Free Union Research Articles

Women's Empowerment and Associated Factors in Kinshasa, Democratic Republic of Congo: A Secondary Data Analysis of the Performance Monitoring Assessment Survey.

Empowering women and promoting gender equality is crucial for accelerating sustainable development in fragile countries, including the Democratic Republic of Congo (DRC). However, there is scarce existing knowledge or understanding of the factors determining women's empowerment in these contexts. We aimed to assess women's empowerment and determine its associated factors in Kinshasa, DRC. We analyzed data from the 2021 Performance Monitoring Assessment (PMA) survey. A sample of 1365 women of childbearing age was retained for this study. Twenty empowerment items related to household decision-making, contraception use, and husband/partner influence were considered. We calculated the average women's empowerment index (aWEI), identified the women's empowerment variables using principal component analysis (PCA), and determined the associated factors for the first three principal components through the performance of multivariate binary logistic regression. In Kinshasa, the overall aWEI was estimated at 0.65. It was low for household decision-making (0.34) and high for husband/partner influence domains (0.93). Three principal components were identified and named, including the absence of threats, control of sexuality, and participation in decision-making. The factors associated with these components were having internet access, being in free union with a partner, being aged 40-49 years, and residing in a non-slum area. Increasing access to information would enable women in Kinshasa to make strategic decisions about their lives, benefiting themselves and others.

PSYCHOPATHOLOGICAL DISORDERS AND ASSOCIATED FACTORS ACCORDING TO SRQ

Background: mental illnesses are a challenge for health systems and nations. Globally, mental disorders account for 12% and in the Americas alone, there are an estimated 400 million people with psychiatric and neurological disorders. By means of the SRQ test (self-reporting questionnaire) created by the World Health Organization (WHO), it is possible to detect and attend to mental health problems in primary care services, mainly in developing countries, requiring less time and trained personnel. Objective: to describe psychopathological disorders and associated factors according to the SRQ in individuals from San Luis de Cumbe Parish, Cuenca Canton. Methods and materials: The study was a cross-sectional quantitative research, with a universe of 6,582 inhabitants of the San Luis de Cumbe Parish, from which a sample of 364 people was taken with a confidence of 95%, margin of error of 5% and prevalence of 50%. The information was collected by means of a sociodemographic survey and the SRQ test. The data were analyzed through tables and graphs with the statistical calculation program SPSS 25 test version. To determine the association between the object of study and the associated factors, the OR was obtained with its 95% CI and the p value to determine the statistical significance. In addition, several bibliographic studies were used as a source, mainly PubMed, Google Scholar and Cochrane. Results: In the study population, 19.2% presented depression, 40.7% had anxiety, 13.2% presented psychosis, 6.6% had epilepsy and 13.2% showed alcoholism. Conclusions: depression and anxiety are the most representative psychopathological disorders found in this study, being more common in young adult women, without leaving behind psychosis and alcoholism present in adults regardless of sex, while epilepsy is more common in males regardless of age group. The Chi-square test between sociodemographic factors and risk factors showed that psychosis, epilepsy and alcoholism are present in people whose marital status is free union. Similarly, it was found that Afro-Ecuadorians have epilepsy, while anxiety was present in those of indigenous and mestizo ethnicity. It is advisable to carry out intervention programs and early detection of any psychopathological disorder is of utmost importance, so that the affected individual can receive timely care and reduce possible complications throughout his or her life. The population should be educated about the risk factors involved in the appearance of these pathologies, so that they can prevent or on the other hand learn to live with them, in addition to motivating people, especially health personnel to conduct new research to contribute to the health of the people not only in this parish but also in others. KEY WORDS: depression, anxiety, alcoholism, psychosis, epilepsy, SRQ, Cumbe, DSM5.

Woolf’s Night and Day and the Free-Union Novel

This article places Woolf’s Night and Day (1919) in the context of the Edwardian free-union novel—works that represent and debate monogamous relationships without legal recognition. In seeking alternatives to marriage, this genre explored what modernity might mean for young, middle-class women. Typically, the narratives’ protagonists ultimately abandon the idea of the free union, the novels often ending after all with a conventional engagement. Night and Day follows this pattern, but only to a point. It examines the free union as an opportunity for a more liberated life for young women and still ends with an engagement, but it also remains committed to seeking a compromise between old and new—reimagining marriage on more equal terms. In this, Night and Day can be seen as a transitional novel, in relation both to Woolf’s own writing and to the shift from Edwardian fiction toward modernism.

Post-Traumatic Stress Risk Among COVID-19 Survivors in Colombia

BackgroundSymptoms of post-traumatic stress are common in people who have experienced a life experience that significantly threatened their physical or psychological integrity. Nevertheless, little information about post-traumatic stress disorder risk (PSTD-R) in Colombian COVID-19 survivors is available. ObjectiveTo establish the prevalence and variables associated with PTSD-R in a sample of COVID-19 survivors in Santa Marta, Colombia. MethodA cross-sectional study was designed with a non-probabilistic sample of adult COVID-19 survivors. Participants were demographically characterized and completed scales for depression risk, insomnia risk, and PTSD-R. ResultsThree hundred and thirty COVID-19 survivors between 18 and 89 years participated; 61.5% were women. The frequency of depression risk was 49.7%; insomnia risk, 60.6%; and PTSD-R, 13.3%. Depression risk (OR=41.4, 95% CI 5.5–311.6), insomnia risk (OR=5.3, 95% CI 1.8–18.7), low income (OR=3.5, 95% CI 1.4–8.7) and being married or free union (OR=2.7, 95% CI 1.1–6.2) were associated with PTSD-R. ConclusionsTwo out of every fifteen COVID-19 survivors are in PTSD-R. Depression and insomnia risk are strongly associated with PTSD-R among Colombian COVID-19 survivors. Studies that follow COVID-19 survivors long-term are needed.

Acceptability of Human Papillomavirus Vaccine by the Population of Two Health Districts in Yaounde-Cameroon

Human papillomavirus (HPV) infections with high oncogenic risk are responsible for 7.7% of cancers (mainly cervical cancer) in developing countries. Vaccination is considered to be one of the greatest public health successes, but despite its proven effectiveness, vaccination does not longer enjoy popular support, which leads to a coverage in terms of HPV vaccine almost non-existent. A descriptive and analytical cross-sectional study was conducted in the health districts of Nkolndongo and Djoungolo, with the aim of analyzing the acceptability of Human Papillomavirus vaccine in these health districts. From a structured questionnaire administered to 330 parents and 32 Community health Workers (CHWs), we found an insufficient 33.6% moderate level of HPV vaccine acceptability, a statistical significant association between parents’ marital status and HPV vaccine acceptability (OR = 0.369; P value = 0.027; 95%; CI = [0.153, 0.890]), a statistically significant association between knowing someone with cervical cancer and accepting her child to get vaccinated against HPV (OR =0.409; P-value = 0.006; 95%; CI= [0.217; 0.769]), a statistically significant association between accepting HPV vaccine and agreeing to have her child vaccinated against HPV at 51.6%, and a statistically significant association between knowing that HPV vaccine was available in health facilities and its acceptability (OR=0.210; P-value = 0.021; 95%; CI = [0.056; 0.793]). To expand HPV vaccination coverage, various activities should be carried out among the population to improve their knowledge about cervical cancer and the availability of HPV vaccine. The focus should be on unmarried parents and parents engaged in a free union relationship. Health workers should use true life stories about cervical cancer as a means of raising awareness and the list of health facilities administrating HPV vaccine should be made known to the population.

Changes in oral health-related quality of life before and after dental treatment in 8–12-year-old Costa Rican schoolchildren

AimsThe aims of this study were to (1) evaluate oral health-related quality of life (OHRQoL) in 8–12-year-old Costa Rican schoolchildren before and after dental treatment and (2) collect clinical and sociodemographic characteristics.MethodsSchoolchildren completed the Child Oral Health Impact Profile-Short Form (COHIP-SF-19) questionnaire before and after dental treatment. One of the parents was asked to complete a sociodemographic survey. Patients were treated for caries, hypomineralizations, and dental malocclusions. The prevalence of these conditions were assessed from the patient's electronic dental record.ResultsEighty participants (39 male and 41 female, average age: 9.4 ± 1.0 years) were recruited. The prevalence of dental caries was 56.1% with a mean deft and DMFT score of 3,15 ± 0.96 and 2.22 ± 0.77, respectively. Prevalence of hypomineralizations was 53.7% and dental malocclusions was 82.9%. The Simplified Oral Hygiene Index before treatment was 1.45 ± 0.45 and after was 1.42 ± 0.43. Mean COHIP-SF-19 total score decreased from 53,7 ± 7,8 before dental treatment to 31,4 ± 4,2 after treatment. Improvements in all subdomains were also observed. Regarding sociodemographic characteristics, 65% of the patients lived in San José, Costa Rica's capital city, and 56.3% of the studied population belonged to a low-income family. Most parents did not complete high school. Regarding the number of family members living in the same house as the patient, an average of four people was reported. In relation to family structure, 58.8% of the children's parents lived together, either married or free union. As for household owning, 53.8% of parents reported owning their house, 36.3% lived in a rented house, and 10% lived in a borrowed home.ConclusionThe prevalence of caries, hypomineralizations, and dental malocclusions were high before dental treatment. Reported sociodemographic characteristics unlikely changed after dental treatment, suggesting dental care played a pivotal role in improving self-perceptions of oral health and quality of life in our clinical setting.

Disjoint union of fuzzy soft topological spaces

<abstract><p>In this work, sums of fuzzy soft topological spaces are defined with free union of a pairwise disjoint non-empty family of fuzzy soft topological spaces. Firstly, we give general information of fuzzy soft topological spaces. Then, we define free union of fuzzy soft topological spaces and disjoint union topology of fuzzy soft topological spaces. We call the free union of a pairwise disjoint non-empty family of fuzzy soft topological spaces the sum of fuzzy soft topological spaces. We show what are the interchangeable properties between fuzzy soft topological spaces and the sum of fuzzy soft topological spaces. For example, there are fuzzy soft interior, fuzzy soft closure, fuzzy soft limit points. Also, we provide some properties showing the relationships between fuzzy soft topological spaces and their sums. Some of these are fuzzy soft base, fuzzy soft sequences, fuzzy soft connected-disconnected, fuzzy soft compact spaces. Also, part of the research for this article is work on fuzzy soft convergence on fuzzy soft topological sum. With this paper, some results, theorems and definitions for fuzzy soft topological sum have been acquired with the help of results, theorems and definitions given in previous studies about fuzzy soft topological spaces.</p></abstract>

Knowledge about kitchen hygiene and associated factors in caregivers in a peri-urban area of Lima

Background: Food and kitchen hygiene are necessary conditions for safe food and prevent foodborne illnesses. The objective of this study was to identify the factors associated with caregivers’ knowledge of kitchen hygiene in San Juan de Lurigancho (SJL). Methods: This was a cross-sectional study. We surveyed 250 mothers at comedores populares (a sort of community kitchens which are very popular in Lima) and who were part of mothers' clubs in the areas of Huascar V and San Pablo, in SJL in Lima. The sample was selected through non-probability convenience sampling. A questionnaire with three dimensions (cleanliness, storage and contamination of children) was administered. Results: On average, in Huascar and San Pablo, most caregivers were the children’s mothers (93.2%); most of the caregivers were between 21 and 30 years old (54%); they had secondary level of education (70.4%); they were living in free union with their partners (69.2%); they were mainly housewives (80.4%); their houses were constructed with materials different from brick and cement (68.4%); and their houses had a bare floor (70.0%). They did not have drinking water in the kitchen (88.4%); they did not use a gas stove (88.4%), a refrigerator (50.0%), a radio (82.0%), or a microwave (16.4%). A good level of knowledge of food hygiene was found in 63.2% of caregivers. No predictive capacity of the assessed sociodemographic characteristics on the level of knowledge of kitchen hygiene was identified. Conclusions: This study determined that the assessed sociodemographic variables were not significantly associated with the level of knowledge about kitchen hygiene. It is necessary to improve mothers' knowledge about the handling and consumption of spoiled food and their effect on children's health.

Caracterización clínica y epidemiológica de pacientes femeninas con VIH del Hospital Gustavo Domínguez, Ecuador

Introducción: En Ecuador, las mujeres representan el 30 % de la totalidad de las personas con diagnóstico de virus de inmunodeficiencia humana (VIH). De hecho, en el año 2019 alrededor del 20 % de las nuevas infecciones se presentó en pacientes de género femenino. Objetivo: Establecer las características clínicas y epidemiológicas de pacientes de sexo femenino con diagnóstico de VIH en el Hospital Gustavo Domínguez durante el período 2014-2019. Materiales y métodos: Se efectuó un estudio analítico descriptivo de 212 pacientes femeninas con diagnóstico de VIH que ingresaron al Hospital Gustavo Domínguez durante el período 2014-2019. Se obtuvo información de las historias clínicas y sistema SIEN. Se incluyó a todas las pacientes con diagnóstico confirmado de infección por VIH y datos clínicos completos. Resultados: El mayor porcentaje de mujeres se encontró en el rango de edad de 25 a 64 años, con instrucción primaria y el estado civil de unión libre. El inicio de la vida sexual fue antes de los 18 años en 59,9 % de las mujeres y 91,1 % tuvo múltiples parejas sexuales. Se encontró una asociación significativa (p<0,05) entre el estado civil de soltera y unión libre, la edad de inicio de vida sexual activa en las menores de 15 años, y el consumo de alcohol semanal con el riesgo de VIH en mujeres. Conclusión: Los determinantes de la salud de mujeres con VIH alertan sobre la necesidad de educación efectiva para prevenir el contagio con VIH y otras infecciones de transmisión sexual.

Study of soft tissue cover in compound lower limb trauma

: Early vascularized soft tissue closure has long been recognized to be essential in achieving eventual infection free union. The question of whether muscle or fasciocutaneous tissue is superior in terms of promoting fracture healing remains unresolved.: To study options of different flaps in compound lower limb trauma and to know the pattern of providing flap cover in our setup. This was prospective observational study conducted in all the cases admitted under orthopaedics department who are hemodynamically stabilised, later referred to our department of plastic surgery for the flap cover. Isolated compound lower limb injuries with or without fractures were included in study.: Among 45 cases one patient (2.2%) had defect in the thigh, two patients had defect around knee (6.6%), nine cases had defect in upper third leg (20%), thirteen patients had defect in middle third leg (28.8%), seventeen patients have defect in lower third leg (37.7%) and three patients had in the foot (6.6%). Cross leg flap were used in 11 cases (24.4%) Gastrocnemius myo-cutaneous flap were used in 9 cases (20%). Fascio-cutaneous flaps superiorly based were used in three cases (6.6%) and Inferiorly based Fasciocutaneous flaps were used in 6 cases (13.3%), Reverse sural artery flap were used in six cases (13.3%) and Lateral premalleolar flap were used in 8 cases (17.7) and Advancement flap done in one case over defect of the thigh (2.2%). In a case with defect over thigh (2.2%). Complications like total flap loss was noted in one case (2.2%) marginal necrosis noted in five cases (11.1%) and pin track infection in three cases (6.6%).In Grade IIIB fractures external fixator was the choice of skeletal stabilisation. Delayed flap cover gave good results but it increases duration of hospital stay.

Knowledge about kitchen hygiene and associated factors in caregivers in a peri-urban area of Lima

Background: The objective of this study was to identify the factors associated with caregivers’ knowledge of kitchen hygiene in San Juan de Lurigancho (SJL). Methods: This was a cross-sectional study. We surveyed 250 mothers at comedores populares (a sort of community kitchens which are very popular in Lima) and who were part of mothers' clubs in the areas of Huascar V and San Pablo, in SJL in Lima. The sample was selected through non-probability convenience sampling. A questionnaire with three dimensions (cleanliness, storage and contamination of children) was administered. Results: On average, in Huascar and San Pablo, most caregivers were the children’s mothers (93.2%); most of the caregivers were between 21 and 30 years old (54%); they had secondary level of education (70.4%); they were living in free union with their partners (69.2%); they were mainly housewives (80.4%); their houses were constructed with materials different from brick and cement (68.4%); and their houses had a bare floor (70.0%). They did not have drinking water in the kitchen (88.4%); they did not use a gas stove (88.4%), a refrigerator (50.0%), a radio (82.0%), or a microwave (16.4%). A good level of knowledge of food hygiene was found in 63.2% of caregivers. No predictive capacity of the assessed sociodemographic characteristics on the level of knowledge of kitchen hygiene was identified. Conclusions: This study determined that the assessed sociodemographic variables were not significantly associated with the level of knowledge about kitchen hygiene. It is necessary to improve mothers' knowledge about the handling and consumption of spoiled food and their effect on children's health.

COGNITIVE INTERVENTION TO THE WOMEN WHO ATTEND THE "BREASTFEEDING SUPPORT GROUP"

Introduction: Breast milk is the best food to meet the nutritional needs of the child, exclusively for the first 6 months and up to two years of age, favoring the establishment of the mother-child bond. Objective: To carry out a cognitive intervention to the women who attend the “breastfeeding support group”. Method: Quantitative research, with a quasi-experimental design, in a census sample made up of 11 pregnant women and 19 breastfeeding women. The Iowa Infant Feeding Attitudes Scale (IIFAS) was used. Results: 33.30% (10) are between 33-35 years old, 63% (19) in the puerperium, 56% (17) with primary education, 60% (18) carry out agricultural / cattle raising activities, 53% (16) in free union. In the pre-intervention, the women had a positive attitude with a score of 17-48 towards artificial breastfeeding 83% (25), in the post-intervention the positive attitude towards breastfeeding changed 87% (26), with a significant difference of p <0.01, in the items of the IIFAS instrument in the pre-intervention a mean and standard deviation of 2.07 ± 1.16, with an increase in the post-intervention of 4.48±0.65, a significance difference <0.05 in the total of questions in the pre-intervention from 35.23, increased after the intervention to 76.13, their attitude changed to exclusive breastfeeding. Conclusions: the cognitive intervention increased the positive attitude towards exclusive breastfeeding, highlighting that a timely educational intervention of promotion, support and accompaniment during pregnancy and postpartum guarantees the duration and exclusivity of breastfeeding.
 
 Keywords: breastfeeding, breastfeeding behavior, breastfeeding, knowledge, attitudes and health practice

Prevalence and variables associated with insomnia among COVID-19 survivors in Colombia.

Background and aim of the work.The prevalence of insomnia is higher in COVID-19 survivors. However, there is little information about his associated variables. The aimed to know the prevalence and variables associated with insomnia among COVID-19 survivors in Colombian adults.Method.Three hundred and thirty COVID-19 survivors participated in a cross-sectional study. Insomnia was quantified with the Athens Insomnia Scale (cut-off score ≤ 6, Cronbach’s alpha of 0.90).Results.COVID-19 survivors were between 18 and 89 years (Mean = 47.7, SD = 15.2); the majority were women (61.5%), university-educated (62.4%), low income (71.2%), married or free union (66.1%), not healthcare workers (85.8%), without comorbidities (63.0%), asymptomatic or mild COVID-19 (66.1%), duration of COVID-19 symptoms in less than three weeks (80.0%) and remission of symptoms less two months by the day of study participation (73.0%). Scores on the Athens Insomnia Scale were observed between 0 and 24 (M = 7.3, SD = 5.1, Me = 7, IQR = 3 – 10), 60% presented insomnia. Insomnia was associated with post-traumatic stress symptoms (OR = 8.8, 95% CI 2.7 – 29.5), COVID-19 symptoms for more than three weeks (OR = 2.1, 95% CI 1.1 – 3.9), female gender (OR = 1.9, 95% CI 1.2 – 3.2) and married or free union marital status (OR = 1.8, 95% CI 1.1 – 3.0).Conclusion.The frequency of insomnia in COVID-19 survivors is high and mainly related to post-traumatic stress, symptoms of COVID-19 for more than three weeks, and the female gender. It is necessary to implement follow-up studies over time to evaluate the persistence of insomnia. (www.actabiomedica.it)

Risk factors associated with patients with anemia during the puerpereum

Anemia is a major health problem worldwide, especially in developing countries. Anemia in the puerperium harms the health of the mother and the newborn; however, postpartum anemia has not received the necessary attention. Objective: To determine the risk factors related to postpartum anemia. Methodology: a quantitative, descriptive-correlational, retrospective and non-experimental cross-sectional study was carried out, the sample consisted of 288 postpartum women with an age range of 13-46 years attended in a hospital from January to December 2020. Results: The mean age was 23.56 years, 50% had secondary schooling. The prevalent marital status was free union with 70.5%. In occupation, 84.7% were housewives. Ninety-nine percent self-identified as mestizo. According to the obstetric history it was determined that 61.8% were multigestation, 94.1% had a term delivery, 76.6% had optimal prenatal control, 49.3% were euthyroid deliveries, 91.7% were in the immediate puerperium. The risk factors found were primary education level and marital status (unmarried). The most important obstetric risk factors were anemia at the beginning of labor and the type of puerperium, type of dystocic delivery, multigestation parity, number of prenatal check-ups. Conclusion: It is important to implement interventions that address the above factors for the prevention of puerperal anemia.

Demographic and Clinical Characteristics in postpartum women with postpartum hemorrhage at Hospital José Félix Valdiviezo

Postpartum hemorrhage is one of the main causes of maternal mortality. The aim of this study was to describe the demographic and clinical characteristics of postpartum women with postpartum hemorrhage in the first 24 hours in a second level hospital at the José Félix Valdivieso Hospital in Santa Isabel, Azuay, Ecuador; a descriptive, retrospective, cross-sectional, retrospective study was conducted with a sample of 105 medical records of gynecological patients attended at the José Félix Valdivieso hospital in Santa Isabel canton In the period between 2016-2020; the results obtained showed that the prevalence is in women between 20 to 30 years of age 49.35% , in free union 49.35 %, housewives 48.3%, of secondary education 80.85%, residing in urban area 48.57%. The main comorbidity is uterine atony 48.57%. In conclusion, it could be demonstrated that postpartum hemorrhage is one of the main problems in this health center, its main cause being uterine atony, and it occurs in the middle age of the patients and it is recommended to carry out prevention and promotion programs for all health professionals and to apply prevention protocols.

Pre-eclampsia Risk Factors in Patients Treated at Guayaquil University Hospital

Objective: The objective of this research is to determine the risk factors of hypertensive pregnancy disorders in pregnant women who attended at prenatal care at the Universitary Hospital of the City of Guayaquil. Materials and methods: descriptive study, quantitative longitudinal cohort, executed in a group of 104 pregnant patients who attended the prenatal control. Techniques to acquire information were based on the application of a survey previously validated by experts and documentary review (medical records). These methods found variables which allowed identifying the risk factors in the hypertensive disorders of pregnant women. Results: Age distribution was in three ranges: under-19 (20.2%), 20 to 34 years (69.2%) 35 years (10.6%). The risk factors were: weight gain (41.3%), family history related to hypertensive alteration (30.8%), Poor nutrition (50%) marital status free union (54.8%), premium parity (35.6%) more than two couples (23.1%) hypertensive disease (13.5%) Conclusions: Risk factors of personal and family history of hypertensive disorders were observed in (30.8%), nutritional factor, prima parity and partner change took an important place; there are questions debatable risk factors that were taken into account. Prenatal control was not representative because patients attended their control as part of their study. Keywords: Hypertension; Pregnant women; Risk Factors; Pre-Eclampsia

Outcome of Infected Nonunion of Long Bones Treated by Single-Stage Bone Grafting and External Fixation at Northwest General Hospital, Peshawar, Pakistan

Background: Infected nonunion of long bones after fractures is one of the most challenging complication to treat in clinical practice. It is commonly treated by a two-stage approach; controlling infection initially and then application of external fixator and bone graft. Treatment with Ilizarov had been the gold standard but is associated with few complications. The objective of the study was to evaluate the clinical, radiological and functional outcomes of infected non-union of long bones treated with single-stage bone grafting and external fixation.Material and Methods: This retrospective study was carried out at Orthopedics Department of Northwest General Hospital, Peshawar Pakistan from 2014 to 2019. Medical records of 17 patients, aged 32 years and treated with Single-stage bone grafting and external fixation were reviewed. Nonunion included 7 humerii, 5 femurs, 3 tibias and 2 radius/ulna. Preoperative plain radiographs for any sequestrum or sclerosed bone margins and baseline investigations (like CBC, ESR, CRP and Vitamin-D status) were reviewed. All patients underwent radical debridement, reaming of intramedullary canals, external fixation and autogenous bone grafting. The outcomes evaluated were union of the bone (clinically and radiologically), resolution of infection, complication rate and number of re-intervention surgeries.Results: Among 17 patients, 10 were males and 7 were females. After treatment, mean follow-up duration was 9.414.48 months (4–18 months). None of the patients were lost to follow-up, had recurrence of infection or required further surgery. The mean duration of bone union was 8.4  4.48 months (range 3 to 17 months) and all of the patients achieved infection free union with satisfactory functional outcome.Conclusions: Single-stage bone grafting and external fixation is an effective technique in terms of resolution of infection and satisfactory bone union without any complications and can be used as an alternative to Ilizarov for treating cases of infected nonunion of long bones.

The ‘Flexibility’ Standard in the African Union and Its Ramification for the Implementation of the African Continental Free Trade Area (AfCFTA) Agreement

African Union’s (AU’s) integration history indicates that the continental body is plagued by flexibility hindering its goal of continental unity. This article investigates the utility of ‘flexibility’ standard in the adoption, ratification, and the implementation of AU treaties. Through an empirical analysis of the seventy treaties currently in force at the AU, thirty-four treaties have been able to secure the minimum level of ratification. Results show that a treaty that lacks the required number of signatories and ratifications creates a big challenge for the continental body. On the other hand, treaty ratification is not a guarantee for successful implementation. Historically, differing views on AU’s role, goals and effect on regional stability has forced a gravitational pull on the essence of the body. Yet, AU continues to facilitate regional free trade agreements and customs union. One of these is the recent African Continental Free Trade Area (AfCFTA) Agreement. This article argues that achieving flexibility under AfCFTA is illusionary, hence AU should strive towards attaining a clear roadmap for flexibility milieu in the implementation of AfCFTA. We argue that, for AfCFTA to be effective, all AU Member States must ratify the agreement, thereby ensuring the harmonization of regional trade agreements, and elimination of tariff and non-tariff barriers. The article concludes that the AU must utilize the principle of variable geometry to have a differentiated level and speed of integration, still achieving the same objective of a unified continent towards maximum intra-trade realization. flexibility, African Union, AfCFTA, variable geometry, regional integration, trade barriers, and trade liberalization

«Щастя треба будувати»: філософська трансформація образу дому в оповіданні «Історія Якимового будинку» В. Винниченка

The article examines the artistic concept of happiness in the story “A Story about Yakim’s House” by V. Vynnychenko and considers the logic of the phased implementation of the theory of building a harmonious, i.e. happy marriage, actualized in the writer’s early diary entries. The research of them helps to determine that the author connects happiness as a fundamental ontological concept with the social institution of marriage, he reveals the problem of happy / unhappy family unions, which he subsequently projects onto the artistic and figurative plane and represents in “A Story about Yakim’s House”. It is noted that this story represents the writer’s artistic experiment to the project of a new family form. A range of factors enables the legitimization of the “free marriage” idea as a way to overcome disharmony and the determinants of the alternative scenario embodiment. Firstly, the traditional Christian morality and sacred commandments have to be rethought, since in a free union of spouses life should be regulated by a new morality and new ethical standards of behavior, in particular by the “honesty with oneself” idea as a result of harmonious coordination of rational and emotional principles. Secondly, the idea of the traditional marriage reforming begins with the recognition of female freedom, equality and independence, as well as her professional self-realization. Thirdly, the creation of a renewed family is determined by the option of an individual’s self-improvement, self-development and self-construction (“build yourself”), due to the balancing of the person’s inner world to establish harmonious relationships. According to these ideas, the writer criticizes marriage as an economic project. It is found that V.Vynnychenko’s “theory of happiness buildings”, which will later define his concordist ontological project, programs the restoration of balance in the “individual – nature” and “personality – society” systems through the vitality actualization and integration into the society.

Vaginal microbiota evaluation and prevalence of key pathogens in ecuadorian women: an epidemiologic analysis

Vaginal infection is a gynecological problem in women of reproductive age with multiple health outcomes. The most common forms of infection include bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and aerobic vaginitis (AV). Our main goals were to evaluate different types of vaginal infections in Ecuadorian women in a large urban area (Quito) and to characterize the vaginal microbiota colonization by opportunistic species. We collected vaginal swabs and epidemiological surveys from 414 women from June 2016 to July of 2017. We analyzed vaginal samples for the presence of any vaginal infection. The microbiological examination was done through Gram-stain, wet mount smears, and polymerase chain reaction (PCR) assays using primers for target genes, such as 16S rRNA (Atopobium vaginae, Mobiluncus mulieris, and Gardnerella species), ddl (Enterococcus faecalis), adk (Escherichia coli) and KER1 (Candida albicans) genes. Most women showed a healthy vaginal microbiota (66.7%). Nearly one-tenth (10.4%) of the participants had intermediate microbiota, and the remaining women (22.9%) had a single vaginal infection (BV, AV, or VC) or coinfections. From the 95 participants that had an infection, AV was the main diagnosed vaginal infection (51.6%), followed by BV (24.2%) and finally VC (7.4%). The remaining women (16.8%) showed coinfections, being BV and AV the most common coinfection. Using univariable logistic regression analyses we found an increased odds of healthy microbiota in women with a sexual partner (P = 0.02, OR = 1.64). Also, women in a free union relationship (P = 0.000, OR = 16.65) had an increased odds of having coinfections. On the other hand, the use of birth control (condom OR = 0.388 or other contraceptive method OR = 0.363) was associated with significantly lower odds of intermediate microbiota (P ≤ 0.05). We found no statistically significant differences between women with infection and a particular group age. Using multivariate logistic regression analyses we initially found an increased odds of having BV in women with M. mulieris (P = 0.020, OR = 4.98) and Gardnerella species (P = 0.010, OR = 4.16). Women with E. coli showed an increased odds of having AV (P = 0.009, OR = 2.81). The presence of C. albicans in women showed an increased odds of having VC (P = 0.007, OR = 17.94). Finally, women with M. mulieris showed a reverse odds of having healthy microbiota (P = 0.008, OR = 0.06). We found no statistically significant differences between women with symptomatic and asymptomatic infections or the presence of Enterococcus faecalis. We found using logistic regression analyses that M. mulieris was the most prevalent opportunistic pathogen among women with vaginal infection. Further studies should evaluate the possibility to use M. mulieris as a potential key predictor for vaginal infections.