• Title/Summary/Keyword: Low-resource hospital

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Reduction of the cetrorelix dose in a multiple-dose antagonist protocol and its impact on pregnancy rate and affordability: A randomized controlled multicenter study

  • Dawood, Ayman S.;Algergawy, Adel;Elhalwagy, Ahmed
    • Clinical and Experimental Reproductive Medicine
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    • v.44 no.4
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    • pp.232-238
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    • 2017
  • Objective: To determine whether reducing the cetrorelix dose in the antagonist protocol to 0.125 mg had any deleterious effects on follicular development, the number and quality of retrieved oocytes, or the number of embryos, and to characterize its effects on the affordability of assisted reproductive technology. Methods: This randomized controlled study was conducted at the Fertility Unit of Tanta Educational Hospital of Tanta University, the Egyptian Consultants' Fertility Center, and the Qurrat Aien Fertility Center, from January 1 to June 30, 2017. Patients' demographic data, stimulation protocol, costs, pregnancy rate, and complications were recorded. Patients were randomly allocated into two groups: group I (n = 61) received 0.125 mg of cetrorelix (the study group), and group II (n = 62) received 0.25 mg of cetrorelix (the control group). Results: The demographic data were comparable regarding age, parity, duration of infertility, and body mass index. The dose of recombinant follicle-stimulating hormone units required was $2,350.43{\pm}150.76$ IU in group I and $2,366.25{\pm}140.34$ IU in group II, which was not a significant difference (p= 0.548). The duration of stimulation, number of retrieved oocytes, and number of developed embryos were not significantly different between the groups. The clinical and ongoing pregnancy rates likewise did not significantly differ. The cost of intracytoplasmic sperm injection per cycle was significantly lower in group I than in group II (US $ $494.66{\pm}4.079$ vs. US $ $649.677{\pm}43.637$). Conclusion: Reduction of the cetrorelix dose in the antagonist protocol was not associated with any significant difference either in the number of oocytes retrieved or in the pregnancy rate. Moreover, it was more economically feasible for patients in a low-resource country.

Combined Screening of Cervical Cancer, Breast Cancer and Reproductive Tract Infections in Rural China

  • Li, Zhi-Fang;Wang, Shao-Ming;Shi, Ju-Fang;Zhao, Fang-Hui;Ma, Jun-Fei;Qiao, You-Lin;Feng, Xiang-Xian
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.7
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    • pp.3529-3533
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    • 2012
  • Objectives: To investigate the current prevalence and knowledge of cervical cancer, breast cancer and reproductive tract infections (RTIs) in rural Chinese women, and to explore the acceptance and feasibility of implementing a combined screening program in rural China. Methods: A population-based, cross-sectional study was conducted among women aged 30 to 59 years old in Xiangyuan County, Shanxi Province from 2009 to 2010. Socio-demographic characteristics, knowledge of cervical cancer, breast cancer and RTIs, and the attitude toward single or combined screening were collected by an interview questionnaire. Each participant received a clinical examination of the cervix, breast and reproductive tract. Examinations included visual inspection, mammography, laboratory tests and pathological diagnosis. Results: A total of 1,530 women were enrolled in this study. The prevalence of cervical precancerous lesions, suspicious breast cancer, suspicious benign breast disease and RTIs was 1.4%, 0.2%, 14.0% and 54.3%, respectively. Cervicitis, trichomonas vaginitis, and bacterial vaginitis were the three most common RTIs among our participants. Television, radio broadcast, and public education during screening were the major source of healthcare knowledge in rural China. Moreover 99.7% of women expressed great interest in participating in a combined screening project. The affordable limit for combined screening project was only 50 RMB for more than half of the rural women. Conclusion: A combined screening program would be more effective and popular than single disease screening projects, while appropriate accompanied education and a co-pay model for its successful implementation need to be explored, especially in low-resource settings.

Beyond Limitations: Practical Strategies for Improving Cancer Care in Nigeria

  • Eguzo, Kelechi;Camazine, Brian
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.5
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    • pp.3363-3368
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    • 2013
  • Background: The burden due to cancers is an emerging public health concern especially in resource-limited countries like Nigeria. The WHO estimates that cancer kills more people than tuberculosis, HIV/AIDS and malaria combined. As people in Nigeria and other developing countries are beginning to survive infectious diseases, there is an observed epidemiologic transition to chronic diseases, such as cancers. In 2008, 75 out of 1,000 Nigerians died of cancer. Despite the rising incidence and public health importance, Nigeria lacks an organized and comprehensive strategy to deal with cancers. Materials and Methods: This article reviewed 30 peer-reviewed manuscripts on cancer care in four countries. It highlights the limitations to cancer care in Nigeria; due to lack of awareness, low health literacy, absence of organized screening programs, inadequate manpower (in terms of quality and quantity) as well as limited treatment options. Results: This review led to the formulation of a proposal for Nigerian National Cancer Policy, mainly drawn from effective strategies used in Canada, Brazil and Kenya. This is a vertical cancer program that is patient-centered with an emphasis on tobacco control and cancer disease screening (similar to Canada and Brazil). Additionally, it emphasizes primary cancer prevention (similar to Kenya). Its horizontal integration with other disease programs like HIV/AIDS will improve affordability in a poor resourced country like Nigeria. Capacity building for health professionals, hub-and-spoke implementation of screening services, as well as investment in effective treatment options and increased research in cancer care are essential. International 'twinning collaborations' between institutions in richer countries and Nigeria will enhance effective knowledge translation and improve the quality of patient care. Conclusions: A national cancer policy must be developed and implemented in Nigeria in order to overcome the present limitations which help contribute to the observed increases in cancer morbidity and mortality rates. Cancer control is feasible in Nigeria if the nation was to consider and employ some of the cost-effective strategies proposed here.

An Uniform Routing Mechanism with Low Energy Consumption over Wireless Sensor Network (유비쿼터스 센서네트워크에서 균일한 에너지 소모를 유도하는 경로설정기법)

  • Yoon Mi-Youn;Lee Kwang-Kyun
    • The Journal of Korean Institute of Communications and Information Sciences
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    • v.31 no.2B
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    • pp.80-90
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    • 2006
  • WSN(Wireless Sensor Network) performs to detect and collect environmental information for one purpose. As examples, WSN is applicable for home network, patient management of a hospital, logistics management, status detection during the war and so on. The WSN is composed of a sink node and several sensor nodes and has a constraint in an aspect of energy consumption caused by limited battery resource. So many required mechanisms in WSN should consider the remained energy condition. A routing mechanism is requested to deliver the collected information to a sink considering energy efficiency in WSN. There have been many researches to establish (a) route(s) for data delivery to the sink. In this paper, we propose establishment of efficient routes. We proposed a uniform routing mechanism together with considering energy efficiency. For the routing, we define energy probability as routing metrics information and Performs suppression of exchange of control messages. In addition, we derive to uniformly consume the energy of the sensor node when establishing the routes. Also, we evaluate and analyze the energy efficiency for proposed mechanisms through NS-2 simulator.

Comparison between Visual Inspection of Cervix and Cytology Based Screening Procedures in Bangladesh

  • Nessa, Ashrafun;Nahar, Khadiza Nurun;Begum, Shirin Akhter;Anwary, Shahin Ara;Hossain, Fawzia;Nahar, Khairun
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.12
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    • pp.7607-7611
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    • 2013
  • Background: Cervical cancer continues to be a major problem in Bangladesh with approximately 18,000 new cases annually of which over 10,000 women die from it. Visual inspection of the cervix after 3-5% acetic acid (VIA) application is a simple and easy to learn method for cervical cancer screening, although cytology-based screening is more often applied in developed countries where it has successfully reduced the prevalence of cervical cancer. Objective: To compare the efficacy of VIA and cytology-based primary methods for cervical cancer screening in Bangladesh. Materials and Methods: This hospital based comparative study was conducted at the VIA centre and Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2008 to October 2010. Results: Among 650 women, 74 (11.4%) were VIA+ve and 8 (1.2%) had abnormalities in their Pap smear reports. During colposcopy, 38 (7.7%) women had different grades of CIN and 4 (0.6%) had cervical cancer. The gold standard histology findings proved 20 women had CIN I, 14 had CIN II/II and 4 had cervical cancer. Among the 38 histology diagnosed abnormalities, VIA test could identify 30 abnormalities including two cervical cancers. However, Pap smear could detect only 8 cases of histological abnormalities (2 low grade and 6 had high grade lesion) and it missed all the cervical cancer cases. The sensitivity and specificity of VIA were 88.9% and 52.1%. The positive predictive value (PPV) and negative predictive value (NPV) were 41.0%, and 92.6% respectively. Moreover, the sensitivity, specificity, PPV and NPV of Pap smear were 33.3%, 95.8%, 75.0% and 79.3%, respectively. Conclusions: VIA test should be used as the primary screening tool even with its low sensitivity and specificity in low resource countries like Bangladesh. False positive results may be greater, but overtreatment can be minimized by colposcopy evaluation of the VIA positive women.

A Study on Psychological Rehabilitation to Decrease Powerlessness in the Elderly Population (노인의 무력감 완화를 위한 심리 재활에 관한 연구)

  • 김조자;임종락;박지원
    • Journal of Korean Academy of Nursing
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    • v.22 no.4
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    • pp.506-525
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    • 1992
  • Older people, because of the psychological and physiological changes related to the aging process are more vulnerable to experiencing powerlessness than any other age group. This self destructive cycle of depression in older people related to the experience of continued and long term powerlessness can lead even to death. The purpose of this study was to measure powerlessness and resources to increase power in older people, and to measure the effectiveness of a psychological rehabilitation program for reducing powerlessness. The research methodology used was a two step process. In the first step, a survey was done of perceived powerlessness and power resources comparing four groups of elderly people ; those living at home, those in hospital, those living in nursing homes and those attending educational programs for the elderly. The total sample size was 236. In the second step, a psychological rehabilitation program was carried out, pre and post measurements were taken related to this program. The sample consisted of 29 residents in a nursing home. The results of the study are as follows : 1. Powerlessness was classified as cognitive, emotional, activity and learning. The lowest score for powerlessness was in the area of activity, that is the people in the sample felt more power concerning their activities. The highest score was in the area of cognition where they felt they had less power. 2. When the different groups of elderly were compared, it was found that the residents of the nursing home had the highest score on perceived powerlessness and the group who were living at home had the lowest score. 3. Among the general characteristics, the factors influencing the powerlessness score were age, sex, level of education, financial resources and health status. In the interaction effects among these factors, it was found that level of education and health status were factors influencing perceived powerlessness. The elderly with lower education and poorer health status had the higher scores for perceived powerlessness. 4. The power resources could be classified into the following areas : physical strength, emotional strength, positive self-image, energy, knowledge, motivation and belief system. Belief system was given the highest score among the power resources and energy, knowledge and motivation were given low scores. 5. The group participating in an educational program for the elderly had the highest score for power resources while the group made up of residents of a nursing home had the lowest score as well as the highest score for perceived powerlessness. 6. The factors influencing the power resource scores were sex, level of education, financial resources and health status. In the analysis of the interaction effect among the factors, it was found that sex, level of education and financial resources were the factors that influenced the power resource score, that is, women, those with a low level of education and those with poor financial resources reported a lower level of power resources. 7. There was a negative correlation between perceived powerlessness and power resources in the elderly in this study. Since power resources explainded 49% of the variance for powerlessness, it can be concluded that the power resources can be used to reduce powerlessness. 8. The psychological rehabilitation program was carried out with the nursing home residents over a period of five weeks. No statistically significant difference was found in the scores on powerlessness between the pre and post tests, but there was a slight decrease in the raw scores on the post test for emotional, activity and learning powerlessness. There was a statistically significant increase in the power resource scores for emotional strength, positive self-image, energy, knowledge and motivation in the post test as compared to the pre test. In conclusion, the study indicates that a psychological rehabilitation program for the elderly could be effective in increasing power resources and this in turn could lead to a decrease in perceived powerlessness.

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Liver Cancer Mortality Trends during the Last 30 Years in Hebei province: Comparison Results from Provincial Death Surveys Conducted in the 1970's, 1980's, 1990's and 2004-2005

  • Xu, Hong;He, Yu-Tong;Zhu, Jun-Qing
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.5
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    • pp.1895-1899
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    • 2012
  • Background and Aims: Liver cancer is a major health problem in low-resource countries. Approximately 55% of all liver cancer occurs in China. Hebei Province is one of the important covering nearly 6% of the population of China. The aim of this paper was to explore liver cancer mortality trends during past 30 years, and provide basic information on prevention strategies. Methods: Hebei was covered covered all the three national surveys during 1973-1975, 1990-1992, and 2004-2005 and one provincial survey during 1984-1986. Subjects included all cases dying from liver cancer in Hebei Province. Liver cancer mortality trend and geographic differences across cities and counties were analyzed. Results: There were 82,878 deaths in Hebei Province during 2004-2005 with an average mortality rate was 600.9/10,000, and an age-adjusted rate of 552.3/10,000. Those dying of cancer were 18,424 cases, accounting for 22.2% of all deaths, second only to cerebrovascular disease as a cause of death. Cancer mortality was 133.6/100,000 (age-adjusted rate was 119.2/100,000). Liver cancer ranked fourth in this survey with a mortality rate of 21.0/100,000, 28.4/100,000 in males and 13.35/10,000 in females, accounting for 15.7%, 17.1% and 13.4% of the total number of cancer deaths and in males and females, respectively. The sex ratio was 2.13. Since the 1970s, liver cancer deaths of Hebei province have been increasing slightly. The crude mortality rates in the four surveys were 11.3, 16.0, 17.4, 21.0 per 100,000, respectively, with age-adjusted rates fluctuating during the past 30 years, but the trend also being upwards. There is a tendency for the mortality rates to be higher in coastal than mountain areas, and is relative lower in the plain area, with crude mortality rates of 25.3, 22.1, and 19.1 per 100,000, respectively. There were no notable differences in cride data between urban and rural, but the age-adjusted mortality rate in rural was much higher. Conclusion: Our study indicated that the mortality of liver cancer in Hebei Province is lower than the national average level. There is a slightly increase trend, especially in some counties. Liver cancer is a major health problem and it is necessary to further promote prevention strategies in Hebei province.

Trends of Perception and Information Needs on Food Additives of Children and Parents by Analyzing the Safety Assessment Reports of Food Additives in 2008~2013 (어린이와 학부모의 식품첨가물에 대한 인식 및 정보요구도 추이 분석: 2008~2013 식품첨가물 섭취 안전성 평가 연구 결과를 중심으로)

  • Kim, Suna;Kim, Ji-Sun;Ko, Joung-Mi;Kim, Jeong-Weon
    • Korean journal of food and cookery science
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    • v.30 no.3
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    • pp.249-261
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    • 2014
  • This study was performed in order to grasp the trends of elementary school children and their parents on their purchasing behavior of processed foods, awareness of food additives and its education experience by analyzing the safety assessment reports of food additives in 2008~2013. The most important factor in purchasing processed foods was safety in both groups followed by nutrition in parents and taste in children, respectively. While purchasing foods, the first item that is checked has been shifted from food additives to the origin of the products. Parents still perceived food additives as the most hazardous factor for food safety; however, recently, children began to regard microbial contaminants as being most hazardous, which is regarded as a desirable educational effect. The most concerned food additives were preservatives, synthetic seasoning and colorants in both groups. However, the awareness level on food additives still remained low as 3.0~3.1/5.0 for parents and 2.4~2.9/5.0 for children. Educational experience on food additives increased in children from 12% in 2008 to 25% in 2013; however, it decreased in parents from 23% in 2008 to 15% in 2013. Information needs for food additives by education and promotion were very high both in parents (4.2~4.5) and children (3.8~4.1). Both groups had an interest in the safety, legal standards of food additives, and foods with food additives, in order. The most reliable resource institutions on food additives were university/research institute and hospital for parents, but, hospital and government for children. The preferred media on food additives were TV and the internet for parents, and school newsletter and TV for children. Overall, the above results demonstrated that the perceptions on food additives did not change much with parents during the last 6 years; however, children's perceptions began to show improvement with the increase of educational experience. Hence, the government needs to make efforts to increase the trust level of consumers by developing educational tools and providing educational experiences including mass media for the promotion of risk communication on food additives.

The factor of sensory processing that affect on the motor and process skill of children with cerebral palsy (뇌성마비 아동의 운동 및 처리기술에 영향을 미치는 감각처리 요인)

  • Park, Myoung-Ok
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.10
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    • pp.221-227
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    • 2016
  • This study was conducted to identify sensory processing factors that affect motor and process skills of children with cerebral palsy. A total of 36 children with cerebral palsy who attended at the J pediatric development center and the N rehabilitation hospital in Seoul participated. Pearson's correlation coefficients were used to test the relationship between motor skills, process skills and sensory processing abilities of children. Moreover, hierarchical multiple regression was used to identify the sensory processing factors influencing motor and process skills. Motor skills of children with cerebral palsy were correlated with auditory filtering, low energy/weakness, and visual/auditory sensitivity of sensory processing items, whereas process skills were correlated with tactile sensitivity and taste/smell sensitivity. The hierarchical regression model for motor skills revealed movement sensitivity, auditory filtering, and low energy/weakness as significant factors influencing sensory processing items. However, no factors were shown to influence process skills. The results of this study will be useful as a basic resource for rehabilitation of children with cerebral palsy. However, further studies evaluating a larger population should be conducted to verify the results presented herein.

A Study on Nursing Service of Chronic Diseases by the First Step and Third Step Medical Treatment (1차 및 3차 진료기관 이용 만성질환자의 간호서비스에 관한 연구)

  • Cho Chong Sook
    • Journal of Korean Public Health Nursing
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    • v.10 no.2
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    • pp.103-118
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    • 1996
  • It is to be growing up the interest of community health affairs through visiting nursing care. The health medical treatment of Korea has been changed largely on the period. The juvenile population has decreased. This means that is has took the population consensus of advanced national organization to be increased by the old age. The transition of disease has changed from the contagious disease importance to the chronicity disease omportance because the domestic district population has experienced the sudden urbanization circumstance district population has experienced the sudden urbanization circumstance to be growing up $70\%$ of the whole population. When the nursing service has common function to be delivering from all direction to home, this study is getting the great important phase velocity in order to manage the kernel questional adult chronicity disease of health medical institution at the present age. (1) community over system or with people particularity (2) the first of third step medical treatments. The variety of medical treatments organization has quantity of the delivery manpower and specially between consumers and rdlated person. A qualitative difference is showed at the purpose to be seizing. That research related person is use at district health center in Seoul, by foundation on nurse registration book of H collage hospital and public health registration book. According the chronicity disease. age. and sex. nature agree-able standard 54 people took the content analysis on nurse registration book of total 108 people. The results of the study were as follows: 1. General background factors are houses or kind of medical facilities and number of patients in family. The first medical treatment is more patients than third medical treatment organization. The first medical treatment of economic environment os appering to be worse. 2. The chronicity disease frequency have been different speciality according to medical treatment organization. On case of the first medical treatment. Diabetes and High Blood Pressure were good but Cerebrum Vascular Accident(CVA) showed many for bed case. In addition. the number of family is comparative large exception of CVA on according for moving condition and health more than the first medical treatment. However. family condition. whole family percentage is decreasing preferably through the potential resource is increasing by the number of and the construction of family. The ability of real resource is considered to be low. 3. The average percentage of nurse service has appered to be differed two groups by the first step medical treatment(33.72 times) and third step medical treatment(45.70 times). However, the difference (the first step medical treatment and third step medical treatment) is to be limited to issue the medicine at the service. The condition of nurse care was the indirect nursing care. Supportiong area was to be related to volunteer service and administration support. 4. The various nursing care average percentage of the chronicity disease was increased by orders of Diabetes. High Blood Pressure. and CVA in examination result and the medical treatment. The indirect nursing care was also same. At third step medical treatment, orders of chronicity disease were same. The case of other area on service conditions were increased by order of Diabetes. High Blood Pressure, and CVA. However. it is never appearing the difference at bottleneck affairs nursing care. 5. When the visiting nursing care demand particularly. the average percentage of nursing care from the first step medical treatment that the time under a person is many more than the time over two people. However, there was no difference in statistic. Third step medical treatment is $49.81\%$ at the time under a person. The average nursing care service is appeared by more many when the visiting nursing care demand is a few by 12.83 at the time over two people. 6. By visiting nursing care percentage to be frequency that nursing care averaghe percentage and inter-relation are large. The related factor of the first medical treatment is 0.96. However, the related factor of third medical treatment has shown the decreased 0.49 for the condition of relation more than that. Therefore. the nursing care average percentage is related to the visiting times of a nurse. This result is be showing the obvious fact that the first step medical treatment is few more than third step medical treatment.

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