Background: Relapse in people with schizophrenia is a major challenge for mental health service providers in Tanzania and other countries. Approximately 10% of people with schizophrenia are re-admitted due to relapse at Muhimbili National Hospital (MNH) Psychiatric Unit each month. Relapse brings about negative effects and it results in a huge burden to patients, their families, the mental health sector and the country?s economy. So far no study has been done to address relapse in Tanzania. The purpose of the study was to explore perspectives on risk and protective factors influencing relapse of people with schizophrenia and their caregivers attending Muhimbili National Hospital Psychiatric Out-patient Department, Dar es Salaam, Tanzania. Methods: A qualitative study was conducted, involving in-depth interviews of seven people with schizophrenia who are out-patients and their seven family caregivers at MNH. Purposive sampling procedure was used to select participants for the study. Audio recorded in-depth interviews in Swahili language were conducted with all study participants. The recorded information was transcribed and analyzed using NVivo 9 computer assisted qualitative data analysis software. Results: Personal risk and protective factors for relapse, environmental risk and protective factors for relapse and suggestions to reduce relapse were the main themes that emerged from this study. People with schizophrenia and their caregivers (all of whom were relatives) perceived non adherence to antipsychotic medication as a leading risk factor of relapse; other risks included poor family support, stressful life events and substance use. Family support, adherence to antipsychotic medication, employment and religion were viewed as protective factors. Participants suggested strengthening mental health psycho-education sessions and community home visits conducted by mental health nurses to help reduce relapse. Other suggestions included strengthening the nurse-patient therapeutic relationship in provision of mental health care. Conclusions: This study calls for improvement in mental health care service delivery to individuals with schizophrenia. Establishing a curricular in mental health nursing that aims to produce competent mental health nurse force would improve nursing practice in mental health care service delivery.
Background: Modern EIT systems require simultaneously operating multiple functions for flexibility, interoperability,and clinical applicability. To implement versatile functions, expandable design and implementationtools are needed. On the other hand, it is necessary to develop an ASIC-based EIT system tomaximize its performance. Since the ASIC design is expensive and unchangeable, we can use FPGAsas a prior step to the digital ASIC design and carefully classify which functions should be included inthe ASIC. In this paper, we describe the details of the FPGA design adopted in the KHU Mark2.5 EITsystem. Methods: We classified all functions of the KHU Mark2.5 EIT system into two categories. One is the controland processing of current injection and voltage measurement. The other includes the collection andmanagement of the multi-channel data with timing controls for internal and external interconnections.We describe the implementation of these functions in two kinds of FPGAs called the impedancemeasurement module (IMM) FPGA and the intra-network controller FPGA. Results: We present functional and timing simulations of the key functions in the FPGAs. From phantomand animal imaging experiments, we show that multiple functions of the system are successfullyimplemented in the FPGAs. As examples, we demonstrate fast multi-frequency imaging and ECGgatedimaging. Conclusion: Given an analog design of a parallel EIT system, it is important to optimize its digital design tominimize systematic artifacts and maximize performance. This paper described technical details ofthe FPGA-based fully parallel EIT system called the KHU Mark2.5 with numerous functions neededfor clinical applications. Two kinds of FPGAs described in this paper can be used as a basis forfuture EIT digital ASIC designs for better application-specific human interface as well as hardwareperformance.
Background: Increasing women's status and male involvement are important strategies in reducing preventable maternal morbidity and mortality. While efforts to both empower women and engage men in maternal health care-seeking can work synergistically, in practice they may result in opposing processes and outcomes. This study examines whether a woman's empowerment status, in sum and across economic, socio-familial, and legal dimensions, is associated with male partner accompaniment to antenatal care (ANC). Methods: Women's empowerment was measured based on the sum of nine empowerment items in the 2010-2011 Demographic and Health Surveys in eight sub-Saharan African countries: Burkina Faso (n = 2,490), Burundi (n = 1,042), Malawi (n = 1,353), Mozambique (n = 414), Rwanda (n = 1,211), Senegal (n = 505), Uganda (n = 428) and Zimbabwe (n = 459). In cross-sectional analyses, bivariate and multivariable logistic regressions models were used to examine the odds of male partner accompaniment to ANC between women with above-average versus below-average composite and dimensional empowerment scores. Results: In the majority of countries, male accompaniment to ANC was not uncommon. However, findings were mixed. Positive associations in women's composite empowerment and male involvement were observed in Burkina Faso (OR = 1.27, 95%CI: 1.08, 1.50) and Uganda (OR = 1.53, 95%CI: 1.00-2.35), and in the economic empowerment dimension in Burkina Faso (OR = 1.24, 95%CI: 1.05-1.47). In Malawi, significant negative associations were observed in the odds of male accompaniment to ANC and women's composite (OR = 0.77, 95%CI: 0.62-0.97) and economic empowerment scores (OR = 0.75, 95CI%: 0.59-0.94). No significant differences were observed in Burundi, Mozambique, Rwanda, Senegal, or Zimbabwe. Conclusion: Women's empowerment can be positively or negatively associated with male antenatal accompaniment. Male involvement efforts may benefit from empowerment initiatives that promote women's participation in social and economic spheres, provided that antenatal participation does not undermine women's preferences or autonomy. The observation of mixed and null findings suggests that additional qualitative and longitudinal research may enhance understanding of women's empowerment in sub-Saharan African settings.
Background: Video stimulated recall (VSR) is a method of enhancing participants' accounts of the consultation using a video recording of the event to encourage and prompt recall in a post consultation interview. VSR is used in education and education research, and to a lesser extent in medical and nursing research. Little is known about the sort of research questions that lend themselves best to the use of VSR or the impact of the specific VSR procedure on study quality. This systematic review describes studies in primary care that have used the method and aims to identify the strengths, weaknesses and role of VSR. Methods: A systematic literature search has been conducted to identify primary care consultation research using VSR. Two authors undertook data extraction and quality appraisal of identified papers and a narrative synthesis has been conducted to draw together the findings. In addition, theory on classifying VSR procedures derived from other disciplines is used as a lens through which to assess the relevance of VSR technique. Results: Twenty eight publications were identified that reported VSR in primary care doctor-patient consultation research. VSR was identified as a useful method to explore specific events within the consultation, mundane or routine occurrences, non-spoken events and appears to particularly add value to doctor's post consultation accounts. However, studies frequently had insufficient description of methods to properly evaluate both the quality of the study, and the influence of VSR technique on findings. Conclusions: VSR is particularly useful for study of specific consultation events when a 'within case' approach is used in analysis, comparing and contrasting findings from the consultation and post-consultation interview. Alignment of the choice of VSR procedure and sampling to the study research question was established as particularly important in the quality of studies. Future researchers may consider the role of process evaluation to understand further the impact of research design on data yielded and the acceptability of the method to participants.
Background: Masking of multiple sequence alignment blocks has become a powerful method to enhance thetree-likeness of the underlying data. However, existing masking approaches are insensitive toheterogeneous sequence divergence which can mislead tree reconstructions. We presentAliGROOVE, a new method based on a sliding window and a Monte Carlo resampling approach,that visualizes heterogeneous sequence divergence or alignment ambiguity related to single taxa orsubsets of taxa within a multiple sequence alignment and tags suspicious branches on a given tree. Results: We used simulated multiple sequence alignments to show that the extent of alignment ambiguity inpairwise sequence comparison is correlated with the frequency of misplaced taxa in treereconstructions. The approach implemented in AliGROOVE allows to detect nodes within a tree thatare supported despite the absence of phylogenetic signal in the underlying multiple sequencealignment. We show that AliGROOVE equally well detects heterogeneous sequence divergence in acase study based on an empirical data set of mitochondrial DNA sequences of chelicerates. Conclusions: The AliGROOVE approach has the potential to identify single taxa or subsets of taxa which showpredominantly randomized sequence similarity in comparison with other taxa in a multiple sequencealignment. It further allows to evaluate the reliability of node support in a novel way.
Background: The selection of disease biomarkers is often difficult because of their unstable identification, i.e.,the selection of biomarkers is heavily dependent upon the set of samples analyzed and the use ofindependent sets of samples often results in a completely different set of biomarkers being identified.However, if a fixed set of disease biomarkers could be identified for the diagnosis of multiple diseases,the difficulties of biomarker selection could be reduced. Results: In this study, the previously identified universal disease biomarker (UDB) consisting of blood miRNAsthat could discriminate between patients with multiple diseases and healthy controls was extended tothe recently reported independent measurements of blood microRNAs (miRNAs). The performanceachieved by UDB in an independent set of samples was competitive with performances achieved withbiomarkers selected using lasso, a standard, heavily sample-dependent procedure. Furthermore, thedevelopment of stable feature extraction was suggested to be a key factor in constructing more efficientand stable (i.e., sample- and disease-independent) UDBs. Conclusions: The previously proposed UDB was successfully extended to an additional seven diseases and is expectedto be useful for the diagnosis of other diseases.
Background: Meckel's diverticulum is a congenital anomaly of the gastrointestinal tract. About 98% of affected patients are asymptomatic. Small intestinal examination has become easier since the development of double-balloon enteroscopy. The present case series describes 10 patients with Meckel's diverticulum in whom double-balloon enteroscopy was useful for diagnosis.Case presentationTen patients (8 men, 2 women) with Meckel's diverticulum underwent double-balloon enteroscopy at Kobe City Medical Center General Hospital from May 2004 through May 2013. Their median age was 31.5 years (range, 14-83 years). Ten retrograde and two anterograde double-balloon enteroscopy procedures were performed. Double-balloon enteroscopy showed Meckel's diverticulum in nine patients, but an inverted Meckel's diverticulum was diagnosed as a lipoma in one patient. Meckel's diverticulum was detected by iodinated contrast medium during anterograde double-balloon enteroscopy in one of the two patients who underwent this procedure. Meckel's diverticulum was suspected using capsule endoscopy in one of two patients who underwent this procedure. Abdominal computed tomography was performed in all patients and revealed abnormalities in six, but Meckel's diverticulum was suspected in only two. Technetium-99 m pertechnetate scintigraphy and a small bowel series were carried out in six patients, revealing Meckel's diverticulum in one and three patients, respectively. Surgery was performed in eight patients, and endoscopic resection was carried out in one; the remaining patient was transferred to another hospital. Ulcer formation was found in or near Meckel's diverticulum in eight patients. Conclusion: Compared with other modalities, double-balloon enteroscopy is excellent for the diagnosis of Meckel's diverticulum because direct observation of both Meckel's diverticulum and ulceration is possible. Double-balloon enteroscopy should be used complementarily to other less invasive examinations when needed to confirm or establish the diagnosis.
Background: Gestational diabetes (GDM) has been associated with an elevated risk of type 2 diabetes in women after the pregnancy. Recognition of the factors differentiating the women at highest risk of progression to overt disease from those who remain normoglycemic after gestational diabetes is of key importance for targeted prevention programmes. To this aim, we investigated the incidence and risk factors of prediabetes and type 2 diabetes with a view to the underlying pathophysiological mechanisms in a long-term follow-up of women with a history of gestational diabetes. Methods: 489 women with GDM and 385 normoglycemic controls attended a follow-up study after pregnancy (mean follow-up time 7.3, SD 5.1 years) in Kuopio, Finland. Glucose tolerance was evaluated with an oral glucose tolerance test, insulin sensitivity by Matsuda insulin sensitivity index (ISI), and insulin secretion by Disposition Index 30 (DI30). Results: GDM increased risk of pre-diabetes and diabetes (HR 3.7, 95% C.I. 2.8-4.7 and HR 40.7, 95% C.I. 5.3-310.1, respectively, after adjustment for confounding factors) and was associated with both increased fasting (P < 0.001) and 2-hour plasma glucose (P < 0.001) during OGTT at the follow-up study. This effect was attenuated when adjusted for Matsuda ISI but abolished after adjustments with DI30 suggesting insulin secretion is the key defect leading to type 2 diabetes after GDM pregnancy. Increase in waist circumference and weight after pregnancy predicted the development of hyperglycemic conditions in women with a history of GDM (P < 0.001, and P = 0.002, respectively). Conclusions: Pre-diabetic stages after GDM pregnancy are frequent and reflect the progressive risk of type 2 diabetes in long-term follow-up. Hyperglycemia after GDM pregnancy results from beta cell failure and inability to compensate the increased insulin resistance by insulin secretion. Importantly, increase in waist circumference and as well as weight gain during the follow-up is associated with progression to prediabetes and type 2 diabetes in women with a history GDM.
Background: Despite an increasing number of studies examining the profile of falls and mobility decline in adults with cerebral palsy (CP), little is known about its impact on an individual?s life quality. The aim of this preliminary study was to assess the wellbeing and health status aspects of health-related quality of life (HRQOL) in ambulant adults with CP and explore the relationship of falls and mobility decline with HRQOL.MethodAmbulant adults with CP completed postal surveys which sought demographic data, mobility (Gross Motor Function Classification System; GMFCS-E&R;), presence of mobility decline, falls history, and HRQOL (Personal Wellbeing Index (PWI), Short Form-36 Health Survey (SF-36)). Results: Thirty-four community-dwelling ambulant adults with CP with a mean age of 44.2?years (SD; 8.6; range 26?65) participated. Twenty-eight (82%) participants reported mobility decline since reaching adulthood, and a similar proportion of individuals (82%) reported having had more than two falls in the previous year. The health status and wellbeing of this sample of ambulant adults with CP were generally lower compared with the Australian normative population. Mobility decline was found by univariate regression analysis to be associated with mental health status (??=?0.52; p?=?0.002), but not when other predictor variables were included in the multivariate model (??=?0.27; p?=?0.072). In contrast, self-reported history of falls was found to be a significant contributing factor for both physical health status (??=??0.55; p?=?0.002) and personal wellbeing (??=??0.43; p?=?0.006). Conclusions: This sample of ambulant adults with CP perceived their HRQOL to be poor, with some health status and wellbeing domains below that of population wide comparisons. A majority of these individuals also experienced a fall in the last year and a decline in their mobility since reaching adulthood. While further research is required, this preliminary study has highlighted the potential implications of falls and mobility decline on HRQOL in adults with CP.
Background: Health and Demographic Surveillance Systems (HDSS) collect independent mortality data that could be used for assessing the quality of mortality data in national civil registration (CR) systems in low- and middle-income countries. However, the use of HDSS data for such purposes depends on the quality of record linkage between the two data sources. We describe and evaluate the quality of record linkage between HDSS and CR mortality data in South Africa with HDSS data from Agincourt HDSS. Methods: We applied deterministic and probabilistic record linkage approaches to mortality records from 2006 to 2009 from the Agincourt HDSS and those in the CR system. Quality of the matches generated by the probabilistic approach was evaluated using sensitivity and positive predictive value (PPV) calculated from a subset of records that were linked using national identity number. Matched and unmatched records from the Agincourt HDSS were compared to identify characteristics associated with successful matching. In addition, the distribution of background characteristics in all deaths that occurred in 2009 and those linked to CR records was compared to assess systematic bias in the resulting record-linked dataset in the latest time period. Results: Deterministic and probabilistic record linkage approaches combined linked a total of 2264 out of 3726 (60.8%) mortality records from the Agincourt HDSS to those in the CR system. Probabilistic approaches independently linked 1969 (87.0%) of the linked records. In a subset of 708 records that were linked using national identity number, the probabilistic approaches yielded sensitivity of 90.0% and PPV of 98.5%. Records belonging to more vulnerable people, including poorer persons, young children, and non-South Africans were less likely to be matched. Nevertheless, distribution of most background characteristics was similar between all Agincourt HDSS deaths and those matched to CR records in the latest time period. Conclusion: This study shows that record linkage of mortality data from HDSS and CR systems is possible and can be useful in South Africa. The study identifies predictors for death registration and data items and registration system characteristics that could be improved to achieve more optimal future matching possibilities.