The second component of this three-paper series studying cloth face masks for children ages 4 to 6 years old concentrates on optimizing aerosol capture and air permeability through fabric selection. Material choices were evaluated in two modes: Flat Filter (FF) and Head Form (HF). FF isolates material factors while HF simulates the performance of the constructed masks on a 3D printed child head form. In FF mode, higher filtration efficiency correlated to lower air permeability in both reusable commercial and experimental face masks regardless of fiber contents, fabric structures, and number of layers. Our prototype face mask developed in design exploration successfully captured 37 ± 12% of 0.3 μm, 87 ± 3% of 0.5 μm, and 87 ± 2% of 1.0 μm particles while maintaining good air permeability, moisture capture, and aerosolized salt capture in HF mode. Sealing masks to minimize outward leakage reduced particle capture up to 64%. Particle leakage data captured at the eye level of the head form illuminated the synergy between mask design, material choice, and fit.
Background Adolescent pregnancy is prevalent in Asian-African countries. Hence, it is critical to track the progress of research and development trends related to the topic. The study aimed to characterize published articles on teen pregnancy by measuring the authors' country and affiliation, most relevant and cited journals, thematic research, and growth trends. Materials and methods Descriptive statistics and retrospective bibliometric analysis were used. Using the Scopus database, we collected published articles from 2010 to 2023. Titles and abstracts were screened. Eligible papers were reviewed based on co-occurrence analysis. Classification and visualization of results were conducted using VOSviewer software version 1.6.17. Results A total of 369 articles were relevant and included in the review. The countries that produced the most publications were South Africa and the United States. The most relevant affiliation was with the University of Cape Town, the University of the Witwatersrand, and the University of Kwazulu-Natal. The most relevant source journals were PLOS One, Reproductive Health, and BMC Public Health. The most cited sources were Lancet, PLOS One, and AIDS Journal. Four clusters were obtained that reflect the main topics, including human immunodeficiency virus (HIV) infection, child, health services, and pregnancy. The current research terms include HIV infection and maternal health services. Conclusions This study suggests more research on the term "vertical transmission, breastfeeding, and partner violence" related to teen pregnancy. In addition, this research will inspire researchers and adolescent health policymakers to expand the scope of research to solve teenage pregnancy problems based on interdisciplinary theories and methods.
In low and middle income countries (LMICs), the rate of teenage pregnancy continues to be high, with significant implications for maternal health. The prevalence of teenage pregnancy is worrisome in Rwanda, and little is known about the consequences faced by teen mothers aged 15-19. Therefore, the present study aims to explore the consequences of adolescent childbearing among teen mothers in Gatsibo district, Rwanda. A descriptive qualitative study design was carried out. We purposively recruited 20 teen mothers aged 15-19 from four health centers in Gatsibo district for in-depth interview. Conversations were conducted in Kinyarwanda and audio recorded. The research team, fluent in both English and Kinyarwanda, carefully listened to each recording and verbatim translated them into English ensuring they are clear and understandable. Transcripts were entered into Dedoose and then inductively and thematically analyzed. Three themes were identified: (1) self-reported health outcomes; (2) socio-economic consequences; and (3) perceived structural barriers of access to healthcare services. Teen mothers in this study reported experiencing physical and psychological problems during pregnancy and after delivery. The socio-economic consequences included lack of social support, feelings of guilt and stigmatization, discrimination, domestic violence, school interruption and dropout, and financial constraint. The structural barriers of access to healthcare included adverse health facility requirements, feeling stigmatized by adult mothers in the healthcare environment, and confronting healthcare providers' negative attitudes toward teen mothers. The results from this study indicated that adolescent childbearing is associated with several negative consequences. Therefore, there is a need in Rwanda to develop interventions addressing these consequences and revise policies and laws to ensure they support the needs of teen mothers.
Introduction Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interaction across multiple contexts and it is marked by repetitive sensory–motor behaviours and restricted interests or activities. Now recognized to occur in up to 1% of the population, the prevalence of ASD has registered a steady increase in the past two decades. Heterogeneity of presentation is a hallmark with comorbid psychiatric and medical morbidities frequently reported. Comorbidities mask and delay the diagnosis and are the cause of inadequate therapies. Objectives In the present paper, we studied a cohort of patients with ASD, investigating the rates and types of psychiatric and medical comorbidities. Methods A retrospective study of psychiatric and medical comorbidities was carried out on a sample of 120 participants that met ASD criteria according to DSM-V. The patients were examined with a detailed medical history, physical examination, as well as some additional functional, imaging, laboratory and genetic investigations. The associated conditions considered were: attention deficit/hyperactivity disorder (ADHD), epilepsy, intellectual disability, gastrointestinal symptoms, ophtalmologic manifestations, infections. Results Of the 120 ASD subjects referred, 25 (20.8%) received the diagnosis of epilepsy. ADHD was established in 24 cases (20%). IQ score was obtained in half of the patients, 43.3% of them presenting a severe intellectual disability (IQ<35). Respiratory disorders occured in 25% of the cases. Ophtalmological findings were observed in 9.1% of the cases. Other frequent comorbidities included motor disturbances and feeding problems. Conclusions A better understanding of comorbidities in ASD patients improves interdisciplinary collaboration, thus facilitating effective treatment programs. Disclosure No significant relationships.
Issue Biomedical approaches want to change locals' behaviors without understanding the sociocultural rationales and contextualizing the cultural and structural backdrop of women's agency. Objectives This study explored the perceptions and practices of rural mothers about fertility and reproductive health and further examine the lack of preference for contraception and birth spacing in Southern Pakistan. Methodology Using purposive sampling we recruited 15 healthcare providers and 20 mothers from Southern Punjab. Key informants and in-depth interviews were used for data collection. We extracted themes and sub themes to analyse qualitative data. Findings Five major themes identified preventing birth spacing and contraceptive use: (1) cultural barriers (2) economic difficulties and demographic factors; (3) gender-related hurdles; (4) spiritual and religious obstacles, and (5) medico-ethical complications. Nearly, ten sub-themes contributing to these major themes were: custom of girls' early marriages, in-laws' permission for contraception, women's concern for medical complications and preference for safer methods, misuse of contraceptive methods by the medical community, mothers' perception of contraception as sinful act and controlling birth is against faith, economic and rural-ethnic factors for high fertility, masculine disapproval of condom use, and wishing to give birth to male children. Suggestions We advocate for understanding the sociocultural explanations for low contraceptive use and urge practice of more natural methods of birth spacing over commercial solutions. The study suggests socio-economic development of less developed communities and empowerment of poor, illiterate, and rural women along with behavior change communication strategies.
Abstract Sandwich generation caregivers are generally those who care for both a child and an older adult. Baby Boomer and Generation X belong to this age cohort. Using data from the 2015-2018 Behavioral Risk Factor Surveillance System Caregiver Module, we compared the prevalence and characteristics of sandwich caregivers across these two generations. Data represent adults from 44 jurisdictions. We categorized caregivers into generations using their age at the time of the survey (N=34,777). Sandwich caregivers were classified as those who lived with a child (≤18 years) and provided care/assistance to a parent/grandparent with a long-term illness/disability during the past 30 days. Prevalence ratios (PR) from log-binomial regression models that included generation, sandwich caregiver status, sex, and race/ethnicity were used to compare weighted estimates. Six percent of Baby Boomers and 31% of Generation X were sandwich caregivers (p<0.001). In adjusted models, sandwich caregivers had a lower prevalence of any chronic health condition (PR=0.77, p=0.01) and fair/poor health (PR=0.87, p=0.003) than other caregivers, but similar frequent mental and physical distress prevalence. Baby Boomer caregivers were more likely to report a chronic health condition, fair/poor health, and frequent physical distress than their Generation X counterparts, but less likely to report frequent mental distress. Sandwich caregivers in these generations appear to be in better health than other caregivers. Nonetheless, it is critical to support the needs of sandwich caregivers as they age, given their important role in meeting the needs of both children and older adults and the additional challenges created by the pandemic.
BACKGROUND: Adolescent girls and young women living with HIV (AGYWLHIV) face heightened risks of unintended pregnancy and often encounter barriers to accessing appropriate family planning (FP) services, particularly in Uganda. Village Health Teams (VHTs) are expected to promote the uptake of modern contraceptives (MCs), yet limited evidence exists regarding their effectiveness among AGYWLHIV in semi-rural areas. This study aimed to determine the prevalence, associated factors, and predictors of MC use among AGYWLHIV accessing HIV care in semi-rural northern Uganda, with a focus on the role of VHTs and other individual, sociocultural, and structural influences. METHODS: A convergent mixed-methods study was conducted in Lira district and city northern Uganda among a stratified sample of AGYWLHIV aged 15–24 accessing antiretroviral therapy (ART) at public health facilities. Quantitative data were collected using interviewer-administered questionnaires while qualitative data were gathered through individual in-depth interviews with a purposively selected subsample reporting non-use of MCs. Participants were asked about their awareness and use of FP services, current MC use, and reasons for non-use. Statistical analysis involved descriptive statistics and multivariable modified Poisson regression at a 5% significance level. Manual thematic analysis was used for qualitative data and integration was performed at interpretation to provide a comprehensive understanding. RESULTS: We recruited 423 AGYWLHIV aged 21.6 ± 2.5. The study found 62.4% (95% CI 57.8–67.0) MC use prevalence. The MC use was significantly associated with the woman being a catholic by religion (p = 0.001, APR 1.262 (95% CI 1.096–1.452), having no fertility desires (p = 0.034, APR 0.728, 95% CI 0.543–0.976), being single (P < 0.001, APR 0.751, 95% CI 0.651–0.866), alcohol use (p = 0.001, APR 1.288 (95% CI 1.117–1.485), being pregnant (p = 0.004, APR 0.306, 95% CI 0.137–0.684) and having an HIV negative male partner (p = 0.009, APR 1.225, 95% CI 1.052–1.425). Qualitative findings highlighted barriers including male partner disapproval, stigma, misinformation, pregnancy or postpartum status and sociocultural norms. CONCLUSION: While MC use prevalence among AGYWLHIV in semi-rural northern Uganda exceeds national, East African and SSA averages, uptake is influenced by multifaceted socio-cultural, individual and systemic factors. The lack of significant associations between the women’s awareness of the various community-based FP resources or providers and their use of MCs but religious affiliation, marital status, alcohol use, fertility desires and male partner’s HIV status implies that socio-cultural, individual and systemic barriers to MC use should be addressed alongside awareness creation to improve the MC use in the AGYWLHIV population.
Introduction One of the central debates in the psychiatric community is the difficulty in distinguishing Dissociative Identity Disorder (DID) from Borderline Personality Disorder (BPD). The fact that core symptoms of these pathologies such as emotional dysregulation, alterations in sense of Self, amnesia, depersonalization, self harm, hearing voices, difficulties in maintaining relationships, are symptoms that feature in both disorders can lead physicians to a misdiagnosis, thus depriving patients with DID of adequate treatment. Objectives To report a complex clinical case of a DID patient initially misdiagnosed as BPD. Methods Clinical case report. Results A 45-year-old Caucasian woman with a history of childhood intrafamilial sexual abuse and domestic violence, substance use disorder, autolesionistic and suicidal behaviour with an active diagnosis of BPD presented to our ambulatory mental health care service. A more thorough examination revealed a history of emotional and affect dysregulation, depersonalization, amnesia, intrusive traumatic memories and nightmares with affective, cognitive, and sensorimotor aspects, persistent negative Self-perception. Auditory verbal hallucinations were also present described as inner space with commentary and derogatory nature with one of them being a child voice. The diagnosis of tertiary structural dissociation and DID was finally made when three Apparently Normal Personalities emerged with several Emotional Personalities, authorising for cautious partial pharmacological washout and initiation of three phase-orientated treatment approach. Conclusions DID is more common than is assumed and the overlap of core symptoms with other disorders can lead to a misdiagnosis. A careful clinical interview and evaluation of symptoms is mandatory to a correct DID diagnosis with a consequent appropriate therapy. Disclosure No significant relationships.
Background Limited information is available on the value of integrating family planning and nutrition services to improve related outcomes among women of reproductive age and effective approaches to achieve this. This study aimed to ascertain the perspectives and experiences of global and regional stakeholders about integrating family planning and nutrition services, examine facilitators and barriers and identify opportunities and considerations for integration. Methods We conducted semistructured interviews with 34 global and regional stakeholders in family planning, nutrition and related domains. Participants were identified through purposive sampling. Interviews were conducted virtually, recorded and transcribed. Data were analysed using thematic analysis. Results Stakeholders considered the integration of family planning and nutrition services potentially valuable given the biological links between family planning and nutritional status, and potential practical benefits including increased service coverage, reduced burden on beneficiaries to access services and increased cost-effectiveness of service delivery. Integration was commonly described within the context of comprehensive health service packages, with integration models encompassing health systems strengthening, life course and multisectoral approaches. Facilitators and barriers included systemic and structural, resource-related and contextual factors. The need for more robust evidence to support integration and identify effective and cost-effective integration models was emphasised. Conclusions Integrating family planning with nutrition services and both with other health services directed towards women of reproductive age and their children may offer greater value in improving health and related outcomes, as opposed to siloed approaches. Further evidence quantifying benefits and highlighting the effectiveness of such integration strategies is key to informing future programmatic efforts.
The African kinship system facilitates the movement of children and adults between households to mitigate hardship, yet few studies have documented membership changes in rural African households over time and addressed the effects of these household dynamics on the developmental outcomes of children. We used a household inventory instrument to document the number of changes in household membership experienced by 93 households in rural Zambia between two timepoints (∼2 years apart). We then used multilevel models to evaluate the effects of migration and household change on the academic learning of the children affected by HIV residing in these households, positing migration between households as a proxy for household connectivity and a potential protective factor for children. Our inventoried households experienced on average 4.12 changes in membership over the measured period. About half of these changes were due to children under 10 moving between relatives' households. No effects of these migration-related variables were found on children's academic progress at the family level. Household connectivity, as operationalized by the movement of individuals between households, may be typical to these children's home life and were not shown to be detrimental to their academic learning.
