The Concordance of Electronic Health Record Diagnoses and Substance use Self-Reports Among Reproductive Aged Women Enrolled in a Community-Based Addiction Reduction Program.

Substance use disorders among reproductive aged women are a major public health issue. There is little work investigating the validity and reliability of electronic health record (EHR) data for measuring substance use in this population. This study examined the concordance of self-reported substance use with clinical diagnoses of substance use, substance abuse and substance use disorder in EHR data. Reproductive age women enrolled in the Community-Based Addiction Reduction (CARE) program were interviewed by peer recovery coaches (PRC) at enrollment. That survey data was linked with EHR data (n = 102). Concordance between self-reported substance use and clinical diagnoses in the EHR was examined for opioids, cannabis/THC, and cocaine. Cohen's kappa, sensitivity, and specificity were calculated. The survey captured a higher number of women who use substances compared to the EHR. The concordance of self-report with EHR diagnosis varied by substance and was higher for opioids (17.6%) relative to cannabis/THC (8.8%), and cocaine (3.0%). Additionally, opioids had higher sensitivity (46.2%) and lower specificity (76.2%) relative to cannabis/THC and cocaine. Survey data collected by PRCs captured more substance use than EHRs, suggesting that EHRs underestimate substance use prevalence. The higher sensitivity and lower specificity of opioids was due to a larger number of women who had a diagnosis of opioid use in the EHR who did not self-report opioid use in the self-report survey relative to cannabis/THC and cocaine. Opioid self-report and diagnosis may be influenced by research setting, question wording, or receipt of medication for opioid use disorder.

Comparative investigation of the catalytic application of α/ß/γ-MnO2 nanoparticles synthesized by green and chemical approaches.

Three phases (α, ß, and γ) of manganese dioxide (MnO2) are successfully stabilized in a single entity for the first time. For this purpose, Citrullus colocynthis (bitter apple) extract is used as a natural surfactant in green synthesis. MnO2 nanoparticles were synthesized in the presence and absence of plant extracts under the same conditions. The morphology of both products is analysed by SEM and STEM to understand the role of plant extract in controlling the morphology of particles. The crystallinity and composition are analysed by XRD and confirmed that the product is composed of multiple phases α, ß, and γ. The reduction of dyes and nitroarenes is studied using MnO2 nanoparticles (green and chemical products) as catalysts. The apparent rate constant, a percentage reduction, time reduction and reduced concentration compare the activities of both catalysts. After comparative data analysis, the catalytic reduction of picric acid is found fastest among all the substrates. All the results are analysed based on structure, functional group and affinity towards catalysts.

The Effect of Reframing the Goals of Family Planning Programs from Limiting Fertility to Birth Spacing: Evidence from Pakistan.

Contraceptive prevalence in Pakistan has plateaued near 34 percent for over a decade, suggesting that fertility levels are likely to stay high unless effective interventions are designed. We evaluate the Family Advancement for Life and Health 2007-2012 (FALAH), a family planning project implemented in 31 districts of Pakistan. Deviating from previous programs, FALAH emphasized birth spacing-as opposed to limiting family size-as the primary purpose of contraceptive use. We use Pakistan Demographic and Health Survey to evaluate FALAH's impact on continuous and binary measures of birth intervals. To estimate the causal effects of the project, we compare the outcomes for multiple children born to the same mother before and after the project. We find that FALAH increased interbirth intervals by 2.4 months on average and reduced the proportion of short birth intervals by approximately 7.1 percentage points. This finding suggests that birth spacing as a goal of contraceptive use may resonate better with Pakistani couples than limiting family size. The project's effects were more pronounced for women with high education, in rural areas, and in the middle of the wealth distribution.

Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study.

BACKGROUND: Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients' socio-economic gradient. METHODS: We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users' characteristics. In the qualitative component, we synthesized users' and providers' narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews. RESULTS: Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced. CONCLUSION: The quality of ANC in Nepal's primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.

Exposure to conflict-related violence and nutritional status of children in Iraq.

There is limited empirical evidence of the health effects of war-related violence on child nutritional status. Using unique micro-level data from Iraq, we create measures of cumulative exposure to violence since conception for children ages two to five based on their date of birth and geographic location. We examine the relationship between height-for-age z-scores, a measure of chronic malnutrition, and four indicators of violence in a regression framework, adjusting for potential confounders and trends. We find that a child exposed to the maximum number of violent incidents is likely to experience a 0.5 standard deviation reduction in height-for-age z-score compared to a child who is exposed to no incidents. Each type of attack we evaluate is negatively associated with height-for-age. Further analysis reveals that the associations are the strongest for children in the northern and central regions where the bulk of the violent incidents occurred. Contrary to our expectation, the associations are similar for boys and girls. Our findings suggest that, in addition to efforts aimed at decreasing violent conflict in Iraq in general, the government and its development partners should focus relief, recovery, and reconstruction efforts in the central and northern regions of the country.

Deforestation and Household- and Individual-Level Double Burden of Malnutrition in Sub-Saharan Africa.

INTRODUCTION: Although forests and forest-based ecosystems have been shown to influence health and sustainable diets, there is limited evidence on how deforestation affects the current nutrition transition and the double burden of malnutrition. We examined the relationship between deforestation and the individual- and household-level double burden of malnutrition in 15 countries in Sub-Saharan Africa. MATERIALS AND METHODS: We combined data from geolocated Demographic and Health Surveys and the Global Forest Change dataset. We defined household-level double burden of malnutrition as the co-occurrence of an overweight woman of childbearing age (WCBA) and a stunted pre-school child (PSC) within the same household. We defined individual-level double burden in two ways: 1) as the co-occurrence of overweight and anemia within an individual WCBA, and 2) as the co-occurrence of overweight and stunting within a PSC. We used logistic regression analysis to examine the association between forest cover loss and these three measures after adjusting for potential confounders. We also assessed the mechanisms linking forest cover loss and nutritional status, such as livestock ownership and access to clean water. RESULTS: In our sample, the prevalence rates of the three measures of the double burden were: overweight and anemic WCBA: 8.4%, overweight WCBA and stunted PSC: 6.9%, overweight and stunted PSC: 2.7%. After adjusting for the confounders as well as country fixed effects and the month of the survey, forest cover loss was marginally associated with a higher odds of an overweight WCBA and stunted PSC (odds ratio (95% CI): 4.80 (0.82, 28.25)). We found no association between forest cover loss and odds of an overweight and stunted PSC (odds ratio (95% CI): 2.47 (0.80, 7.60)) or the odds of an anemic and overweight WCBA (odds ratio (95% CI): 0.71 (0.15, 3.32)). DISCUSSION: Deforestation does not seem to be an important driver of the double burden of malnutrition in SSA. However, deforestation influences several intermediate factors which, in turn, may influence the double burden. The overall weak association between forest cover loss and double burden measures mask significant heterogeneity across regions within SSA. Future research should unpack the mechanisms behind these regional differences.

Comparison of primary wound closure with delayed primary closure in perforated appendicitis.

BACKGROUND: Delayed primary closure in cases of acute appendicitis is debated among the surgeons as to whether it decreases the rate of wound infection in comparison to primary closure. The aim of this study was to find out the optimal method of wound closure in cases of perforated appendicitis. METHODS: This randomized control trial was conducted at the surgical units of Ayub Teaching Hospital Abbottabad from May to November 2012. A total of 158 patients having perforated appendicitis were included in the study. They were randomly divided two groups. The wounds were primarily closed in one group and left open with daily saline soaked dressing, to be closed on postoperative day 4 in case of the other group. The main outcome measure was wound infection. A wound was considered infected if it was discharging pus, was red and swollen on postoperative day 8th. The method of wound closure was considered efficacious if there was no wound infection till 8th postoperative day. RESULTS: A total of 158 patients, 56 (35.4%) male and 102 (64.6%) female were included in the study. Primary closure group had a total number of 79 patients with 26 (32.9%) male and 53 (67.1%) female. Delayed primary group had also a total number of 79 patients with 30 (38%) male and 49 (62%) female. The mean age of patients in the primary closure group was 26.67 ± 7.32 years while in the delayed primary group was 28.15 ± 6.88 years. In the entire series, 36 (22.8%) patients developed wound infection. There was a significant association between wound infection and type of skin closure (Delayed Primary Closure 6.3% vs. Primary Closure 39.2%, p < 0.000). CONCLUSION: Delayed Primary closure is the optimal management strategy in case of perforated appendicitis as it decreases the incidence of wound infection.