Addressing social and gender norms to improve uptake of maternal health services in Mali: a descriptive study of CARE’s Project Hope for Mothers and Newborns (PEMN)

Abstract

This study examines the design and implementation of a maternal mortality prevention intervention in central Mali. It uses Project Hope for Mothers and Newborns (PEMN) as a case study to examine the context around implementation, with special emphasis on the role of social, gender and power norms in meeting programme objectives. Interventions to strengthen the health system and workforce were coupled with a social norms change approach to catalyse the personal transformation of staff, community-level health workers and communities via critical reflection and dialogue on gender and social power norms related to maternal health. Processes of reflection among staff, health workers and the community, coupled with activities that challenged restrictive norms, provided a platform for critical thinking, communication and motivation for change. Rigorous and comprehensive monitoring and evaluation is needed to identify and understand unique pathways to transformative change.     

Oestrogen receptor gene polymorphisms and ovarian stimulation for in- vitro fertilization

Experimental evidence has shown that mice lacking the oestrogen receptor (ESR) gene are infertile with cystic ovaries and follicular arrest. In humans, several polymorphisms and mutations in the ESR gene have been identified. In this study we have analysed a common PvuII and a rare BstUI polymorphism in the ESR gene. Analysis was carried out on DNA samples from women undergoing ovarian stimulation for in-vitro fertilization (IVF) and embryo transfer and controls having at least one pregnancy. Comparisons were done between the three PvuII genotypes, concerning the mean numbers of follicles and oocytes and the mean ratios of follicles to oocytes harvested in two consecutive cycles. Significantly lower ratios were identified in the group lacking the PvuII polymorphism, compared with the groups with heterozygous or homozygous PvuII polymorphisms (P > 0.05 and P > 0.01 respectively). The rare haplotype having both PvuII and BstUI restriction sites on one chromosome was present only in the IVF group. Pregnancies from IVF were significantly rarer in patients who were homozygous for the PvuII polymorphism (P > 0.05). Our results suggest that genetic variability in the ESR has a role in the quality of the ovarian follicles as judged by the ovarian response to stimulation and may also affect implantation.      

Luteinizing hormone response to gonadotrophin-releasing hormone in normal women undergoing ovulation induction with urinary or recombinant follicle stimulating hormone

Oestradiol enhances pituitary sensitivity to gonadotrophin-releasing hormone (GnRH) in normal women, while in women undergoing ovulation induction the putative factor gonadotrophin surge attenuating factor (GnSAF) attenuates the response of luteinizing hormone (LH) to GnRH. To study the relationships between oestradiol and GnSAF during ovulation induction, 15 normally ovulating women were investigated in an untreated spontaneous cycle (control, first cycle), in a cycle treated with daily i.m. injections of 225 IU urinary follicle-stimulating hormone (FSH) (Metrodin HP, uFSH cycle) and in a cycle treated with daily s.c. injections of 225 IU recombinant FSH (Gonal-F, rFSH cycle). Treatment with FSH started on cycle day 2. The women during the second and third cycle were allocated to the two treatments in an alternate way. One woman who became pregnant during the first treatment cycle (rFSH) was excluded from the study. In all cycles, an i.v. injection of 10 microg GnRH was given to the women (n = 14) daily from days 2-7 as well as from the day on which the leading follicle was 14 mm in diameter (day V) until mid-cycle (n = 7). The response of LH to GnRH at 30 min (deltaLH), representing pituitary sensitivity, was calculated. In the spontaneous (control) cycles, deltaLH values increased significantly only during the late follicular phase, i.e. from day V to mid-cycle, at which time they were correlated significantly with serum oestradiol values (r = 0.554, P < 0.01). Initially during the early follicular phase in the uFSH and the rFSH cycles, deltaLH values showed a significant decline which was not related to oestradiol (increased GnSAF bioactivity). Then, deltaLH values increased significantly on cycle day 7 and further on day v with no change thereafter up to mid- cycle. On these two days, deltaLH values were correlated significantly with serum oestradiol values (r = 0.587 and r = 0.652 respectively, P < 0.05). During the pre-ovulatory period, deltaLH values in the FSH cycles were significantly lower than in the spontaneous cycles. Significantly higher serum FSH values were achieved during treatment with uFSH than rFSH. However, serum values of oestradiol, immunoreactive inhibin, and deltaLH as well as the number of follicles > or = 12 mm in diameter did not differ significantly between the two FSH preparations. These results suggest that in women undergoing ovulation induction with FSH, oestradiol enhances pituitary sensitivity to GnRH, while GnSAF exerts antagonistic effects. The rFSH used in this study (Gonal-F) was at least as effective as the uFSH preparation (Metrodin-HP) in inducing multiple follicular maturation in normally cycling women.      

Effect of cooling on cutaneous microvascular adrenoceptors in vivo in the rabbit ear

Previous studies have suggested that moderate cooling increases the responsiveness of vascular α₂-adrenoceptors. However, limited information is available documenting the influence of temperature changes on adrenoceptor responses in the microvasculature of thermoregulatory organs (e.g., the human digit and the rabbit ear) subjected to a wide range of temperatures. In the present study, the effect of local cooling (24°C) on cutaneous microvascular adrenoceptors in the ear was observed in vivo in male New Zealand White rabbits (total: 66 ears). The rabbit ear was studied in a temperature-controlled tissue bath; the ear preparation was pretreated with terazosin (an α₁-adrenoceptor antagonist) (10^?5 M) or a combination of terazosin (10^?5 M) and propranolol (a β-adrenoceptor antagonist) (10^?6 M). The microvascular diameter responses of the ear to norepinephrine (10^?l1-10^?4M) then were determined at 24 or 34°C, respectively, to determine the influences of low temperature on adrenoceptor responses to norepinephrine stimulation. The results demonstrated that low concentrations of norepinephrine induced vasodilation in arterioles and arteriovenous anastomoses. This vasodilation was followed by vasoconstriction with an increased concentration of norepinephrine in animals with α₁-adrenergic blockade at 34°C. Moderate tissue cooling increased the microvascular maximal response of the rabbit ear to norepinephrine and abolished the vasodilatation induced by a low concentration of norepinephrine. There was no significant difference in the microvascular response to norepinephrine between the two temperature conditions after simultaneous blockade of α₁-adrenoceptors and β-adrenoceptors. Data from the present study indicate that moderate cooling does not enhance the responsiveness of α₂-adrenoceptors to norepinephrine. In contrast, cooling reduced the β-adrenergic activity of arterioles and arteriovenous anastomoses after norepinephrine stimulation.     

A randomized trial of diagnostic ultrasound to improve outcomes in focal neuropathies

Introduction: Neuromuscular ultrasound is valid, reliable, and accurate, but it is not known whether combining it with electrodiagnostic studies leads to better outcomes in individuals with focal neuropathies. Methods: One hundred twenty individuals with focal neuropathy, based on history, examination, and electrodiagnosis, were enrolled in this study. All patients underwent neuromuscular ultrasound and were randomized to either have their ultrasound results sent to the referring physician or not have them sent. Outcomes were assessed at 6 months by evaluators blinded to group assignment. Results: The Overall Disability Sum Score and 7 of 8 domains of the Medical Outcomes Study 36‐item Short‐Form Health Survey (SF‐36) showed more improvement in the “report sent” group, although only the general health perception domain was significant (P = 0.005). Conclusions: Most 6‐month outcomes did not reach statistical significance between the 2 groups. However, the “report sent” group had trends toward better outcomes, with significance being reached in the general health perception domain of the SF‐36. Muscle Nerve 52 : 746–753, 2015     

Multiscattering-enhanced optical biosensor: multiplexed,non-invasive and continuous measurements of cellular processes

The continuous measurement of uptake or release of biomarkers provides invaluable information for understanding and monitoring the metabolism of cells. In this work, a multiscattering-enhanced optical biosensor for the multiplexed, non-invasive, and continuous detection of hydrogen peroxide (H₂O₂), lactate and glucose is presented. The sensing scheme is based on optical monitoring of the oxidation state of the metalloprotein cytochrome c (cyt c). The analyte of interest is enzymatically converted into H₂O₂ leading to an oxidation of the cyt c. Contact microspotting is used to prepare nanoliter-sized sensing spots containing either pure cyt c, a mixture of cyt c with glucose oxidase (GOx) to detect glucose, or a mixture of cyt c with lactate oxidase (LOx) to detect lactate. The sensing spots are embedded in a multiscattering porous medium that enhances the optical signal. We achieve limits of detection down to 240 nM and 110 nM for lactate and glucose, respectively. A microfluidic embodiment enables multiplexed and crosstalk-free experiments on living organisms. As an example, we study the uptake of exogenously supplied glucose by the green algae Chlamydomonas reinhardtii and simultaneously monitor the stress-related generation of H₂O₂. This multifunctional detection scheme provides a powerful tool to study biochemical processes at cellular level.OCIS codes: (170.1530) Cell analysis, (170.1610) Clinical applications, (170.4580) Optical diagnostics for medicine, (280.4788) Optical sensing and sensors, (290.4210) Multiple scattering, (300.1030) Absorption     

Functional differences between two Fc receptor ITAM signaling motifs

Most Ig receptors exist as multi-subunit complexes with a unique ligand binding alpha chain and a common signaling FcR gamma-chain. The myeloid Fc gamma RIIa (CD32) appears unique among FcR because both ligand- binding and signaling capacity are found in the alpha chain. Within the cytoplasmic tails of Fc gamma RIIa and FcR gamma-chain similar, but not identical, activatory motifs (ITAMs) have been defined, in which tyrosines play an important role. Previously, Fc gamma RIIa-ITAM was shown to be critical for both proximal and distal activatory functions in IIA1.6 B-cell transfectants. Triggering of interleukin-2 (IL-2) release and antigen presentation was absent in Fc gamma RIIa, but not in FcR gamma-chain receptor complexes. We now assessed the capacity of Fc gamma RIIa wild-type and Fc gamma RIIa/gamma chimeric molecules to trigger IL-2 production and antigen presentation by B cells. Both of these functions could solely be triggered by receptors containing the FcRIIa was capable of functional interaction with FcR gamma-chain, thus reconstituting the capacity to trigger IL-2 release and antigen presentation. These data document qualitative differences between Fc receptor ITAMs.