Provider acceptability of Sayana® Press: results from community health workers and clinic-based providers in Uganda and Senegal

Background

Sayana® Press (SP), a subcutaneous formulation of depot medroxyprogesterone acetate (DMPA) in Uniject™, has potential to be a valuable innovation in family planning (FP) because it may overcome logistic and safety challenges in delivering intramuscular DMPA (DMPA IM). However, SP's acceptability is unknown. We measured acceptability of SP among clinic-based providers (Senegal only) and community health workers.

Study design

This open-label observational study was conducted in clinics in three districts in Senegal and community-based services in two districts in Uganda. Providers administered SP to clients seeking reinjection of DMPA IM. We conducted in-depth interviews with 86 providers (52 in Senegal, 34 in Uganda) to assess their experiences providing SP to clients.

Results

Almost all providers (84/86; 98%) preferred SP over DMPA IM. The main reason Uganda providers preferred SP was the prefilled/all-in-one design made preparation and administration easier and faster. Some providers thought the SP all-in-one feature may decrease stock outs (DMPA IM requires syringe and vial). Providers also felt clients preferred the shorter SP needle because it is less intimidating and less painful. Similarly, the main reasons Senegal providers preferred SP were its characteristics (prefilled/all-in-one) and client preference (especially less pain). They also saw a potential to increase access to FP, especially through community-based distribution. Providers from both countries reported SP introduction would be enhanced through client counseling and community engagement. Providers also said SP must be accessible, affordable and in stock.

Conclusion

Almost all providers preferred SP over DMPA IM. Provider recommendations should be considered during SP introduction planning.

Implications

We found that SP was acceptable to both clinic-based FP providers and community health workers. Providers' positive attitudes towards SP may facilitate introduction and uptake of this method.     

Biocompatibility of silk-tropoelastin protein polymers

Blended polymers are used extensively in many critical medical conditions as components of permanently implanted devices. Hybrid protein polymers containing recombinant human tropoelastin and silk fibroin have favorable characteristics as implantable scaffolds in terms of mechanical and biological properties. A firefly luciferase transgenic mouse model was used to monitor real-time IL-1β production localized to the site of biomaterial implantation, to observe the acute immune response (up to 5 days) to these materials. Significantly reduced levels of IL-1β were observed in silk/tropoelastin implants compared to control silk only implants at 1, 2 and 3 days post-surgery. Subsequently, mice (n = 9) were euthanized at 10 days (10D) and 3 weeks (3W) post-surgery to assess inflammatory cell infiltration and collagen deposition, using histopathology and immunohistochemistry. Compared to control silk only implants, fewer total inflammatory cells were found in silk/tropoelastin (∼29% at 10D and ∼47% at 3W). Also fewer ingrowth cells (∼42% at 10D and ∼63% at 3W) were observed within the silk/tropoelastin implants compared to silk only. Lower IL-6 (∼52%) and MMP-2 (∼84%) (pro-inflammatory) were also detected for silk/tropoelastin at 10 days. After 3 weeks implantation, reduced neovascularization (vWF ∼43%), fewer proliferating cells (Ki67 ∼58% and PCNA ∼41%), macrophages (F4/80 ∼64%), lower IL-10 (∼47%) and MMP-9 (∼55%) were also observed in silk/tropoelastin materials compared to silk only. Together, these results suggest that incorporation of tropoelastin improves on the established biocompatibility of silk fibroin, uniquely measured here as a reduced foreign body inflammatory response.     

胰岛素自我注射者皮下脂肪增生现状与危险因素的调查分析

目的探讨自我注射胰岛素患者皮下脂肪增生现状与危险因素。方法选择我院2017年6月至2018年6月门诊自我注射胰岛素发生皮下脂肪增生患者100例作为研究对象,选择同期100例未发生皮下脂肪增生的自我胰岛素注射患者作为对照,确定皮下脂肪增生发生的危险因素。结果多因素logistic回归分析显示,年龄>60岁、胰岛素注射不规范、糖尿病病程>10年、胰岛素应用时间≥3年、同一针头应用次数>10次,胰岛素注射用量均是皮下脂肪增生发生的独立危险因素(P<0.05)。结论胰岛素自我注射者皮下脂肪增生发生与其年龄、病程以及胰岛素自我注射规范性密切相关,可给予针对性干预措施,以减少皮下脂肪增生的发生率。     

胸腔闭式引流并发大面积皮下气肿1例护理总结

目的：总结胸腔闭式引流并发皮下气肿的原因及护理措施。方法：对1例留置胸腔闭式引流管接水封瓶后出现大面积皮下气肿的患者进行护理并分析发生的原因。结果：患者病情好转。结论：胸腔闭式引流置管术后正确的护理是减少并发症的关键。     

皮下注射血管内皮生长因子基因提高大鼠背部随意皮瓣活力的实验研究

目的 探索基因治疗在组织移植方面的方法。应用 构建并体外扩增表达质粒pcDNA3.1/Zeo( )-VEGF165，以之直接皮下注射转染SD大鼠背部随意皮瓣模型。通过与对照组相比较，观察其对皮瓣活力的影响，并采集组织行免疫组化检查。结果 基因转染组在毛细血管周围及肌间隙可见VEGF的沉积，与对照组相比皮瓣的平均成活面积显著增加。结论 皮下注射的基因在组织中能够表达VEGF，增加皮瓣活力，是一种简单有效的基因治疗方法。     

腹腔镜门静脉插管皮下泵植入术(附4例报告)

目的:探讨腹腔镜门静脉插管皮下泵植入术的手术方法与技巧。方法:回顾分析4例晚期原发性肝癌患者行腹腔镜门静脉插管皮下泵植入术的临床资料。结果:4例晚期原发性肝癌患者行腹腔镜门静脉插管皮下泵植入术均获成功,无中转开腹、手术死亡及手术并发症发生,患者均于术后3d接受经皮下泵门静脉灌注化疗。结论:腹腔镜门静脉插管术安全可行,丰富的腹腔镜手术经验、手术组医师之间的协调配合与合适的病例选择是保证手术成功的关键。     

Subcutaneous Tissue Mechanical Behavior is Linear and Viscoelastic Under Uniaxial Tension

Subcutaneous tissue is part of a bodywide network of “loose” connective tissue including interstitial connective tissues separating muscles and surrounding all nerves and blood vessels. Despite its ubiquitous presence in the body and its potential importance in a variety of therapies utilizing mechanical stretch, as well as normal movement and exercise, very little is known about loose connective tissue's biomechanical behavior. This study aimed to determine elastic and viscoelastic mechanical properties of ex-vivo rat subcutaneous tissue in uniaxial tension with incremental stress relaxation experiments. The elastic response of the tissue was linear, with instantaneous and equilibrium tensile moduli of 4.77 kPa and 2.75 kPa, respectively. Using a 5 parameter Maxwell solid model, material parameters μ₁ = 0.95 ± 0.24 Ns/m and μ₂ = 8.49 ± 2.42 Ns/m defined coefficients of viscosity related to time constants τ_1M = 3.83 ± 0.15 sec and τ_2M = 30.15 ± 3.16 sec, respectively. Using a continuous relaxation function, parameters C = 0.25 ± 0.12, τ_1C = 1.86 ± 0.34 sec, and τ_2C = 110.40 ± 25.59 sec defined the magnitude and frequency limits of the relaxation spectrum. This study provides baseline information for the stress-strain behaviors of subcutaneous connective tissue. Our results underscore the differences in mechanical behaviors between loose and high-load bearing connective tissues and suggest that loose connective tissues may function to transmit mechanical signals to and from the abundant fibroblasts, immune, vascular, and neural cells present within these tissues.