Psychosocial factors influencing contraceptive use among adolescent mothers in the Volta Region of Ghana: application of the Health Belief Model

BackgroundGlobally, complications arising from pregnancy and childbirth are the leading cause of death among pregnant women aged 15 to 19 years. This study investigated the psychosocial factors influencing contraceptive use among adolescent mothers in the Volta Region using the Health Belief Model (HBM).MethodsThis was a cross-sectional study conducted among 422 adolescent mothers. An interviewer-administered structured questionnaire was used to collect data. Binary logistic regression was used to determine the strength of association between the independent and the dependent variables at a p-value less than 0.05.ResultsThe prevalence of contraceptive use was 18.7%. Concerning perceived susceptibility, there was a significant association between contraceptive use and the perception of being at risk of pregnancy complications (p<0.001). Perceived barriers showed a significant association between fear of side-effects of contraceptives and contraceptive use (p=0.007). Concerning perceived self-efficacy, there was a significant association between contraceptive use and confidence to suggest to a partner to use contraceptives (p=0.003); confidence to ask for contraceptives from health facilities (p<0.001) and confidence to use contraceptives (p<0.001).ConclusionProgrammes to increase contraceptive use should aim at heightening the perception of risk of pregnancy complications, reduce barriers to contraceptive use and increase the skills in negotiating contraceptive use.     

Laparoscopic paravaginal repair of anterior compartment prolapse

STUDY OBJECTIVE: To assess the results of laparovaginal repair of anterior vaginal prolapse in terms of perioperative morbidity and repair durability. DESIGN: Longitudinal study of a consecutive series of women assessed with the pelvic organ prolapse quantification (POPQ) system before and after laparoscopic paravaginal repair of anterior vaginal prolapse (Canadian Task Force classification II-2). SETTING: University hospital in South Australia. PATIENTS: Two hundred twelve women undergoing laparoscopic paravaginal repair for anterior compartment prolapse, with average follow-up of 14.2 months and 10 (4.7%) lost to follow-up. INTERVENTIONS: All women underwent bilateral laparoscopic paravaginal repair that was combined with uterosacral hysteropexy or colpopexy in women with concomitant level I defects (n = 42) and supralevator repair in those with posterior fascia defects (n = 47). Recurrences were treated with graft-reinforced anterior colporrhaphy (n = 18). MEASUREMENTS AND MAIN RESULTS: Nine women (4.2%) had major complications, and there were 61 minor complications. The POPQ assessment on follow-up (mean 14.2 months) gave a prolapse cure of the laparoscopic repair of 76% (95% CI 70.7%-82.1%). Eighteen of 23 women with a residual central defect subsequently had a graft-reinforced anterior colporrhaphy, after a mean interval of 14 months, which increased the cure rate to 84% (95% CI 79.6%-89.3%). CONCLUSION: Laparoscopic paravaginal repair followed by graft-reinforced anterior colporrhaphy for central defects, when necessary, is associated with a low morbidity rate and achieves an anatomic cure rate greater than 80%.     

Laparovaginal hysterectomy: a decade of evolution

OBJECTIVE: To compare surgical outcomes for laparoscopically-assisted vaginal hysterectomy (LAVH) to total laparoscopic hysterectomy (TLH) and to document the modifications to the technique of laparovaginal hysterectomy which have occurred over the last decade at Flinders Endogynaecology, South Australia, Australia. The method of choice at the start of the decade was LAVH and by the end of the study period it had been superceded by TLH. SAMPLE: Seven hundred and ninety-four consecutive women underwent hysterectomy between January 1992 and December 2001 at Flinders Endogynaecology. This included 424 women who underwent TLH and 370 who underwent LAVH. Methods: Retrospective review of case history notes and manual extraction of data. MAIN OUTCOME MEASURES: Demographic data including patient age, weight and parity were extracted. Intraoperative complications including ureteric injury, cystotomy, bowel damage or conversion to open procedure were recorded. The rate of non-autologous blood transfusion was recorded and miscellaneous data including length of procedure, estimated blood loss, length of hospitalisation, concomitant procedures carried out and re-admission rates were also recorded. RESULTS: There was a statistically significant reduction in major morbidity in the TLH group when compared to the LAVH group. The lower rate of conversion to laparotomy in the TLH group was statistically significant (3.0 vs 0.9%). A non-significantly higher rate of ureteric injury was observed in the TLH group (0.7 vs 0.3%). Other outcome measures showed a trend toward an improved outcome for TLH but were not statistically significant. This includes a lower rate of bowel injury in the TLH group (0 vs 0.3%), a lower rate of cystotomy in the TLH group (1.4 vs 3.0%) and lower rate in non-autologous blood transfusion in the TLH group (1.2 vs 3.0%). There was a statistically significant reduction in hospital stay from 4.5 days in the LAVH group to 3.4 days in the TLH group. CONCLUSION: The evolution of laparovaginal hysterectomy from LAVH to TLH over the last 13 years has resulted in improved patient outcomes. Ongoing modification of the technique to ensure ureteric protection must remain a priority.     

Complete surgical resection in children with low-grade astrocytomas after neoadjuvant chemotherapy

INTRODUCTION: Low-grade astrocytomas constitute the majority of pediatric central nervous system neoplasms. Gross total resection is desirable as the initial therapeutic approach and is curative in most cases. In the past, radiation therapy was often recommended for patients in whom complete resection was not achieved, although there are special concerns about secondary malignancy and cognitive impairment. There has been increasing interest in the use of chemotherapy to treat these tumors, but appropriate indications still need to be defined. CASE REPORTS: The use of neoadjuvant chemotherapy to ease surgical resection in two children with inoperable pilocytic astrocytomas who presented with extrinsic compression of mesencephalic structures is described. DISCUSSION: This paper also emphasizes and discusses the therapeutic approach for very selected cases of low-grade gliomas in children presenting with inoperable giant lesions, in whom the use of chemotherapy may be considered initially.     

Snail Based Carbonated-Hydroxyapatite Material as Adsorbents for Water Iron (II)

Carbonated hydroxyapatite (CHAp) adsorbent material was prepared from Achatina achatina snail shells and phosphate-containing solution using a wet chemical deposition method. The CHAp adsorbent material was investigated to adsorb aqua Fe(II) complex; [Fe(H₂O)₆]²⁺ from simulated iron contaminated water for potential iron remediation application. The CHAp was characterized before and after adsorption using infrared (IR) and Raman spectroscopy. The IR and the Raman data revealed that the carbonate functional groups of the CHAp adsorbent material through asymmetric orientation in water bonded strongly to the aqua Fe(II) complex adsorbate. The adsorption behaviour of the adsorbate onto the CHAp adsorbent correlated well to pseudo-second-order kinetics model, non-linear Langmuir and Freundlich model at room temperature of a concentration (20–100 mg L⁻¹) and contact time of 180 min. The Langmuir model estimated the maximum adsorption capacity to be 45.87 mg g⁻¹ whereas Freundlich model indicated an S-type isotherm curvature which supported the spectroscopy revelation.     

Cost–effectiveness of community-based practitioner programmes in Ethiopia,Indonesia and Kenya

Objective

To assess the cost–effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya.

Methods

Incremental cost–effectiveness ratios for the three programmes were estimated from a government perspective. Cost data were collected for 2012. Life years gained were estimated based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia and Kenya, estimates of coverage before and after the implementation of the programme were obtained from empirical studies. For Indonesia, coverage of health service interventions was estimated from routine data. We used the Lives Saved Tool to estimate the number of lives saved from changes in reproductive, maternal, neonatal and child health-service coverage. Gross domestic product per capita was used as the reference willingness-to-pay threshold value.

Findings

The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya, $999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis, there was greater than 80% certainty that each programme was cost-effective.

Conclusion

Community-based approaches are likely to be cost-effective for delivery of some essential health interventions where community-based practitioners operate within an integrated team supported by the health system. Community-based practitioners may be most appropriate in rural poor communities that have limited access to more qualified health professionals. Further research is required to understand which programmatic design features are critical to effectiveness.     

Curcumin loaded Ag–TiO2-halloysite nanotubes platform for combined chemo-photodynamic therapy treatment of cancer cells

The use of naturally occurring anticancer materials in combination with doped metal oxide has emerged as one of the most promising ways for improving anticancer treatment efficacy. In this study, the anticancer potential of curcumin-loaded Ag–TiO₂-halloysite nanotubes (curcumin-loaded Ag–TiO₂-HNTs) was examined. Ag–TiO₂-HNTs with different wt% of Ag–TiO₂ were synthesized and characterized using XRD, TGA, FT-IR, UV-Vis spectroscopy, and SEM-EDX. The XRD results revealed the presence of crystalline TiO₂. However, the presence of Ag was detected through the SEM-EDX analysis. Cyclic voltammetry measurements suggested the enhancement of the release of ROS from TiO₂ upon deposition with Ag. FT-IR and TGA analysis confirmed the successful loading of curcumin inside the nanotubes of the halloysite. In vitro drug released studies revealed the release of approximately 80–99% curcumin within 48 hours. Kinetic model studies revealed that the release of curcumin from HNT and Ag–TiO₂-HNT followed the first-order and Higuchi models, respectively. The light irradiated curcumin-loaded Ag–TiO₂-HNTs samples exhibited considerable anticancer potential as compared to the free curcumin, irradiated Ag–TiO₂ NPs samples, and unirradiated curcumin loaded Ag–TiO₂-HNTs samples. The obtained results revealed that combined chemo- and photodynamic therapy using curcumin-loaded Ag–TiO₂-HNTs nanomaterial has the potential as an effective anticancer treatment method.

The synergy between photogenerated reactive oxygen species and the anticancer potency of curcumin was examined by exposing HeLa cancer cells to irradiated curcumin loaded halloysite nanotubes-Ag–TiO₂ nanomaterial. 0% cell viability was obtained.     

Guided ultrasound calibration: where,how, and how many calibration fiducials

Purpose

Many image-guided interventions rely on tracked ultrasound where the transducer is augmented with a tracking device. The relationship between the ultrasound image coordinate system and the tracking sensor must be determined accurately via probe calibration. We introduce a novel calibration framework guided by the prediction of target registration error (TRE): Between successive measurements of the calibration phantom, our framework guides the user in choosing the pose of the calibration phantom by optimizing TRE.

Methods

We introduced an oriented line calibration phantom and modeled the ultrasound calibration process as a point-to-line registration problem. We then derived a spatial stiffness model of point-to-line registration for estimating TRE magnitude at any target. Assuming isotropic, identical localization error, we used the model to estimate TRE for each pixel using the current calibration estimate. We then searched through the calibration tool space to find the pose for the next fiducial which maximally minimized TRE.

Results

Both simulation and experimental results suggested that TRE decreases monotonically, reaching an asymptote when a sufficient number of measurements (typically around 12) are made. Independent point reconstruction accuracy assessment showed sub-millimeter accuracy of the calibration framework.

Conclusion

We have introduced the first TRE-guided ultrasound calibration framework. Using a hollow straw as an oriented line phantom, we virtually constructed a rigid lines phantom and modeled the calibration process as a point-to-line registration. Highly accurate calibration was achieved with minimal measurements by using a spatial stiffness model of TRE to strategically choose the pose of the calibration phantom between successive measurements.