The burden of caesarean section refusal in a developing country setting

Objective  To investigate the prevalence, aetiology and outcomes of caesarean section refusal in pregnant women.
Design  A prospective controlled study.
Setting  University of Nigeria Teaching Hospital and Aghaeze Hospital, Enugu, Nigeria.
Population  A total of 62 Nigerian women who declined elective caesarean section.
Method  Interviewer-administered questionnaires at the time of caesarean section refusal and postdelivery. The delivery outcomes of the subjects were compared with that of a matched control group of women who accepted caesarean section.
Main outcome measures  Prevalence, maternal reasons for caesarean section refusal and the resultant maternal and perinatal mortality.
Results  The prevalence of caesarean section refusal was 11.6% of all caesarean deliveries. Maternal reasons for refusing caesarean section include fear of death, economic reasons, desire to experience vaginal delivery and inadequate counselling. Outcomes were significantly worse among women who refused elective caesarean section than in the controls with a maternal mortality of 15% (versus 2%, P = 0.008) and a perinatal mortality of 34% (versus 5%, P < 0.001).
Conclusion  There is a high prevalence of caesarean section refusal in south-eastern Nigeria. Women declining caesareans have very poor maternal and perinatal outcomes and need extra support.     

Increased risk of atrial fibrillation among elderly Norwegian men with a history of long‐term endurance sport practice

Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence increases with increasing age. In middle‐aged men, endurance sport practice is associated with increased risk of AF but there are few studies among elderly people. The aim of this study was to investigate the role of long‐term endurance sport practice as a risk factor for AF in elderly men. A cross‐sectional study compared 509 men aged 65–90 years who participated in a long‐distance cross‐country ski race with 1768 men aged 65–87 years from the general population. Long‐term endurance sport practice was the main exposure. Self‐reported AF and covariates were assessed by questionnaires. Risk differences (RDs) for AF were estimated by using a linear regression model. After multivariable adjustment, a history of endurance sport practice gave an added risk for AF of 6.0 percent points (pp) (95% confidence interval 0.8–11.1). Light and moderate leisure‐time physical activity during the last 12 months reduced the risk with 3.7 and 4.3 pp, respectively, but the RDs were not statistically significant. This study suggests that elderly men with a history of long‐term endurance sport practice have an increased risk of AF compared with elderly men in the general population.     

城乡学龄儿童的自我意识比较研究

目的 比较城乡学龄儿童自我意识之间的差异。方法 随机抽取8—17岁城乡学龄儿童以2名，使用“Piers-Harris儿童自我意识量表”进行调查。结果 农村组在“行为”和“焦虑”二个分量表的得分明显高于城市组，差异有显著性(P＜0．01)；父母文化程度与儿童自我意识的“行为”、“智力”和“躯体外貌与属性”三个分量表得分相关。结论 该研究样本的城市学龄儿童更容易认为自己的行为不恰当，并表现出更多的情绪问题(如焦虑、紧张)；父母文化程度的不同也影响学龄儿童的行为表现、智力发展和对自我躯体外貌的认同。     

Perception of nurse prescribing among nurses and psychiatrists in a developing country: A cross‐sectional survey

Nurse prescribing has the potential to improve patients’ access to, and experiences of, treatment. The aim of the present study was to examine nurse and psychiatrist attitudes about this extended role in a developing country. We conducted a cross‐sectional survey using a previously‐used, 65‐item, seven subscale measure of attitudes to nurse prescribing in mental health. We achieved a 79% response rate. The majority of participants had trained in developing countries where nurse prescribing has yet to be implemented. Across five subscales (general beliefs, impact, uses, training, and supervision), both groups reported positive attitudes about nurse prescribing. Both groups scored the training subscale particularly highly. Compared with psychiatrists, nurses were more confident about the range of clinical settings where nurse prescribing could be applied (e.g. acute inpatient and substance use). Although both groups had less favourable attitudes on the two subscales relating to clinical and legal responsibility, compared to nurses, psychiatrists were more undesirable. Although, overall, clinician attitudes do not seem to represent a barrier towards the potential implementation of nurse prescribing in the study setting, clarity about clinical and legal responsibility needs to be addressed.     

Outcomes of Intra- and Extraocular Retinoblastomas from a Single Institute in South India

Aim: To report treatment outcomes of intra- and extraocular retinoblastomas seen at Aravind Eye Hospital, Coimbatore, South India.

Methods: Retrospective case series from January 2006 to December 2011 involving 106 babies. Clinical records were reviewed and data collected on presenting signs, gender, age, family history, ocular findings and treatment outcomes. All eyes were classified using the International Retinoblastoma Classification.

Results: The mean follow up was 35.4 months (range 1–75 months, SD 20.2, median 33 months). The mean age of presentation was 20.8 months (range 5 days to 120 months). There were 68 unilateral and 38 bilateral cases. Globe salvage rates were 100% for group A (11 eyes), B (16 eyes) and C (2 eyes). For group D, eye salvage rate was 29.5% (10/34 eyes). Survival rate of orbital retinoblastoma in our study was 55.5% (5/9 cases) at a mean follow up of 33.6 months. The overall patient survival rate was 89.6% with 11 deaths (10.4%). The commonest cause of death (7/11) was distant metastasis due to refusal to take initial treatment.

Conclusion: Greater improvement in patient survival can be achieved not only by early treatment of intraocular disease but also to convince patients to accept treatments including enucleation in this part of the world.     

International Impact of COVID-19 on the Diagnosis of Heart Disease

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified.ObjectivesThe study sought to assess COVID-19’s impact on global cardiovascular diagnostic procedural volumes and safety practices.MethodsThe International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained.ResultsSurveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth.ConclusionsCOVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world’s economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted.     

The fate of the pregnant diabetic in a developing country: Kenya

Summary A six-year survey of pregnancies complicated by diabetes has been performed at the Kenyatta National Hospital, Nairobi. Fifty-five babies were delivered with 14 perinatal deaths — a perinatal mortality rate of 254/1000, which was five times that of the nondiabetic population. There was one maternal death. Diabetes tended to be of short duration compared with similar series reported from developed countries. There were no perinatal deaths within a small sub-group managed according to a simple plan based on early referral for antenatal care, monitoring of diabetic control by blood glucose, and timing of delivery by use of the shake test.     

Implementation of a Multidisciplinary Inpatient Cardiology Service to Improve Heart Failure Outcomes in Guyana

Background

Guyana is a small developing country with a high burden of cardiovascular disease and extensive barriers to optimal care delivery. We investigated the effectiveness of a newly established multidisciplinary inpatient cardiology service in this setting.