What happens during antenatal visits? An ethnographic study of pregnant women’s experiences with midwives in Benin

Pregnancy and childbirth place women at risk of morbidity and mortality, particularly in Benin where the health system is fragile. This study aimed to understand women’s experiences concerning their interactions with midwives during antenatal visits and to explore contextual factors influencing these interactions and the quality of care received. A qualitative study was conducted from June to August 2015 in two primary health facilities in So-Ava, Benin. One hundred seven individual in-depth interviews with 100 pregnant women, five midwives, and two physicians and one focus group discussion with seven government decision-makers were conducted. Despite midwives’ good intentions, most pregnant women reported absenteeism, delays, cold attitudes, fear-based communication, and arbitrary and non-consensual interventions during antenatal visits and believed midwives would interfere with their family relationships. The suboptimal quality of care provided by midwives was interpreted as due to several factors, including lack of accountability of midwives in health facilities. The communication of midwives with pregnant women needs improvement. Results of this study highlight the importance of understanding the problem from the perspective of the political economy of the Benin health system to address its structural and systemic failures with open dialogue, including implementation of accountability measures.     

Managing money flow to safeguard your practice

Whether payments for service come in the form of patient cash or checks, or insurer payments, it is paramount that a doctor implement a strong accounting system to disclose all daily financial transactions. It is also essential that a strong audit trail be part of this accounting system. By taking a few minutes at the end of each day to do the necessary review, dentists protect their income and provide one of the best protections an owner can have against embezzlement. Let the staff know you are on top of the books!     

Female urinary incontinence and intravaginal electrical stimulation: an observational prospective study

Objective

To assess the efficacy of intravaginal electrical stimulation in the management of female urinary incontinence.

Study design

359 Women with urinary incontinence (207 with stress incontinence [group A], 33 with urge incontinence [group B] and 119 with mixed urinary incontinence [group C]) were included in this multicenter prospective observational study. Patients were managed by home intravaginal electrical stimulation of the pelvic floor for 20–30 min per day, 5 days a week, for a period of 10 weeks. Identical clinical assessments were performed before and after pelvic floor rehabilitation, comprising a voiding diary and validated symptom and quality of life scores.

Results

Objective assessment demonstrated an overall cure rate of 63.5% (228/359): 65.7% (136/207) for group A, 57.6% (19/33) for group B, and 61.3% (73/119) for group C. The overall significant improvement rate was 15.6% (56/359): 14.6% (30/207) for group A, 24.2% (8/33) for group B and 15.1% (18/119) for group C. All domains of quality of life were significantly improved after pelvic floor muscle training (p < 0.0001) with a patient satisfaction rate of 83.6%. Treatment was well tolerated with 1.4% (5/359) of patients describing pain at the highest stimulation intensities. No significant difference was observed between the various types of electrodes used (p < 0.0001).

Conclusion

The quantitative and qualitative efficacy in terms of social and psychological consequences and quality of life of home pelvic floor muscle training stimulators probably make this treatment modality one of the first-line treatments for female stress urinary incontinence.     

The outcome after cryosurgery and intralesional steroid injection in vulvar lichen sclerosus corresponds to preoperative histopathological findings

BACKGROUND: Vulvar lichen sclerosus (LS) still presents a therapeutic challenge. QUESTIONS: The aim of the present study was to investigate whether there is a correlation between preoperative histopathological findings in female LS and long-term results after cryosurgery and intralesional steroid injections. MATERIAL AND METHODS: 22 females with LS, mean age 65.3 +/- 10.5 years, were treated with cryosurgery (-186 degrees C) using the contact method with 1 freeze-thaw cycle per lesion and intralesional triamcinolone acetonide injection. The time between surgery and follow-up examination was 27.8 +/- 14.6 months. We compared the clinical outcome and the thickness of the epidermis, the zone of sclerosis and the inflammatory infiltrate in biopsy specimens taken before treatment. RESULTS: In 14 of 22 patients, a relapse after cryosurgery occurred (median after 7.5 months). Patients would 'moderately' recommend cryosurgery for LS (2.2 +/- 0.9; minimum: 0, optimum: 4). Pruritus was significantly reduced (visual analog scale: preoperative 7.1 +/- 2.6 vs. postoperative 2.0 +/- 2.4; p = 0.001) even in patients with relapse (preoperative 7.6 +/- 2.4 vs. postoperative 3.1 +/- 2.28; p = 0.001). Women with relapse showed a significantly higher composed thickness of epidermis, sclerosis and inflammatory infiltrate (430 +/- 139.0 microm) than those without relapse (314 +/- 41.2 microm; p = 0.046). CONCLUSION: In our patients, cryosurgery and intralesional steroid injections were efficient in the treatment of LS. Patients showing relapse had a thicker epidermis and a stronger inflammatory infiltrate. Therefore a treatment of LS should be performed at an early stage of the disease.     

The Impact of Sex-Specific Survival on the Incidence of Dementia in Parkinson's Disease

Objective

The aim of our study is to analyze sex-specific patterns of Parkinson's disease dementia (PDD) incidence. We are investigating the extent to which sex differences in survival after initial Parkinson's disease (PD) diagnosis influence differences in PDD risk among PD patients.

Methods

We used a random sample of German longitudinal health claims data of persons ages 50+ (2004–2019; n = 250,000) and identified new PD cases ages 65+ who were followed-up for a PDD diagnosis or death between 2006 and 2017. We performed Cox and competing-risk regression models, with death as competing event, to calculate PDD hazard ratios (HR) adjusted for age at PD onset, PD severity as measured by the modified Hoehn and Yahr (HY) scale, comorbidities, and medications.

Results

Of 2195 new PD cases, 602 people died before PDD and 750 people developed PDD by the end of 2017. The adjusted risk of PDD differs by sex, with men having a higher PDD risk than women. When accounting for death, men and women do not differ in their PDD risk (HR = 1.02, P = 0.770). Sex-specific analyses showed significant age and severity effects in women (age: HR = 1.05, P < 0.001; HY 3–5 vs. 0–2.5: HR = 1.46, P = 0.011), but not in men.

Conclusion

Older age at first PD diagnosis and higher disease severity increase PDD risk, but this association is attenuated for PD men when controlling for death. This implies that the most frail PD men die rapidly before receiving a dementia diagnosis, whereas women with PD survive at higher rates, regardless of their age at onset and disease severity. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.     

Platelet disorders in children: A diagnostic approach

The investigation of children with suspected inherited platelet disorders is challenging. The causes of mucocutaneous bleeding are many, and specialized testing for platelet disorders can be difficult to access or interpret. An algorithm developed for the investigation of suspected platelet disorders provides a sequential approach to evaluating both platelet function abnormalities and thrombocytopenia. Investigation begins with a clinical evaluation and laboratory testing that is generally available, including platelet counting, peripheral blood cell morphology, and aggregometry. Based on results of initial investigations, the algorithm recommends specialized testing for specific diagnoses, including flow cytometry, immunofluorescence microscopy, electron microscopy, and mutational analysis.