Secondary Health Centers Research Articles

A Novel Ensemble Method for PTB Classification in CXRs

Pulmonary tuberculosis (PTB) is a contagious disease that affects the lung region. PTB is a life-threatening disease if it is detected late or left untreated. To perform the initial screening of PTB, the World Health Organization has recommended chest radiograph. Till now, the screening process requires either the patients to come to secondary health centers from rural areas or the radiologists to go the remote locations. This process is rejuvenated with the introduction of computer-aided diagnosis (CAD) systems. CAD systems reduce the need for expert radiologists in the screening process. However, the development and deployment are still in the early phases as new methods are being developed to improve the performance of CAD systems in terms of accuracy, specificity and sensitivity. In this study, a deep learning-based PTB classification system has been presented that achieves the state-of-the-art performance for TB classification. Firstly, a proposed architecture based on the blocks is presented and then it is used to create an ensemble. In the proposed ensemble, two standard architectures namely AlexNet, and ResNet have also been used in addition to the proposed architecture. All the architectures are trained and evaluated on a combined dataset formed using publicly available standard datasets. The proposed ensemble attains the accuracy of 90.00% and area under the curve equal to 0.96, which is better than the performance of the existing methods.

Antenatal care in rural Bangladesh: current state of costs, content and recommendations for effective service delivery

BackgroundMeasurement of antenatal care (ANC) service coverage is often limited to the number of contacts or type of providers, reflecting a gap in the assessment of quality as well as cost estimations and health impact. The study aims to determine service subcomponents and provider and patient costs of ANC services and compares them between community (i.e. satellite clinics) and facility care (i.e. primary and secondary health centers) settings in rural Bangladesh.MethodsService contents and cost data were collected by one researcher and four interviewers in various community and facility health care settings in Gaibandha district between September and December 2016. We conducted structured interviews with organization managers, observational studies of ANC service provision (n = 70) for service contents and provider costs (service and drug costs) and exit interviews with pregnant women (n = 70) for patient costs (direct and indirect costs) in health clinics at community and facility levels. Fisher’s exact tests were used to determine any different patient characteristics between community and facility settings. ANC service contents were assessed by 63 subitems categorized into 11 groups and compared within and across community and facility settings. Provider and patient costs were collected in Bangladesh taka and analyzed as 2016 US Dollars (0.013 exchange rate).ResultsWe found generally similar provider and patient characteristics between the community and facility settings except in clients’ gestational age. High compliance (> 50%) of service subcomponents were observed in blood pressure monitoring, weight measurement, iron and folate supplementation given, and tetanus vaccine, while lower compliance of service subcomponents (< 50%) were observed in some physical examinations such as edema and ultrasonogram and routine tests such as blood test and urine test. Average unit costs of ANC service provision were about double at the facility level ($2.75) compared with community-based care ($1.62). ANC patient costs at facilities ($2.66) were about three times higher than in the community ($0.78).ConclusionThe study reveals a delay in pregnant women’s initial ANC care seeking, gaps in compliance of ANC subcomponents and difference of provider and patient costs between facility and community settings.

Late termination of pregnancy for fetal anomalies: Experience at a tertiary-care hospital in South Africa

Background. Early diagnosis and appropriate management of congenital anomalies can help prevent neonatal morbidity and mortality. Termination of pregnancy for severe congenital anomalies is permitted under South African law. Objective . To determine factors causing delayed diagnosis of lethal congenital abnormalities requiring late termination of pregnancy at Steve Biko Academic Hospital in Pretoria, South Africa. Methods. Medical records of pregnant women who presented with lethal fetal anomalies over a period of 7.5 years were analysed. Patients’ demographic profile, the interval from referral to feticide, gestational age at first scan and diagnosis, type of anomaly and feticide methods were considered. The cohort was divided in two groups based on timing of termination (i.e. earlier than 28 weeks and later than 28 weeks’ gestation) for statistical comparison. Results. The majority of women ( n =45; 78.9%) were younger than 35 years and had no chronic medical conditions or risk factors ( n =40; 70%). Although 30 women (52.6%) had been booked for antenatal examination early in their pregnancy, only three (5.2%) had a first-trimester scan. Mean time to referral was not significantly different between the women whose pregnancies terminated earlier than 28 weeks and those with a termination after 28 weeks ( p =0.671). Conclusion. A basic ultrasound scan in the second trimester is recommended for all pregnant women. Task shifting can be a viable option to provide this facility at primary and secondary health centres. A national registry should be established to document all late terminations for fetal anomalies.

Prevalence of afebrile malaria and development of risk-scores for gradation of villages: A study from a hot-spot in Odisha.

IntroductionMalaria is a public health emergency in India and Odisha. The national malaria elimination programme aims to expedite early identification, treatment and follow-up of malaria cases in hot-spots through a robust health system, besides focusing on efficient vector control. This study, a result of mass screening conducted in a hot-spot in Odisha, aimed to assess prevalence, identify and estimate the risks and develop a management tool for malaria elimination.MethodsThrough a cross-sectional study and using WHO recommended Rapid Diagnostic Test (RDT), 13221 individuals were screened. Information about age, gender, education and health practices were collected along with blood sample (5 μl) for malaria testing. Altitude, forestation, availability of a village health worker and distance from secondary health center were captured using panel technique. A multi-level poisson regression model was used to analyze association between risk factors and prevalence of malaria, and to estimate risk scores.ResultsThe prevalence of malaria was 5.8% and afebrile malaria accounted for 79 percent of all confirmed cases. Higher proportion of Pv infections were afebrile (81%). We found the prevalence to be 1.38 (1.1664–1.6457) times higher in villages where the Accredited Social Health Activist (ASHA) didn’t stay; the risk increased by 1.38 (1.0428–1.8272) and 1.92 (1.4428–2.5764) times in mid- and high-altitude tertiles. With regard to forest coverage, villages falling under mid- and highest-tertiles were 2.01 times (1.6194–2.5129) and 2.03 times (1.5477–2.6809), respectively, more likely affected by malaria. Similarly, villages of mid tertile and lowest tertile of education had 1.73 times (1.3392–2.2586) and 2.50 times (2.009–3.1244) higher prevalence of malaria.ConclusionPresence of ASHA worker in villages, altitude, forestation, and education emerged as principal predictors of malaria infection in the study area. An easy-to-use risk-scoring system for ranking villages based on these risk factors could facilitate resource prioritization for malaria elimination.

Endoscopic butterfly graft myringoplasty in small to medium perforation in adolescent chronic otitis media: our experience in 15 cases

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media is one of the most common paediatric conditions but ear surgery in children is challenging. The high rates of failure have often questioned surgical management of dry asymptomatic perforations in pediatric age group. This study aimed to assess the results of butterfly cartilage myringoplasty in adolescent population with small to medium perforation in chronic otitis media.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We studied 15 cases in our prospective cross sectional observational study performed in the department of ENT at a secondary health centre in the eastern suburbs of Mumbai between October 2016 and September 2017. Children aged between 12 to 18 years with chronic otitis media mucosal inactive type with a central, small to medium sized tympanic membrane perforation and mild to moderate conductive hearing loss were included in this study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Results showed that the average age was 14.63 (SD=1.79 years) with an M: F ratio of 1:1.14. The mean hearing gain in cases with medium perforation was 11.75 dB and 5.7 dB in cases having small perforations two cases showed residual crescentic perforation.&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study shows that endoscopic butterfly graft myringoplasty in small to medium perforation in adolescent age group has good success rate and is safe, quick and minimally invasive day care procedure.&lt;/p&gt;

DISPOSITIONAL FACTORS INFLUENCING VULNERABILITY TO PERCEIVED WORKPLACE VIOLENCE AMONG NURSES IN ONDO AND OSUN STATES, NIGERIA

Perceived workplace violence against nurses has become a major concern to scholars, occupational safety and health administrators. However, dispositional factors in nurses’ perception of workplace violence in Nigeria have not been sufficiently explored. This study therefore, examined dispositional factors predicting workplace violence among nurses in Ondo and Osun State, Nigeria. The study adopted the cross-sectional study across the study setting; four hundred and fifteen (415) nurses from 14 health centres consisting of primary, secondary and tertiary health centres were selected using multi-stage sampling technique. A structured questionnaire which focused on socio-demographic characteristics, perceived workplace violence (α = 0.91), trait anger (TA) (α = 0.67), negative affectivity (NA) (α = 0.96), self control (SC) (α = 0.83) was used. Data was analysed using multiple regression, one-way ANOVA, and independent t-test at p<.05 level of significance. The results reveal that the respondents’ average age was 39.89±12.12 years. Females (83.1%) constituted the larger percentage of the respondents. 64.8% were registered nurses (RN), 28.4% had Nursing degree, 3.4% had Masters’ degree and 2.4% had other qualifications. The nurse worked in the floor shifts (31.6%), critical care (22.9%), intensive care (18.3%) and the operating room (12%) units. Nurses’ trait anger (β = .15), negative affectivity (β = .13) organisational attribution style (β = .15) were significantly associated with frequent experience of perceived workplace violence. In conclusion, nursing staff dispositional traits and attribution styles makes them vulnerable to workplace violence.

Medical coma in a secondary health centre in Benin City, Nigeria: A 3-year review

Background: Medical coma is an emergency requiring prompt decision and immediate intervention. Knowledge of the commoner causes of coma would improve the treatment outcome. Aim: The aim of our study was to describe the frequency and pattern of medical coma in a secondary health center in Benin City, Nigeria. Methods: It was a retrospective review of the medical records of all comatose adult patients, admitted between January 2012 and December 2016 at the Central Hospital Benin. Demographic and clinical data were obtained from the medical records of each patient. Data was analyzed using statistical Package for Social Sciences (SPSS) version 21. Results: Ninety patients presented in coma within the 3-year period under review and, this constituted 1.7% of all medical admissions. There were 49 (54.4%) males and 41 (45.6%) females with a mean age of 64.6 ±17.0 years. The Glasgow coma score ranged from 3 – 8. The commonest cause of coma was stroke (57.9%), followed by metabolic and toxic causes (23.3%) and central nervous system infections (11.1%). The main presenting complains were sudden collapse (85.6%) and fever (31.6%). The most predisposing co-morbid conditions were hypertension (71.1%) and diabetes mellitus (24.4%). Conclusion: Stroke was the most frequent cause of coma. With the high mortality associated with the comatose state, it is hoped that preventive measures to identify and treat risk factors for stroke be vigorously pursued.

Tuberculosis-diabetes screening: how well are we doing? A mixed-methods study from North India.

Public health care facilities in Sonipat District, Haryana State, India. To assess 1) the proportion of tuberculosis (TB) patients screened for diabetes mellitus (DM) and vice versa, 2) factors associated with screening, and 3) the enablers, barriers and solutions related to screening. A mixed-methods study with quantitative (cohort study involving record reviews of patients registered between November 2016 and April 2017) and qualitative (interviews of patients, health care providers [HCPs] and key district-level staff) components. Screening for TB among DM patients was not implemented, despite documents indicating that it had been. Of 562 TB patients, only 137 (24%) were screened for DM. TB patients registered at tertiary and secondary health centres were more likely to be screened than primary health centres. Low patient awareness, poor knowledge of guidelines among HCPs, lack of staff and inadequate training were barriers to screening. Enablers were the positive attitude of HCPs and programme staff. The key solutions suggested were to improve awareness of HCPs and patients regarding the need for screening, training of HCPs and wider availability of DM testing facilities. The implementation of bidirectional screening was poor. Adequate staffing, regular training, continuous laboratory supplies for DM diagnosis and widespread publicity should be ensured.

Effect of an Educational-Psychological Intervention on Anxiety, Bodily Embarrassment, Judgment Concern, and Comfort in Female Patients who referred to a Male General Surgeon for Colorectal Examination

Introduction: Psychological issues are big barriers for female patients referring for colorectal examination. Some interventions might reduce these issues. This study aimed to determine the effect of an educational-pyschyological intervention on anxiety, bodily embarrassment, judgment concern, and comfort in female patients who referred to a male general surgeon for colorectal examination. Methods: This clinical trial with a pre/posttest design was conducted in Imam Hassan Mojtaba Clinic, Darab, Iran. Total of 110 female patients who referred to a male general surgeon for colorectal examination were included in this study. The participants were randomly assigned to an intervention (n=55) and control (n=55) groups. The psychological training program was conducted for 60 minutes (30 minutes for examinations and 30 minutes for the psychological counseling). Beck Anxiety Inventory and Medical Embarrassment Questionnaires were used. The data were analyzed using chi-square, independent and paired t-test. Results: After the intervention, a significant difference was observed between the intervention and control groups in terms of bodily embarrassment and comfort. In addition, a significant difference was found in the intervention group regarding the mean differences of anexity, bodily embarrassment, judgment concern, and comfort scores before and after the intervention (p&lt;0.001). Conclusion: The findings showed that the educational-psychological intervention reduced anxiety, bodily embarrassment, and judgment concern, and it improved comfort in female patients who referred to the male general surgeon for colorectal examination. Hence, this intervention might be used in primary, secondary and tertiary health centers to educate patients when referring to a male surgeon.

Pattern of computed tomographic findings in patients referred with head injury secondary to road traffic accident in a Nigerian otolarhyngologic center

Background: Head injuries are common causes of morbidity and mortality in trauma patients. Computed tomography (CT) is an important imaging modality in the management of patients with a head injury. This study aimed at documenting the pattern of CT findings among patients with a head injury who presented to the Radiology Department of a tertiary hospital which has neither a Neurology nor a Neurosurgical unit. Patient and Methods: This is a one-year retrospective study carried out on 127 patients seen at the National Ear Care Centre (NECC), a premier Ear Nose and Throat health institution, which serves as a referral center for cities and towns within Nigeria. Radiology request cards, duplicate copy of radiology reports, and soft copy of their CT images were analyzed. All patients with a history of head trauma from other causes were excluded from the study. Results: A total of 127 patients were recruited from January 2017 to December 2017 and had cranial CT done. Their mean age was 35.5 (range 1–70 yrs) with M: F of 3:1. The most frequently involved age group was 21–30 years, accounting for 26.7%. Referrals from secondary and primary health centers accounted for 22% and 28%, respectively. Thirty-seven (29%) patients had normal brain CT findings. The most common abnormal findings were skull fractures and intracerebral hemorrhage in 63 (26%) and 55 (18.8%) patients, respectively. Less common findings include midline shifts, intracranial pneomocoeles, metallic foreign bodies, ventricular hemorrhages, effacements, and compressions. Conclusions: The patronage of CT imaging modality by primary and secondary health centers is significant, constituting 50% of the referrals. This suggests that medical personnel in the secondary and primary health centers are maximizing the use of CT as a diagnostic modality. Also, skull fracture still dominates the CT findings.

Domestic Violence Inducing Females’ Gynecological and Urological Problems: The Forensic and Social Perspectives

Background: Domestic violence is a major health and social issue. Forensic documentation of this problem might be of great significance. This study aims to define the primary forensic and social features of domestic violence. Materials and Subjects: The study materials consisted of 779 Saudi Arabian females, aged 15-60 years, attending the gynecology, and urology clinics at three secondary health centers in the Eastern Province, Saudi Arabia. A self-administrated questionnaire was employed in this study, which entails two scales to cover both forensic and social aspects of the assault. The SPSS/PC software package for version 25.0 was utilized to perform the statistical analysis. Results: During the study period, 950 women have attended the clinics with (82%) response rate. The percentage of physical violence was higher than the other forms (75%).The highest incidence of domestic violence (42.6%) was in the age group (20-30) and in married women. The frequency of abusing shows a significantly higher percentage of occasional answers (75.68%).The most commonly reported injury sites were the head (45.27%). Slaps/ push were the sorts of violation in (56.4%) of cases. Husbands (57.4%) were the main perpetrators. Six gynecological and urological symptoms were significantly more common in women with a history of domestic violence. Conclusion: The results of this work denoting the great importance of forensic practicing in the era of domestic violence investigations. Medicolegal researches should be considered as a cornerstone in the programs designed for proper reporting, and prevention of violence against women.

Determinants of Uptake of Cervical Cancer Screening in Northern India

Background: The launch of operational framework for India’s first national cancer screening programme in 2016 was a landmark event in the background of poor screening coverage status. Our study aims to determine the factors deciding the uptake of cervical screening amongst women in rural India. Method: A cross-sectional, observational study was carried out amongst the women attending a secondary health centre of a district from Northern India. A total of 1250 women aged above 30 years who were never diagnosed or treated for cervical cancer were enrolled. After taking informed consent all women were interviewed about their bio-social profile and if they ever underwent screening of cervical cancer. Chi-square or Fisher’s exact test was applied to find out significant difference in distribution of bio-social variables (predictors) amongst the study population. The significant predictor variables were subjected to Binary and Multiple Logistic Regression. Unadjusted and Adjusted Prevalence Odds Ratio with 95% Confidence Interval were generated. Results: Religion, working status of the women, history of multiple sexual contacts were important factors influencing the utilization of screening. Conclusion: We conclude that cervical cancer screening is a cost-effective strategy in saving lives. We can tap its benefits only when we identify and remove the hurdles in the utilization of cervical cancer screening.

Variation in Salmonella typhi Infection Among Local Populations in Southern Benue, Nigeria

Background: Typhoid fever caused by Salmonella typhi is endemic in many developing countries. Objective: This study aimed to investigate the prevalence of S. typhi in patients attending secondary health centers within the 9 local government areas (LGAs) of Benue. Materials and Methods: A total of 1022 stool samples, from 583 (57.0%) males and 439 (43.0%) females were collected from patients diagnosed using Widal reaction between August 2016 and July 2017. Selenite broth, Salmonella-Shigella agar, Xylose Lysine Deoxycholate agar and Bismuth Sulfite agar were used for isolation. S. typhi was identified using cultural and biochemical characteristics. Univariate analysis and multivariate logistic regression were performed to analyze the collated data. Results: A high prevalence of S. typhi (43.7%, n = 447) and significant differences were observed (P < 0.05) in the study site, age, sex and month of sampling. Oju LGA accounted for the highest rate, 64.2% (n = 123). S. typhi infection was highest in patients aged ≤10 years (52.7%, n = 243). Males had a significantly higher isolation frequency of 46.8% (adjusted odds ratio [AOR] = 1.321, CI = 1.027–1.700) than females (39.6%). Isolation rates were higher between January (50.0%, n = 31) and May (61.8%, n = 76). Some Widal positive samples were negative for S. typhi upon culturing. Conclusion: These findings suggest the existence of a significant public health hazard which can negatively affect the livelihood of rural dwellers. There is a need for a review of the approach to the diagnoses of typhoid fever in the study area. Increased efforts at sanitation and personal hygiene are advocated.

Knowledge, motivation, self-efficacy, and their association with insecticidal net use among pregnant women in a secondary health centre in Maiduguri, Nigeria

BackgroundDespite the high prevalence of malaria among pregnant women and its associated complications, the level of compliance with insecticide-treated nets (ITN) remains very low. Motivation and self-efficacy have been reported as important determinants of health behaviour, and may be important factors to consider in developing health intervention programmes. The aim of this study was to determine the knowledge, motivation and self-efficacy of ITN use, and their association with its practice, among pregnant women in a secondary health centre in Maiduguri.MethodsThe study utilized a cross-sectional study design, using a structured and pre-tested questionnaire to obtain information from 380 respondents. Respondents were classified as ITN users if they slept under an ITN for at least 3 days in a week, while those who did not at all, or slept under it less frequently were classified as ITN non-users. Chi squared test was performed to test the bivariate association between ITN use and each of the items of the questionnaire. A further multivariate logistic regression was performed to determine the predictors of ITN use.ResultsThe respondents’ ages ranged from 15 to 45 years, with median (interquartile range) age of 25 (8) years. Eighty percent of them were aware of ITN, but 50.5% believed ITNs could be dangerous. Only 5.5% and 0.8% respectively felt that sleeping under and ITN was either just bad or very bad for their health. Thirty-five percent of the respondents were ITN users. Not having a previous miscarriage (OR = 2.38; 95% CI 1.41–4.03, p = 0.001), knowledge that ITNs were not to be washed after every 1 month (OR = 3.60; 95% CI 1.18–11.06), significant others thinking they should sleep under an ITN (OR = 3.06; 95% CI 1.35–6.96), ability to effectively persuade others to sleep under an ITN (OR = 2.37; 95% CI 1.14–4.94) were significantly associated with ITN use.ConclusionsA large proportion of pregnant women in this study were not sleeping under ITNs. The development of health promotion interventions aimed at boosting their self-efficacies for ITN use, and improving social support from their spouses are, therefore, recommended. Health education on ITN use should also be incorporated into post-abortal management.

Marital Functioning in Couples Practicing Periodic Abstinence for Family Planning.

To compare dyadic (marital) functioning between users of natural family planning (NFP) and users of artificial methods of contraception (AMC). A cross-sectional study was conducted in healthy, over eighteen-year-old couples living in stable relationships recruited from primary and secondary health centers in Santiago, Chile. Participants were assessed using a structured interview on sociodemographic and sexual aspects. Primary outcome, marital functioning, was studied using the Dyadic Adjustment Scale (DAS). One hundred and thirty-eight couples were studied, sixty-nine in each user group. Both groups had a similar average time living together (124.3 vs. 126.9 months). DAS results were consistent with functional couples in both groups, but on average, the NFP group had a significantly higher DAS score than AMC. After controlling for age, socioeconomic status, time in the relationship, and religious commitment in multivariable analysis, the NFP group had a 47 percent (odds ratio = 1.47) greater possibility of having a functional marital score above the cutoff (DAS > 114) when compared with the AMC group. The AMC group reported more frequency of sexual intercourse but similar sexual satisfaction. Most (>60 percent) of the NFP couples mentioned that their methods improved their relationship. There are sociodemographic differences between both groups, explained partly by unequal access to NFP centers. Both groups have DAS scores within functional range, but NFP users have a higher probability of being in that functional range. This study of mentally and emotionally healthy couples highlights the importance of family planning methods on intimate relationships. Summary Marital functioning is affected by family planning methods. A structured interview and a specific inventory to address conjugal functioning were applied to a group of healthy couples who live in stable relationships and are users of natural family planning (NFP) or artificial methods of contraception (AMC). The results were consistent with functional couples in both groups, but on average, the NFP group had a significantly higher score than the AMC group. The use of NFP explained this difference. This study of mentally and emotionally healthy couples highlights the importance of family planning methods on intimate relationships.

Structured peer-led diabetes self-management and support in a low-income country: The ST2EP randomised controlled trial in Mali.

ObjectivesOur objective was to evaluate the effectiveness of peer-led self-management education in improving glycaemic control in patients with type 2 diabetes in a low-income country (Mali).MethodsWe conducted an open-label randomised controlled trial. A total of 151 adults (76% women, mean age 52.5) with type 2 diabetes (HbA1c≥8%), treated in the diabetes consultation units of two secondary health centres in Bamako, were allocated to peer-led structured patient education (n = 76) or conventional care alone (n = 75). The intervention group received 1 year of culturally tailored structured patient education (3 courses of 4 sessions) delivered in the community by five trained peer educators. Both groups underwent conventional diabetes monitoring and follow-up. Primary outcome was the mean absolute change in HbA1c from baseline to 12 months.Results177 education sessions were delivered to the intervention group. Patient attrition was 8%. From baseline to 12 months, the decrease in HbA1c levels was 1.05% (SD = 2.0; CI95%: 1.54;-0.56) in the intervention group compared with 0.15% (SD = 1.7; CI95%: -0.56; 0.26) in the control group, p = 0.006. Mean BMI change was -1.65 kg/m2 (SD = 2.5; CI95%: -2.25; -1.06) in the intervention group and +0.05 kg/m2 (SD = 3.2; CI95%: -0.71; 0.81) in the control group, p = 0.0005. Mean waist circumference decreased by 3.34 cm (SD = 9.3; CI95%: -5.56;-1.13) in the intervention group and increased by 2.65 cm (SD = 10.3; CI95%: 0.20; 5.09) in the control group, p = 0.0003.ConclusionsPeer-led structured patient education delivered over 1 year to patients with poorly controlled type 2 diabetes in Mali yielded substantial improvements in glycaemic control and anthropometric parameters. This is of importance for the scaling up of efficient interventions in low-resource settings in the future.Trial registrationClinicalTrials.gov NCT01485913

The Accuration of LiquidBased Cytology and HPV DNA Test Combination as Precervical Cancer Lesion Screening

Objective: To investigate the accuracy of liquid-based cytology, HPV DNA test, and the combination of liquid-based cytologyband HPV DNA test, compared to histopathology as the gold standard of precervical cancer lesion screening.&#x0D; Methods: This was a cross-sectional study. The medical records of patients who came to the Women’s Health Clinic of Dr. Cipto Mangunkusumo Hospital during the period of July 2013 to December 2015 were evaluated.&#x0D; Results: The high risk type HPV DNA is detected in 76% CIN 1, 88.46% CIN 2, and 84.21 CIN 3 in histopathology results. The accuracy of liquid-based cytology; sensitivity 88.54%, specificity35.71%, PPV 75.89%, and NPV 57.69%. The accuracy of HPV DNA; sensitivity 81.25%, specificity 78.57%, PPV 89.66%, and NPV 64.71%. The accuracy of combination: sensitivity 94.79%, specificity 35.71%, PPV 77.12%, and NPV 75%.&#x0D; Conclusion: The addition of HPV DNA test increased the sensitivity from 88.54% to 94.79% because of decreasing of false negative of liquid-based cytology. This thing has showed that the combination of liquid-based cytology and HPV DNA test could the one of the option of precervical cancer lesion screening method, especially in secondary or tertier health center in Indonesia.&#x0D; Keywords: accuracy test, HPV DNA, liquid-based cytology, precervical cancer lesion, precervical cancer lesion screening

The key elements and effects of the integration between private secondary hospital and public township health center in China

Introduction: It is a challenging issue in China that how to change the segmentation and build an integrated health systems in the new health care reform initiated in 2009. Constructing the collaboration among primary, the secondary and tertiary health institutions is regarded as one of the most feasible ways which has been encouraged and tried in practice. Therefore, it is vital to know the key elements of this intervention and its effects. Given different roles of primary and secondary health institutions, it is also important to understand whether the functions of primary health institutions were influenced by the integration intervention.Description of practice: The collaboration was established between primary health institution “Lixian Township Health Center (THC)” and a private secondary hospital “Renhe Hospital” in Daxing District in Beijing. Key integration strategies included the management, medical services, and human resources in the first stage.Aim and theory of change: Based on the theory of framework on integrated, people-centered health services, the goal was to strengthen the competency of primary health system and provided empirical basis for the establishment of dual referral system highlighted by the new health care reform.Targeted population and stakeholders: The intervention targeted both supply and demand sides. The supply side includes hospital administrators and medical technicians. The demand side pointed to the patients seeking services from Lixian THC. The stakeholders included the executive officers of Daxing District, the officers of Daxing health bureau, the administrators of Renhe Hospital and the administrators of Lixian THC.Timeline: It began on Dec 31, 2014 and last for five years in the contract signed by Renhe and Lixian THC.Highlights: The most important innovation is that the collaboration is between a private secondary hospital and a public THC compared with other integration interventions. The initial distinct outcome represents at the improvement of management and medical services by directly appointing deputy administrator of Renhe Hospital to Lixian and making medical experts to Lixian.Sustainability: Renhe Hospital played a vital role in the collaboration and made the majority of investment including equipment, the training of health workers, and medical experts, etc. There was almost no subsidy from Lixian and Daxing District. The sustainability is challenging if the intervention is implemented in such a way in the following years.Transferability: The private hospital bring advanced management opinion to public THC to improve the efficiency which was not shown in the other collaborations among pure public institutions. The most challenging issue is the different nature and goal between public and private hospitals. Given the short period of the integration by now, we need to keep cautious attitude towards the transferability.Conclusions: The initial effects have been shown on the change of management opinion, the increase of outpatient visits, and the improvement of competency of health workers in Lixian THC. For Renhe hospital, it gained the trust of officers of Daxing District and generated good public image. The other effects need to be supervised in the following implementing periods.Discussions and lessons learned: It is disputed about the integration between private secondary hospital and public THC. It is worth to try this intervention in practice but the time is too short to do the assessment of the model. We need to keep cautious attitude when disseminating.

Safety of thrombolysis in stroke mimics: an observational cohort study from an urban teaching hospital in Sweden

ObjectivesAcute stroke management has changed dramatically over the recent years, where a timely assessment is driven by the expanding treatment options of acute ischaemic stroke. This increases the risk in...

Why are abortions the answer? Prevalence, knowledge and attitude towards induced abortions among women attending a secondary level health care facility in Tamil Nadu, Southern India

Background: In India, from 2010 to 2011, government statistics on family welfare recorded 620,472 abortions in government-approved institutions. On the downside, a study conducted by the Indian Council of Medical Research (ICMR) in rural areas, found that abortions by uncertified health care personnel/in unapproved institutions were twice as many as in the approved ones (13.5 v 6.1 per 1000 pregnancies).This could be attributed to low levels of modern contraceptive use, being only 48% in 2007-08 (DLHS-3). The aim was to assess prevalence, knowledge and attitude towards induced abortions among women who attend a secondary health center, in Tamil Nadu, IndiaMethods: The study was a hospital-based cross-sectional study, done in the Out-patient department of a secondary level health care facility in Vellore, in September 2015. The women attending the secondary level health care facility; who were then pregnant or just post-delivery and those who had greater than two years of inter-pregnancy interval; were eligible to be enrolled in the study.Results: Only 27 out of the 175 women (15.4%) used any form of contraception. We found a rate of 72.69 abortions per 1000 married woman years in our study. Out of the 175 women, 29 (16.5%), 95% CI (10.9%, 22.1%), reported to have had at least one induced abortion; the main reason was unwanted pregnancy 22 (75.86%). Most women 116 (66.3%) had poor knowledge and attitude on induced abortions.Conclusions: We conclude that contraceptive use should be strongly advocated to women for birth planning and prevention of unwanted pregnancy and subsequent induced abortions.