they will prove useful. They are provided in editable format so that others can modify them as they see fit
Prevalence and factors associated with depression, anxiety and post-traumatic stress disorder among healthcare workers from sub-Saharan Africa: systematic review
Full text linkBackground: Depression, anxiety and post-traumatic stress disorder (PTSD) are prevalent among healthcare workers (HCWs), including those from sub-Saharan Africa (SSA). However, there are limited summary data on the burden and factors associated with these disorders in this region. We conducted this systematic review (registration no. CRD42022349136) to fill this gap.
Aims: The aim of this review was to systematically summarise the available evidence on the prevalence and factors associated with depression, anxiety and PTSD, or their symptoms, among HCWs from SSA.
Method: We searched African Index Medicus, African Journals Online, CINAHL, PsycINFO and PubMed for articles published, from database inception to 15 February 2024. The keywords used in the search were ‘depression/anxiety/PTSD’, ‘healthcare workers’, ‘SSA’ and their variations.
Results: Sixty-nine studies met our inclusion criteria, most of which (n = 55, 79.7%) focused on the burden of these disorders during the COVID-19 pandemic. Across studies, wide-ranging prevalence estimates of depressive (2.1–75.7%), anxiety (4.8–96.5%) and PTSD symptoms (11.7–78.3%) were reported. These disorders appear to have been heightened during the COVID-19 pandemic. Several sociodemographic, health-related, COVID-19-related and work-related factors were reported to either increase or lower the risk of these disorders among HCWs from SSA.
Conclusions: The burden of depression, anxiety and PTSD among HCWs from SSA is high and appears to have been worsened by the COVID-19 pandemic. The correlates of these disorders among HCWs from this region are multifactorial. A multi-component intervention could contribute to addressing the burden of mental disorders among HCWs from this region
Cervical HPV 18 detection is associated with high-grade cervical dysplasia in Kenyan and Ugandan women living with HIV
Full text linkObjectives Cervical cancer, caused by “high-risk” (HR) HPV, is the most common malignancy and the leading cause of cancer deaths among women living in Kenya and Uganda. Women living with HIV (WLWH) are at a high risk for HR-HPV infection. This longitudinal, observational cohort analysis was conducted to identify factors that are important among WLWH in prediction of cervical intraepithelial neoplasia grades 2 or 3 (CIN2/3).
Methods Data of this analysis was based on a study of HPV natural history and cervical cancer among Kenyan and Ugandan WLWH. Demographic, behavioral and biological data were collected; HR-HPV DNA testing of cervical swabs was performed (Roche Cobas Assay); all WLWH underwent cervical biopsy on two occasions.
Results Of 114 WLWH enrolled, the median age was 38.2 years. All WLWH were receiving ART during the study. CIN2/3 was found in 13 (11.4 %) WLWH; HPV 16 was detected in 10 (8.8 %); HPV 18 in 11 (9.6 %), and Non-16/18 HR-HPV in 62 (54.4 %). Aflatoxin exposure was not associated with CIN2/3 in this analysis. A multivariable logistic regression found that cervical detection of HPV 18 was significantly associated with CIN2/3 (OR = 6.36, 95 % CI = 1.36–29.75, p = 0.019), after adjusting for the effects of HIV viral load, CD4 counts, and Non-16/18 HR-HPV detection.
Conclusions CIN2/3 was detected in 11.4% of WLWH; HPV 18 detection in cervical swabs was strongly associated with CIN2/3. Larger studies among WLWH are needed to determine optimal approaches for screening and treatment to prevent cervical cancer
Abstract C109: Single-nucleus sequencing reveals a functionally distinct breast tumor microenvironment by ancestral group with implications for disease progression and therapy
No full textBreast cancer biology is influenced by both genetic ancestry and the environment with implications for disease outcomes. However, we lack the knowledge how non-cancerous cells within tumors are functionally altered by these factors at single-cell resolution. Here, we created a single-nucleus (sn) dataset from 33 African American, 25 Kenyan, and 24 European American women with breast cancer using combined RNA and ATAC sequencing. We successfully isolated intact, high-quality single nuclei from archival frozen breast tumor tissue using an optimized combination of enzymatic digestion and automated tissue homogenization. SnMultiome sequencing of 82 tumors was performed using the 10x Genomics platform. Following filtering, normalization, peak calling, and integration, our dataset includes a total of 292,458 nuclei. Cancerous (163,419 nuclei) and non-cancerous (129,039 nuclei) cells were distinguished based on DNA copy number. Within the microenvironment, 11 major immune, epithelial, and stromal cell types were identified. CD45+, EPCAM- cells were further analytically extracted, clustered, and manually annotated based on known marker genes, detecting 26 distinct immune subpopulations across our samples. After adjustment for potential confounders (age, body mass index, and tumor molecular subtype) in all analyses, we found that women of African descent possessed distinct, activated mesenchymal and endothelial cell subpopulations within the tumor vasculature that promote inflammation, angiogenesis, and cancer cell invasion. Women of African descent exhibited a more immune-suppressive tumor microenvironment, with elevated expression of immune checkpoint markers (PD-1, TIGIT, CTLA-4, and LAG-3), functional impairment of dendritic cells, and enrichment of regulatory and tolerogenic lymphocytic subpopulations. Further, malignant cells from African descent patients expressed a discrete set of CAR-T targets with potential implications for precision immunotherapy. Lastly, we developed three gene signatures within the microenvironment that are predictive of survival with external validation in both tumor-adjacent normal and cancerous tissues from the TCGA. Together, we uncovered molecular breast tumor characteristics of clinical significance in women of African ancestry
The relationships between sporadic and repetitive non-suicidal self-injury and mental disorders among first-year college students: results from the World Mental Health International College Student Initiative
Full text linkBackground: Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time–order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults.
Methods: We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time–order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1–5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in relation to DSM-5 mood, anxiety, and externalizing disorders.
Results: We estimated a lifetime NSSI rate of 24.5%, with approximately half reporting sporadic NSSI and half repetitive NSSI. The time–order associations between onset of NSSI and mental disorders were bidirectional, but mental disorders were stronger predictors of the onset of NSSI (median RR = 1.94) than vice versa (median RR = 1.58). These associations were stronger among individuals engaging in repetitive rather than sporadic NSSI. While associations between NSSI and mental disorders generally did not differ by sex, repetitive NSSI was a stronger predictor for the onset of subsequent substance use disorders among females compared to males. Most mental disorders marginally increased the risk for persistent repetitive NSSI (median RR = 1.23).
Conclusions: Our findings offer unique insights into the temporal order between NSSI and mental disorders. Further work exploring the mechanism underlying these associations will pave the way for early identification and intervention of both NSSI and mental disorders
Successful retrieval of dislodged stent and fractured balloon after entrapment in one setting
No full textBackground: Stent dislodgement during percutaneous coronary intervention (PCI) is a feared complication, associated with coronary tortuosity and calcifications. Similarly, the balloon can become entrapped inside the vessel after puncture or failure to deflate. Both these mishaps can cause serious consequences including a myocardial infarction, stroke, and death and may require surgery as the last resort.Case summary: We report a case of an elderly dyspneic man presenting with anterior wall myocardial infarction. During PCI to the left anterior descending artery, the stent dislodged but was successfully retrieved with the twirling wire technique. During postdilatation of both stents with a noncompliant balloon, failure of deflation led to balloon entrapment and attempts to pull it resulted in fracture of the shaft. Successful recovery of the compromised apparatus was made by snaring the proximal wire end attached to the rest of the trapped equipment.Discussion: The Twisted Guidewire technique was used to retrieve a dislodged stent, aided by a pre-positioned wire. Common retrieval methods include small-balloon, two-wire, and snaring techniques. Balloon shaft rupture is managed based on fragment location. Preventive measures include lesion preparation and guide catheter extensions. The simultaneous occurrence of stent dislodgement and balloon shaft fracture is rare and may relate to tortuous, calcified vessels..Take-home message: The risk of rare, life-threatening PCI complications in complex cases necessitates stringent precautions and operator expertise in identifying and managing both common and rare events