Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Physical therapists’ experiences and perceptions of antepartum and postpartum care
Get PDFBackground:
Little is known about the physical therapists’ practice and perceptions toward management of pregnancy/postpartum-related disorders in Taiwan. The aim of this study was to document current practice of physical therapy in antepartum and postpartum care in Taiwan.
Methods:
An exploratory, cross-sectional study was conducted in registered physical therapists living in Taiwan. An anonymized online survey was designed, piloted, and advertised widely from March 2020 to March 2021. Data were analyzed using descriptive statistics, Chi square analysis and multivariate logistic regression.
Results:
Of the 364 respondents, 37.6% had experience of treating pregnant or postpartum women in clinical practice. The most commonly treated pregnancy/postpartum-related disorder in practice was low back pain (61.3%). All respondents reported little to moderate level of confidence in their ability to manage pregnancy/postpartum-related disorder. Being female (p < 0.01); working at a regional hospital (p = 0.01), district hospital or district teaching hospital (p < 0.01), clinic (p = 0.01) or physiotherapy clinic (p = 0.01); and having prior experience of treating antepartum or postpartum women (p < 0.01) were significantly associated with willingness to provide customer-oriented service or health education to patients/clients with pregnancy/postpartum-related disorder after controlling for other confounding variables. The most commonly reported barrier was “lack of available training” (81.3%).
Conclusion:
The majority of participating physical therapists indicated a positive attitude to antepartum and postpartum care but were not confident in management of various pregnancy/postpartum-related disorder in practices. The findings of this study highlight the educational needs related to antepartum and postpartum care in clinical practice for physical therapists in Taiwan
Progressive skeletal muscle loss after surgery and adjuvant radiotherapy impact survival outcomes in patients with early stage cervical cancer
Get PDFThe effect of skeletal muscle loss associated with surgery and adjuvant radiotherapy on survival outcomes in patients with early-stage cervical cancer remains unclear. We analyzed the data of 133 patients with early-stage cervical cancer who underwent surgery and adjuvant radiotherapy between 2013 and 2018 at two tertiary centers. Skeletal muscle changes were measured using computed tomography scans at baseline, at simulation for radiotherapy, and at 3 months post-treatment. A decrease of ≥5% in the skeletal muscle was defined as “muscle loss.” The Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) was used to assess gastrointestinal toxicity. The Patient-Generated Subjective Global Assessment (PG-SGA) was used for nutritional assessment. Predictors of overall survival were identified using the Cox regression models. The median follow-up period was 3.7 years. After treatment, 32 patients (24.1%) experienced muscle loss. The rate of muscle loss was higher in patients with PRO-CTCAE score ≥3 or PG-SGA score ≥4 at the end of radiotherapy than in patients with PRO-CTCAE score ≤2 or PG-SGA score 0–3 (75.0 vs. 10.5%, p < 0.001; 71.4 vs. 2.2%, p < 0.001). The 3-year overall survival was significantly lower in patients with muscle loss than in those with muscle preserved (65.6 vs. 93.9%, p < 0.001). Multivariate analysis showed that muscle loss was independently associated with poor overall survival (hazard ratio, 4.55; 95% confidence interval: 1.63–12.72; p < 0.001). Muscle loss after surgery and adjuvant radiotherapy was associated with poor overall survival in patients with early-stage cervical cancer. Muscle loss is associated with patient-reported gastrointestinal toxicity and deterioration in nutritional status
Children’s understandings of gender-based violence at home: the role school can play in child disclosure
Get PDFBoth official data and scientific evidence have shown that gender violence and the impact it has on children is an important social problem and ways of preventing it do not appear to be working. As this is an issue that affects children, it was decided to involve children in this research from the outset. To this end, six children's advisory groups were formed. Focus groups were then organised to explore children’s perspectives on gender-based violence and the best ways for them to seek help and information in order to enhance early disclosure. Twelve focus groups were conducted with a total participation of 45 children aged 10–16 from Catalonia (Spain). The focus group discussions were transcribed verbatim and analysed through Theoretical Thematic Analysis. The results demonstrate the importance of children’s active participation in research processes. It is clear that their understanding of the term is fairly comprehensive, wide-ranging and associated with the patriarchal system. The results point out that gender-based violence occurs in many spheres of social relations and schools are highlighted as privileged spaces for disclosure. The figure of the teacher is particularly highlighted as a key agent, and seen as one of the professionals closest to the children and identified as a person of trust. Teacher training is a pending challenge in addressing the prevention and intervention on gender-based violence
Ascending reproductive tract infection in pig-tailed macaques inoculated with mycoplasma genitalium
Get PDFMycoplasma genitalium is a sexually transmitted bacterial pathogen that causes urogenital disease in men and women. M. genitalium infections can persist for months to years and can ascend to the upper reproductive tract in women where it is associated with serious sequelae including pelvic inflammatory disease, tubal factor infertility, and preterm birth. An animal model is needed to understand immune evasion strategies that allow persistence, mechanisms of ascending infection, and factors associated with clearance. In earlier studies, we determined that pig-tailed macaques are susceptible to cervical infection; however, not all primates were successfully infected, persistence varied between animals, and ascension to the upper reproductive tract was not observed after 4 or 8 weeks of follow-up. Building on our previous findings, we refined our inoculation methods to increase infection rates, extended observation to 18 weeks, and comprehensively sampled the upper reproductive tract to detect ascending infection. With these improvements, we established infection in all (3/3) primates inoculated with M. genitalium and demonstrated lower tract persistence for 16 to 18 weeks. Ascension to the upper reproductive tract at endpoint was observed in two out of three primates. All three primates developed serum and local antibodies reacting primarily to the MgpB and MgpC adherence proteins. Elevated genital polymorphonuclear leukocytes (PMNs) and inflammatory cytokines and chemokines, erythema of the ectocervix in one primate, and histologic evidence of vaginitis and endocervicitis in two primates suggest a mild to moderate inflammatory response to infection. This model will be valuable to understand the natural history of M. genitalium infection including mechanisms of persistence, immune evasion, and ascension to the upper reproductive tract
Body weight is a valid predictor of the long-term prognosis of cervical cancer
Get PDFObjective:
To identify and validate effective clinical predictors for the long-term prognosis of patients with cervical cancer.
Methods:
Cervical cancer patients were retrieved from the TCGA database, and patients' clinical data were collected and analyzed for the predictive value of long-term prognosis. In the other branch of the study, patients with cervical cancer and admitted to our hospital between January 1, 2016, and December 31, 2016, were retrieved and followed up for prognosis analysis.
Results:
In the database patient cohort of our study, 607 cases with cervical cancer were analyzed. Aneuploidy score (p = 0.012), Buffa hypoxia score (p = 0.013), histologic grade (p = 0.01), fraction genome altered >0.4 (p 60 kg (p 160 cm (p = 0.047), BMI 0.5 (p = 0.035), person neoplasm status (p 70 kg (p < 0.001), and complicated with other cancer (p < 0.001) were clinical factor influencing the long-term OS.
Conclusions:
Clinical factors, especially common to both cohorts, could be used to show the long-term prognosis of cervical cancer
Sexually transmitted infections among patients attending a sexual assault centre: a cohort study from Oslo, Norway
Get PDFObjectives:
We estimate the prevalence of sexually transmitted infection (STI) among patients after sexual assault, assess the possible value of azithromycin prophylaxis, and identify risk factors for assault-related STI and for not presenting at follow-up.
Design:
Prospective observational cohort study.
Setting:
Sexual assault centre in Oslo, Norway.
Participants:
645 patients, 602 (93.3%) women and 43 (6.7%) men, attending the centre from May 2017 to July 2019.
Outcome measures:
Microbiological testing at the primary examination and at follow-up consultations after 2, 5 and 12 weeks. Estimated relative risk for assault-related STI and for not presenting at follow-up.
Results:
At primary examination, the prevalence of genital chlamydia was 8.4%, Mycoplasma genitalium 6.4% and gonorrhoea 0.6%. In addition, the prevalence of bacterial STI diagnosed at follow-up and possibly from the assault was 3.0% in total: 2.5% for M. genitalium, 1.4% for genital chlamydia and 0.2% for gonorrhoea. This prevalence did not change when azithromycin was no longer recommended from January 2018. There were no new cases of hepatitis B, hepatitis C, HIV or syphilis. We found no specific risk factors for assault-related STI. Patients with previous contact with child welfare service less often presented to follow-up (relative risk (RR) 2.0 (95% CI 1.1 to 3.5)), as did patients with a history of sex work (RR 3.6 (1.2 to 11.0)) or substance abuse (RR 1.7 (1.1 to 2.7)).
Conclusions:
Most bacterial STIs were diagnosed at the primary examination, hence not influenced by prophylaxis. There was no increase in bacterial STI diagnosed at follow-up when azithromycin prophylaxis was not routinely recommended, supporting a strategy of starting treatment only when infection is diagnosed or when the patient is considered at high risk. Sex work, substance abuse and previous contact with child welfare services were associated with not presenting to follow-up
Post-COVID-19 vaccine-associated menstrual cycle changes: A multifaceted problem for Pakistan
Get PDFA research study to measure the efficacy of terminating cervical cancer via customized optimum pathway
Get PDFBackground:
To develop a precise prognostic model of overall survival in patients with terminating cervical cancer based on surveillance, epidemiology, and end results (SEER) program.
Methods:
The patients were retrieved from SEER data who are diagnosed with terminating cervical cancer from 2004 to 2016. The data were performed using univariate and multivariate analyses and constructed nomograms for predicting survival. Use C-index to validate the model accuracy.
Results:
Totally 15839 patients diagnosed with cervical cancer were independently allocated into the training set (n = 11088) and validation set (n = 4751). The multivariate analysis results indicated that age, race, stage_T, stage_M, and stage_N were confirmed as independent risk predictors, and those factors are applied to construct this clinical model. The C-index of overall survival in the training set was 0.6816 (95% confidence intervene (CI), 0.694–0.763) and that in the validation set was 0.6931(95% CI, 0.613–0.779). All calibration curves of various factors were consistent with predicted and actual survival.
Conclusion:
The nomogram provides a novel method for predicting the survival of patients with terminating cervical cancer, assisting in accurate therapeutic methods for patients with primary terminating cervical cancer
An action learning brief with principles and priority actions for UNICEF Country offices
No full textThis action brief outlines four general principles and six priority actions that pre-position UNICEF Country Offices to implement the Gender Equality Core Commitment for Children in Humanitarian Action.
The resource is the result of an independent review of 14 UNICEF Country Office Emergency Preparedness Plans and a participatory prioritization exercise that engaged a diverse range of UNICEF leadership and staff from across sections, divisions, and offices in more than 20 Country and Regional Offices.
All UNICEF Country Offices are encouraged to reference these priority actions as they update their Emergency Preparedness Platforms (EPPs) in consultation with national and local partners
Analysis of Heavy Rainfall in Sub-Saharan Africa and HIV Transmission Risk, HIV Prevalence, and Sexually Transmitted Infections, 2005-2017
Get PDFImportance: Extreme precipitation, including heavy rains and flooding, is associated with poor health outcomes mediated in part by decreases in income and food production. However, the association between heavy rains and HIV burden is unknown.
Objective: To investigate the association between heavy rainfall, HIV prevalence, and HIV transmission risk over a 12-year span in sub-Saharan Africa.
Design, setting, and participants: A cross-sectional population-based study, using data collected from the 2005-2017 Demographic and Health Surveys, was conducted in 21 countries in sub-Saharan Africa and analyzed from July 29, 2021, to June 14, 2022.
Exposures: Heavy rainfall was defined based on the extent to which annual rainfall deviated from the historical average (standardized precipitation index ≥1.5) at the enumeration area level.
Main outcomes and measures: HIV, self-reported sexually transmitted infections (STIs), and number of sexual partners.
Results: The study included 288 333 participants aged 15 to 59 years; 172 344 were women (59.8%), and 183 378 were married (63.6%). Mean (SD) age was 31.9 (10.0) years. Overall, 42.4% of participants were exposed to at least 1 year of heavy rainfall in the past 10 years. Each year of heavy rainfall was associated with 1.14 (95% CI, 1.11-1.18) times the odds of HIV infection and 1.11 (95% CI, 1.07-1.15) times the odds of an STI in the past 12 months. There was also an association between heavy rainfall and the reported number of sexual partners (incident rate ratio, 1.12; 95% CI, 1.10-1.15). The odds were greater for the association between heavy rainfall and HIV prevalence and STIs among participants aged older than 20 years and participants in rural areas.
Conclusions and relevance: The findings of this study suggest that heavy rainfall was associated with a higher HIV burden in sub-Saharan Africa. The association between heavy rainfall and STIs and number of sexual partners suggests that an increase in the risk of sexual transmission is a plausible mechanism for the observed findings around HIV prevalence. Heavy rainfall could also worsen food insecurity, increasing the risk of transactional sex, or cause damage to public health infrastructure, reducing access to STI education, HIV testing, and treatment