Comparative Disease Assessment: a multi-causal approach for estimating the burden of mortality

Journal of Public Health - The Comparative Risk Assessment (CRA) framework comprehensively evaluates the impact of exposure to risk factors on health populations using the counterfactual causal...     

Rapid identification of the course of anomalous coronary arteries in adults: the "dot and eye" method

It is often difficult to delineate the true course of anomalous coronary arteries by angiography because it only provides a 2-dimensional view of a complex 3-dimensional structure. The purpose of this study was to confirm morphologically the radiographic appearance of anomalous coronary arteries and to construct a protocol for rapid determination of their true course. Twenty-one adults who had anomalous origin of coronary arteries without other evidence of congenital heart disease were reviewed. Using an anatomically correct model of the heart, solder wire was placed in the pathologically described anomalous positions and radiographed. With this model the pathologically described courses could be easily recognized and separated radiographically. These courses were confirmed in the operating room in 2 patients and a rare anomaly of posterior origin of a coronary artery was also confirmed by autopsy.     

Assessment of percutaneous transluminal coronary angioplasty by atrial pacing and thallium-201 myocardial imaging: a case report

Combined atrial pacing and thallium-201 scintigraphy were performed in a man with multiple coronary artery lesions unable to perform exercise stress testing. Severe angina and ischemic ST depression in the inferior and anterior ECG leads occurred at a peak double product of 22,400 beats-mm Hg/min; thallium-201 scintigraphy showed reversible perfusion defects of the inferior, posterior, and septal segments. After angiographically successful angioplasty of a 95% right coronary artery lesion, repeat atrial pacing/thallium-201 scintigraphy (peak double product 27,750 beats-mm Hg/min) produced mild angina no ST depression in the inferior leads, and a normal thallium-201 scan. This case illustrates the value of the atrial pacing/thallium-201 stress test for evaluating the need for, and results of, coronary angioplasty in patients unable to perform exercise stress testing.     

Non-inferiority of short-term urethral catheterization following fistula repair surgery: study protocol for a randomized controlled trial

Background

Contraception is a major component of reproductive health. Assessing the levels of contraceptive awareness and use helps to identify potential areas of intervention. Hence, this study was conducted to assess awareness, practice and associated factors of modern contraceptives among street women in North-West Ethiopia.

Methods

A cross-sectional study was conducted on 204 street women from Gondar and Bahir Dar cities. Participants were recruited from “cluster” sites such as main road sides, isolated slum areas, around Churches and/or Mosques (in the mornings of Sundays and other religious feast days) and streets where street women usually reside and/or sleep. Data were collected using a pre-tested and structured interview questionnaire in local language (Amharic) after informed verbal consent. Data were then entered into SPSS version 16.0 for analysis. Binary logistic regression models were fit to assess associations and control confounding. Associations were measured by the Odds ratio and its 95% confidence interval.

Results

The mean (±SD) age of participants was 30.9 (± 8.7) years. Majority (90.7%) had ever heard about modern contraceptives. Nearly half (47.1%) had ever used and a third (34.3%) were current users. Three quarter of the current users (74.3%) were using injectables while 10% were on long acting or permanent methods. Marital status (AOR=2.81), family size (AOR=2.67) and age of 25–34 years (AOR=3.45) were associated with modern contraceptive use.

Conclusions

Current contraceptive use among street women is satisfactory considering their life styles and living conditions. However, further research is required to explain perceptions and hidden barriers.     

Nurse versus physician-provision of early medical abortion in Mexico: a randomized controlled non-inferiority trial

Objective

To examine the effectiveness, safety, and acceptability of nurse provision of early medical abortion compared to physicians at three facilities in Mexico City.

Methods

We conducted a randomized non-inferiority trial on the provision of medical abortion and contraceptive counselling by physicians or nurses. The participants were pregnant women seeking abortion at a gestational duration of 70 days or less. The medical abortion regimen was 200 mg of oral mifepristone taken on-site followed by 800 μg of misoprostol self–administered buccally at home 24 hours later. Women were instructed to return to the clinic for follow-up 7–15 days later. We did an intention-to-treat analysis for risk differences between physicians’ and nurses’ provision for completion and the need for surgical intervention.

Findings

Of 1017 eligible women, 884 women were included in the intention-to-treat analysis, 450 in the physician-provision arm and 434 in the nurse-provision arm. Women who completed medical abortion, without the need for surgical intervention, were 98.4% (443/450) for physicians’ provision and 97.9% (425/434) for nurses’ provision. The risk difference between the group was 0.5% (95% confidence interval, CI: −1.2% to 2.3%). There were no differences between providers for examined gestational duration or women’s contraceptive method uptake. Both types of providers were rated by the women as highly acceptable.

Conclusion

Nurses’ provision of medical abortion is as safe, acceptable and effective as provision by physicians in this setting. Authorizing nurses to provide medical abortion can help to meet the demand for safe abortion services.     

A global research agenda for family planning: results of an exercise for setting research priorities

Objective

To develop a global research agenda that will guide investment in effective interventions to satisfy the large unmet need for modern methods of family planning.

Methods

In a global survey, experts on contraception were invited to identify and rank the types of research that would be needed – and the knowledge gaps that would have to be filled – to reduce the unmet need for family planning in the next decade. The experts were then asked to score the research on a given topic in terms of the likelihood of its leading to an intervention that would: (i) be deliverable, affordable and sustainable; (ii) substantially reduce the unmet need for contraceptives; (iii) be effective and efficient in improving health systems; (iv) be ethically implemented; and (v) improve equity in the target population. The overall scores were then ranked.

Findings

Most of the topics that received the 15 highest scores fell into three categories: implementation of policies in family planning; the integration of services to address barriers to contraceptive use; and interventions targeted at underserved groups, such as adolescents.

Conclusion

Experts on contraception gave top priority ranking to research on improving the implementation and integration of health services and on strengthening the health systems supporting family planning services. The results of the exercise may help decision-makers, researchers and funding agencies to develop a clear and focused approach to satisfying the global need for family planning and reach the target set by the Family Planning 2020 initiative.