Increasing facility delivery through maternity waiting homes for women living far from a health facility in rural Zambia: a quasi-experimental study.

OBJECTIVE: To report on the effectiveness of a standardised core Maternity Waiting Home (MWH) model to increase facility deliveries among women living >10 km from a health facility. DESIGN: Quasi-experimental design with partial randomisation at the cluster level. SETTING: Seven rural districts in Zambia. POPULATION: Women delivering at 40 health facilities between June 2016 and August 2018. METHODS: Twenty intervention and 20 comparison sites were used to test whether MWHs increased facility delivery for women living in rural Zambia. Difference-in-differences (DID) methodology was used to examine the effectiveness of the core MWH model on our identified outcomes. MAIN OUTCOME MEASURES: Differences in the change from baseline to study period in the percentage of women living >10 km from a health facility who: (1) delivered at the health facility, (2) attended a postnatal care (PNC) visit and (3) were referred to a higher-level health facility between intervention and comparison group. RESULTS: We detected a significant difference in the percentage of deliveries at intervention facilities with the core MWH model for all women living >10 km away (DID 4.2%, 95% CI 0.6-7.6, P = 0.03), adolescent women (<18 years) living >10 km away (DID 18.1%, 95% CI 6.3-29.8, P = 0.002) and primigravida women living >10 km away (DID 9.3%, 95% CI 2.4-16.4, P = 0.01) and for women attending the first PNC visit (DID 17.8%, 95% CI 7.7-28, P < 0.001). CONCLUSION: The core MWH model was successful in increasing rates of facility delivery for women living >10 km from a healthcare facility, including adolescent women and primigravidas and attendance at the first PNC visit. TWEETABLE ABSTRACT: A core MWH model increased facility delivery for women living >10 km from a health facility including adolescents and primigravidas in Zambia.

Early repair of ventral incisional hernia may improve quality of life after surgery for abdominal malignancy: a prospective observational cohort study.

PURPOSE: Recent work has shown that over 40% of patients undergoing surgery for abdominal malignancy develop ventral incisional hernias (VIH) within 2 years. We hypothesized that early repair of VIH for cancer survivors could improve long-term quality of life (QoL). METHODS: All patients presenting with a history of surgery for abdominal malignancy and a VIH were prospectively enrolled. QoL was assessed at baseline and 3-, 6-, 12-, 18-, and 24-month follow-up using abdominal wall-specific (HerQLes) and cancer-specific (FACT-G) instruments. At the study's conclusion, patients were divided into 2 groups-those that underwent VIH repair during the study's course (Repair Group) and those that did not (Control Group). Categorical variables were analyzed using Pearson's Chi-square and continuous variables with Wilcoxon rank sum test. RESULTS: Eighty-four patients were enrolled. Overall, 46 patients (55%) underwent VIH repair, with 36 repairs (78%) occurring within 3 months of initial evaluation. Sixty-six (79%) had complete 1-year follow-up data, and 30 (36%) had 2-year data, with a median follow-up duration of 15.6 months. At baseline, both groups were similar with respect to demographics, cancer stage, and HerQLes/FACT-G scores. Compared to the Controls, the Repair Group showed greater improvements over baseline HerQLes Summary Scores at the 3-, 6-, 12-, and 18-month time points (median increase, 37 vs. 26 points), and in FACT-G total scores at the 3-, 6-, and 12-month time points (median increase, 6 vs. 4 points). CONCLUSIONS: Repair of VIH after surgery for abdominal malignancy may improve abdominal wall-specific and cancer-specific QoL, making post-resection abdominal wall reconstruction an important aspect of cancer survivorship.

Osprey distribution, abundance, reproductive success and contaminant burdens along lower Columbia River, 1997/1998 versus 2004.

The osprey (Pandion haliaetus) population nesting along the lower portion of the Columbia River (river mile 29 to 286) increased from 94 in 1997 to 103 occupied nests in 1998 (9.6% annual rate of increase) to 225 occupied nests in 2004 (13.9% annual rate of increase). The more recent rate of population increase was associated with higher reproductive rates than in 1997/1998, and significantly lower egg concentrations of most organochlorine (OC) pesticides, polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). A comparison of observed egg residue concentrations in 2004 with effect-level information for ospreys indicated that reproduction at few, if any, nests was adversely affected. As recent as 1997/1998, dichlorodiphenyldichloroethylene (DDE) was still adversely affecting reproductive success for a portion of this population. Mercury was the only contaminant evaluated in both 1997/1998 and 2004 that showed a significant increase in eggs over time, but concentrations in 2004 (0.09 microg g(-1) ww) remained below established effect levels for birds (generally reported at 0.50 microg g(-1) ww or higher). The significant increase in mercury justifies the need for future monitoring. All contaminants mentioned that biomagnify up food chains can be effectively monitored in osprey eggs. The osprey has been shown to be an excellent sentinel species for long-term monitoring with their many useful traits described.

Mercury and drought along the lower Carson River, Nevada: I. Snowy egret and black-crowned night-heron annual exposure to mercury, 1997-2006.

The dynamic nature of the annual volume of water discharged down the Carson River over a 10-year period, which included a century flood and drought, was examined in order to gain a better understanding of mercury movement, biological availability, and exposure to waterbirds nesting at Lahontan Reservoir. Total annual water discharge directly influenced total mercury (THg) in unfiltered water above the reservoir and downstream of a mining area, whereas methyl mercury (MeHg) at the same site was negatively related to annual discharge. Annual water storage at Lahontan Reservoir in the spring and early summer, as expected, was directly related to annual Carson River discharge. In contrast to the findings from above the reservoir, annual MeHg concentrations in water sampled below the reservoir were positively correlated with the total discharge and the amount of water stored in the reservoir on 1 July; that is, the reservoir is an important location for mercury methylation, which agrees with earlier findings. However, unfiltered water MeHg concentrations were about 10-fold higher above than below the reservoir, which indicated that much MeHg that entered as well as that produced in the reservoir settled out in the reservoir. Avian exposure to mercury at Lahontan Reservoir was evaluated in both eggs and blood of young snowy egrets (Egretta thula) and black-crowned night-herons (Nycticorax nycticorax). Annual MeHg concentrations in unfiltered water below the reservoir, during the time period (Julian Days 90-190) when birds were present, correlated significantly with mercury concentrations in night-heron blood (r(2 )= 0.461, p = 0.027), snowy egret blood (r(2 )= 0.474, p = 0.024), and night-heron eggs (r(2) = 0.447, p = 0.029), but not snowy egret eggs. A possible reason for lack of an MeHg water correlation with snowy egret eggs is discussed and relates to potential exposure differences associated with the food habits of both species. THg concentrations in water collected below the reservoir were not related to egg or blood mercury concentrations for either species.