Women's experiences of care after stillbirth and obstetric fistula: A phenomenological study in Kenya

Background

Stillbirth and (obstetric) fistula are traumatic life events, commonly experienced together following an obstructed labour in low- and middle-income countries with limited access to maternity care. Few studies have explored women's experiences of the combined trauma of stillbirth and fistula.

Aim

To explore the lived experiences of women following stillbirth and fistula.

Methods

Qualitative, guided by Heideggerian phenomenology. Twenty women who had experienced a stillbirth were interviewed while attending a specialist Hospital fistula service in urban Kenya. Data were analysed following Van Manen's reflexive approach.

Results

Three main themes summarised participants' experiences: ‘Treated like an alien’ reflected the isolation and stigma felt by women. The additive and multiplying impacts of stillbirth and fistula and the ways in which women coped with their situations were summarised in ‘Shattered dreams’. The impact of beliefs and practices of women and those around them were encapsulated in ‘It was not written on my forehead’.

Conclusion

The distress women experienced following the death of a baby was intensified by the development of a fistula. Health professionals lacked an understanding of the pathophysiology and identification of fistula and its association with stillbirth. Women were isolated as they were stigmatised and blamed for both conditions. Difficulty accessing follow-up care meant that women suffered for long periods while living with a constant reminder of their baby's death. Cultural beliefs, faith and family support affected women's resilience, mental health and recovery. Specialist services, staff training and inclusive policies are needed to improve knowledge and awareness and enhance women's experiences.

Patient or Public Contribution

A Community Engagement and Involvement group of bereaved mothers with lived experience of stillbirth and neonatal death assisted with the review of the study protocol, participant-facing materials and confirmation of findings.     

Tropomyosin receptor kinase inhibitors: an updated patent review for 2010-2016 – Part II

Introduction: TrkA/B/C receptor activation supports growth, survival, and differentiation of discrete neuronal populations during development, adult life, and ageing but also plays numerous roles in human disease onset and progression. Trk-specific inhibitors have therapeutic applications in cancer and pain and thus constitute a growing area of interest in oncology and neurology. There has been substantial growth in the number of structural classes of Trk inhibitors and the number of industrial entrants to the Trk inhibitor field over the past six years.

Areas covered: In Part II of this two-part review, the discussion of recent patent literature covering Trk family inhibitors is continued from Part I and clinical research with Trk inhibitors is considered.

Expert opinion: Trk has been molecularly targeted for over a decade resulting in the progressive evolution of structurally diversified Trk inhibitors arising from scaffold hopping and HTS efforts. Correspondingly, there have been a growing number of clinical investigations utilizing Trk inhibitors in recent years, with a particular focus on the treatment of NTRK-fusion positive cancers and chronic pain. The observed potential of Trk inhibitors to cause adverse CNS side effects however suggests the need for a more rigorous consideration of BBB permeation capabilities during drug development.     

Minimal impact of response shift for SF-12 mental and physical health status in homeless and vulnerably housed individuals: an item-level multi-group analysis

Purpose

The purpose of this study was to examine whether homeless or vulnerably housed individuals experienced response shift over a 12-month time period in their self-reported physical and mental health status.

Methods

Data were obtained from the Health and Housing in Transition study, a longitudinal multi-site cohort study in Canada (N = 1190 at baseline). Multi-group confirmatory factor analysis (MG-CFA) and methods for response shift detection at the item level, based on the approach by Oort, were used to test for reconceptualization, reprioritization, and recalibration response shift on the SF-12 in four groups of individuals who were homeless (n = 170), housed (n = 437), or who reported a change in their housing status [from homeless to housed (n = 285) or housed to homeless (n = 73)] over a 12-month time period. Mean and variance adjusted weighted-least squares estimation was used to accommodate the ordinal and binary distributions of the SF-12 items.

Results

Using MG-CFA, a strict invariance model showed that the measurement model was equivalent for the four groups at baseline. Although we found small but statistically significant response shift for several measurement model parameters, the impact on the predicted average mental and physical health scores within each of the groups was small.

Conclusions

Response shift does not appear to be a significant concern when using the SF-12 to obtain change scores over a 12-month period in this population.

     

Does hepatitis C virus play a role in "non-viral" chronic liver disease?

It has recently been suggested that the hepatitis C virus may play a significant role in chronic liver diseases, such as autoimmune chronic active hepatitis, which are usually attributed to non-viral causes. We tested for antibodies to hepatitis C virus (anti-HCV) in sera from 140 patients with well characterised "non-viral" chronic liver diseases as well as sera from 51 patients thought to have chronic non-A, non-B (NANB) hepatitis (acting as positive controls) and 25 patients with non-hepatic autoimmune disorders. As expected, 45 of 51 patients (88%) diagnosed as having chronic NANB hepatitis were anti-HCV seropositive. Among 26 patients with cryptogenic cirrhosis, 8 were anti-HCV seropositive; in 5 patients (22%) there was no apparent risk factor for parenteral transmission. In the remaining 114 patients with chronic liver disease, 10 patients (9%) were seropositive for anti-HCV. However, 5 of these patients had a significant risk factor for parenteral transmission of hepatitis C virus, leaving only 5 of 106 (4.7%) with unexplained positive anti-HCV test results. Among patients with high titres of circulating autoantibodies but no liver disease, no positive results occurred. It is concluded that hepatitis C virus infection may account for some cases of cryptogenic cirrhosis. Although anti-HCV occurs more commonly in patients with other "non-viral" chronic liver diseases than has been reported in the community (0.5%-1.2%), the low prevalence of the antibodies indicates that hepatitis C virus infection is unlikely to be important in the aetiology or pathogenesis of autoimmune chronic active hepatitis and other poorly understood chronic liver diseases.     

Treatment with the artificial kidney (dialysis).

For patients with chronic renal disease, haemodialysis can provide reasonable rehabilitation and, in most cases, a life expectancy in excess of 10 years. However, dialysis is unable to provide for any loss of the kidneys' endocrine or metabolic activities and the kidneys' excretory capacity is only replaced suboptimally. Recent well controlled studies on the frequency, time and techniques of dialysis, instigated mostly as a consequence of recent hypotheses, such as the "middle molecule" theory and consideration of the potential importance of residual renal function, have resulted in a complete reassessment of the nature of adequate dialysis. Developments such as sorbent-based dialysis are leading to a wearable dialyser. Theoretical and hardware developments are providing not only more adequate treatment, but improved rehabilitation for those patients on chronic dialysis therapy.     

Capillary junctions of the rat are not affected by osmotic opening of the blood-brain barrier

Summary Osmotic opening of the blood-brain barrier had no effect on the structure of the interendothelial tight junctions located within approximately 9 m² of brain capillary endothelial plasma membrane (junction-containing) examined in this study. These tight junctions restrict the passive diffusion between the blood and the brain and constitute the anatomic basis of the blood-brain barrier. Increased permeability of the blood-brain barrier in the cerebral cortex of the right hemisphere of rats, induced by an infusion of a hypertonic solution of arabinose and monitored with the protein tracer horseradish peroxidase (HRP), was evidenced by the extravasation of the tracer into the extracellular compartment of the brain. Freeze-fracture analysis of the capillaries from the same tissue revealed no alterations in the intramembrane components of the endothelial tight junctions. The junctions, which consist of 8–12 highly anastomosed parallel ridges situated on the PF fracture face of the endothelial plasmalemma, showed no loss of ridge continuity or intraridge connections, and were identical to zonulae occludentes from control capillaries. Consistent labeling of numerous vesiculo-tubular elements by HRP in the endothelia of experimental tissue and the threedimensional nature of these elements observed in platinum replicas support the interpretation that these structures represent transendothelial conduits which are continuous with the luminal and abluminal surfaces of the endothelial cells. Absence of similar structures in control endothelia is taken as evidence that their presence in experimental tissues is a direct response to the osmotic insult. It was concluded, therefore, that during osmotic opening of the blood-brain barrier passage of HRP across the endothelium of brain capillaries is not by an inter-endothelial route due to disruption of tight junctions but rather by a transendothelial route due to amplified vesicular activity.Supported by the Natural Science and Engineering Council of Canada     

Effects of pubertal anabolic-androgenic steroid (AAS) administration on reproductive and aggressive behaviors in male rats

Adolescence in human males is a hormonally sensitive period when many adult behaviors develop, including sexual and aggressive behaviors. Using a rat model, the authors examined the effects of three anabolic-androgenic steroids (AAS) during puberty: testosterone, nandrolone, and stanozolol. Copulation, vocalizations, scent-marking, and aggression were tested following AAS exposure. Relative to gonadally intact controls, rats injected with testosterone showed a significant increase in scent-marking and aggression in the opponent's home cage. Nandrolone had no effect. Stanozolol significantly inhibited all behaviors. Results suggest that depending on the chemical structure of the steroid, AAS exposure during puberty affects several androgen-dependent behaviors. Because adolescence in humans is a period of hormonal change, abuse of AAS, particularly stanozolol, during this time may disrupt the establishment of normal adult behavior patterns.