Psychosocial challenges and individual strategies for coping with mental stress among pregnant and postpartum adolescents in Nairobi informal settlements: a qualitative investigation.

BACKGROUND: This study was part of a project funded under the Grand Challenges Explorations initiative to engage adolescent girls living in the main slums of Nairobi. This involved an innovative co-creation initiative through jointly designing and testing the feasibility of a toolkit of information, skill, and confidence-building, and coping mechanisms that can effectively shield them and their peers against the risks of mental stress during pregnancy and early motherhood. METHODS: Qualitative interviews and discussions from visual methodologies including Photovoice, digital storytelling, and public service announcements were conducted with 30 pregnant and adolescent mothers aged 14-19 years in four informal settlements either pregnant or having a child less than 2 years. The aims included; to generate an inventory of mental stressors during pregnancy and early motherhood; understand how mental stress affects the ability to seek care for themselves and their child, and understand individual coping strategies. RESULTS: The psychosocial challenges identified in order of importance included: chased from home by the parents; economic hardship; neglect and abandonment by the person responsible for the pregnancy; stigmatization by family, friends, and the community; feelings of shattered dreams; and daily stress related to living in poor and unhygienic conditions. During the pregnancy and early motherhood, the participants experienced feelings of embarrassment, shame, hopelessness, and to the extreme, suicidal thoughts clouded their minds. Main coping strategies included social isolation for some, socializing with other pregnant and adolescent mothers, and negative behaviors like the uptake of illicit drugs and alcohol and risky sexual relationships. CONCLUSION: The unpreparedness for early motherhood infused with inadequate psychosocial support led to increased mental stress and risk of depression. The interconnection between the triggers to mental stress showed the need to focus on a multifaceted approach to address the wellbeing of pregnant and adolescent mothers.

The pattern and socio-cultural determinants of intimate partner violence in a Nigerian rural community.

BACKGROUND: Intimate partner violence (IPV) refers to a violation of women's reproductive rights as it impacts on their sexual and reproductive health autonomy. AIM: In this study, we aimed at assessing the pattern of IPV and the socio-cultural determinants and predictors of partner violence in a rural community setting where the bulk of the abuse prevails. SETTING: This study was conducted in a rural community in Southern Nigeria. METHODS: This study employed a mixed method comprising seven focus group discussions (FGDs) and quantitative components. The cross-sectional survey was conducted amongst 209 ever married or cohabited females in 2018 using the World Health Organization (WHO) multi-country survey questionnaire adapted to the study objectives. Data analysis was conducted by using IBM SPSS v21.0. The level of significance was set at p 0.05. RESULTS: The overall IPV prevalence was 79.4%. The prevalence of partner's controlling behaviour, emotional IPV, physical IPV and sexual IPV was 62.6%, 55.98%, 49.3% and 2.6%, respectively. Membership of an interest group was protective against IPV (OR = 0.430, 95% CI = 0.193-0.957) whilst the belief that a good wife obeys her partner even if she disagrees (OR = 9.201, 95% CI = 1.299-65.194) and the belief that it is the wife's obligation to have sex with the husband even if she doesn't feel like (OR = 2.356, 95% CI = 1.049-5.288) were risk factors. CONCLUSION: The burden of IPV in the studied rural community is enormous. There should be public enlightenment to desensitise people regarding the erroneous views that encourage partner violence. We encourage women to become a part of social groups that can enhance their education and empowerment.

Serum calcium-magnesium ratio in women with pre-eclampsia at a tertiary hospital in Nigeria.

OBJECTIVE: To determine the serum calcium-magnesium ratio in pre-eclampsia and compare with normotensives. METHODS: A case-control study was conducted in a tertiary hospital between October 2017 and March 2018 among 81 pregnant women (27 cases and 54 controls matched for age, gestational age, and parity). An interviewer-administered questionnaire was used to obtain data on demography/clinical history. Venous blood was collected without stasis and sent for biochemical analysis. Statistical analysis used IBM SPSS 21.0. RESULTS: The levels of serum Ca2+ (7.73 + 1.24 vs 9.17 + 0.77; P<0.001), Ca2+ -Mg2+ ratio (3.36 + 0.60 vs 3.83 + 0.41; P=0.001), and Mg2+ (2.35 + 0.35 vs 2.41 + 0.16; P=0.469) were lower among cases. Serum Ca2+ level correlated negatively with systolic (r=0.45, P=0.05) and diastolic blood pressure (r=0.50, P=0.010) among the cases. Hypocalcemia was a risk factor (adjusted odds ratio [AOR] 7.63, 95% confidence interval [CI] 1.64-35.37) while social classes 2 and 3 were protective factors (AOR 0.01, 95% CI 0.00-0.46 and AOR 0.01, 95% CI 0.00-0.24, respectively) against pre-eclampsia. CONCLUSION: The result of this research supported the implication of micronutrients in pre-eclampsia and may help to understand the pathophysiological process of pre-eclampsia. It will also help to establish and enhance existing preventive strategies for the condition. The recommendation by WHO on calcium supplementation in pregnancy as a step in preventing the occurrence of pre-eclampsia should be practiced.

The shape of things to come: linking developmental plasticity to post-metamorphic morphology in anurans.

Development consists of growth and differentiation, which can be partially decoupled and can be affected by environmental factors to different extents. In amphibians, variation in the larval environment influences development and causes changes in post-metamorphic shape. We examined post-metamorphic consequences, both morphological and locomotory, of alterations in growth and development. We reared tadpoles of two phylogenetically and ecologically distant frog species (the red-eyed treefrog Agalychnis callidryas and the African clawed frog Xenopus laevis) under different temperatures with ad libitum food supply and under different food levels at a constant temperature. Low temperature and low food levels both resulted in similarly extended larval periods. However, low temperature yielded relatively long-legged frogs with a lower degree of ossification than warm temperature, whereas low food yielded relatively short-legged frogs with a higher degree of ossification than high food levels. Such allometric differences had no effect on locomotor performance of juveniles. Our results provide a basis for understanding the relationship between growth, differentiation and post-metamorphic shape in anurans and help explain many of the discrepancies reported in previous studies.

Smooth muscle protein kinase C.

Protein kinase C (PKC) was first implicated in the regulation of smooth muscle contraction with the observation that phorbol esters induce slowly developing, sustained contractions. In some vascular smooth muscles, e.g., ferret aorta, phorbol ester induced contractions occur without an increase in sarcoplasmic free-Ca2+ concentration ([Ca]i) or myosin light chain phosphorylation. This response appears to be mediated by a Ca(2+)-independent isoenzyme of PKC (probably PKC epsilon), since saponin-permeabilized single ferret aortic smooth muscle cells, which retain receptor coupling, developed force in response to phenylephrine at low free [Ca2+] (pCa 7.0-8.6) and the constitutively active proteolytic fragment of PKC (PKM) elicited a contraction at pCa 7 comparable with the phenylephrine-induced contraction. Both contractions were reversed by a pseudo-substrate peptide inhibitor of PKC. These observations suggest a mechanism whereby alpha-adrenergic agonists may elicit a contractile response without a Ca2+ signal: alpha-adrenergic stimulation of phosphatidylcholine-specific phospholipase C or D (the latter in conjunction with phosphatidate phosphohydrolase) generates diacylglycerol. In the absence of an increase in [Ca2+]i, diacylglycerol specifically activates so-called novel PKCs, of which epsilon is the only isoenzyme known to be expressed in vascular smooth muscle. Recent evidence suggests that PKC may trigger a cascade of phosphorylation reactions, resulting in activation of mitogen-activated protein kinase and phosphorylation of the thin filament associated protein caldesmon. Alternatively, or additionally, PKC may directly phosphorylate calponin, another thin filament associated protein. These phosphorylations are predicted to alleviate inhibition of the cross-bridge cycling rate by these thin-filament proteins.(ABSTRACT TRUNCATED AT 250 WORDS)

Contraction of single vascular smooth muscle cells by phenylephrine at constant [Ca2+]i.

The mechanism of alpha-adrenergic agonist-mediated force generation was investigated in single hyperpermeable vascular smooth muscle cells. By use of a previously described method, force was recorded from individual ferret aortic cells made hyperpermeable by exposure to saponin. When the cells were clamped at pCa 7, addition of protein kinase M (PKM), the constitutively active form of protein kinase C (PKC), caused a sustained increase in force, which was reversible upon addition of the PKC pseudosubstrate inhibitor peptide (PSSI) corresponding to residues 19-31 of PKC. Phenylephrine at pCa 7 caused a dose-dependent increase in contractile force of the hyperpermeable cells, which was reversible on addition of phentolamine. The phenylephrine contraction could also be inhibited by the same concentration of PSSI that was effective toward the PKM-induced contraction. The response of the cells to a constant [phenylephrine] in different Ca buffers showed a lack of Ca dependence between pCa 8.6 and 7.0. The addition of PSSI to unstimulated cells caused a small but significant drop in basal tone. Taken together, these results suggest that a fraction of the basal tone, as well as the phenylephrine contraction that occurs in the skinned cells at constant intracellular free Ca2+ concentration, is the result of activation of a Ca-independent isozyme of PKC.

Anticalculus effect of a dentifrice containing 0.5% zinc citrate trihydrate.

A doubleblind 3-month anticalculus clinical study was conducted to determine the magnitude of the antitartar effect to be derived from use of a 0.5% zinc citrate dentifrice. From a population of 1600 subjects exhibiting calculus, 1210 subjects (age 18 and over) were selected and received a dental prophylaxis. The subjects were initially stratified on the basis of calculus score, age, and sex, then allocated randomly to a 3-month usage period of one of two treatment groups. These were a dentifrice containing 0.5% zinc citrate or a control dentifrice without zinc citrate. Calculus was assessed using the Volpe-Manhold Index. Oral soft tissue status was assessed throughout the course of the study. At the conclusion of the study 964 subjects had completed the trial: 486 using the zinc citrate dentifrice and 478 using the control. The results showed that the mean calculus scores in the group using the dentifrice containing zinc citrate were 13.7% lower than those of the group using the control dentifrice. This finding was statistically significant (P less than 0.05). No adverse effects related to the use of either dentifrice were observed.

Short course of antibiotic therapy in treatment of postpartum endomyometritis.

To evaluate the safety and efficacy of an abbreviated course of antibiotic therapy in postpartum endomyometritis, 109 patients with endomyometritis were randomized to three study groups. All were treated with clindamycin and tobramycin until afebrility and clinical signs of disease were absent. Patients in group I received antibiotics for greater than or equal to 24 hours, group II received therapy for greater than or equal to 48 hours, and group III received antibiotic therapy for greater than or equal to 48 hours that preceded a 7-day course of oral Augmentin. The groups were similar in size and in demographic and clinical parameters. Two patients from each group required a third antibiotic, and no patient required rehospitalization. Group III required more days of antibiotic therapy than did group I, 2.9 versus 2.1 days (p less than 0.01), and cost $412.00 more per patient. This data strongly suggest that a short course of antibiotic therapy is efficacious and safe and would result in substantial monetary savings.

Urinary fluoride levels of children residing in communities with naturally occurring fluorides in the drinking water.

The studies by Dean and others in the 1930's established excessive fluorides as the causative agent in the mottling of teeth. Although cultural and dietary patterns have changed during the past half century, this study suggests that the fluoride intake has remained relatively constant and generally proportional to the community's water fluoride level.

A current study of mottled enamel in Texas.

Enamel mottling is strongly associated with the water fluoride level of the community water supply. About 32% of the variation in the mottled enamel scores of subjects aged 7 to 12 was attributable to their community's water fluoride level. Objectionable mottling (moderate mottling) occurred at 2.3 times the currently accepted optimum water fluoride level. Subjects with incomes less than $10,000 have slightly more mottling (mostly moderate mottling) than subjects from higher income families. It should be emphasized that the effect of gender, ethnic group, or family income on enamel mottling is small compared with the effect of water fluoride level. Although many other personal and water supply characteristics were evaluated, virtually none of the remaining variation in mottled enamel scores could be attributed to any of these characteristics.

Synovial sarcoma of the neck: report of case.

Synovial sarcoma is an uncommon neoplasm that usually arises in the extremities and rarely in the head and neck. A case arising in the neck has been reported herein. The tumor is composed of two intimately associated cellular patterns; one resembles synovial structures and the other resembles fibrosarcoma. The tumor is fairly slow growing and is fairly well circumscribed but not actually encapsulated. There is a predilection for males; most occur in the third through fifth decades of life. Recurrence follows inadequate therapy. Although local excision was the therapy used in this case, the patient is alive and free of disease 30 months postoperatively.