ABSTRACT
PROBLEM: Early pregnancy losses [EPL] are common, varied, and require different courses of management and care. BACKGROUND: In the UK, women who suspect or suffer a pregnancy loss are usually provided specialist care in early pregnancy assessment units [EPAUs]. Their configuration has recently been evaluated, but recommendations for change in-line with best practice for optimum outcomes were unable to be implemented due to the COVID-19 pandemic health system shock. AIM: To compare women's experiences of EPAUs during the pandemic to themes previously found in qualitative work undertaken with women who utilised EPAUs before the pandemic. METHODS: We conducted semi-structured virtual interviews, with women (N = 32) who suffered an early pregnancy loss during the pandemic; analysing transcripts using Template Analysis, based on findings about women's (pre-pandemic) experiences of EPAU from The VESPA Study. FINDINGS: We report on seven key themes: Barriers to Accessing Services; Communication & Information; Retention of Relational Care; Involvement in Care Decisions; Staffs' Attitude or Approach; Efficiency of Service Delivery; Sensitive Patient Management. DISCUSSION: Sensitive patient management and woman-staff interactions in EPAU settings remain a fundamental issue. Women also reported their experiences of EPAUs were comparatively worse during the pandemic. CONCLUSIONS: Women valued the care provided by EPAUs and found services to be efficient, despite pandemic-related restrictions. However, psychological recognition surrounding EPL and appropriate, sensitive, relational care and support continue to be areas in need of improvement. Our recommendation is to implement the improvements suggested by VESPA as a priority to ameliorate present sub-optimal experiences and prevent further deterioration.
Subject(s)
Abortion, Spontaneous , Maternal Health Services , Pregnancy , Female , Humans , Male , Abortion, Spontaneous/psychology , Pandemics , Qualitative ResearchABSTRACT
Hodgkin's lymphoma is rarely diagnosed in pregnancy, occurring in 1:6000 deliveries. However, improvements in survival and the use of less gonadotoxic treatments have increased the number of Hodgkin's lymphoma survivors becoming pregnant. Both de novo and relapsed Hodgkin's lymphoma in pregnancy pose difficult decisions for both clinicians and patients. This review discusses important diagnostic and treatment considerations of relapsed Hodgkin's lymphoma in pregnancy. We discuss a difficult case which illustrates these particular dilemmas and suggests the evidence behind different modalities of investigation and management.
ABSTRACT
BACKGROUND: The burden of non-communicable diseases is growing, particularly in developing countries. The greatest economic burden is due to dementia, the prevalence of which is rising with increasing longevity. In Africa, where the rate of increase of elderly persons is the fastest in the world, dementia is normally dismissed as a part of normal ageing. The lack of awareness means that many patients are suffering undiagnosed. This review aims to assess the information on the prevalence of dementia in Africa in order to estimate the current burden. METHODS: A parallel search of Medline, EMBASE and Global Health limited to post-1980 found only 10 relevant studies. Data on prevalence and risk factors were extracted and analysed. We modelled the available information and used the UN population figures for Africa to determine the age-specific and overall burden of dementia. RESULTS: The overall prevalence of dementia in adults older than 50 years in Africa was estimated to be about 2.4%, which translates to 2.76 million people living with a disease in 2010. About 2.10 millions of them live in Sub-Saharan Africa. Prevalence was the highest among females aged 80 and over (19.7%) and there was little variation between regions. Alzheimer disease was the most prevalent cause of dementia (57.1%) followed by vascular dementia (26.9%). The main risk factors were increasing age, female sex and cardiovascular disease. CONCLUSIONS: Information on dementia prevalence in Africa is very limited. Further research will not only provide a more reliable estimate of prevalence, and consequently the burden of disease, but will also raise awareness of the problem. This is critical in promoting help-seeking behaviour and generating the political commitment to make dementia a public health priority in Africa.
ABSTRACT
BACKGROUND: Epilepsy is a leading serious neurological condition worldwide and has particularly significant physical, economic and social consequences in Sub-Saharan Africa. This paper aims to contribute to the understanding of epilepsy prevalence in this region and how this varies by age and sex so as to inform understanding of the disease characteristics as well as the development of infrastructure, services and policies. METHODS: A parallel systematic analysis of Medline, Embase and Global Health returned 32 studies that satisfied pre-defined quality criteria. Relevant data was extracted, tabulated and analyzed. We modelled the available information and used the UN population figures for Africa to determine the age-specific and overall burden of epilepsy. RESULTS: Active epilepsy was estimated to affect 4.4 million people in Sub-Saharan Africa, whilst lifetime epilepsy was estimated to affect 5.4 million. The prevalence of active epilepsy peaks in the 20-29 age group at 11.5/1000 and again in the 40-49 age group at 8.2/1000. The lowest prevalence value of 3.1/1000 is seen in the 60+ age group. This binomial pattern is also seen in both men and women, with the second peak more pronounced in women at 14.6/1000. CONCLUSION: The high prevalence of epilepsy, especially in young adults, has important consequences for both the workforce and community structures. An estimation of disease burden would be a beneficial outcome of further research, as would research into appropriate methods of improving health care for and tackling discrimination against people with epilepsy.
