Maternal priorities for preventive therapy among HIV‐positive pregnant women before and after delivery in South Africa: a best–worst scaling survey

Introduction

Pregnant women newly diagnosed with HIV during pregnancy are often lost to follow up and their adherence rates drop after delivery. We quantified changes in priorities related to isoniazid preventive therapy (IPT) and antiretroviral therapy (ART) among pregnant women living with HIV.

Methods

We enrolled pregnant women recently diagnosed with HIV from 14 primary health clinics during pregnancy and followed them after delivery in Matlosana, South Africa. Best–worst scaling (BWS) was used to determine the women's priorities out of 11 attributes related to preventive therapy in the ante‐ versus postpartum periods. Aggregate BWS scores were calculated based on the frequency with which participants selected each attribute as the best or worst among five options (across multiple choice sets). Individual BWS scores were also calculated and rescaled from 0 (always selected as worst) to 10 (always selected as best), and changes in BWS scores in the ante‐ versus postpartum periods were compared, using a paired t‐test. Factors associated with the changes in BWS scores were examined in multiple linear regressions. Spearman's rho was used to compare the ranking of attributes.

Results

Out of a total of 204 participants, 154 (75.5%) completed the survey in the postpartum at the median 15 (IQR: 11 to 27) weeks after delivery. Trust in healthcare providers was most highly prioritized both in the ante‐ (individual BWS Score = 7.34, SE = 0.13) and postpartum periods (BWS = 7.21 ± 0.11), followed by living a long life (BWS = 6.77 ± 0.09 in the ante‐ vs. BWS = 6.86 ± 0.10 in the postpartum). Prevention for infants’ health was more prioritized in the post‐ (BWS = 6.54 ± 0.09) versus antepartum periods (BWS = 6.11 ± 0.10) (p = 0.05). This change was associated with IPT initiation at enrolment (regression coefficient = 0.78 ± 0.33, p = 0.001). Difficulty in daily pill‐uptake was significantly more prioritized in the postpartum (BWS = 5.03 ± 0.11) than in the antepartum (BWS = 4.43 ± 0.10) (p < 0.01). Transportation cost and worry about side effects of pills were least prioritized. Overall ranking of attributes was similar in both time periods (spearman's rho = 0.90).

Conclusions

Comprehensive interventions to build trust in healthcare providers and support adherence may increase uptake of preventive therapy. Counselling needs to emphasize medication benefits for both maternal and infant health among HIV‐positive pregnant women.

     

Women and alcohol: misrepresented and misunderstood

Women's use of alcohol has been increasing over the last few decades. The physical, psychological and social effects of alcohol are more severe for women than for men. The underlying causes of women's drinking differ from those of men, which poses a challenge to nurses working in the specialist field of alcohol misuse. This article explored women's relationship with alcohol and treatment services, and identified that these treatment services are not specific to women's needs. To conclude, in order to offer women sensitive services, practitioners need knowledge of gender issues.     

护理干预对剖宫产术后高危人群深静脉血栓预防效果观察

目的观察护理干预对剖宫产术后可能发生深静脉血栓的高危人群的预防效果。方法2002年12月～2007年6月，对本院收治的行子宫下段剖官产术的足月高危孕妇143例．随机分为对照组73例与实验组70例．对照组采用传统的产科围手术期护理常规，实验组在常规产科围手术期护理基础上，对孕妇进行评估，并实施针对性的预防对策；观察两组产后1周肺栓塞、下肢深静脉血栓、双侧下肢肿胀及疼痛的发生情况。结果实验组肺栓塞、下肢深静脉血栓及下肢肿胀及疼痛发生率较对照组低，两组比较，均P〈0．05，差异有统计学意义。结论术前对行剖宫产术的孕妇进行评估，对可能发生深静脉血栓的高危人群进行相关知识教育；术后及早实施功能锻炼，可有效预防产妇深静脉血栓的形成。     

The Relationship of Knowledge of Osteoporosis and Bone Health in Postmenopausal Women in Silesia Osteo Active Study

The Silesia Osteo Active Study was designed to assess osteoporosis-related knowledge and its relationships with skeletal status in an epidemiological population-based program. Participants were chosen randomly from postmenopausal women over 55?yr. The study group consisted of 388 patients (mean age 65?±?7). All participants fulfilled medical and socioeconomic questionnaires and test concerning osteoporosis-related knowledge. They underwent proximal femur and lumbar spine densitometry. The mean level of osteoporosis knowledge was 7.3?±?2.0 for 10 questions. Osteoporosis knowledge seems to have no influence on densitometry results in the population; nevertheless it improves femoral neck (FN) density in those without prior personal experience of osteoporosis (r?=?0.15; p?<?0.05). Higher knowledge of osteoporosis was connected with osteoporosis in family, hormone replacement therapy or smoking history, and higher educational degree. The level of knowledge was significantly better in younger than in older participants (7.4 vs 6.7; p?<?0.01). Osteoporosis (T-score?<??2.5) was established in 6.4%, 2%, and 33% for FN, total hip, and spine, respectively. As a conclusion, current study revealed a positive influence of the knowledge of osteoporosis on FN density in postmenopausal women without prior personal experience of the disease.     

Evaluation of Different Screening Tools for Predicting Femoral Neck Osteoporosis in Rural South Indian Postmenopausal Women

The measurement of bone mineral density by dual-energy X-ray absorptiometry scan is the “gold standard” for the diagnosis of osteoporosis, which has limited availability in many parts of India. This study was done to assess the diagnostic performance of 6 internationally validated tools (Simple Calculated Osteoporosis Risk Estimation [SCORE], age, bulk, one or never estrogen [ABONE], Osteoporosis Risk Assessment Instrument [ORAI] and Osteoporosis Self-Assessment Tool for Asians [OSTA], Fracture Risk Assessment Tool [FRAX®], and calcaneal quantitative ultrasound [QUS]) for the diagnosis of osteoporosis at the femoral neck (FN). This was a cross-sectional study conducted in 2108 ambulatory South Indian rural postmenopausal women who were assessed with SCORE, ABONE, ORAI, OSTA, and FRAX® tools. QUS was performed in 850 subjects. Bone mineral density was estimated by dual-energy X-ray absorptiometry scan at the FN, and sensitivity and specificity were calculated for all tools for predicting FN osteoporosis. The receiver operating characteristic curve was constructed for each tool and the area under the curve (AUC) was calculated. FN osteoporosis was seen in 27%. The sensitivities of SCORE, ABONE, OSTA, ORAI, FRAX®, and QUS were 91.3%, 91.0%, 88.5%, 81.0%, 72.7%, and 81.9%, and the specificities were 36.0%, 33.5%, 41.7%, 52.0%, 60.5%, and 50.3%, respectively, for the FN osteoporosis. When the receiver operating characteristics were constructed, the AUC was good only for SCORE (0.806), and the performance of the rest was under fair category (0.713–0.766). In our large cohort of rural postmenopausal women, the SCORE screening tool was found to be useful with good sensitivity and good AUC for predicting FN osteoporosis. Thus, this tool may be used in resource-limited countries to screen the population at risk and to enable treating physicians to make appropriate management decisions.     

Does a Gender Difference in Response to Cardiac Resynchronization Therapy Exist?

BACKGROUND: Cardiac resynchronization therapy (CRT) has a beneficial effect on clinical symptoms, exercise capacity, and systolic left ventricular (LV) performance in patients with heart failure. The aim of the current study was to evaluate whether a gender difference exists in response to CRT. METHODS: Consecutive patients with end-stage heart failure (New York Heart Association, NYHA, class III-IV), LV ejection fraction (LVEF) < or =35%, QRS duration >120 ms, and left bundle branch block configuration underwent CRT. At baseline and 6 months post-CRT, clinical and echocardiographic parameters were evaluated; follow-up was obtained up to 5 years. The effects of CRT were compared between women and men. RESULTS: The study population comprised 137 men and 36 women (mean age 66 +/- 11 years). No differences in baseline characteristics were observed except that nonischemic cardiomyopathy was more frequent in women than men (67% vs 38%, P < 0.05). In all patients, clinical and echocardiographic parameters improved significantly at 6-month follow-up. The magnitude of improvement in different parameters was similar between women and men, e.g., the improvement in NYHA Class was 0.9 +/- 0.6 in women and 1.0 +/- 0.7 in men (NS) and the increase in LVEF was 8 +/- 8% in women as compared to 7 +/- 9% in men (NS). The percentage of individual responders was not different between women and men (76% vs 80%, NS) and 2-year survival was comparable for women and men (84% vs 80%, NS). CONCLUSION: No gender differences were observed in response to CRT and long-term survival after CRT.     

产后家庭保健服务对产妇产后康复及新生儿健康状况的影响

目的探讨顺产产妇产后48h出院对产后母婴恢复的影响。方法对顺产后48h母婴无特殊的产妇，根据家庭环境和生活条件，可自愿出院，出院后由院方派经验丰富的医护人员上门为产妇和婴儿延续医院各项护理服务2～3d至会阴拆线。收集我院2004年3～2004年10月，开始实行家庭保健产妇为随访组，以2003年10--2003年12月产后4～5d出院产妇为对照组，观察产妇子宫复旧及泌乳量和会阴伤口恢复情况，以及新生儿黄疸减轻和新生儿皮肤及脐部感染情况。结果从产后第3d开始随访组产妇子宫复旧及乳量分泌和新生儿黄疸的减轻与对照组比较差异有显著意义（P〈0．01），产妇会阴伤口感染和新生儿皮肤及脐部感染2组比较无显著性意义（P〉0．05）。结论顺产产妇提早出院，在熟悉、舒适的休养环境下，直接得到全方位的优质服务，对产妇子宫复旧及乳量的分泌和新生儿黄疸减轻起到十分重要的作用。     

Effects of alendronate sodium therapy on carotid intima media thickness in postmenopausal women with osteoporosis

Osteoporosis and cardiovascular disease are major health problems that lead to morbidity and mortality. Bisphosphonates are among the drugs used most frequently worldwide to treat osteoporosis, especially in older women. B-mode ultrasonography has recently become a valuable tool for early diagnosis of atherosclerotic disease because of its ability to measure carotid artery intima media thickness (CIMT). The purpose of the present study was to investigate whether alendronate sodium therapy has an effect on CIMT in postmenopausal women with osteoporosis. A total of 71 postmenopausal women with osteoporosis were evaluated before and after they began taking alendronate sodium; follow-up was provided for an average of 13±2 mo. Osteoporosis was diagnosed with the use of dual-energy x-ray absorptiometry, and therapy with alendronate sodium was begun at a dose of 70 mg/wk. For CIMT, B-mode ultrasonography was performed on the right and left middle and distal main carotid arteries. Before alendronate sodium therapy was initiated, the average CIMT value was 0.734±0.121 mm; after therapy, the average CIMT was 0.712±0.111 mm. This difference was not confirmed to be statistically significant. Treatment of osteoporosis does not seem to have an effect on CIMT, which is an early marker of atherosclerosis.     

Women living with type II diabetes: the intrusion of illness

This study is part of a larger research project which aimed to create an understanding of how people with type II diabetes incorporated chronic illness into their lives. We aimed to find wellness in the context of a chronic illness. The participatory action-orientated research (PAR) approach is consumer based and managed, and six women with diabetes and the research team met for eight two-hour sessions in August and September 1998. The objectives were to contribute to understanding of the health of adults who live with chronic illness by providing greater insight and understanding into the worlds of people who live with a chronic illness and allowing the voices of people with diabetes to be clearly heard in relation to their health. There was a wellness theme around taking time out, but considering the other dominant negative experiences, this study can only be considered as an attempt to find wellness in the context of chronic illness. The PAR process, built upon sharing, listening and reconstructing stories, worked toward the women being heard and having a voice for the first time. Listening and acting upon the voices of the women has implications for the practice of health care professionals.     

妊娠期症状性上尿路结石的外科治疗

目的探讨妊娠期症状性上尿路结石的外科治疗手段及疗效。方法对19例复发性严重肾绞痛及梗阻性肾积水合并肾周围炎孕患，首选13F小儿膀胱镜下5F双J管逆插留置，逆插失败者选择输尿管镜手术或患肾造瘘术。结果全部病例疼痛消失无复发，泌尿系感染控制，复查肾积水消失或减轻。6例术后3周内结石自行排出。结论小儿膀胱镜下双J管逆插留置安全有效，是外科治疗复发性严重肾绞痛与梗阻性感染的最佳手段。输尿管镜手术是逆插失败后的选择。