Need For Prevention Services Research Articles

Prevention of sexual exploitation of children in sport clubs and social work in Switzerland

Abstract The Convention on the Rights of the Child, ratified in 1989, provides a clear normative basis for the protection of children from violence, abuse and exploitation. Despite efforts to protect children, many children and young people are victims of sexual violence. In the extracurricular sector, clubs offer great potential for preventing sexual exploitation. However, obstacles such as the taboo nature of the topic and the clubs’ limited resources make it difficult to develop and independently implement specific prevention offers. The aim of the project was to record the activities and competencies of sports clubs, youth associations and other youth organizations in the area of prevention of sexual assault among children and adolescents in the leisure sector and to determine the need for prevention services in the canton of Zurich in Switzerland. In addition, information was obtained on the impact of existing prevention services as well as information on their further development in terms of content and organization. Together, 979 participants from sports clubs, youth associations and youth organizations (e.g. board members, coaches, leaders) as well as the parents of children who are members of these clubs were surveyed. An impact model was developed for systematic modeling, as proposed by “Health Promotion Switzerland”. The prevention of sexualized violence is seen as a very relevant topic by sports clubs, youth associations, open child and youth work and parents. However, the current implementation of prevention measures also shows that there are still barriers to implementation and room for improvement in prevention work. Participants from all areas would particularly like support with advice on how to deal with suspected cases/incidents, the provision of information materials and the creation of a protection concept. Specific ideas for the further development of prevention work were also generated and will be discussed. Key messages • The prevention of sexualized violence is seen as a very relevant topic by sports clubs, youth associations, open child and youth work and parents. • The study reveals that prevention measures are only partially implemented and identifies barriers and facilitators for improvement.

BUILDING ADMINISTRATIVE CAPACITY: TACKLING DOMESTIC VIOLENCE AMIDST THE COVID-19 PANDEMIC

The implementation of Covid-19 mitigation policies has hindered the effective functioning of public services. During the Covid-19 pandemic, domestic violence cases remained hidden due to victims' limited access to reporting channels, despite the government's efforts in establishing P2TP2A and SEJIWA psychological services. The persistently high incidence of domestic violence prompted Farazmand (2009) to advocate for increasing the state's administrative capacity to confront unforeseen challenges. This article examines Indonesia's approach to addressing domestic violence during the pandemic through Farazmand's Administrative Capacity Building recipe, utilizing a descriptive qualitative methodology with a literature study. The analysis reveals a pressing need for preventive services in Indonesia, such as social marketing and the implementation of artificial intelligence (AI) technology in creating applications that can proactively combat domestic violence, aligning with Farazmand's notion of "anticipatory" administrative capacity.

Emotional problems in young children during the SARS-CoV-2-pandemic and child attachment.

Restrictions imposed by national governments during SARS-CoV-2-pandemic have impacted the mental health of children around the world. Studies have already proven the importance of secure attachment acting as a protective factor in child development. Therefore, children with secure attachment have a higher chance of developing and using appropriate coping mechanisms. The goal of this study was to explore the possible connection between the pandemic, as well as child attachment, and young children's emotional health. The general hypothesis assumes a lower rate of emotional problems among children with secure attachment and a higher rate of emotional problems among children with insecure-disorganized attachment, as well as an increase of these problems during the pandemic. The analysis included N = 129 mothers (M = 39.98 years) and their children (M = 5.19 years). Via an online survey, which was held at different time points during the pandemic, information on the children's emotional problems was retrieved. The survey used the Strengths and Difficulties Questionnaire (SDQ). Data regarding the quality of attachment was collected via the Strange Situations Test (SST). At this point the participating children were approximately 12 months old. The calculation of a mixed ANCOVA showed, that attachment quality had a significant influence on children's emotional problems [F(2, 121) = 4.01, p = .021]. The interaction effect between time and child attachment reached significance [F(3.45, 208.42) = 3.58, p = .011]. The calculation of an additional mixed ANCOVA showed, that the reported emotional problems of girls were higher than those of boys F(1, 118) = 4.56, p = .035). Our study shows that there is an association between attachment security and emotional problems and the impact of the SARS-CoV-2 pandemic on the mental health of preschool children in Germany. The emotional problems of all children increased, especially the disorganized attached children had been reported as emotionally stressed in the first lockdown. The results indicate the need for preventive services (for children and parents) to promote and maintain stress coping skills in order to maintain children's mental health in times of crisis.

Depression, anxiety, and suicidal ideation in a population-based cohort of young adults before and during the first 12months of the COVID-19 pandemic in Canada.

Findings from a birth cohort study indicated that the mental health of young adults had not worsened during the first wave of the COVID-19 pandemic, compared to 2018. This study examined longitudinal changes in mental health between March 2018 and June 2021 in the context of protracted public health mitigation measures about 12months after the onset of the pandemic. Participants from the Quebec Longitudinal Study of Child Development (n = 2120 at inception; n = 1461 during the COVID-19 pandemic), a population-based cohort of individuals born in 1997/1998, reported on their depressive and anxiety symptoms as well as suicidal ideation prior to the pandemic in 2018 (age 20), and during the pandemic in the summer of 2020 (age 22) and spring of 2021 (age 23). Depressive (Cohen's d = 0.15 [95% CI: 0.09 to 0.20]) and anxiety (Cohen's d = 0.33 [95% CI: 0.27 to 0.39]) symptoms increased between 2018 and 2021 for both males and females, but suicidal ideation did not change. There was also a significant increase in moderate to severe depressive (31.7% to 36.3%) and anxiety (14.7% to 24.8%) symptoms from 2018 to 2021. Youth who were students, those who were experiencing financial stress, food insecurity, and loneliness, and those without pre-existing poor mental health experienced the largest increase in depressive and anxiety symptoms over time. These findings highlight the mental health burden experienced by young adults during the COVID-19 pandemic, highlighting the need for preventive services and continued longitudinal follow-ups of these youths.

Examining rural-urban disparities in perceived need for health care services among adults with disabilities.

PurposeThe purpose of this study is to parse out differences between unmet need and perceived need for health care services among rural and urban adults with disabilities in the United States. While unmet need focuses primarily on environmental factors such as access to health insurance or provider availability, perceived need relates to personal choice. This distinction between unmet and perceived need is largely ignored in prior studies, but relevant to public health strategies to improve access and uptake of preventive care.MethodsUsing Wave 2 data from the National Survey on Health and Disability, we explored rural and urban differences in unmet and perceived health care needs among working-age adults with disabilities for acute and preventive services.FindingsAlthough we found no significant differences in unmet needs between rural and urban respondents, we found that perceived needs for dental care and mental health counseling varied significantly across geography. Using logistic regression analysis and controlling for observable participant characteristics, we found that respondents living in noncore counties relative to metropolitan counties were more likely to report not needing dental care (OR 1.89, p = 0.028), and not needing mental health counseling services (OR 2.15, p ≤ 0.001).ConclusionThese findings suggest additional study is warranted to understand perceived need for preventive services and the levers for addressing rural disparities.

Access to contraception in pharmacies during the COVID-19 pandemic

BackgroundAs a result of the coronavirus disease 2019 (COVID-19) pandemic, shifts in traditional contraception access points have presented new challenges, leading people to seek alternative sources of contraception care, including pharmacies. Pharmacists in one-fourth of U.S. states are able to prescribe hormonal contraception, a model known as pharmacy access. Pharmacy access became available in California in 2016 and in Colorado in 2017. ObjectiveTo characterize how access to contraception products and services in pharmacies changed during the COVID-19 pandemic, including pharmacist prescribing practices and innovations in service delivery. MethodsWe conducted a cross-sectional survey among California and Colorado pharmacists from September to October 2020. Survey questions included pharmacist and pharmacy practice site characteristics, prescribing practices, pharmacist perspectives, and pharmacy services in the context of the COVID-19 pandemic. ResultsA total of 128 pharmacists participated in the study, with 38% (n = 49) from California and 62% (n = 79) from Colorado. Among participants, 41% (n = 53) prescribed contraception, of which 94% (n = 50) continued, 4% (n = 2) started, and 2% (n = 1) suspended during the pandemic. Most participants reported interest (79%) and effort (75%) in prescribing contraception to be about the same during the pandemic. Community need for contraceptive services was perceived to be slightly or much higher (45%) or about the same (47%). Patient interest in pharmacy access was perceived to be slightly or much higher by 26% and about the same by 57% of the participants. When distributing contraception prescriptions, pharmacies increased curbside (from 12% to 52%), home delivery (from 40% to 60%), and mailing options (from 41% to 71%) during the pandemic. ConclusionsPharmacists prescribing hormonal contraception who participated in this study remained committed to providing this service during the pandemic. Some perceived increased community need for contraception and patient interest in direct pharmacy access. There was an increase in options for patients to receive contraception prescriptions with minimal contact.

Occupational Safety and Health Education Experience and Prevention Service Needs among South Korean Farmers: A National Survey

ABSTRACT Objective Objective data on farmers’ awareness of occupational safety and health are needed for the development of national policy measures. Yet, relevant research is lacking in South Korea. Methods This study investigated occupational safety and health education experience, perceived needs for prevention services, and factors affecting these among South Korean farmers. The data are from a personal-visit survey conducted on 9,970 sample farms nationwide. Results While 69.9% of the farmers felt the need for agricultural health and safety education and 60.6% were willing to receive it, only 30.3% had at least one educational experience. A total of 51.9% felt the need for professional on-farm services. By group, education experience and perceived need for prevention services were consistently low among women, people aged 70 or older, low-income individuals, or farmers with a farming career duration of less than five years. Experience of safety and health education increased the desire for other prevention services: people who had received safety and health education were 6.4 times more likely to feel the need for education, 5.5 times more willing to participate in education, 2.0 times more likely to feel the need to improve their work environments, and 1.7 times more likely to feel the need for professional on-farm services. Conclusion Despite the high desire for injury prevention services, farmers have had very limited opportunities to receive safety education; measures are also needed for groups whose safety education has been neglected. Further studies on education methods and on-farm services tailored to South Korean farmers are needed.

Need for Contraceptive Services Among Women of Reproductive Age - 45 Jurisdictions, United States, 2017-2019.

Ensuring access to contraceptive services is an important strategy for preventing unintended pregnancies, which account for nearly one half of all U.S. pregnancies (1) and are associated with adverse maternal and infant health outcomes (2). Equitable, person-centered contraceptive access is also important to ensure reproductive autonomy (3). Behavioral Risk Factor Surveillance System (BRFSS) data collected during 2017-2019 were used to estimate the proportion of women aged 18-49 years who were at risk for unintended pregnancy* and had ongoing or potential need for contraceptive services.† During 2017-2019, in the 45 jurisdictions§ from which data were collected, 76.2% of women aged 18-49 years were considered to be at risk for unintended pregnancy, ranging from 67.0% (Alaska) to 84.6% (Georgia); 60.7% of women had ongoing or potential need for contraceptive services, ranging from 45.3% (Puerto Rico) to 73.7% (New York). For all jurisdictions combined, the proportion of women who were at risk for unintended pregnancy and had ongoing or potential need for contraceptive services varied significantly by age group, race/ethnicity, and urban-rural status. Among women with ongoing or potential need for contraceptive services, 15.2% used a long-acting reversible method (intrauterine device or contraceptive implant), 25.0% used a short-acting reversible method (injectable, pill, transdermal patch, or vaginal ring), and 29.5% used a barrier or other reversible method (diaphragm, condom, withdrawal, cervical cap, sponge, spermicide, fertility-awareness-based method, or emergency contraception). In addition, 30.3% of women with ongoing or potential need were not using any method of contraception. Data in this report can be used to help guide jurisdictional planning to deliver contraceptive services, reduce unintended pregnancies, ensure that the contraceptive needs of women and their partners are met, and evaluate efforts to increase access to contraception.

The relationship between spatial access and modern contraceptive use: is proximity to a healthcare facility a determinant of use among women in Kinshasa, DRC?

Background: Spatial access has a direct effect on health service utilization in many settings. Distance to health facility has proven to affect family planning (FP) service use in many Sub-Saharan countries. Studies show that women who reside closer to facilities offering family planning services are more likely to use modern contraceptives. However, researchers often test the theory of distance decay. This study analyzed the significance of proximity to family planning services, service availability, and quality of family planning services on modern contraceptive use in Kinshasa, Democratic Republic of the Congo. Methods: We used a pool of four rounds of facility- and population-based survey data in Kinshasa from PMA2020 between 2014 and 2016. We used GPS coordinates to calculate the distance between the health facilities and households. We tested if women who live closer to service delivery points with higher level of availability and quality are more likely to use modern contraceptives or less likely to have unmet need for contraceptive services. Results: 10,968 women were interviewed over four rounds of data collection. Our findings show that living closer to an SDP is not a determinant of modern contraceptive use or having unmet need for FP services. Lack of cognitive access, economic barriers, bypassing the closest facility, and sociocultural norms are strong barriers for women in Kinshasa to use modern contraceptives. Proximity to quality services did not necessarily result in increased FP use among women of reproductive age living in Kinshasa, thus suggesting that a bypass phenomenon may occur when obtaining modern contraceptive services. Conclusions: This study notes that barriers other than proximity to access may be substantial determinants of contraceptive use or unmet need. More research should be conducted that directly measures multidimensional components of access in order to interpret women’s contraceptive seeking behaviors in urban areas of Sub-Saharan Africa.

Reducing unmet need for contraceptive services among youth in Homabay and Narok counties, Kenya: the role of community health volunteers \u2013 a qualitative study

BackgroundAccess to contraceptive services is a cornerstone of human well-being. While Community Health Volunteers (CHVs) promote family planning in Kenya, the unmet need for contraceptives among youth remains high. CHVs seem to pay little specific attention to the contraceptive needs of the youth.MethodsWe conducted a qualitative study exploring the role of CHVs in increasing access and uptake of contraceptive services among youth aged 18–24 years in Narok and Homabay Counties, Kenya. We undertook 37 interviews and 15 focus group discussions involving CHVs, youth, community members, community leaders, youth leaders and health programme managers. Data were recorded, transcribed, translated, coded and thematically analysed, according to a framework that included community, CHV and health system-related factors.ResultsCHVs often operated in traditional contexts that challenge contraceptive use among unmarried female and male youth and young married couples. Yet many CHVs seemed to have overcome this potential ‘barrier’ as well as reigning misconceptions about contraceptives. While private and facility-based public contraceptive services were somehow available, CHVs were the preferred service provider for many youth due to ease of access and saving time and transport costs. This was influenced by varied perceptions among youth of CHVs’ knowledge, skills and attitudes regarding contraceptives and provider-client interaction, and specifically their commitment to maintain confidentiality.ConclusionsCHVs have the potential to increase access to contraceptives for young people, reducing unmet need for contraceptives. Their knowledge, skills and attitudes need strengthening through training and supervision, while incentives to motivate them and broadening the range of contraceptives they are allowed to offer should be considered.

A qualitative study on HIV related risk behaviors, current status and need for prevention services among 28 money boys

Objective: To understand the characteristics of HIV-related risk behaviors and needs for prevention services among males who sell sex for money or anything of value (commonly known as money boys or MB), and to provide evidence for the development of targeted interventions. Methods: Using non-probability purposive sampling method and one-on-one interviews. Results: A total of 28 MBs were interviewed, with age range between 20 and 67, and education primarily at junior high school level. Among them 6 were married. Their household registration for residency cut across 15 provinces, and their sexual orientation is diverse. They migrate primarily among tier one cities and provincial capitals. Most enter the trade for economic reasons, relying on clubs and personal networks to find clients, and on word of mouth to obtain knowledge and skills. In addition to their primary clientele of the male homosexual community, 5 out of 28 serve male heterosexuals and 6 out of 28 also serve females. They have some awareness of self protection from diseases, primarily from word of mouth. Nevertheless, over half of them cannot maintain consistent condom use, and 12 out of 28 have a history of illegal drug use. Three of them reported being tested positive for HIV, and all continue to engage in sex work. They prefer their communication messages to be simple and straight-forward. Privacy comes first when they are accessing testing and treatment services. Conclusion: The bridge role of the MB community in transmitting HIV to the general population cannot be ignored, and interventions targeting the MB population need to be strengthened.

Implementing internet- and tele-based interventions to prevent mental health disorders in farmers, foresters and gardeners (ImplementIT): study protocol for the multi-level evaluation of a nationwide project

BackgroundFarmers are a vulnerable population for developing depression or other mental health disorders due to a variety of risk factors in their work context. Beyond face-to-face resources, preventive internet- and tele-based interventions could extend available treatment options to overcome barriers to care. The German Social Insurance Company for Agriculture, Forestry and Horticulture (SVLFG) implements several guided internet- and mobile-based interventions and personalised tele-based coaching for this specific target group provided by external companies within a nation-wide prevention project for their insured members. The current study aims to evaluate the implementation process and to identify determinants of successful implementation on various individual and organisational levels.MethodsThe current study includes two groups of participants: 1) insured persons with an observable need for prevention services, and 2) staff-participants who are involved in the implementation process. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and the Consolidated Framework for Implementation Research (CFIR) will be used to track and evaluate the implementation process. A mixed-method approach will provide insights on individual and organizational level (e.g. degree of normalization, readiness for change) and helps to identify determinants of successful implementation. In-depth insights on experiences of the participants (e.g. acceptance, satisfaction, barriers and facilitating factors of intervention use) will be yielded through qualitative interviews. Focus groups with field workers provide insights into barriers and facilitators perceived during their consultations. Furthermore, intervention as well as implementation costs will be evaluated. According to the stepwise, national rollout, data collection will occur at baseline and continuously across 24 months.DiscussionThe results will show to what extent the implementation of the internet- and tele-based services as a preventive offer will be accepted by the participants and involved employees and which critical implementation aspects will occur within the process. If the implementation of the internet- and tele-based services succeeds, these services may be feasible in the long-term.Trial registrationGerman Clinical Trial Registration: DRKS00017078. Registered on 18.04.2019.

Assessment of contraceptive use in Puerto Rico during the 2016 Zika virus outbreak

ObjectivesThe objectives of this analysis were to 1) estimate prevalence of contraceptive use among women at risk for unintended pregnancy and 2) identify correlates of contraceptive use among women with ongoing or potential need for contraceptive services in Puerto Rico during the 2016 Zika virus (ZIKV) outbreak. Study designWe conducted a cell-phone survey July–November, 2016. Women aged 18–49 years living in Puerto Rico were eligible. We completed 3059 interviews; the overall response rate was 69.2%. After weighting, the data provide population-based estimates. For this analysis, we included women at risk for unintended pregnancy, and assessed ongoing or potential need for contraceptive services in this group, excluding women using permanent contraceptive methods. ResultsMost women reported using contraception (82.8%), and use increased with age. Female sterilization and male condoms were most frequently reported (40.8% and 17.1%, respectively). Among women with ongoing or potential need for contraceptive services, 24.7% talked to a healthcare provider about ZIKV, and 31.2% reported a change in childbearing intentions due to ZIKV. Most women were at least a little worried about getting infected with ZIKV (74.3%) or having a baby with a birth defect (80.9%). Being very worried about getting infected with ZIKV and already having Zika were significantly associated with use of any contraception (adjusted prevalence ratio: 1.19, 95% CI: 1.03–1.38 and 1.32, 95% CI: 1.01–1.72, respectively). ConclusionsThese findings underscore the need for regular contraceptive prevalence studies to inform programs about contraceptive needs, especially during public health emergencies. ImplicationsWhen the 2016 Zika virus outbreak began in Puerto Rico there were no recent population-based data available on contraceptive prevalence. To fill this information gap, we conducted a population-based survey. Our findings provided baseline contraceptive prevalence estimates to support response planning and allocation of health resources.

A study to assess the unmet need for contraception among married women in the urban field practice area of a medical college

Background: The concept of unmet need for family planning points to the gap between some women’s reproductive intentions and their contraceptive behaviour. The National Population policy (NPP) 2000 states that the immediate objective is to address the unmet need for contraceptive services. Unintended pregnancy related to unmet need is a worldwide problem that affects women and their families and societies at large.Methods: A community based cross-sectional study was conducted from November 2016 to October 2017 in Maralur and Maralur Dinne, urban localities under urban health Training Centre of Sri Siddhartha Medical College. 260 Married women (15–49 years) were interviewed by house to house survey. The questionnaire was used to collect data to assess their reproductive intentions and contraceptive behaviour.Results: Out of 260 participants, 144 (55.4%) of them belonged to the group where their contraceptive needs were met for spacing and limiting births, 59 (22.69%) of them of did not have any need for contraceptives, 16 (6.15%) had unmet need for spacing births and 41 (15.77%) of the participants had unmet need for limiting births.Conclusions: The unmet need for contraceptives was 21.92% in the study which is much higher compared to NFHS-4 data for urban India (12.1%). The reasons and the factors associated with the unmet need should be addressed.

Contraceptive Use Among Women at Risk for Unintended Pregnancy in the Context of Public Health Emergencies - United States, 2016.

Ensuring access to and promoting use of effective contraception have been identified as important strategies for preventing unintended pregnancy (1). The importance of ensuring resources to prevent unintended pregnancy in the context of public health emergencies was highlighted during the 2016 Zika virus outbreak when Zika virus infection during pregnancy was identified as a cause of serious birth defects (2). Accordingly, CDC outlined strategies for state, local, and territorial jurisdictions to consider implementing to ensure access to contraception (3). To update previously published contraceptive use estimates* among women at risk for unintended pregnancy† and to estimate the number of women with ongoing or potential need for contraceptive services,§,¶ data on contraceptive use were collected during September–December 2016 through the Behavioral Risk Factor Surveillance System (BRFSS). Results from 21 jurisdictions indicated that most women aged 18–49 years were at risk for unintended pregnancy (range across jurisdictions = 57.4%–76.8%). Estimates of the number of women with ongoing or potential need for contraceptive services ranged from 368 to 617 per 1,000 women aged 18–49 years. The percentage of women at risk for unintended pregnancy using a most or moderately effective contraceptive method** ranged from 26.1% to 65.7%. Jurisdictions can use this information to estimate the number of women who might seek contraceptive services and to plan and evaluate efforts to increase contraceptive use. This information is particularly important in the context of public health emergencies, such as the recent Zika virus outbreak, which have been associated with increased risk for adverse maternal-infant outcomes (2,4–6) and have highlighted the importance of providing women and their partners with resources to prevent unintended pregnancy.

The Relationship Between Maternal Domestic Violence and Infant and Toddlers' Emotional Regulation: Highlighting the Need for Preventive Services.

In an effort to further understand the impact of domestic violence (DV) on infant and toddlers' development, this research utilized data from the second cohort of National Survey of Child and Adolescent Well-Being (NSCAW II) to examine the relationship between maternal DV and infant and toddlers' emotional regulation, and determine whether mothers' receipt of DV services mediated this relationship. The sample was limited to children aged 0 to 3 years and included (a) infants less than 1 year old (n = 603), (b) infants 1 to less than 2 years old (n = 310), and (c) toddlers 2 to 3 years old (n = 268). Infant/toddlers' emotional regulation was measured using mothers' response on the How My Infant/Toddler/Child Usually Acts questionnaire. In addition, data were collected to assess whether (a) active DV was present during the time of the Child Protective Services (CPS) investigation and (b) mothers received DV services during the past year. Study research questions were examined using a series of multiple regression analyses. Mediation was tested based on Baron and Kenny's recommended model for establishing mediation. The mediational model was not found to be significant; however, a positive relationship existed between maternal DV and emotional regulation among infants aged less than 1 year old (β = 1.61, p = .039). There were no statistically significant relationships between DV and emotional regulation in the other age groups. These findings highlight the need to provide CPS-involved families victimized by DV with services that focus on preventing poor infant emotional regulation.

Receipt of Selected Preventive Health Services for Women and Men of Reproductive Age - United States, 2011-2013.

Receipt of Selected Preventive Health Services for Women and Men of Reproductive Age - United States, 2011-2013.

A qualitative study exploring factors associated with Pap test use among North Korean refugees

ABSTRACTLack of medical care in North Korea and vulnerability to human trafficking during their migration increase risks of cervical cancer among North Korean refugees. To better understand factors influencing Pap test use, we conducted a qualitative study of eight North Korean refugees in South Korea. Individual barriers were limited knowledge, lack of perceived need for preventive services, and concerns about costs. Environmental facilitators included having female providers, receiving family support, and free screenings. Refugees' health outlook, including viewing cancers as fatal diseases, hindered seeking Pap tests. Multi-faceted approaches to address individual and environmental factors in promoting Pap tests are warranted.

Fertility Transitions in Ghana and Kenya: Trends, Determinants, and Implications for Policy and Programs

As a continent with 54 independent states Africa’s diversity is often highlighted but frequently forgotten when fertility is discussed. Fifty and more years ago to consider that all African countries and societies had a single fertility pattern (large numbers of children) and single trend (unchanging over time) was a valid characterization. Since the 1960s however that uniformity has disappeared replaced by substantial inter- and intra-country differences in fertility patterns and trends that render previous perceptions of continent-wide homogeneity obsolete. In this chapter we consider two African countries—Ghana and Kenya—whose fertility patterns and trends and their determinants have been well documented (Bongaarts 2008; Garenne 2008; Machiyama 2010; Shapiro and Gebreselassie 2008; Sneeringer 2009). Both countries have benefited from regularWorld Fertility Surveys (WFS) and Demographic and Health Surveys (DHS) that record trends in fertility family planning (FP) and other relevant indicators. The recently introduced Performance Monitoring and Accountability 2020 (PMA2020) surveys monitor progress since 2012 for the FP2020 initiative and occasional Situation Analysis and Service Provision Assessment surveys have also detailed the readiness of the health system in both countries to make quality FP services available. Ghana and Kenya share some common history: both have relatively strong health system legacies from the period of British colonialization; both were among the earliest countries to achieve independence; they were the first two African countries that developed policies to address population growth in the 1960s; and both have received substantial and sustained resources over several decades from many external donors and technical assistance organizations explicitly intended to increase the availability and quality of family planning services. However they are composed of cultures that are both diverse within each country and markedly different in many ways between the two countries. The two countries demonstrate remarkably different pathways in fertility and family planning patterns and trends from the 1970s to the present. We highlight some of the key differences and similarities explain why they have occurred and identify insights that could inform a wider understanding of fertility transitions and the role of family planning in other African countries. (excerpt)

Self-inflicted injuries are an important cause of penetrating traumatic injuries in Japan.

Japan has a low crime rate, but a high suicide rate. The aim of this study is to review the causes of penetrating traumatic injuries in a tertiary care emergency center in Japan. We retrospectively reviewed all admissions for traumatic injuries over a 3-year period, and calculated the proportion of patients with penetrating traumatic injuries. Weapon used, age, gender, Injury Severity Score, cause of injury, and site of injury in all patients with penetrating injuries were reviewed. The proportion of patients with penetrating injuries among patients with all types of traumatic injuries requiring surgical intervention was calculated. Of 1,321 patients admitted over 3 years, 65 patients (5%) suffered from penetrating injuries. Most were stab wounds, with only one gunshot (2%). The most common site of injury was an extremity (48%). The most common cause of penetrating injury was self-inflicted (38%). The abdomen is the most common site injured among self-inflicted injuries. Of patients with all types of traumatic injuries requiring surgical intervention, penetrating injuries accounted for 23%. Penetrating injuries represent 23% of all patients with traumatic injuries who required surgical intervention. Self-inflicted penetrating injuries were most common, supporting the need for preventive services. Acute care surgeons must be familiar with the surgical management of penetrating traumatic injuries, even in a country with a low crime rate.