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Family planning in the Eastern Democratic Republic of the Congo: personal beliefs, intimate partner negotiations and social pressure.
The Democratic Republic of the Congo (DRC) has a low prevalence of family planning use. Recent studies have highlighted the significant role that socio-cultural factors play in the decision to use family planning or not. This qualitative study explored barriers to women's use of family planning methods in an ongoing conflict region, South-Kivu, DRC. Focus group discussions and individual in-depth interviews were conducted to understand perceptions and habits regarding family planning. An inductive approach was used to analyse the data. Precariousness of life, religious beliefs and fear of side effects were limiting factors to the use of family planning. Power relations within the couple also played an important role in decision-making. Sole provider ('breadwinner') women were more likely to use family planning, including hormonal methods. Our findings highlight the continued importance of family planning programmes that respond to socio-cultural factors, personal beliefs, and fear of side effects in parallel with addressing availability and accessibility. This will require including the community in their design and implementation in order to meet unmet family planning needs. Health care providers' capacity building and training to help women manage family planning side effects will also be beneficial
Short-term data suggests cognitive benefits in the elderly with single-implant overdentures.
DESIGN
This study was an extension of a randomized crossover clinical trial approved by the institutional ethics committee (approval number: D2014-148) and adhered to the CONSORT guidelines. The original study juxtaposed patient contentment with single-implant overdentures (1-IODs) against conventional complete dentures (CCDs), with patient satisfaction being the primary focus. In this follow-up study, the cognitive function of edentulous patients receiving 1-IODs was assessed, specifically monitoring for the emergence of mild cognitive impairment (MCI) throughout a three-year period. Patient outcomes were systematically recorded at predetermined intervals: initially, two months post-1-IOD placement, after one year (with groups alternated between denture types at eight-month marks), then after two and three years. A prosthodontist with a decade of expertise performed all denture-related procedures. This follow-up emphasized the cognitive outcomes using the Montreal Cognitive Assessment (MoCA-J), considering it alongside previously documented results on masticatory function, bone resorption, survival rates, and patient-reported outcomes.
CASE SELECTION
Between 2015 and 2016, a follow-up study enrolled edentulous patients over 50 years of age who were proficient in Japanese, had sufficient mandibular bone for implants, and were free of systemic health issues and habits that could impact oral health. The participants were randomly divided into two groups after receiving a central mandibular implant. Group 1 initially used 1-IODs, and Group 2 used unloaded CCDs. After two months and subsequent periods, they swapped denture types. Eventually, all patients chose 1-IODs for continued use. Implant success was monitored over three years. The design featured block randomization and accounted for a sample size of 22, determined to be sufficient for evaluating the primary outcome of patient satisfaction. All patients underwent careful allocation and received customized dental interventions, with detailed radiographic planning and surgical precision guiding the implantation process.
DATA ANALYSIS
Multivariable linear mixed models were used to assess within-group changes in both overall and specific cognitive function scores across five timepoints. Age, assessment interval, and upper jaw denture status were incorporated as consistent variables, while individual participants were considered variable elements in the analysis. SPSS software version 22.0 was utilized to conduct the statistical tests, and a p value threshold of 0.05 was predetermined to establish statistical significance.
RESULTS
Twenty-two patients with edentulous mandibles received 1-IODs. Memory and executive functions saw significant score increases at multiple timepoints over the three-year period, with statistical significance. Though one participant dropped out and another passed away, and two did not complete the 3-year follow-up, the remaining 18 participants provided comprehensive data. Age and type of maxillary denture were significant factors, influencing MoCA-J scores with older participants and those with fixed dentures showing lower scores in certain domains. Overall, the findings illustrated the positive correlation between 1-IODs and cognitive function in older adults.
CONCLUSIONS
Older adults with no natural teeth left in their mandible showed improved cognitive function after one and three years of using 1-IODs, as reflected by their total and specific cognitive domain scores. The study suggests that such implant therapy may offer protective benefits against cognitive decline, demonstrating clinical relevance for patient care, regardless of the maxillary arch (antagonist) condition
Congestion patterns in severe tricuspid regurgitation and transcatheter treatment: Insights from a multicentre registry.
AIMS
While invasively determined congestion holds mechanistic and prognostic significance in acute heart failure (HF), its role in patients with tricuspid regurgitation (TR)-related right- heart failure (HF) undergoing transcatheter tricuspid valve intervention (TTVI) is less well established. A comprehensive understanding of congestion patterns might aid in procedural planning, risk stratification, and the identification of patients who may benefit from adjunctive therapies before undergoing TTVI. The aim of this study was to investigate the role of congestion patterns in patients with severe TR and its implications for TTVI.
METHODS AND RESULTS
Within a multicentre, international TTVI registry, 813 patients underwent right heart catheterization (RHC) prior to TTVI and were followed up to 24 months. The median age was 80 (interquartile range 76-83) years and 54% were women. Both mean right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were associated with 2-year mortality on Cox regression analyses with Youden index-derived cut-offs of 17 mmHg and 19 mmHg, respectively (p < 0.01 for all). However, RAP emerged as an independent predictor of outcomes following multivariable adjustments. Pre-interventionally, 42% of patients were classified as euvolaemic (RAP <17 mmHg, PCWP <19 mmHg), 23% as having left-sided congestion (RAP <17 mmHg, PCWP ≥19 mmHg), 8% as right-sided congestion (RAP ≥17 mmHg, PCWP <19 mmHg), and 27% as bilateral congestion (RAP ≥17 mmHg, PCWP ≥19 mmHg). Patients with right-sided or bilateral congestion had the lowest procedural success rates and shortest survival times. Congestion patterns allowed for discerning specific patient's physiology and specifying prognostic implications of right ventricular to pulmonary artery coupling surrogates.
CONCLUSION
In this large cohort of invasively characterized patients undergoing TTVI, congestion patterns involving right-sided congestion were associated with low procedural success and higher mortality rates after TTVI. Whether pre-interventional reduction of right-sided congestion can improve outcomes after TTVI should be established in dedicated studies
Duration of face mask exposure matters: evidence from Swiss and Brazilian kindergartners' ability to recognise emotions.
Wearing facial masks became a common practice worldwide during the COVID-19 pandemic. This study investigated (1) whether facial masks that cover adult faces affect 4- to 6-year-old children's recognition of emotions in those faces and (2) whether the duration of children's exposure to masks is associated with emotion recognition. We tested children from Switzerland (N = 38) and Brazil (N = 41). Brazil represented longer mask exposure due to a stricter mandate during COVID-19. Children had to choose a face displaying a specific emotion (happy, angry, or sad) when the face wore either no cover, a facial mask, or sunglasses. The longer hours of mask exposure were associated with better emotion recognition. Controlling for the hours of exposure, children were less likely to recognise emotions in partially hideen faces. Moreover, Brazilian children were more accurate in recognising happy faces than Swiss children. Overall, facial masks may negatively impact children's emotion recognition. However, prolonged exposure appears to buffer the lack of facial cues from the nose and mouth. In conclusion, restricting facial cues due to masks may impair kindergarten children's emotion recognition in the short run. However, it may facilitate their broader reading of facial emotional cues in the long run
Validation of a 9-item Perceived Suicide Awareness Scale (PSAS-9) for adolescents.
BACKGROUND
Robust empirical data on suicide awareness are needed, to better plan and evaluate suicide prevention interventions. However, there is a lack of validated measures of suicide awareness. This is especially true for perceived suicide awareness, which focuses on perceived knowledge about suicide, willingness, and confidence to talk about suicide and get help. Using the theoretical framework of Social Cognitive Theory, this study aimed to validate a measure of perceived suicide awareness.
METHODS
We re-used data from a suicide prevention trial conducted in Swiss secondary schools (n = 366). Baseline and one-month follow-up data were used to validate the scale. The main measure was an initial 14-item perceived suicide awareness scale (PSAS). Perceived knowledge of help-seeking resources, suicide-related knowledge, and support networks were used to assess convergent validity.
RESULTS
A nine-item version, the PSAS-9, showed satisfactory psychometric properties, including high internal consistency (α = 0.78), acceptable test-retest (r = 0.68), and a one-factor structure explaining 95 % of the variance. The convergent validity was acceptable (0.19 ≤ r ≤ 0.40). The PSAS-9 was not correlated with suicide-related knowledge (r = 0.02).
LIMITATIONS
The study missed a similar construct to properly assess convergent validity and had a modest sample size. In addition, it only included secondary school adolescents, so further research in other samples of youths is needed to robustly validate the PSAS-9.
CONCLUSIONS
This study was an important step towards validating a perceived suicide awareness scale, which appears as a new dimension of suicidality, distinct from suicide-related knowledge. The PSAS-9 could be used to develop, evaluate, and improve suicide prevention efforts
Use of Vitex agnus-castus in patients with menstrual cycle disorders: a single-center retrospective longitudinal cohort study.
PURPOSE
To evaluate clinical characteristics, quality of life (QoL) and effectiveness in patients with menstrual cycle disorders (MCDs) including abnormal uterine bleeding, dysmenorrhea and mastodynia/mastalgia related to premenstrual syndrome taking the Vitex agnus-castus (VAC) products Cyclodynon® or Mastodynon® in a real-world setting.
METHODS
A single-center retrospective longitudinal cohort study (3 ± 1 months), using data obtained from healthcare data archive and telephone interviews. The main study variables were changes in bleeding, menstrual pain, breast tenderness and patients' QoL.
RESULTS
Data from 1700 women with a mean age of 30.2 years (± 6.3) were analyzed. The most common MCDs were dysmenorrhea (43.8%) and mastodynia/mastalgia (21.1%). Three-month treatment with VAC extract substantially decreased the percentage of patients with irregular cycle (from 9.1% to 0.1%) and breast tenderness (from 39.9% to 0.8%). Improvement in bleeding intensity, frequency and menstrual pain was experienced by 83.4%, 79.2%, and 85.2% of the patients, respectively. When analyzed by disease category, these parameters improved in almost all dysmenorrhea patients, while they improved to a lesser extent in mastodynia/mastalgia patients. QoL improved in all aspects, but was reported by a higher proportion of dysmenorrhea patients compared to mastodynia/mastalgia patients. Treatment was overall well tolerated with a favorable safety profile.
CONCLUSION
These real-world data demonstrate the effectiveness of the VAC-containing products Cyclodynon® and Mastodynon® in the three-month treatment of MCDs, with a pronounced improvement in key disease symptoms and QoL. Intriguingly, while QoL was generally greatly improved, the response to VAC therapy varied depending on the type of underlying MCD
A Versatile Broadband Attached Proton Test Experiment for Routine 13C Nuclear Magnetic Resonance Spectroscopy.
The proposed broadband attached proton test sequence allows the user to easily record 13C nuclear magnetic resonance multiplicity-edited and quaternary-carbon-only spectra. Compared to earlier attached proton test experiments, it preserves both a tolerance for wide ranges of one-bond-coupling constant values and the effective suppression of residual CHn signals in the quaternary-carbon-only spectra. The recording of edited spectra or quaternary-carbon-only spectra is made easy by a single, user-controllable constant. These attributes make the broadband attached proton test experiment attractive for the 13C analysis of small molecules, including spectral editing, particularly in high-throughput analysis laboratories
Differences in femoral fracture localizations in men and women in Switzerland between 1998 and 2021-reversal of the secular trend?
UNLABELLED
Number and age-standardized incidences of femoral fractures by sex and localization were determined annually between 1998 and 2021 in subjects aged 45 years or older living in Switzerland. The number and incidences of femoral neck, pertrochanteric, subtrochanteric, and femoral shaft fractures followed distinct unexpected trend patterns.
INTRODUCTION
Long-term incidence trends for femoral fractures by individual localizations are unknown.
METHODS
Annual absolute number of hospitalizations and median age at hospital admission between 1998 and 2021 were extracted from the medical database of the Swiss Federal Office of Statistics by sex and 10-year age groups for the following 10th International Classification of Diseases (ICD-10) codes: femoral neck (ICD-10 S72.0), pertrochanteric (S72.1), subtrochanteric (S72.2), and femoral shaft fractures (S72.3). Age-standardized incidence rates (ASI) and corresponding trends were calculated.
RESULTS
Over 24 years, the number of femoral neck fractures increased in men (+ 45%) but decreased in women (- 7%) with ASI significantly decreasing by 20% and 37% (p < 0.001 for trend for both), respectively. By contrast, the number of pertrochanteric fractures increased by 67% and 45% in men and women, respectively, corresponding to a horizontal ASI-trend in men (n.s.) and a modest significant decreasing ASI-trend in women (p < 0.001). The number of subtrochanteric fractures increased in both sexes with corresponding modest significant reductions in ASI-trends (p = 0.015 and 0.002, respectively). Femoral shaft fractures almost doubled in men (+ 71%) and doubled in women (+ 100%) with corresponding significant increases in ASI-trends (p = 0.001 and p < 0.001, respectively). Age at admission increased for all fracture localizations, more so in men than in women and more so for subtrochanteric and shaft fractures than for "typical" hip fractures.
CONCLUSION
Incidence changes of pertrochanteric fractures and femoral shaft fractures deserve increased attention, especially in men. Pooling diagnostic codes for defining hip fractures may hide differing patterns by localization and sex