1,720,989 research outputs found
Self-Reported Antenatal Medicines Use Among Women Living with and Without HIV in Western Cape, South Africa: A Sub-Analysis of the B Positive Cohort Study
Full text linkGlobally, innumerable women take medication while they are pregnant, and this trend is growing. The pipeline of medicines targeting maternal comorbidities is expanding. However, for most medicines, there is insufficient data on their safety in pregnancy. In addition, women may be taking medication for chronic or acute conditions before they recognize that they are pregnant. This study compared the self-reported pattern of medicine use during the course of pregnancy in a cohort of pregnant women either living with or without HIV; seeking care at Gugulethu primary health care obstetric clinic in Western Cape, South Africa. Data on medicine use was collected over 3 antenatal visits. Medications reported were manually classified and coded by a clinical pharmacist and medical doctor. Structured interviews using a detailed questionnaire on medication use were administered to n=989 pregnant women. Women who had an ectopic pregnancy or an elective termination of pregnancy (TOP) were excluded from the analysis. 982 of these women were included in our analysis (n=507 HIV-negative and n=475 HIV positive). Of these, 39 (4.0%) did not report taking any medicine during pregnancy. Most 907 (92.3%) pregnant women reported using at least one over-the-counter medicine (OTC) and the majority, 601 (61.2%), at least one prescription medicine. A total of 36 (3.7%) reported using at least one herbal or traditional medicine over the course of the pregnancy. Pregnant women living with HIV were significantly less likely to report use of OTC medicine (56.2% vs 77.7%, p=<0.001). Pregnant women living with HIV also reported less herbal medicine use (2.9% vs 4.7%, p=0.07) compared to pregnant women living without HIV, though the effect was non-significant within this sample. Excluding antiretroviral medicines, prescription medicine use was essentially the same among pregnant women living with and without HIV (30.5% vs 30.2%, p=0.96). Exposure to medicines known to be potentially teratogenic or unsafe in pregnancy was reported in 300 (30.65%) pregnant women, with aspirin 238 (24.2%) and nonsteroidal anti-inflammatory medicines 46 (4.7%) medicines being the most reported. This study provides valuable information on self-reported medication use among pregnant women living with and without HIV in a South African primary healthcare setting. Medicine use was widespread in the study cohort, particularly OTC, with high prevalence of potentially unsafe medicines used during pregnancy. Our finding highlights the urgent need to build awareness around rational and safe medicine use among antenatal staff; pharmacists; and women of child-bearing age in South Africa, encouraging the taking of a thorough history of medicine exposure throughout the antenatal period
The use of m-Health active participant centred (MAPC) systems to improve surveillance of adverse events following Immunization (AEFIs) in Zimbabwe
Full text linkIntroduction A robust national AEFI surveillance system ensures timely AEFI detection, good quality AEFI reports, prompt case investigation and robust causality assessment for corrective AEFI case management, signal detection and appropriate feedback ultimately to improve public safety and trust in vaccines and the immunization programme. Each AEFI surveillance method has advantages and disadvantages. This thesis aimed to develop an evidence-based and empirical foundation to guide recommendations for the use of mHealth for active vaccine safety surveillance (AVSS) in Zimbabwe to strengthen its passive (spontaneous) AEFI surveillance system. The primary hypothesis of the thesis is that an mHealth application system that supports AEFI detection and reporting is a feasible approach to supporting active AEFI surveillance in Zimbabwe. Method I used mixed methods comprising a scoping and narrative literature review, a descriptive evaluation of Zimbabwe's AEFI system, a randomised control trial (RCT) to assess the impact of the Zimbabwe stimulated telephone assisted rapid safety surveillance (Zm-STARSS) approach, and a consumer and healthcare professional (HCP) survey to assess their experience and the acceptability of Zm-STARSS. Results The scoping and narrative review revealed that most MAPC AEFI surveillance studies (92%, 24/26) were conducted in High Income Countries(HICs) and only two in Low Middle-Income Countries (LMICs). The mean response rate to (Short Message Services)SMS prompts was 71% among 23 studies. Out of 1440 assessed Zimbabwean AEFI reports 54.2% were non-serious, 29.7% non-serious but deemed medically important, 6.6% causing prolonged hospitalizations and 8.1% fatal. In the Zm-STARSS RCT, despite a relatively low (31%, n = 704) response rate, we demonstrated that the SMS group had a 2% AEFI detection rate compared to 0% in the passive control arm. Of the 31 HCPs and 96 consumers who responded, 96% and 71%, respectively, supported the use of Zm-STARSS for improving AEFI reporting. Respondents identified lack of feedback after reporting, fear of negative consequences, and mobile phone costs as major barriers to SMS reporting. Conclusion and recommendations The paucity of MAPC surveillance in LMICs highlights the need for more active surveillance of AEFIs in these regions. Zm-STARSS AEFI surveillance improved AEFI detection and reporting in an LMIC setting. Although the response rate was lower than what was seen in HICs, potential barriers to responding can be mitigated with simple reprogramming. Therefore, we recommend its use in LMIC settings. To support this improved reporting and ensure appropriate responses to these reports, it is imperative to strengthen the remaining elements of AEFI surveillance, including case investigation, causality assessment, case management and feedback. In addition, prioritising training and awareness initiatives aimed at mitigating factors contributing to underreporting, including addressing HCPs and consumers' fear of victimisation, is essential. The cost of MAPC for both consumers and HCPs should be minimised to improve AEFI reporting in Zimbabwe and similar LMICs. This may require engagement with mobile phone operators to lower rates (toll-free) for mHealth surveillance systems. Further studies should investigate the feasibility and effectiveness of the mHealth approach in other LMIC settings, particularly consumer response rates, impact on AEFI reporting rates and the regulatory and Immunization programmes' responses to these reports
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Noma in northwest Nigeria: a neglected disease in neglected populations
Full text linkBackground Noma, also known as cancrum oris, is a gangrenous infection of the oral cavity, which causes widespread orofacial destruction. If untreated, noma has a reported 90% mortality rate within weeks after the onset of first symptoms. Noma progresses through distinct stages defined by the World Health Organisation (WHO); Stage 0: simple gingivitis; Stage 1: acute necrotizing gingivitis; Stage 2: oedema; Stage 3: gangrene; Stage 4: scarring. Stage 5: sequelae. It is unclear how many patients with the early stages of noma will progress to the later stages of disease. Treatment in the early reversible stages with antibiotics, wound debridement and nutritional support greatly reduces morbidity and mortality. Acute noma is most often reported in children aged between two and five years. Many patients who survive the acute stages of the disease suffer into adulthood with disfigurement and disability of varying degrees. Noma is thought to be most prevalent in developing countries in Africa and Asia. Estimates for noma prevalence and incidence vary. In 1998, the WHO estimated an annual incidence of 140,000 cases of acute noma and 770,000 noma survivors living with sequelae. Two Nigerian studies estimated the burden of disease ranged from seven cases per 1,000 children aged between one and 16 years (2003) to 6.4 per 1,000 children (2003). A study from 2019 estimated the period prevalence of noma from 2010 to 2018 was 1.6 per 100,000 population at risk in Nigeria. These estimates are based on expert opinion, number of hospital admissions and retrospectively collected hospital-based data and it is unclear which stages of noma were included. Risk factors for the disease include poor oral hygiene, malnutrition, comorbidities and low socioeconomic status. Despite its ancient history (reported by Hippocrates (460 - 370 BC)), noma-related literature remains mainly confined to case reports and case series. By employing both qualitative and quantitative methods, we sought to examine the biopsychosocial features of noma, its epidemiology and treatment in northwest Nigeria in order to inform advocacy and prevention efforts. The three overarching objectives to fulfil this aim were to assess the distribution of noma among children in northwest Nigeria; identify factors associated with noma (including factors influencing health-seeking behaviour and risk factors for the development of noma) and gain an understanding of the biomedical and non-biomedical care provided to noma patients in this setting. The knowledge gained through this thesis will support the assessment of the need for advocacy around noma, effective resource allocation and the planning of intervention strategies. Methods We conducted a scoping literature review, three quantitative studies (risk factors, outcomes, prevalence) and two qualitative studies (language and beliefs and traditional healing practices) in northwest Nigeria. Data were collected from patient caretakers at the Noma Children's Hospital, hospital staff, children and traditional healers in villages within Sokoto and Kebbi States. Data collection methods included quantitative surveys, oral screenings, anthropometric measurements, quality of life questionnaires, qualitative in-depth interviews and focus group discussions. Consenting adult respondents answered questionnaires and participated in interviews, and where applicable, data was collected from assenting children. Quantitative analyses included descriptive statistics as well as univariable and multivariable risk factor analyses. Qualitative data was manually coded and analysed thematically. Findings We included 74 cases (noma patients presenting at the hospital in the year preceding data collection) and 222 controls (both median age of five years (inter-quartile range 3, 15 years)) in the risk factor study. Vaccination coverage for polio and measles was below 7% in both cases and controls. The multivariable analysis identified the child being fed pap every day (adjusted odds ratio (aOR) 9.8; 95% confidence interval (CI 1.5, 62.7) as a risk factor. The mother being the primary caretaker (aOR 0.08; CI 0.01, 0.5) and the caretaker being married (aOR 0.006; CI 0.0006, 0.5) were protective factors. Of the 37 patients with noma sequelae included in the outcomes study, 21 (56.8%) were male and 22 (62.9%) were aged six years or older. Fifteen patients (40.5%) had two to three surgeries. The most frequently used surgical procedure was a deltopectoral flap (n=16 patients; 43.2%). Trismus was released in 12 patients (32.4%), of these; none had a normal mouth opening at the follow-up visit. Despite this finding, all respondents reported that the surgery had improved their quality of life. In the cross-sectional study assessing the prevalence of all stages of noma, we included 3,499 households and 7,122 children aged <15 years; 4,239 (59.8%) were aged 0 to 5 years. Simple gingivitis was identified in 3.1% (n=181; CI 2.6-3.8), acute necrotizing gingivitis in 0.1% (n=10; CI 0.1-0.3), and oedema in 0.05% (n=3; CI 0.02-0.2). No cases of late-stage noma were detected. Naming of the disease differed between caretakers and healthcare workers in the language and beliefs study. Beliefs about the causes of noma were varied (spirits, animals, insects, previous infections). Noma patient caretakers spoke of the mental health strain due to stigmatization as a key issue. Difficulty in accessing care was evident. A lack of trust in the health system was mentioned as a barrier to care. Traditional healers offered specialised forms of care for specific conditions and referral guidance. They viewed the stages of noma as different conditions with individualised remedies and were willing to refer noma patients. Caretakers trusted traditional healers. Conclusion Social conditions and childhood feeding practices are associated with the occurrence of noma in northwest Nigeria. This thesis has shown that following their last surgical intervention, noma patients do experience some improvements in their quality of life, but continue to face functional challenges that inhibit their daily life. We found many, widely distributed, early-stage noma cases in northwest Nigeria indicating a large population at risk of progressing to the later stages of disease. Caretaker and practitioner perspectives may enlighten efforts to improve case finding, and to understand barriers to accessing health care. Differences in disease naming illustrated the difference in beliefs about the disease. Traditional healers could play a crucial role in the early detection of noma and the health-seeking decision-making process of patients. Intervention programmes should include traditional healers through training and referral partnerships. In conclusion, this thesis provides a unique view of the biopsychosocial features, epidemiology and treatment options for noma in northwest Nigeria. Noma is a disease, which is indicative of a weak health system and socio-economic environments of extreme deprivation. Intervention programmes should include widespread health system improvements that could address a host of risk factors for noma, and simultaneously other childhood diseases. These include increasing access to quality health care (including vaccinations), ensuring effective referral mechanisms, predominantly in rural areas, and the creation of a robust surveillance network. Health financing initiatives would need to be paired with these improvements. Nutritional programs aimed at caretakers of young children and community-based oral health initiatives could be effective mechanisms to curb the number of noma cases. Awareness-building initiatives targeting healthcare workers and community members are necessary to improve the detection and timely management of noma in endemic settings. The combined findings of this thesis highlight the neglected nature of noma and make a strong case for placing noma on the WHO neglected tropical diseases list. This initiative could foster awareness among policy-makers and governments and direct much needed funding to facilitate further research, surveillance and targeted health interventions that would contribute to the eradication of noma
A comparative analysis of the medicine use and exposures in infants who are HIV exposed uninfected and HIV unexposed uninfected in the first year in Cape Town, South Africa
No full textBackground: Despite several studies investigating medicine exposures in infants, the administration and monitoring of medications in infants who are HIV-exposed uninfected (HEU), a growing population, remains poorly studied. This study aimed to describe and compare medication consumption patterns, including immunization coverage, between infants who are HEU and HIV-unexposed uninfected (HUU) during their first year of life. Methods: This was a secondary analysis of a birth cohort study of pregnant women living with and without HIV and their infants between 2017 and 2019 in Cape Town, South Africa. Interviewer- administered questionnaires captured sociodemographic factors, self-reported medication use, infant feeding practices, and vaccine use over four postnatal visits (<7 days, 10 weeks, 6 and 12 months). Data was manually classified and coded by a clinical pharmacist and student. Logistic regression models were employed to compare patterns of use among infants who are HEU and HUU, as well as identify other maternal and infant factors associated with medication use and vaccine coverage. Findings: A total of 772 mother-infant pairs were analyzed. Compared to infants who are HUU, HEU infants were preterm (64/393 vs. 39/379; p = 0.02), less often breastfed (314/393 vs. 322/379; p <0.001), and weighed less (median, 3288g vs. 3405 g; p = 0.03). HEU infants were found to take at least one medication at a significantly higher rate 388/393 (98.7%) vs 345/379 (91.0%) than infants who are HUU (p <0.001). HEU infants reported lower use of over-the-counter (OTC) medicine (69.2% vs. 80.2%; p <0.01) and traditional, complementary, and alternative medicine (TCAM) (16.8% vs. 26.1%; p <0.001) compared to HUU infants. Mothers of HEU infants were less likely to forget a medicine's name (29.3% vs. 36.9%, p<0.001) than HUU mothers. Prescription medicine use, excluding antiretroviral (ARV) prophylaxis medicines routinely administered to infants who are HEU at birth, was significantly higher among infants who are HEU compared to HUU (65.4%. vs. 23.0%; p <0.01). Vaccine coverage showed no significant difference between infants who are HEU and HUU but steadily declined over the year (95.0% coverage with birth immunizations, vs 70.0% at 9 months) across the entire cohort. Only 293 infants (38.0%) had complete immunization coverage at 1 year. In the adjusted models, being a HEU infant was a protective factor against self-medication. (aOR 0.45; 95% CI 0.31 –0.65; p <0.001). Conversely, being breastfed (aOR 2.46; 95% CI 1.56 –3.83; p <0.001) was a significant risk factor for self-medication infants. Prescription medicine use (excluding ARV prophylaxis medicines) was significantly associated with increased maternal age (aOR 1.06; 95% CI 1.03 – 1.08; p <0.001) and infants who are HEU (aOR 6.52; 95% CI 4.66 – 9.21; p <0.001). No significant associations were found between maternal and infant characteristics and full vaccine coverage. Interpretation: The study revealed that infants who are HEU were more exposed to prescribed medicine (excluding ARV prophylaxis medicines) compared to their HUU counterparts, however, mothers of HUU infants, generally reported higher usage of both TCAM and OTC compared to HEU infants. The study also revealed drops in vaccine coverage rates among infants over the first year of life, indicating a gap in protection against vaccine-preventable diseases. Further research is needed to study medication patterns in different settings. Medication literacy efforts need to be prioritized in pregnant women and mothers of newborns to support rational and safe medicine (including vaccine) usage and subsequently improve the health outcomes for all infants, irrespective of HIV status
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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