In the Philippines, one in four pregnancies are unintended and 610 000 unsafe abortions are performed each year. This study explored the association between missed opportunities to provide family ...planning counseling, quality of counseling and its impact on utilization of effective contraception in the Philippines.
One-hundred-one nationally representative health facilities were randomly selected from five levels of the health system. Sexually-active women 18-49 years old, wanting to delay or limit childbearing, attending primary care clinics between April 24 and August 8, 2017 were included. Data on contraceptive use, counseling and availability were collected using interviews and facility assessments. Effective contraceptive methods were defined as those with rates of unintended pregnancy of less than 10 per 100 women in first year of typical use.
849 women were recruited of whom 51.1% currently used effective contraceptive methods, 20.6% were former effective method users and 28.3% had never used an effective method. Of 1664 cumulative clinic visits reported by women in the previous year, 72.6% had a missed opportunity to receive family planning counseling at any visit regardless of level of facility, with 83.7% having a missed counseling opportunity on the day of the interview. Most women (55.9%) reported health concerns about modern contraception, with 2.9% receiving counseling addressing their concerns. Only 0.6% of former users and 2.1% never-users said they would consider starting a modern contraceptive in the future. Short and long acting reversible contraceptive methods were available in 93% and 68% of facilities respectively.
Missed opportunities to provide family planning counseling are widespread in the Philippines. Delivery of effective contraceptive methods requires that wider legal, policy, social, cultural, and structural barriers are addressed, coupled with systems approaches for improving availability and quality of counseling at all primary health care contacts.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries. However, the inordinate focus on reducing financial risk ...burden and increasing coverage without sufficient focus on expanding quality of services may account for slow progress of the MDGs in many countries. Human Resources for Health underlie quality and service delivery improvements, yet remains under-addressed in many national strategies to achieve Universal Health Coverage. Without adequate investments in improving and expanding health professional education, making and sustaining gains will be unlikely. The transition from the Millennium Development Goals (MDG) to the Sustainable Development Goals (SDG), with exciting new financing initiatives such as the Global Financing Facility brings the potential to enact substantial gains in the quality of services delivered and upgrading human health resources. This focus should ensure effective methodologies to improve health worker competencies and change practice are employed and ineffective and harmful ones eliminated (including undue influence of commercial interests).
Au cours de la dernière décennie dans l’ère des OMD (Objectifs du Millénaire pour le Développement), l’accent a été fortement mis sur la volonté d’atteindre les quintiles économiques inférieurs dans les pays à revenu faible et moyen. Toutefois, l’insistance démesurée mise sur l’allè- gement du risque financier, et sur l’accroissement de la prise en charge en l’absence d’un effort suffisant à fournir pour une meilleure qualité de services peut expliquer la lenteur de la progression des OMD dans de nombreux pays. Les Ressources Humaines pour la Santé sont à la base d’une meilleure qualité des prestations de service, mais elles restent t insuffisamment sollicitées dans les nombreuses stratégies mises en place par les pays avec pour objectif la Couverture de Santé Universelle. Sans les investissements appropriés pour améliorer et développer la formation dans les professions médicales, l’obtention et le maintien de progrès sont improbables. Le passage des Objectifs du Millénaire pour le Développement (MDG) aux Objectifs de Développement Durable (SDG), avec de nouvelles initiatives intéressantes, telles que la Facilité de Financement Mondiale, permet d’obtenir des gains substantiels dans la qualité des services offerts, et de valoriser les ressources dans la santé humaine. Cet effort devrait permettre à des méthodologies efficaces d’améliorer les compétences des travailleurs de la santé, et de changer les pratiques qui sont employées, en éliminant celles qui sont inefficaces et nuisibles (y compris l’influence injustifiée des intérêts commerciaux).
Durante la última década de los Objetivos de Desarrollo del Milenio (ODM) se presenció un enfoque sustancial en alcanzar a los quintiles económicos más bajos en los países de ingresos bajos y medios. Sin embargo, el enfoque excesivo en reducir la carga de riesgo financiero y en incrementar la cobertura sin suficiente atención a la expansión de la calidad del servicio, puede explicar el lento progreso de los ODMs en muchos países. Los Recursos Humanos para la Salud (RHS) forman la base de la calidad y de las mejoras del servicio, pero aún continúan sin ser abordados en muchas estrategias nacionales para obtener la Cobertura de Salud Universal. Sin la inversión requerida para mejorar y expandir la educación médica profesional, lograr y sostener mejorías es poco probable. La transición de los ODMs a los Objetivos de Desarrollo Sostenible (ODSs) con nuevas iniciativas vigorosas de financiamiento como al Facilidad Financiera Global tienen el potencial de crear mejoras sustanciales en la calidad de los servicios y de actualizar los recursos humanos de salud. Este enfoque debe garantizar que se usen metodologías efectivas para mejorar las aptitudes de los trabajadores de salud y para cambiar las prácticas, y que las metodologías ineficaces y dañinas sean eliminadas (incluyendo la influencia innecesaria del sector comercial.
千年发展目标的最后十年见证了就低收入与中等收入国家处 于经济底层的五分之一人口开展的大量重点工作。然而, 过 度关注降低财务风险负担及提高覆盖面, 却没有充分地关注扩 大服务质量, 可能会导致千年发展目标在部分国家的进展缓 慢。医疗服务方面的人力资源是改进服务质量与供给的基础, 但仍然在部分国家实现全民医疗覆盖的国家战略中处于未被 解决的状态。若没有足够的投资来改善和扩大医疗执业教育, 取得或维持成果则缺乏可能性。千年发展目标向可持续发展 目标转变, 并与诸如全球融资机制等激奋人心的新融资举措一 道, 会激发提升医疗服务质量和医疗人力资源水平的潜力。工 作应将重点放在确保有有效的方法来改善医疗工作者的能力, 变革就业实践, 淘汰无效及有害者（包括商业利益的不当影 响）。
STUDY QUESTION
What is the contribution of the underuse of modern methods (MM) of contraception to the annual undesired pregnancies in 35 low- and middle-income countries?
SUMMARY ANSWER
Fifteen ...million out of 16.7 million undesired pregnancies occurring annually in 35 countries could have been prevented with the optimal use of MM of contraception.
WHAT IS KNOWN ALREADY
Every year, 87 million women worldwide become pregnant unintentionally because of the underuse of MM of contraception.
STUDY DESIGN, SIZE, DURATION
Demographic and health surveys (DHS) of 35 countries, conducted between 2005 and 2012, were analysed.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Contraceptive use of 12 874 unintentionally pregnant women was compared with 111 301 sexually active women who were neither pregnant nor desiring pregnancy.
MAIN RESULTS AND THE ROLE OF CHANCE
An average of 96% of 15- to 49-year-old eligible women took part in the survey. When adjusted for covariates and compared with the use of MM of contraception, the use of traditional methods was associated with a 2.7 95% confidence interval (CI): 2.3–3.4 times increase in odds of an undesired pregnancy, while non-use of any method was associated with a 14.3 (95% CI, 12.3–16.7) times increase. This corresponded to an estimated 16.7 million undesired pregnancies occurring annually in the 35 countries, of which 15.0 million could have been prevented with the optimal use of MM of contraception (13.5 million women did not use MM whilst 1.5 million women utilized MM incorrectly). Women with the lowest educational attainment and wealth quintile were 8.6 (95% CI: 8.2–9.1) and 2.6 (95% CI: 2.4–2.9) times less likely to use contraceptives compared with those with the highest level of each, respectively. Of the 14 893 women who neither desired pregnancy nor used contraception, 5559 (37.3%) cited fear of side effects and health concerns as the reason for non-use, 3331 (22.4%) cited they or their partner's opposition to contraception or religious prohibition and 2620 (17.6%) underestimated the risk of pregnancy.
LIMITATIONS, REASONS FOR CAUTION
Despite the fact that DHS are considered high-quality studies, we should not underestimate the role played by recall bias for past pregnancies. Few women report a current pregnancy in the first trimester and undesired pregnancies at that time are probably prone to under-reporting. Some terminated pregnancies may not be included in the current pregnancy group. Furthermore, covariates measured at the time of the survey may not have reflected the same covariates at the time the currently pregnant women became pregnant.
WIDER IMPLICATIONS OF THE FINDINGS
Underuse of MM of contraception burdens especially the poor and the less educated. National strategies should address unfounded health concerns, fear of side effects, opposition and underestimated risk of pregnancy, which are major contributors to undesired pregnancies.
FUNDING/CONFLICT(S) OF INTEREST
No external funding was utilized for this report. There are no conflicts of interest to declare.
Around 1.5 million annual neonatal deaths occur in the first week of life, and infections represent one of the major causes in developing countries. Neonatal sepsis is often strictly connected to ...infection of the maternal genital tract during labour.
The association between signs suggestive of puerperal infection and early neonatal mortality (<7 days of life) was performed using Demographic and Health Surveys (DHS) data of six countries, conducted between 2010 and 2013. The population attributable fraction (PAF) was generated using the estimates on early neonatal mortality of a 1990-2013 systematic analysis for the Global Burden of Disease Study.
Signs of puerperal infection ranged from 0.7% in the Philippines to 16.4% in Honduras. Infection was associated with a 2.1 adjusted Risk Ratio (95% CI: 1.4-3.2) of early neonatal mortality. Around five percent of all deaths in the first week of life were attributable to signs suggestive of puerperal infections and varied from 13.9% (95% CI: 1.0-26.6) in Honduras to 3.6% (95% CI: 1.0-8.5) in Indonesia.
Targeted interventions should be addressed to contain the burden of puerperal infections on early neonatal mortality. Consideration of the PAF will help in the discussion of the benefits of antenatal and perinatal measures.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The Omicron variant of severe acute respiratory syndrome coronavirus 2 caused the largest surge of coronavirus disease (COVID-19) cases in Japan starting in the summer of 2022. We describe the ...mechanisms introduced to provide appropriate health care to all Omicron cases, provide appropriate health care to all non-COVID-19 patients, and protect health-care workers (HCWs) while providing necessary health services. Optimization of care for elderly patients was particularly important.
Japan is home to 125 million people, of whom 28.6% are 65 years or older. Between January and June 2022, the country experienced 4.3 times more COVID-19 cases than in the previous 2 years (7.3 million vs 1.7 million).
To adjust care pathways, inpatient treatment capacity was increased, a home-based care system was established, and an on-site treatment scheme at long-term care facilities was started. Among essential health services, disruption of emergency care became most noticeable. Administrative and financial support was provided to hospitals with emergency departments to maintain emergency medical services. To protect HCWs while maintaining hospital services, flexible exemptions were introduced to enable those who became close contacts to return to work, and broadly targeted contact tracing and testing in case of nosocomial outbreaks were all helpful.
As a result of the adjustments made to inpatient capacity and patient flow, bed occupancy for COVID-19 patients decreased, mostly because many patients were cared for at home or in temporary-care facilities.
From this study, we extracted two essential lessons to aid in current and future health emergencies: how to balance the provision of acute medical care for elderly patients and maintain their well-being; and how to maintain essential health services.
SEE WINGER AND ZAMVIL DOI101093/BRAIN/AWW121 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: The innate immune system plays a central role in the chronic central nervous system inflammation that drives ...neurological disability in progressive forms of multiple sclerosis, for which there are no effective treatments. The mucosal immune system is a unique tolerogenic organ that provides a physiological approach for the induction of regulatory T cells. Here we report that nasal administration of CD3-specific antibody ameliorates disease in a progressive animal model of multiple sclerosis. This effect is IL-10-dependent and is mediated by the induction of regulatory T cells that share a similar transcriptional profile to Tr1 regulatory cells and that suppress the astrocyte inflammatory transcriptional program. Treatment results in an attenuated inflammatory milieu in the central nervous system, decreased microglia activation, reduced recruitment of peripheral monocytes, stabilization of the blood-brain barrier and less neurodegeneration. These findings suggest a new therapeutic approach for the treatment of progressive forms of multiple sclerosis and potentially other types of chronic central nervous system inflammation.
Multiple sclerosis (MS) is considered to be an autoimmune disease of the central nervous system (CNS) that in many patients first presents clinically as optic neuritis. The relationship of optic ...neuritis to MS is not well understood. We have generated novel T cell receptor (TCR) transgenic mice specific for myelin oligodendrocyte glycoprotein (MOG). MOG-specific transgenic T cells are not deleted nor tolerized and are functionally competent. A large proportion (>30%) of MOG-specific TCR transgenic mice spontaneously develop isolated optic neuritis without any clinical nor histological evidence of experimental autoimmune encephalomyelitis (EAE). Optic neuritis without EAE could also be induced in these mice by sensitization with suboptimal doses of MOG. The predilection of these mice to develop optic neuritis is associated with higher expression of MOG in the optic nerve than in the spinal cord. These results demonstrate that clinical manifestations of CNS autoimmune disease will vary depending on the identity of the target autoantigen and that MOG-specific T cell responses are involved in the genesis of isolated optic neuritis.
Tim-1, a phosphatidylserine receptor expressed on B cells, induces interleukin 10 (IL-10) production by sensing apoptotic cells. Here we show that mice with B cell-specific Tim-1 deletion develop ...tissue inflammation in multiple organs including spontaneous paralysis with inflammation in the central nervous system (CNS). Transcriptomic analysis demonstrates that besides IL-10, Tim-1+ B cells also differentially express a number of co-inhibitory checkpoint receptors including TIGIT. Mice with B cell-specific TIGIT deletion develop spontaneous paralysis with CNS inflammation, but with limited inflammation in other organs. Our findings suggest that Tim-1+ B cells are essential for maintaining self-tolerance and restraining tissue inflammation, and that Tim-1 signaling-dependent TIGIT expression on B cells is essential for maintaining CNS-specific tolerance. A possible critical role of aryl hydrocarbon receptor (AhR) in regulating the B cell function is discussed, as we find that AhR is among the preferentially expressed transcription factors in Tim-1+ B cells and regulates their TIGIT and IL-10 expression.
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•Tim-1+ B cells are required for maintaining immune tolerance•Tim-1+ B cells differentially express TIGIT and other co-inhibitory molecules•B cell expression of TIGIT and many other regulators requires Tim-1 signaling•B cell TIGIT expression is preferentially required for maintaining CNS tolerance
Xiao et al. find that Tim-1 expression and signaling in B cells is required for maintaining self-tolerance. Tim-1+ B cells execute their regulatory function by expressing a set of negative immune regulators, of which checkpoint receptor TIGIT is preferentially required for the B cell-mediated tolerance in the central nervous system.
The coronavirus disease (COVID-19) pandemic has transformed clinical practice and health systems. This paper provides an overview of COVID-19 clinical management and health-care pathway challenges ...that the World Health Organization and its Member States in the Western Pacific Region have faced. The experiences and lessons identified can help countries to better prepare for future pandemics.
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