bluuebunny/crossref_metadata_2025 huggingface dataset:
Delayed Facial Palsy after Microvascular Decompression: Report of Two Cases
Authors: Prasad G. Lakshmi , Kumar Vinod , Menon Girish
Published: June 2017

Microvascular decompression (MVD) is a novel surgical procedure predominantly performed for treating trigeminal neuralgia (TN) and hemifacial spasm (HS). Multiple studies have proven the long-term success of MVD for both these conditions. The most common complications of MVD reported include chemical meningitis, facial hypesthesia, cerebrospinal fluid leak, facial paresis, and hearing loss. Delayed facial palsy (DFP) is an uncommon complication mostly noted in MVD for HS and after the removal of acoustic tumors. We report two cases of DFP occurring after performing MVD, one each for HS and TN. This is also the first case of DFP to be reported after MVD for TN. Both were young females who developed DFP 2 weeks after surgery. They were managed with oral steroids and acyclovir for 2–3 weeks and achieved excellent outcome at an average of 4.5 weeks from the onset. We conclude that although majority of the cases improve spontaneously, steroids and acyclovir might assist in faster recovery.
Mental Health Orientation for Self-Help Group Members: A Feasibility Study
Authors: Shrinivasa Basavaraj , Janardhana Navaneetham , Nirmala Bergai Parthsarathy
Published: June 2017

Background: Treatment gap for mental health care in low- and middle-income (LAMI) countries is very large, and building workforce using the locally available resources is very much essential in reducing this gap. The current study is a preliminary work toward this direction. Materials and Methods: A single group pre- and post-design was considered for assessing the feasibility of Mental Health Orientation (MHO) Program for Self-Help Group members. Assessment of participants’ MHO using Orientation Towards Mental Illness (OMI) scale was undertaken at three levels: baseline assessment before the intervention, after completing 2 days orientation program, and 6 weeks later. Results: Analysis of data resulted in statistically significant mean scores in the domains of areas of causation (F[1.41, 40.7] = 21.7, P < 0.000, ηp
2 = 0.428), perception of abnormality (F[1.27, 36.8] = 15.8, P< 0.000, ηp
2 = 0.353), treatment (F[1.42, 41.3] = 34.8, P < 0.000, ηp
2 = 0.546), and after effect (F[1.36,39.4] = 26.7, P < 0.000, ηp
2 = 0.480). Although the overall mean scores of all the domains of OMI were found to be statistically significantly different, there was no significant difference in the mean scores between post and follow-up assessments on areas of causation (µd = 1.27, P = 0.440) and treatment (µd = 1.00, P = 0.156). Conclusion: Overall, the findings of our study demonstrate that brief MHO program can exert a beneficial effect on bringing about significant change in the orientation of the participants toward mental illness but need to be refreshed over time to make the impact of the program stay longer.
Environmental Arsenic Contamination and Its Effect on Intelligence Quotient of School Children in a Historic Gold Mining Area Hutti, North Karnataka, India: A Pilot Study
Authors: R. Manju , Hegde Amitha M. , Parlees Paul , Keshan Anisha
Published: June 2017

Context: Arsenic is a rare crystal element that naturally occurs in all environmental media. A combination of regional and site-specific biogeochemical and hydrological factors governs its dispersion in the environment. It has far reaching consequences on human health. Exposure to arsenic in drinking water has been associated with a decline in intellectual function in children. Aim: The aim of this study is to assess the relationship between exposure to arsenic by drinking water and children’s intelligence in Karnataka state, India. Settings and Design: Twenty school children of age 10–14 years from Sandur, Bellary, Karnataka, and from Hutti, Raichur, Karnataka, were categorized as control and study group, respectively. Subjects and Methods: Water samples were collected from both the villages for the analysis of arsenic and fluoride levels. Hair and nail samples were collected from the participants, and the arsenic levels were determined. Intelligence quotient (IQ) assessment was done using the Raven’s Standard Progressive Matrices. Statistical Analysis Used: Chi-square test, Mann–Whitney U-test, and Fisher’s exact test. P < 0.05 was considered statistically significant. Results: There was a significant increase in the arsenic content in the hair and nail samples of children in the study group. The mean IQ tests score in the control group and study group was 30.55 and 17.95, respectively, and this difference was statistically significant. Conclusion: Chronic arsenic exposure could be a possible cause for the reduced IQ scores seen in children residing in Hutti, Raichur District, North Karnataka.
Junctional Chiasmatic Syndrome Due to Large Anterior Communicating Artery Aneurysm
Authors: Kesani Maruthi , Pelluru Pavan Kumar , Bhattacharjee Suchanda , Alugolu Rajesh , Purohit A. K.
Published: June 2017

Even though aneurysm involving the anterior communicating artery (A Com A) was common in clinical practice, producing compressive symptoms such as visual loss was rare. We report a case, in which patient had gradually progressive visual loss with features of the junctional chiasmatic syndrome, imaging revealed partially thrombosed large A Com A aneurysm. Intraoperatively, aneurysm was found compressing the optic chiasm and right optic nerve, following clipping and decompression of the optic nerve and chiasm there was gradually improvement in the vision over 2 weeks postoperatively.
Cognitive and Functional Outcomes following Inpatient Rehabilitation in Patients with Acquired Brain Injury: A Prospective Follow-up Study
Authors: Patil Maitreyi , Gupta Anupam , Khanna Meeka , Taly Arun B. , Soni Amit , Kumar J. Keshav , Thennarasu K.
Published: June 2017

Objectives: To study the effects of cognitive retraining and inpatient rehabilitation to study the effects of cognitive retraining and inpatient rehabilitation in patients with acquired brain injury (ABI). Design and Setting: This was a prospective follow-up study in a neurological rehabilitation department of quaternary research hospital. Patients and Methods: Thirty patients with ABI, mean age 36.43 years (standard deviation [SD] 12.6, range 18–60), mean duration of illness 77.87 days (SD 91.78, range 21–300 days) with cognitive, physical, and motor-sensory deficits underwent inpatient rehabilitation for minimum of 14 sessions over a period of 3 weeks. Nineteen patients (63%) reported in the follow-up of minimum 3 months after discharge. Type of ABI, cognitive status (using Montreal Cognitive assessment scale [MoCA] and cognitive Functional Independence Measure [Cog FIM]®), and functional status (motor FIM®) were noted at admission, discharge, and follow-up and scores were compared. Results: Patients received inpatient rehabilitation addressing cognitive and functional impairments. Baseline MoCA, motor FIM, and Cog FIM scores were 15.27 (SD = 7.2, range 3–30), 31.57 (SD = 15.6, range 12–63), and 23.47 (SD = 9.7, range 5–35), respectively. All the parameters improved significantly at the time of discharge (MoCA = 19.6 ± 7.4 range 3–30, motor FIM® = 61.33 ± 18.7 range 12–89, Cog FIM® =27.23 – 8.10 range 9–35). Patients were discharged with home-based programs. Nineteen patients reported in follow-up and observed to have maintained cognition on MoCA (18.8 ± 6.8 range 6–27), significantly improved (P < 0.01) on Cog FIM® (28.0 ± 7.7 range 14–35) and motor FIM® =72.89 ± 16.2 range 40–96) as compare to discharge scores. Conclusions: Cognitive and functional outcomes improve significantly with dedicated and specialized inpatient rehabilitation in ABI patients, which is sustainable over a period.
Single Parietal Burr-hole Craniostomy with Irrigation and Drainage for Unilateral Chronic Subdural Hematoma in Young Adults <40 Years: A Rationale behind the Procedure
Authors: Chandran Raj S. , Nagar Milesh , Sharmad M. S. , Prabhakar Rajmohan B. , Peethambaran Anil K. , Kumar Shailesh , Sharma Saurabh , Jain Sourabh K.
Published: June 2017

Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. It is mostly a disease of elderly population with very little data about the young patients. There is also the debate regarding treatment strategies. We decided to determine the overall efficacy of the single burr-hole craniostomy (SBHC) for unilateral CSDH in young adults <40 years. Subjects and Methods: We performed a retrospective study of young patients undergoing SBHC for unilateral CSDH between January 2013 and June 2016 at our institution. Medical records were assessed based on patient characteristics in the form of sex of the patient, etiology, presenting symptoms, comorbidities, and signs including Glasgow Coma Scale, computed tomography (CT) brain findings (site and thickness of SDH with midline shift), and intraoperative presence of chronic/subacute component. Results: Mean age of the patient was 33.69 years (range 18–40 years), mean thickness of SDH was 15.47 mm, and mean midline shift was 11.26 mm. 61.54% patients were male, trauma being the most common etiology (92.31%) with most common presenting complaint being headache (90.38% patients). 69.23% patients presented within 1 day of onset of symptoms. On CT scan, most of the patients were having SDH thickness between 11 and 20 mm (67.31%) with midline shift of 6–10 mm (53.85%). Right-sided SDH was present in 53.85%. Intraoperatively, 63.46% patients had subacute SDH whereas 34.61% had chronic component. There were total 2 recurrences (3.85%). Conclusions: Young adults who present with unilateral CSDH usually have a history of trauma. They have shorter duration of symptoms and present mainly with the features of raised intracranial pressure such as headache and vomiting. SBHC with irrigation and drainage has excellent result for unilateral CSDH in young adults compared to other methods of drainage and should be considered treatment of choice unless contraindicated.
Higherℓ2-Betti Numbers of Universal Quantum Groups
Authors: Bichon Julien , Kyed David , Raum Sven
Published: June 2017

We calculate alll2-Betti numbers of the universal discrete Kac quantum groupsas well as their half-liberated counterparts
Associations between Household Latrines and the Prevalence of Diarrhea in Idiofa, Democratic Republic of the Congo: A Cross-Sectional Study
Authors: Cha Seungman , Lee Jae Eun , Seo Dong Sik , Park Byoung Mann , Mansiangi Paul , Hwang Jae-sang , Lee Jungwook
Published: June 2017

Despite the importance of sanitation, few studies have assessed the effects of latrines on the health outcomes of children under 5 years of age. We assessed the relations between latrine coverage and the prevalence of diarrhea in children under 4 years of age. In this cross-sectional study, we analyzed the baseline data obtained as part of a longitudinal survey targeting 720 households in Idiofa, Bandundu, Democratic Republic of the Congo. We categorized latrines according to the presence of each major component and investigated whether diarrhea prevalence of children under 4 years of age is associated with latrine availability and improvement. Latrines have health benefits regardless of whether they are improved. Also worth noting is that comparatively well-equipped and more appropriately managed latrines could prevent child diarrhea more effectively than less equipped or inappropriately managed latrines. Households who have a latrine with a superstructure, roof, and no flies (a partly improved latrine) were found to be 52% less likely to report cases of diarrhea than households with unimproved latrines (adjusted odds ratio [OR] = 0.48, confidence interval [CI] = 0.31–0.76), which are all the other latrines not included in the partly improved latrine category. We have observed the profound protective effect of latrines with a superstructure. This study demonstrates that latrines are associated with significant improvements in health even when they do not fully meet the conditions of improved latrines. This study adds value to the limited evidence on the effect of latrines on health parameters by demonstrating that latrines have correlations with health benefits regardless of whether they are improved, as well as by elucidating the most essential components of improved latrines.
Bartonella Infection in Hematophagous, Insectivorous, and Phytophagous Bat Populations of Central Mexico and the Yucatan Peninsula
Authors: Stuckey Matthew J. , Chomel Bruno B. , Galvez-Romero Guillermo , Olave-Leyva José Ignacio , Obregón-Morales Cirani , Moreno-Sandoval Hayde , Aréchiga-Ceballos Nidia , Salas-Rojas Mónica , Aguilar-Setién Alvaro
Published: June 2017

Although emerging nonviral pathogens remain relatively understudied in bat populations, there is an increasing focus on identifying bat-associated bartonellae around the world. Many novel Bartonella strains have been described from both bats and their arthropod ectoparasites, including Bartonella mayotimonensis, a zoonotic agent of human endocarditis. This cross-sectional study was designed to describe novel Bartonella strains isolated from bats sampled in Mexico and evaluate factors potentially associated with infection. A total of 238 bats belonging to seven genera were captured in five states of Central Mexico and the Yucatan Peninsula. Animals were screened by bacterial culture from whole blood and/or polymerase chain reaction of DNA extracted from heart tissue or blood. Bartonella spp. were isolated or detected in 54 (22.7%) bats, consisting of 41 (38%) hematophagous, 10 (16.4%) insectivorous, and three (4.3%) phytophagous individuals. This study also identified Balantiopteryx plicata as another possible bat reservoir of Bartonella. Univariate and multivariate logistic regression models suggested that Bartonella infection was positively associated with blood-feeding diet and ectoparasite burden. Phylogenetic analysis identified a number of genetic variants across hematophagous, phytophagous, and insectivorous bats that are unique from described bat-borne Bartonella species. However, these strains were closely related to those bartonellae previously identified in bat species from Latin America.
Evaluation of Onchocerciasis Transmission in Tanzania: Preliminary Rapid Field Results in the Tukuyu Focus, 2015
Authors: Paulin Heather N. , Nshala Andreas , Kalinga Akili , Mwingira Upendo , Wiegand Ryan , Cama Vitaliano , Cantey Paul T.
Published: June 2017

To compare diagnostic tests for onchocerciasis in a setting that has suppressed transmission, a randomized, age-stratified study was implemented in an area in Tanzania that had received 15 rounds of annual mass drug administration (MDA) with ivermectin. Study participants (N = 948) from 11 villages underwent a questionnaire, skin examination, skin snips, and blood draw. The burden of symptomatic disease was low. Ov-16 antibody rapid diagnostic test (RDT) results were positive in 38 (5.5%) participants, with 1 (0.5%), 1 (0.4%), and 2 (0.8%) in children aged 0–5, 6–10, and 11–15 years, respectively. Despite significant impact of MDA on transmission, the area would have failed to meet World Health Organization serologic criteria for stopping MDA if a full evaluation had been conducted. The specificity of the RDT, which is 97–98%, may result in the identification of a number of false positives that would exceed the current stop MDA threshold.
Identification of Risk Factors Associated with Transmission of Plague Disease in Eastern Zambia
Authors: Nyirenda Stanley S. , Hang’ombe Bernard M. , Machang’u Robert , Mwanza Jackson , Kilonzo Bukheti S.
Published: June 2017

Plague is a fatal, primarily rodent-flea-borne zoonotic disease caused by Yersinia pestis. The identification of risk factors of plague was investigated through questionnaire interview and conducting focus group discussion (FGD) in Sinda and Nyimba districts of eastern Zambia. A total of 104 questionnaires were administered to individual respondents and 20 groups consisting of 181 discussants, which comprised FGD team in this study. The study revealed that trapping, transportation, and preparation of rodents for food exposed the community to rodent and their fleas suggesting that plague may have occurred primarily by either flea bites or contact with infected wild rodents. The study also revealed that most people in communities consumed rodents as part of their regular diet; therefore, contact with small wild mammals was a common practice. The mode of transportation of freshly trapped rodents, in particular, carcasses risked human to flea bites. Questionnaire respondents (75%) and FGD discussants (55%) indicated that trappers preferred to carry rodent carcasses in small bags, whereas 55.8% and 20% respectively, reported hunters carrying carcasses in their pockets. Carrying of carcass skewers on trappers’ shoulders was reported by 38.4% and 20% of individual respondents and FGD, respectively. All these activities were exposing humans to rodents and their fleas, the natural reservoirs and vectors of plague, respectively. This study also showed that there is a statistically significant (χ2 = 4.6878, P < 0.05), between digging of rodents from their burrows and the presence of fleas on the hunter’s bodies or clothes, which exposes humans to potentially flea bites in an enzootic cycle.
Serological Evidence of Rickettsia spp. in Western Australian Dogs
Authors: Bennett Mark David , Abdad Mohammad Yazid , Stenos John
Published: June 2017

It has been claimed that dogs can be useful sentinels for public health monitoring of vector-borne infectious diseases, including Rickettsia spp. We used 153 canine blood samples opportunistically collected at Murdoch University Veterinary Hospital and 156 canine sera collected from Aboriginal communities in northwest Western Australia to test for evidence of Rickettsia spp. exposure, using microimmunofluorescence (MIF) in the latter case, and both MIF and polymerase chain reaction (PCR) in the former. Conventional and real-time PCR failed to amplify any Rickettsia spp. DNA. The seroprevalence for spotted fever group/transitional group Rickettsia spp. in Western Australian dogs was 17.3% (54/312), and for typhus group (TG) Rickettsia spp., 18.4% (57/310), with a cut-off titer of 1:128. Young dogs (≤ 2 years) from Aboriginal communities had significantly lower seropositivity to TG Rickettsia spp. compared with all other groups, and young Perth dogs had a significantly higher seropositivity to TG Rickettsia spp. than all Aboriginal community dogs.
The Role of Risk Proximity in the Beliefs and Behaviors Related to Mosquito-Borne Diseases: The Case of Chikungunya in French Guiana
Authors: Flamand Claude , Camille Fritzell  , Pauline Obale  , Quenel Philippe , Raude Jocelyn
Published: June 2017

Human behaviors are increasingly recognized to play a key role in the spread of infectious diseases. Although a set of social and cognitive determinants has been consistently found to affect the adoption of health protective behaviors aiming to control and prevent a variety of infections, little is currently known about the ecological drivers of these behaviors in epidemic settings. In this article, we took advantage of the outbreak of chikungunya, a reemerging mosquito-borne disease, that occurred in French Guiana in 2014–15 to test empirically the assumption proposed by Zielinski-Gutierrez and Hayden that the proximity of the disease and perceptions of the natural environment may considerably shape public response to an emerging health threat. To achieve this, a cross-sectional survey was conducted among high school students of the region (N = 1462) at an early stage of the epidemic. Surprisingly, spatial analysis of the collected data leads to counterintuitive results as the participants who lived in the most affected area expressed less concern about the disease and practiced preventive behaviors less frequently than did other participants. These paradoxical results may be attributed to the possible activation of risk denial processes which have previously been observed in the risk perception literature, and described by several social and psychological defensiveness theories.
The Effects of an Integrated Community Case Management Strategy on the Appropriate Treatment of Children and Child Mortality in Kono District, Sierra Leone: A Program Evaluation
Authors: Ratnayake Ruwan , Ratto Jeffrey , Hardy Colleen , Blanton Curtis , Miller Laura , Choi Mary , Kpaleyea John , Momoh Pheabean , Barbera Yolanda
Published: June 2017

Integrated community case management (iCCM) aims to reduce child mortality in areas with poor access to health care. iCCM was implemented in 2009 in Kono district, Sierra Leone, a postconflict area with high under-five mortality rates (U5MRs). We evaluated iCCM’s impact and effects on child health using cluster surveys in 2010 (midterm) and 2013 (endline) to compare indicators on child mortality, coverage of appropriate treatment, timely access to care, quality of care, and recognition of community health workers (CHWs). The sample size was powered to detect a 28% decline in U5MR. Clusters were selected proportional to population size. All households were sampled to measure mortality and systematic random sampling was used to measure coverage in a subset of households. We used program data to evaluate utilization and access; 5,257 (2010) and 3,649 (2013) households were surveyed. U5MR did not change significantly (4.54 [95% confidence interval [CI]: 3.47–5.60] to 3.95 [95% CI: 3.06–4.83] deaths per 1,000 per month (P = 0.4)) though a relative change smaller than 28% could not be detected. CHWs were the first source of care for 52% (2010) and 50.9% (2013) of children. Coverage of appropriate treatment of fever by CHWs or peripheral health units increased from 45.5% [95% CI: 39.2–52.0] to 58.2% [95% CI: 50.5–65.5] (P = 0.01); changes for diarrhea and pneumonia were not significant. The continued reliance on the CHW as the first source of care and improved coverage for the appropriate treatment of fever support iCCM’s role in Kono district.
Respiratory Complications of Plasmodium vivax Malaria: Systematic Review and Meta-Analysis
Authors: Val Fernando , Machado Kim , Barbosa Lisiane , Salinas Jorge Luis , Siqueira André Machado , Costa Alecrim Maria Graças , Portillo Hernando del , Bassat Quique , Monteiro Wuelton Marcelo , Guimarães Lacerda Marcus Vinícius
Published: June 2017

Malaria, a major global public health problem, is mainly caused by Plasmodium falciparum and Plasmodium vivax, and is responsible for nearly half a million deaths annually. Although P. vivax malaria was not believed to cause severe disease, recent robust studies have proved otherwise. However, the clinical spectrum and pathogenesis of severe vivax malaria and, especially, its respiratory complications remain poorly understood. A systematic search for articles reporting respiratory complications associated with vivax malaria was performed in Lilacs, Cochrane, Scielo, Web of Science, and Medline databases irrespective of publication date. Prevalence of acute respiratory distress syndrome (ARDS) and associated mortality among vivax patients were calculated from cross-sectional and longitudinal studies, whereas factors associated with mortality were calculated from data pooled from case reports and series of cases. A total of 101 studies were included (49 cross-sectional or longitudinal and 52 case reports or series of cases). Prevalence of ARDS was 2.8% and 2.2% in children and adults, respectively, with nearly 50% mortality. Moreover, female sex (P = 0.013), having any comorbidity (P = 0.036), lower body temperature (P = 0.032), lower hemoglobin (P = 0.043), and oxygen saturation (P = 0.053) values were significantly associated with mortality. Plasmodium vivax malaria respiratory complications included ARDS and were associated with high mortality. Demographics and clinical characteristics upon presentation to hospital were associated with mortality among patients with respiratory complications in vivax malaria. This study reaffirms the evidence of severe and fatal complications of P. vivax malaria and its associated respiratory complications.
Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative
Authors: Robertson Sandy L. , Robinson Mark D. , Reid Alfred
Published: June 2017

Background 

Physician burnout is a problem that often is attributed to the use of the electronic health record (EHR).

Objective 

To estimate the prevalence of burnout and work-life balance satisfaction in primary care residents and teaching physicians, and to examine the relationship between these outcomes, EHR use, and other practice and individual factors.

Methods 

Residents and faculty in 19 primary care programs were anonymously surveyed about burnout, work-life balance satisfaction, and EHR use. Additional items included practice size, specialty, EHR characteristics, and demographics. A logistic regression model identified independent factors associated with burnout and work-life balance satisfaction.

Results 

In total, 585 of 866 surveys (68%) were completed, and 216 (37%) respondents indicated 1 or more symptoms of burnout, with 162 (75%) attributing burnout to the EHR. A total of 310 of 585 (53%) reported dissatisfaction with work-life balance, and 497 (85%) indicated that use of the EHR affected their work-life balance. Respondents who spent more than 6 hours weekly after hours in EHR work were 2.9 times (95% confidence interval [CI] 1.9–4.4) more likely to report burnout and 3.9 times (95% CI 1.9–8.2) more likely to attribute burnout to the EHR. They were 0.33 times (95% CI 0.22–0.49) as likely to report work-life balance satisfaction, and 3.7 times (95% CI 2.1–6.7) more likely to attribute their work-life balance satisfaction to the EHR.

Conclusions 

More after-hours time spent on the EHR was associated with burnout and less work-life satisfaction in primary care residents and faculty.
A Study to Analyze the Efficacy of Levonorgestrel Intrauterine System in the Management of Abnormal Uterine Bleeding among Urban Indian Women
Authors: Chowdhury Bijit , Sanyal Poushali , Gupta Anshu , Roychoudhury Bidisha , Zoha MMS
Published: June 2017

Objective

The study tried to analyze the efficacy of levonorgestrel intrauterine system (LNGIUS) for the treatment of heavy menstrual bleeding in the urban and suburban Indian women.

Materials and methods

The present study was conducted in the Department of Gynecology and Obstetrics, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, over a period of 1 year. A total of 20 patients suffering from abnormal uterine bleeding in the age group of 20 to 45 years were recruited in this study. The LNGIUS was inserted in all the women and they were followed up at the end of 3, 6, and 12 months. All subjects completed 1 year duration of follow-up. We used the Student’s paired t-test to evaluate the reduction in the menstrual blood loss, passage of clots, and increase in hemoglobin concentration at each point from the baseline.

Results

At the end of 6 months, most (90%) of the women had an acceptable bleeding, with 10% having amenorrhea (pictorial blood-loss assessment chart score 0). Statistically significant improvement in the hemoglobin level was observed at the end of 3, 6, and 12 months postinsertion. The level of satisfaction increased steadily with time.

Conclusion

Levonorgestrel intrauterine system is an effective reversible treatment for menorrhagia. Levonorgestrel intrauterine system can be used as an effective alternative to hysterectomy in the future in the urban and suburban affluent Indian women.

How to cite this article

Gupta A, Roychoudhury B, Sanyal P, Chowdhury B, Zoha MMS. A Study to Analyze the Efficacy of Levonorgestrel Intrauterine System in the Management of Abnormal Uterine Bleeding among Urban Indian Women. J South Asian Feder Menopause Soc 2017;5(1):19-22.
Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country
Authors: Khan Erum S , Irfan Sheikh , Khalid Natasha
Published: June 2017

Introduction

Surgical site infections (SSIs) are among the most common complications in surgical patients and have serious consequences for outcomes and costs. There is a dearth of information on risk factors for developing SSI in patients undergoing gynecologic cancer surgery, and this has not been studied using national data.

Objectives

The objectives of this study were to estimate the prevalence, preoperative and operative risk factors associated with the higher risk of SSIs in gynecologic cancer patients undergoing surgery in a tertiary care facility in a developing country.

Setting

Department of Obstetrics and Gynaecology, Aga Khan University Hospitals, Karachi, Sindh, Pakistan.

Materials and methods

Retrospective record review of gynecologic oncology patients admitted for surgery from January 2015 to December 2015 was performed.

Results

A total of 100 patients met the inclusion criteria. Of these, 15 were identified with SSIs, which were all found to be of the superficial type. Approximately, 44, 40, and 7% were diagnosed with endometrial, ovarian, and cervical cancers respectively. The mean time from surgery to developing SSI was 12.9 days. Among endometrial cancer, 22.7% (10/44) had SSI compared with 7.5% (3/40) for ovarian cancer and 14.2% (1/7) for cervical cancer. The significant predictors of SSI were body mass index ≥35 (p-value <0.004), endometrial cancer diagnosis, the American Society of Anesthesiologists class more than 3, modified surgical complexity scoring system 3 to 4, and blood sugar levels more than 180 mg/dL within 48 hours after surgery in known diabetics.

Conclusion

About 15% of patients undergoing laparotomy for gynecologic malignancy developed SSIs. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSIs, and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery.

How to cite this article

Khan ES, Irfan S, Khalid N. Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country. J South Asian Feder Menopause Soc 2017;5(1):23-27.
Knowledge and Awareness of Cervical Cancer and Human Papilloma Virus Vaccine among Medical Students: A Cross-sectional Study
Authors: Rathod Setu , Samal Sunil K , Samal Sunita
Published: June 2017

Aim

Cervical cancer is still one of the most common cancers affecting females in India, leading to a lot of mortality and morbidity. Since it is a preventable cancer, the study is aimed to assess the knowledge and awareness of cervical cancer and human papilloma virus (HPV) vaccine among medical students.

Materials and methods

This is a cross-sectional study conducted among the medical students in a tertiary care center in Mahatma Gandhi Medical College & Research Institute, Puducherry, India. Three hundred students were administered a validated 53-point questionnaire regarding knowledge of cervical cancer, its risk factors, preventive measures, HPV vaccine, and screening tests. Data were kept confidential and the results were analyzed by Statistical Package for the Social Sciences software version 16.

Results

The results show 93.3% of students were aware that cervical cancer is caused by HPV, but only 61.4% knew that HPV vaccine was available. Majority of the students were uncertain about age group, number of doses, and side effects of vaccine. Only 11.74% felt the need to get vaccinated in future; 96.64% of students knew that pap smear was used to screen for cervical cancer, but only 57.72% opted to screen themselves or family members in future as they believed that they were not at risk. The common obstacle against vaccination was worry about complications, inadequate information, and efficacy of vaccine.

Conclusion

The study showed that there were misconceptions among medical students regarding cervical cancer, vaccine, and screening, which have to be cleared. Creating awareness among health care workers on risk factors, vaccination, and current methods for cervical cancer screening is a necessary step toward implementing effective prevention programs in the society.

How to cite this article

Rathod S, Samal SK, Samal S, Ghose S. Knowledge and Awareness of Cervical Cancer and Human Papilloma Virus Vaccine among Medical Students: A Cross-sectional Study. J South Asian Feder Menopause Soc 2017;5(1):41-44.
Too Hot to Handle: Climate Change and Agricultural Water Use
Authors: Fort Denise
Published: June 2017

The world faces enormous challenges in responding to looming crises in food and water. Responding to this challenge will require flexibility; such flexibility may be impeded by legal institutions. This paper looks at the western United States and discusses the role of irrigated agriculture in that region. Because of climate change, a growing population, declining groundwater, the need to protect ecosystems and other conflicts, the author suggests that all water uses, including long-standing agricultural water rights, need to be examined in light of these changes. Legal systems have tended to serve the status quo, but perhaps the law can help facilitate this re-examination.
Application of Environmental Conflict Resolution to Public Interest Issues in Water Disputes
Authors: Jeffrey QC Michael , Craig Donna
Published: June 2017

This article examines the role of environmental conflict resolution (ECR) in the public interest issues of water disputes. The article endeavours to  illustrate the strengths and weaknesses of a range of alternative dispute resolution (ADR) and negotiation approaches in the context of decision-making. Although many embrace ECR as the cheaper and more effective alternative to more formalistic and entrenched judicial processes before courts of law and quasi-judicial tribunals, the authors argue that there is an urgent need for a more critical, contextual and issue-oriented approach. In particular, the article highlights the significant difficulties associated with representing the full range of stakeholders who should be involved in an ADR process, and the lack of transparency and procedural safeguards associated with ADR in complex public interest disputes. The strength of ADR in smaller project-specific disputes involving a very limited number of stakeholders is well understood. The authors argue that ADR may have a significant role in scoping the issues and associated research as well as facilitating agreement on procedural aspects of large, complex public interest water disputes. However, ADR has severe limitations as a decision-making process. For example, water conflicts necessarily involve the concept of sustainability that in turn touches on a complex maze of social, political, economic and ecological values. The probability of reaching a mediated settlement in such a context is severely curtailed. A preferable approach may be one that is entirely transparent, capable of being both monitored and enforced, and is binding on all stakeholders whether or not they are parties to the mediation.
The regulation of diffuse pollution in the European Union: science, governance and water resource management
Authors: Hendry Sarah , Reeves Alison
Published: June 2017

Reducing diffuse pollution is a perpetuating problem for environmental regulators. This paper will consider novel ways to regulate its impacts on the aquatic environment, with particular reference to rural landuse. It will look at the relationship between science, policy and law, and the contributions of integrated water resources management and governance at regional, national and river basin scales. Regulatory frameworks for water in the European Union will be explored, along with their implementation nationally in Scotland and at catchment scale in the Tweed river basin. It will conclude that regulation has a role to play, but that it is necessary to take a visionary holistic and integrated approach, nesting regulation within a governance framework that involves all stakeholders and takes full account of developing science and socio-economic drivers to meet environmental objectives.
The progress on governing REDD+ in Indonesia
Authors: Santosa Mas Achmad , Khatarina Josi , Suwana Aldilla Stephanie
Published: June 2017

Indonesia is one of the ten most forest-rich countries in the world. Almost 70 per cent of Indonesia’s mainland is covered with forest. However, Indonesia faces one of the highest rates of forest loss in the world. Deforestation and forest degradation accounts for more than 60 per cent of carbon emissions in Indonesia. Being aware of that fact and the danger of climate change, in October 2009, Indonesia voluntarily committed to reduce emissions by 26 per cent from business as usual by 2020 through national efforts, and by 41 per cent with international support. Indonesia’s commitment has gained international support; chiefly from Norway, which signed a Letter of Intent on 26 May 2010. To formalise the commitment, Presidential Decree No 19/2010 on Task Force for the preparation of REDD+ Agency and Presidential Instruction No 10/2011 on moratorium on new licenses and improvement of natural primary forest and peat land governance have been issued. The Presidential Decree ended on 30 June 2011 and was continued by Presidential Decree No 25/2011, which was later amended by Presidential Decree No 05/2013. The third Presidential Decree will conclude in the middle of 2013. The expected outputs are: establishment of a New REDD+ agency; measurement, reporting and verification instrument; funding instrument; improvement on forest governance, including legislative reform, law enforcement and administrative procedures; and gazetting forest areas and consolidating licenses through legal audit and legal compliance or legal due diligence in the pilot province. The new REDD+ Agency is expected to be established in 2013. The Agency will be an independent central agency, directly responsible to the President of the Republic of Indonesia, and will be responsible for leading and coordinating the national effort to reduce the country’s carbon emission.
Attracting private investment into REDD+ projects: An overview of regulatory challenges
Authors: Chapman Sophie May , Wilder Martijn
Published: June 2017

To date, forest carbon projects around the world have faced common challenges within what are nonetheless unique, country-specific legal and political systems. These issues include the role of land tenure in forest carbon projects, the importance of legal frameworks in clarifying the legal foundations for forest carbon projects (such as with respect to the right to carbon or the process under which forest carbon projects can be approved) and the need to properly address leakage, additionality, permanence, and community and biodiversity benefits within forest carbon project design. By addressing these issues, both international and national regulation has a role to play in creating the enabling conditions for private sector investment. This paper will provide an overview of the regulatory issues that need to be addressed to enable private sector investment into REDD+ projects by 1) outlining current international policy, noting the role of the private sector in REDD+ implementation and describing the voluntary market’s role as a testing ground for early forest carbon projects; 2) discussing REDD+ implementation from a project-level perspective, including both the general and legal issues that need to be addressed in REDD+ project design; and 3) considering how these lessons (drawn largely from land-based forest carbon projects) apply to mangroves, peatlands and other wetlands as sites for implementing REDD+ activities.
Summary proceedings: Workshop on REDD+ and legal regimes of mangroves, peatlands and other wetlands: ASEAN and the world
Authors: Bhullar Lovleen , Koh Kheng Lian , Lye Lin-Heng
Published: June 2017

This report summarises the proceedings of the workshop as interpreted by the assigned rapporteur and editors of the Asia-Pacific Centre for Environmental Law, which were reviewed and approved by the presenters.
Open-cut coal mining in Australia's Hunter Valley: Sustainability and the industry's economic, ecological and social implications
Authors: Cottle Drew , Keys Angela
Published: June 2017

This article questions the sustainability of open-cut coal mining in the Hunter Valley region of Australia. The issue of sustainability is examined in relation to the economic, ecological and social implications of the Hunter Valley’s open-cut coal mining industry. The article demonstrates that critical social and ecological ramifications have been overshadowed by the open-cut coal mining industry’s importance to the economy of the Hunter region and of New South Wales.
Mine Lifecycle Planning and Enduring Value for Remote communities
Authors: Robertson Stuart , Blackwell Boyd
Published: June 2017

Mine lifecycle planning is critical to developing enduring value from mining for remote communities. The history of mining is replete with examples of communities being unsustainable post mine closure. The concept of enduring value involves ensuring that a sustainable community will remain following the closure of an associated mine. Since 2003, awareness has increased amongst the International and Australian peak mining bodies for the need to plan for enduring community value. This increased awareness has developed alongside the requirement for mining companies to operate in a socially responsible manner by maintaining a social license to operate. This paper thematically reviews the literature relevant to mine life cycle planning, enduring value, the socio-economic impacts of mining, and mine closure. Conditions required for a community to gain enduring value from mining include: ‘normalisation’ rather than being a ‘closed’ town; the existence of government support and funding; and realised economic diversification opportunities. It is imperative that these conditions are given due consideration 1) in the initial stages of mine and town planning and 2) throughout the life of the mine through ongoing monitoring and community engagement. However, we acknowledge the shortcomings in assuming planning is a panacea and suggest areas for further testing.
The governance of natural resources: Issues affecting better management of revenues and distribution of benefits within Papua New Guinea
Authors: Polume-Kiele Hitelai
Published: June 2017

Papua New Guinea is rich in natural resources, including minerals, oil, gas, timber and fish, and cash crops such as coffee, palm oil, cocoa, copra, rubber, tea and spices which contribute significantly to Papua New Guinea’s overall development. Several mining, oil and gas companies are currently operating in Porgera, Ok Tedi, Lihir, Hidden Valley, Sinivit, Simberi, Tolukuma, Kutubu and Gobe. The operations of these companies have generated an estimated K13.42 billion to Papua New Guinea’s economy. Landowners affected by these developments also receive royalties from those operations. However this wealth has not been translated into tangible human development across the country, as shown in persistently poorly performing social indicators. Instead income from the exploitation of natural resources is being used in unplanned projects and not focused on the delivery of core social functions, such as the provision of a stable and non-distorting policy aimed at building and sustaining the development of a modern market, and legislative and regulatory frameworks, social services, social security and social infrastructure which would lead to the improvement in the delivery of essential services to all Papua New Guineans. There is widespread evidence of benefits not being distributed to all landowners. Landowners are yet to fulfil their aspirations regarding these developments and to see improvements in their living standards. This paper discusses two case studies: the Porgera and Lihir mines, outlining the landowners associations’ experiences, which illustrate issues of governance and management of the distribution of benefit flows from the exploitation of Papua New Guinea’s natural resource wealth.The focus of the article’s discussion is on governance and management issues that affect the distribution of benefits, delivery of essential services to rural areas of PNG, stability within government, and the expectations of landowners.
The contribution of carbon pricing to sustainable mining
Authors: Meng Sam , Siriwardana Mahinda , McNeill Judith
Published: June 2017

Reductions in greenhouse gas emissions are essential to reducing the rate and scale of anthropogenic climate change to levels that can sustain the planet’s biosphere. A carbon tax is a policy measure that is designed to reduce greenhouse gas emissions by increasing the prices of the highest carbon-polluting goods and services in an economy, thus encouraging substitution towards resultant relatively cheaper and less-polluting goods where possible. When Australia introduced such a tax in 2012, there was a fear that it could threaten the resources boom, considered the engine of Australian economic growth in recent years. By employing a computable general equilibrium model and an environmentally-extended Social Accounting Matrix, this paper demonstrates the effects of a carbon tax on the resources sector. The modelled results show that, in a flexible exchange rate regime, all resources within the sector will be affected negatively but to different degrees. The brown coal sector will be the hardest hit, with a 25.74 per cent decrease in output, 52.94 per cent decrease in employment and 89.37 per cent decrease in profitability. However, other resources in the sector would be only mildly affected. From the point of view of sustainability, the most significant results are that, under the carbon tax, the resources sector contributes considerably to the carbon emission reduction target of Australia. Given that brown coal accounts for only a small portion of the resources sector, it is reasonable to suggest that a carbon tax would not significantly affect the overall performance of the sector.
Editorial: Mining in a Sustainable World
Authors: Branagan Marty , Williams Jacqueline , Kennedy Amanda
Published: June 2017

Humanity has reaped great benefits from mining. Over the millennia that humans have practiced mining, there have been many obvious improvements in mining’s environmental and social impacts. However, some aspects of mining still involve an element of ecological violence and, in Australia, there is a growing amount of conflict concerned with mining. These two related issues – ‘ecological violence’ and ‘conflict’ – were explored at the ‘Mining in a Sustainable World’ conference on 13 to 15 October 2013 at the University of New England campus in Armidale, Australia. The conference was a joint initiative of the University of New England’s Peace Studies and Australian Centre for Agriculture and Law. Specifically, conference delegates were interested in exploring the work being done to reduce ecological violence and conflict. Articles in this special edition of the International Journal of Rural Law and Policy arose from that conference. This editorial provides an overview of the rationale for the conference and the issues explored.