Listening to Women's Voices: The Quality of Care of Women Experiencing Severe Maternal Morbidity, in Accra, Ghana

Background

Women who survive severe obstetric complications can provide insight into risk factors and potential strategies for prevention of maternal morbidity as well as maternal mortality. We interviewed 32 women, in an urban facility in Ghana, who had experienced severe morbidity defined using a standardized WHO near-miss definition and identification criteria. Women provided personal accounts of their experiences of severe maternal morbidity and perceptions of the care they received.

Methods and Findings

The study took place in a referral facility in urban Accra, and semi-structured interviews were conducted with women who had either a maternal near miss (n = 17) or a potentially life-threatening complication (n = 15). The most common themes surrounding the traumatic delivery were the fear of dying and concern over the potential (or actual) loss of the baby. For many women, the loss of a baby negatively influenced how they viewed and coped with this experience. Women’s perceptions of the quality of the care highlighted several key factors such as the importance of information, good communication and attitudes, and availability of human (i.e., more doctors) and physical resources (i.e., more beds, water) at the facility.

Conclusions

Our results suggest that experiences of women with severe maternal morbidity may inform different aspects of quality improvement in the facilities, which in turn have a positive impact on future health seeking behavior, service utilization and reduction in maternal morbidity and mortality.     

Slender,Older Women Appear to Be More Susceptible to Nontuberculous Mycobacterial Lung Disease

Background: Nontuberculous mycobacteria (NTM) are environmental microbes that are associated with a variety of human diseases, particularly chronic lung infections. Over the past several decades, NTM lung disease has been increasingly seen in postmenopausal women with slender body habitus.Objective: This article reviewed the clinical and experimental evidence that supports the observation that thin older women (aged 50–80 years) are predisposed to NTM lung disease. We posited 3 potential pathways for this predisposition: relative estrogen deficiency, abnormal levels of adipokines that alter immune responses, and abnormal expression of transforming growth factor-β (TGF-β) related to fibrillin anomalies similar to Marfan syndrome (MFS).Methods: Using the PubMed database, a literature search was performed (all publications up to July 2009) by pairing the key phrase nontuberculous mycobacteria with weight, malnutrition, female gender, body habitus, leptin, adipokines, estrogen, menopause, postmenopausal, or body mass index. Non-English-language articles were included if their abstracts were in English. Relevant articles were also identified from the abstracts.Results: Published case reports and series indicate that in the past 20 years, NTM lung disease has been recognized in disproportionately increased numbers in postmenopausal women. Among these patients, slender body habitus and thoracic cage abnormalities, such as pectus excavatum and scoliosis, are commonly described. Notably, no long-term prospective clinical studies exist to corroborate that low weight is an independent risk factor for NTM lung disease. However, based on the findings of a limited number of experimental studies, we hypothesize that decreased leptin, increased adiponectin, and/or decreased estrogen in older women with slender body habitus may account for their increased susceptibility to NTM infections. We further speculate that in some patients with features mindful of MPS (slender, scoliosis, pectus excavatum, or mitral valve prolapse), there may be anomalies of fibrillin, similar to MFS, that lead to the expression of the immunosuppressive cytokine TGP-β further increasing their susceptibility to NTM.Conclusions: It is likely that both sufficient environmental exposure and host susceptibility are required for the establishment of NTM lung disease. The observation that NTM lung infections are more common in slender, older women without any overt immune defects suggests that abnormal expression of adipokines, sex hormones, and/or TGF-β may play an important role in their susceptibility.     

The Influence of the Digital Divide on Face Preferences in El Salvador: People without Internet Access Prefer More Feminine Men,More Masculine Women,and Women with Higher Adiposity

Previous studies on face preferences have found that online and laboratory experiments yield similar results with samples from developed countries, where the majority of the population has internet access. No study has yet explored whether the same holds true in developing countries, where the majority of the population does not have internet access. This gap in the literature has become increasingly important given that several online studies are now using cross-country comparisons. We therefore sought to determine if an online sample is representative of the population in the developing country of El Salvador. In studies of Hispanic men and women aged 18–25, we tested facial masculinity and adiposity preferences by collecting data in person as well as online. Our results showed that there were no differences in preferences between people who reported having internet access, whether they were tested online or in person. This provides evidence that testing style does not bias preferences among the same population. On the other hand, our results showed multiple differences in preferences between people who reported having internet access and people who reported not having internet access. More specifically, we found that people without internet access preferred more feminine men, more masculine women, and women with higher adiposity than people with internet access. We also found that people without internet access had fewer resources (e.g. running water) than people with internet access, suggesting that harshness in the environment may be influencing face preferences. These findings suggest that online studies may provide a distorted perspective of the populations in developing countries.     

Escherichia coli Serogroups Isolated from Streams in Pennsylvania, 1965 to 1972

Of 3,200 cultures of Escherichia coli isolated from streams in Pennsylvania over a 7-year period, 82.46% or 2,639 were O serogrouped. The largest number of cultures (33.4%) belonged to O groups 1 to 26, and the second highest number (16.8%) belonged to O groups 60 to 88. The individual E. coli O groups most frequently isolated were ADO3, 18ac, 2a, 3, 7, 73, 139, and OX13. Practically every known standard E. coli O group was found in the streams. It was not possible to identify the K and H antigen of every E. coli isolate. Serotypes of E. coli O2a:K1:H6, O26:K60:H11, O55:K59:H27, O86:K62:H2, 112ab:K68:H2, 125ab:K70:H21, 128ab:K67:H2, and O138:K81:H14 known to be pathogenic for humans and animals were identified. Cultures having the same K antigen but a different H antigen for enteropathogenic E. coli O groups 6, 18ab, 18ac, 111ab, 126, 127a, 139, 141, and 147 were also isolated.     

Variation in chemical composition of the River Frome, England, from 1965 to 1972

This study covers a 7-year period from 1965 to 1972, and shows the variation in flow, water chemistry and throughput of nutrients. The annual discharge of the River Frome varied considerably from year to year, ranging from a mean value of 4.48 m³ sec⁻¹ in 1971 to one of 8.38 m³ sec⁻¹ in 1966. The mean annual nutrient losses calculated over all 7 years of study from the River Frome catchment were: Nitrate 11.4 kg ha⁻¹, phosphorus 0.49 kg ha⁻¹ and potassium 8.4 kg ha⁻¹. There has been an increase in annual throughput (in years of similar flow) of 21% in phosphate and 41% in nitrate from 1965 to 1972.     

Cache Valley virus: isolations from mosquitoes in Saskatchewan, 1972-1974.

Eighteen isolations of Cache Valley virus (Bunyaviridae) were obtained from a total of 113,694 mosquitoes collected in Saskatchewan during the summers of 1972 to 1974. Most of the isolations were from mosquitoes collected during August. Culiseta inornata, the most abundant mosquito (38% of total collected), had the highest minimum vector-infection rate (0.83 isolations per 1000 mosquitoes). The virus was also isolated from Culex tarsalis and Aedes vexans. It is indicated in the isolations that the prairie grasslands of the province are enzootic for Cache Valley virus.     

Women from Venus,men from Mars: inter‐sex foraging differences in the imperial cormorant Phalacrocorax atriceps a colonial seabird

Colonial seabirds are central place foragers and likely to be subject to substantial competition for resources. Mechanisms proposed for reducing intra‐specific competition include differential inter‐sex area use mediated by adult choice. We used GPS loggers and dive recorders to study area use and dive depth in a total of 27 male and 26 female imperial cormorants Phalacrocorax atriceps breeding at a colony of some 6500 birds at Punta Leon, Chubut, Argentina during 2004 and 2005. Although time spent travelling and distances between the colony and foraging sites were similar for both sexes, males and females travelled away from their colony using routes virtually perpendicular to each other so that their foraging areas were distinctly different; females hunted close to the coast while males foraged offshore in deeper water. Consideration of foraging efficiency underwater, defined as the duration spent on the bottom divided by the dive cycle duration, showed that females were more efficient at depths < 40 m while males more efficient at depths > 40 m. We suggest that the substantial sexual dimorphism in this species may be responsible for the different depth‐linked foraging efficiencies and that selection for appropriate depths could lead to differential habitat use and putative differences in prey selection.     

The Intelligent Egg, and How It Got That Way: from Genes to Genius in a Few Easy Lessons

A seed has no flowers or leaves, and an egg no fingers or lungs. Yet plants and animals not only have these things but they resemble their parents in detail throughout their bodies. Something is inherited, but what is it? Life is based on the activities of cells. An organism has large numbers of them—a human has trillions! Cells live as separate units, which enables them each to do its own thing within its particular organ, but to be an organism they must work together. A cell can only detect its immediate local environment, but that includes various kinds of signals or information from nearby or far away within the body—or even from the external environment. It is by being local but responding globally in this way that an egg becomes an organism, an organism manages its way through life, and organisms make up species and ecosystems that interact with each other. The evolution of these abilities has produced the glorious array of living forms that populate the world. In these ways, an egg may have no thoughts but is a highly intelligent being.     

Shifting Transversals: Trans Women's Move from Spirit Mediumship to Beauty Work in Mandalay

Long active as spirit mediums, trans women have become increasingly important players in the beauty business in Mandalay, Burma, as elsewhere in Southeast Asia. I ask what affinities we might discern in these two roles of spirit medium and beautician such that trans women should be thought especially suited to take them on. The boundary-crossing implicit in both turns on self-fashioning, a process which connects humans to spirits and/or ordinary individuals to the prestigiously modern.     

Factors Associated with Four or More Antenatal Care Visits and Its Decline among Pregnant Women in Tanzania between 1999 and 2010

In Tanzania, the coverage of four or more antenatal care (ANC 4) visits among pregnant women has declined over time. We conducted an exploratory analysis to identify factors associated with utilization of ANC 4 and ANC 4 decline among pregnant women over time. We used data from 8035 women who delivered within two years preceding Tanzania Demographic and Health Surveys conducted in 1999, 2004/05 and 2010. Multivariate logistic regression models were used to examine the association between all potential factors and utilization of ANC 4; and decline in ANC 4 over time. Factors positively associated with ANC 4 utilization were higher quality of services, testing and counseling for HIV during ANC, receiving two or more doses of SP (Sulphadoxine Pyrimethamine)/Fansidar for preventing malaria during ANC and higher educational status of the woman. Negatively associated factors were residing in a zone other than Eastern zone, never married woman, reported long distance to health facility, first ANC visit after four months of pregnancy and woman''s desire to avoid pregnancy. The factors significantly associated with decline in utilization of ANC 4 were: geographic zone and age of the woman at delivery. Strategies to increase ANC 4 utilization should focus on improvement in quality of care, geographic accessibility, early ANC initiation, and services that allow women to avoid pregnancy. The interconnected nature of the Tanzanian Health System is reflected in ANC 4 decline over time where introduction of new programs might have had unintended effects on existing programs. An in-depth assessment of the recent policy change towards Focused Antenatal Care and its implementation across different geographic zones, including its effect on the perception and understanding among women and performance and counseling by health providers can help explain the decline in ANC 4.     

Emotional Eating,Alexithymia, and Binge‐Eating Disorder in Obese Women

Objective: To investigate the relationships between alexithymia and emotional eating in obese women with or without Binge Eating Disorder (BED). Research Methods and Procedures: One hundred sixty‐nine obese women completed self‐report questionnaires, including the Beck Depression Inventory, the State Trait Anxiety Inventory, the Stress Perceived Scale, the Dutch Eating Behaviour Questionnaire, and the Toronto Alexithymia Scale. The presence of BED, screened using the Questionnaire of Eating and Weight Patterns, was confirmed by interview. Results: Forty obese women were identified as having BED. BED subjects and non‐BED subjects were comparable in age, body mass index, educational level, and socioeconomic class. According to the Dutch Eating Behaviour Questionnaire, BED subjects exhibited higher depression, anxiety, perceived stress, alexithymia scores, and emotional and external eating scores than non‐BED subjects. Emotional eating and perceived stress emerged as significant predictors of BED. The relationships between alexithymia and emotional eating in obese subjects differed between the two groups according to the presence of BED. Alexithymia was the predictor of emotional eating in BED subjects, whereas perceived stress and depression were the predictors in non‐BED subjects. Discussion: This study pointed out different relationships among mood, alexithymia, and emotional eating in obese subjects with or without BED. Alexithymia was linked to emotional eating in BED. These data suggest the involvement of alexithymia in eating disorders among obese women.     

Cued to Act on Impulse: More Impulsive Choice and Risky Decision Making by Women Susceptible to Overeating after Exposure to Food Stimuli

There is increasing evidence that individual differences in tendency to overeat relate to impulsivity, possibly by increasing reactivity to food-related cues in the environment. This study tested whether acute exposure to food cues enhanced impulsive and risky responses in women classified on tendency to overeat, indexed by scores on the three factor eating questionnaire disinhibition (TFEQ-D), restraint (TFEQ-R) and hunger scales. Ninety six healthy women completed two measures of impulsive responding (delayed discounting, DDT and a Go No-Go, GNG, task) and a measure of risky decision making (the balloon analogue risk task, BART) as well as questionnaire measures of impulsive behaviour either after looking at a series of pictures of food or visually matched controls. Impulsivity (DDT) and risk-taking (BART) were both positively associated with TFEQ-D scores, but in both cases this effect was exacerbated by prior exposure to food cues. No effects of restraint were found. TFEQ-D scores were also related to more commission errors on the GNG, while restrained women were slower on the GNG, but neither effect was modified by cue exposure. Overall these data suggest that exposure to food cues act to enhance general impulsive responding in women at risk of overeating and tentatively suggest an important interaction between tendency for impulsive decision making and food cues that may help explain a key underlying risk factor for overeating.     

Women's role orientations and expected fertility: Evidence from the Detroit area, 1978

Abstract

The paper investigates whether there is empirical evidence to support the hypothesis that women's attitudes toward traditionally female family roles affect their expected fertility net of the much‐discussed link between women's employment and fertility. Along with several socio‐demographic variables, the study uses a nonwork related attitude variable comprised of a motherhood role attitude measure and a housekeeping attitude measure. The study uses a probability sample of white, fecund, once‐married women under 35 living with their husbands in the Detroit Metropolitan Area in 1978. Findings suggest that nonwork related attitudes have a significant effect on fertility expectations net of labor force participation. They also suggest that general fertility surveys could benefit from including questions on nonwork related role orientations.