26858 research outputs found
Sort by
The impact of implementing the women\u27s reproductive rights agenda on climate change
Full text linkThe 1994 International Conference on Population and Development (ICPD) established sexual and reproductive health and rights (SRHR) as foundational to sustainable development. Thirty years later, advancing women\u27s reproductive rights (WRR), encompassing agency, decision-making autonomy, and universal access to family planning—remains critical not only for health and gender equity but also for mitigating environmental degradation. By reducing unintended pregnancies and empowering women to align childbearing with personal and ecological capacity, WRR alleviates ecological stressors such as deforestation while enhancing health resilience in climate-vulnerable communities. Yet, despite well-documented linkages between population dynamics and environmental change, contemporary climate policies and funding mechanisms persistently exclude WRR. This oversight undermines the potential of reproductive justice to enhance climate resilience. Additionally, claims that integrating WRR into climate agendas covertly promotes population control or represses women in low- and middle-income countries are fundamentally misleading. Crucially, research is needed to quantify the specific environmental impacts of WRR, underscoring the urgent need for robust global models to predict and validate these co-benefits. Strengthening this evidence base is imperative to inform policies that integrate WRR indicators into climate financing frameworks, ensuring gender-responsive programming. Bridging this gap requires interdisciplinary collaboration to develop metrics that capture WRR\u27s role in reducing resource consumption and enhancing adaptive capacity. Embedding WRR within climate agendas would harmonize reproductive justice with environmental action, unlocking synergies between gender equity, health resilience, and sustainability. Fulfilling the ICPD\u27s vision demands centering WRR in global climate strategies, thereby advancing a just and livable future for all
Placental transfer of SARS-CoV-2 antibodies in mother-neonate pairs: a prospective nested cohort study
Full text linkBackground
Newborns depend on the transfer of IgG across the placenta to acquire protection against pathogens. We assessed the placental transfer of SARS-CoV-2 antibodies, primarily derived from infection, from seropositive pregnant women enrolled in a pregnancy cohort in Kilifi, Kenya. Methods
The study was nested within a prospective observational multi-country cohort study. All available paired maternal delivery and cord blood samples were selected. Maternal sera were tested for SARS-CoV-2 receptor binding domain (RBD) IgM/IgG total antibodies using the Wantai assay. For positive samples, maternal and corresponding cord blood samples were tested for SARS-CoV-2 IgG antibodies against the spike (anti-spike) and nucleocapsid proteins (anti-NCP) using ELISA kits from Euroimmun. Results
A total of 492 (56.1%) out of 877 maternal delivery samples were positive for RBD IgM/IgG total antibodies. Of these, 416 (84.6%) were seropositive for either anti-NCP IgG, anti-spike IgG antibodies or both. A total of 412 out of 496 (83%) cord blood samples tested positive for either anti-NCP or anti-spike antibodies. The geometric mean ratio was 1.04 (95% CI: 0.90, 1.21), indicating no significant difference between the anti-spike IgG concentration in cord and maternal blood samples. The log-transformed maternal and cord blood anti-spike IgG concentrations showed a weak positive correlation (r = 0.364, n = 496, p \u3c 0.001). No maternal or neonatal factors were associated with the anti-spike IgG placental transfer ratio. Conclusion
Placental transfer of SARS-CoV-2 antibodies was evident in a population of pregnant women whose immunity was primarily derived from infection given the low SARS-CoV-2 vaccine coverage in the study area. The positive correlation between maternal and cord blood anti-spike concentrations suggests that interventions that increase maternal antibody concentrations such as vaccination may increase passive immunity and protection against severe COVID-19 disease in neonates
The modification of risk assessment ranking when considering the female population and children in the INFORM risk index for selected countries
No full textThe INFORM (Index for Risk Management) identifies risk hotspots by assessing Hazard and Exposure, Vulnerability, and Coping capacity across 76 indicators. However, the original index may have overlooked the specific vulnerabilities of women and children, even within the vulnerable group in emergencies. This study recalibrated the index by redefining key indicators to better reflect risks for these groups. INFORM Index Risk formulation is Risk = Hazard and Exposure 1/3 x Vulnerability 1/3 x Lack of coping capacity 1/3\u27 resulted in a total score ranging from 0 to 10, with the higher score being the higher risk. We recalibrated the 2024 INFORM Risk formula by adjusting for female and child (ages 0-14) populations in 67 countries across the Eastern Mediterranean, South Asia, and Sub-Saharan Africa. We categorized the 76 metrics as (1) those with gender-disaggregated data, (2) those adaptable for specific populations using literature, and (3) generalized indicators needing no adjustment. Shifts in risk classifications were noted among 67 countries. Initially, 13 countries (19.4%) were at \u27very high\u27 risk, and 18 (26.9%) were at \u27high\u27 risk. After recalibration, 52 countries (77.6%) showed score changes from 0.1 to 0.6 points. Six countries moved from \u27high\u27 to \u27very high\u27 risk, raising this class to 19 (28.3%). The paired t-test revealed a statistically significant difference between the original and recalibrated risk scores (mean difference = -0.17, 95% CI: -0.20, -0.13, p \u3c 0.001). The difference in Vulnerability scores (mean difference = -0.32; 95% CI: -0.44, -0.21; p-value \u3c 0.000) and Coping capacity (mean difference = -0.18; 95% CI: -0.23, -0.12; p-value \u3c 0.000) were significant, derived changes in the INFORM Risk Index. The recalibrated INFORM index highlights that accurate, disaggregated data is crucial for understanding the specific needs of vulnerable populations, enabling more informed decision-making in risk management and resilience planning
Introduction: The Habsburg Legacy and the Governance of Muslim Communities in Central and Southeast Europe
No full text
Comparison of opportunities and perceptions towards neurosurgery between the public and private sector in Pakistan: A national survey of medical students and recent graduates
No full textPublic and private medical institutes must adhere to the same standards of quality set by the Pakistan Medical & Dental Council (PMDC). However, studies have noted varied learning environments. The current study aims to assess opportunities and compare the differences in perceptions between the two sectors. An online survey was conducted among medical students, interns, and medical officers across Pakistan. Respondents were divided into two groups: private and public sector and the survey responses of the two groups were compared. Descriptive statistical analyses of responses were performed, and a chi-square test was used to obtain the p-values. 2,481 responses were collected (48.6% public vs 51.3% private sector). A higher proportion of public sector respondents reported neurosurgery within their curriculum (71.2% public, 58.9% private) ( p \u3c 0.001), while a greater proportion of private sector respondents had less exposure to neurosurgery clerkships (58.5% public, 71.9% private). A higher proportion from the private sector reported that sufficient mentorship opportunities (38.3% private, 29.5% public) (p \u3c 0.001) were provided by their medical college. More private sector respondents reported lack of work-life balance (39.5% public, 42.4% private), competitive work environment (55.9% public, 61.3% private) (p \u3c 0.001) and financial burden (67.3% private, 60.8% public) (p \u3c 0.001) as major barriers towards pursuing neurosurgery. Our study outlines key areas for improvement from the perspective of the learners themselves. These include increasing exposure to neurosurgery in medical colleges and affiliated hospitals and improving post-graduate training among all sectors. Addressing these concerns of the medical students, interns, recent graduates and medical officers can foster the pursuit of neurosurgery as a career in Pakistan. It is crucial to further investigate medical education in Pakistan and study differences in the public and private education sector globally
Acute splanchnic venous thrombosis following laparoscopic sleeve gastrectomy: A case report
No full textIntroduction and importance: Splanchnic venous thrombosis is a rare but serious complication of bariatric surgery. This case report highlights a unique occurrence of acute portal, mesenteric, and splenic vein thrombosis in a 39- year-old woman three weeks after undergoing laparoscopic sleeve gastrectomy for severe obesity.
Case presentation: A 39-year-old woman with a BMI of 38.1 kg/m2 and no prior medical history presented with a six-day history of diffuse abdominal pain, nausea and subjective fever but no change in bowel habits or blood in stool. A CT scan abdomen with IV contrast revealed extensive thrombosis involving the intrahepatic and extrahepatic veins, extending to the portal, splenic, and mesenteric veins. Laboratory findings supported a hypercoagulable state. Treatment included anticoagulation, intravenous antibiotics, supportive care, and close monitoring.
Clinical discussion: Diagnosing SVT is difficult due to its non-specific symptoms, relying on advanced imaging techniques like Doppler ultrasound, CT, or MRI. Anticoagulation therapy, such as low-molecular-weight heparin (LMWH) followed by direct oral anticoagulants (DOACs), is essential for managing SVT. Supportive treatments, including PPIs and antibiotics, improve outcomes, and surgery may be necessary for complicated cases like end organ damage for instance intestinal ischemia and necrosis.
Conclusion: This case underscores the need for high clinical suspicion of splanchnic venous thrombosis in post- bariatric surgery patients presenting with persistent abdominal pain. Proper patient selection and stratification, adequate thromboprophylaxis are crucial preventive strategies. Early diagnosis and aggressive management with multidisciplinary team approach are critical to preventing severe complications and improving outcomes
Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention: A pragmatic randomised controlled trial in Pakistan
No full textIntroduction: Incentive-linked prescribing, which is when healthcare providers accept incentives from pharmaceutical companies for prescribing promoted medicines, is a form of bribery that harms patients and health systems globally. We developed a novel method using data collectors posing as pharmaceutical company sales representatives to evaluate private doctors\u27 engagement in incentive-linked prescribing and the impact of a multifaceted educational intervention on reducing this practice in Karachi, Pakistan.Methods: We made a sampling frame of all doctors running for-profit, primary-care clinics and randomly allocated participants to control and intervention groups (1:1). The intervention group received a multifaceted seminar on ethical prescribing and reinforcement messages over 6 weeks. The control group attended a seminar without mention of ethical prescribing. The primary outcome was the proportion of participants agreeing to accept incentives in exchange for prescribing promoted medicines from data collectors posing as pharmaceutical company representatives, 3 months after the seminars.Results: We enrolled 419 of 440 eligible participants. Of 210 participants randomly allocated to the intervention group, 135 (64%) attended the intervention seminar and of 209 participants allocated to the control group, 132 (63%) attended the placebo seminar. The primary outcome was assessed in 130 (96%) and 124 (94%) of intervention and control participants, respectively. No participants detected the covert data collectors. 52 control group doctors (41.9%) agreed to accept incentives as compared with 42 intervention group doctors (32.3%). After adjusting for doctors\u27 age, sex and clinic district, there was no evidence of the intervention\u27s impact on the primary outcome (OR 0.70 [95% CI 0.40 to 1.20], p=0.192).Conclusions: This first study to covertly assess deal-making between doctors and pharmaceutical company representatives demonstrated that the practice is strikingly widespread in the study setting and suggested that substantial reductions are unlikely to be achieved by educational interventions alone. Our novel method provides an opportunity to generate evidence on deal-making between doctors and pharmaceutical companies elsewhere
Self-reported illnesses in Thatta: Evidence from a rural and underdeveloped district in Sindh province, Pakistan
No full textIntroduction: Self-reported illnesses (SRI) surveys are widely used as a low-cost substitute for weak Disease Surveillance Systems in low- and low-middle-income countries. In this paper, we report findings of a district-level disease prevalence survey of all types of illnesses including chronic, infectious, injuries and accidents, and maternal and child health in a rural district in Pakistan.Methods: A district-level survey was conducted in Thatta in 2019 with a population-representative sample of all ages (n = 7811) a. Survey included questions on demographics and SRIs from the respondents. Prevalence was estimated for all SRIs categorized into six major and 16 minor illnesses. The influence of important socio-demographic covariates on the illnesses and multiple comorbidities was explored by estimating prevalence ratios with a Generalized Linear Model of the Poisson family and by Zero-Inflated Poison Distribution respectively.Findings: 36.57% of the respondents to the survey reported at least one SRI. Prevalence of communicable illnesses was 20.7%, followed by non-communicable illnesses (4.8%), Gastrointestinal disorders (4.4%), and injuries/disabilities (1.9%). Urban inhabitants were more likely to have Chronic Obstructive Pulmonary Disorders (3.34%) and Diabetes (1.62%). Females were most likely to have injuries (1.20,), disabilities (1.59), and Musculoskeletal Disorders (1.25). Children aged \u3c 1 year (0.80) and elderly \u3e65 years (0.78) were more likely to have comorbidities.Discussion: Our estimated prevalence of SRI is quite higher than the prevalence of unknown SRIs in national-level surveys in Pakistan. This research\u27s findings serve as an example of aiding evidence-based priority settings within the health sector. Our findings on gender, and young and old age as positive predictors of SRI are consistent with similar surveys in a few LMICs.Recommendation and conclusion: We provide evidence of a complete disease profile of a district that is otherwise unavailable in the country. This study can reshape the existing health surveys and to aid evidence-based priority settings in the health sector. We, however, support strengthening the Disease Surveillance System as a reliable source of disease prevalence data
How low should we go? outcomes of ECMO in neonates with low gestational age or birth weight
No full textPurpose: Initial recommendations for ECMO had relative contraindications for low birth weight (BW) or low gestational age (GA) babies. However, more recent literature has demonstrated improved and acceptable outcomes of ECMO in smaller neonates. The purpose of this study was to understand both utilization and survival in patients with lower GA and BW.Methods: All neonates captured in the Extracorporeal Life Support Organization (ELSO) registry who underwent a single ECMO run from 2009 to 2019 were included. The primary outcome measure was mortality and the secondary outcome measure was major adverse outcomes, defined as a composite outcome variable any severe ECMO complications. Univariate and multivariable statistical tests were performed to estimate the association between GA and BW with both outcome variables.Results: A total of 14,167 cases met inclusion criteria. Univariate analysis noted that birth weight, gestational age, ECMO mode, pulmonary support type, pH and ventilator settings were highly significant predictors of survival. Multivariable assessment noted significant linear relationship of mortality rates with increasing GA and BW (p \u3c 0.001, OR = 0.82 GA, 0.51 BW). The highest ECMO-related mortality was observed in neonates with GA 30-31 weeks and BW 1.5-2.0 kg, with a 70-75% in-hospital mortality rate.Conclusions: Decreasing GA and BW were strongly correlated with increasing odds of mortality and/or ECMO-related complications. However, even in low GA or BW neonates, survival may be possible in up to a quarter of patients put on ECMO