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Article ; Online: Oral Probiotic Supplementation in Pregnancy to Reduce Group B Streptococcus Colonisation (OPSiP trial): study protocol for a double-blind parallel group randomised placebo trial.

Hayes, Kelly / Janssen, Patricia / Payne, Beth A / Jevitt, Cecilia / Johnston, Will / Johnson, Patricia / Butler, Michelle

BMJ open

2024 Volume 14, Issue 2, Page(s) e076455

Abstract: Introduction: Group B streptococcus: Methods and analysis: This double-blind parallel group randomised trial aims to recruit 450 pregnant participants in Vancouver, BC, Canada and will compare GBS colonisation rates in those who have received a daily ...

Abstract	Introduction: Group B streptococcus Methods and analysis: This double-blind parallel group randomised trial aims to recruit 450 pregnant participants in Vancouver, BC, Canada and will compare GBS colonisation rates in those who have received a daily oral dose of three strains of probiotics with those who have received a placebo. The primary outcome will be GBS colonisation status, measured using a vaginal/rectal swab obtained between 35 weeks' gestation and delivery. Secondary outcomes will include maternal antibiotic exposure and urogenital infections. Analysis will be on an intention-to-treat basis. Patient or public involvement: There was no patient or public involvement in the design of the study protocol. Ethics and dissemination: This study protocol received ethics approval from the University of British Columbia's Clinical Research Ethics Board, Dublin City University and Health Canada. Findings will be presented at research rounds, conferences and in peer-reviewed publications. Trial registration number: NCT03407157.
MeSH term(s)	Pregnancy ; Infant, Newborn ; Female ; Humans ; Streptococcus agalactiae ; Streptococcal Infections/prevention & control ; Streptococcal Infections/drug therapy ; Canada ; Probiotics/therapeutic use ; Anti-Bacterial Agents/adverse effects ; Pregnancy Complications, Infectious/drug therapy ; Pregnancy Complications, Infectious/prevention & control ; Randomized Controlled Trials as Topic
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2024-02-05
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-076455
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Article ; Online: The economic burden of cervical cancer on women in Uganda: Findings from a cross-sectional study conducted at two public cervical cancer clinics.

Dau, Hallie / Nankya, Esther / Naguti, Priscilla / Basemera, Miriam / Payne, Beth A / Vidler, Marianne / Singer, Joel / McNair, Avery / AboMoslim, Maryam / Smith, Laurie / Orem, Jackson / Nakisige, Carolyn / Ogilvie, Gina

PLOS global public health

2024 Volume 4, Issue 3, Page(s) e0002554

Abstract: There is limited research on how a cervical cancer diagnosis financially impacts women and their families in Uganda. This analysis aimed to describe the economic impact of cervical cancer treatment, including how it differs by socio-economic status (SES) ...

Abstract	There is limited research on how a cervical cancer diagnosis financially impacts women and their families in Uganda. This analysis aimed to describe the economic impact of cervical cancer treatment, including how it differs by socio-economic status (SES) in Uganda. We conducted a cross-sectional study from September 19, 2022 to January 17, 2023. Women were recruited from the Uganda Cancer Institute and Jinja Regional Referral Hospital, and were eligible if they were ≥ of 18 years and being treated for cervical cancer. Participants completed a survey that included questions about their out-of-pocket costs, unpaid labor, and family's economic situation. A wealth index was constructed to determine their SES. Descriptive statistics were reported. Of the 338 participants, 183 were from the lower SES. Women from the lower SES were significantly more likely to be older, have ≤ primary school education, and have a more advanced stage of cervical cancer. Over 90% of participants in both groups reported paying out-of-pocket for cervical cancer. Only 15 participants stopped treatment because they could not afford it. Women of a lower SES were significantly more likely to report borrowing money (higher SES n = 47, 30.5%; lower SES n = 84, 46.4%; p-value = 0.004) and selling possessions (higher SES n = 47, 30.5%; lower SES n = 90, 49.7%; p-value = 0.006) to pay for care. Both SES groups reported a decrease in the amount of time that they spent caring for their children since their cervical cancer diagnosis (higher SES n = 34, 31.2%; lower SES n = 36, 29.8%). Regardless of their SES, women in Uganda incur out-of-pocket costs related to their cervical cancer treatment. However, there are inequities as women from the lower SES groups were more likely to borrow funds to afford treatment. Alternative payment models and further economic support could help alleviate the financial burden of cervical cancer care in Uganda.
Language	English
Publishing date	2024-03-15
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0002554
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Article ; Online: Side effects and acceptability measures for thermal ablation as a treatment for cervical precancer in low-income and middle-income countries: a systematic review and meta-synthesis.

Piret, Evelyne Marie / Payne, Beth A / Smith, Laurie W / Trawin, Jessica / Orem, Jackson / Ogilvie, Gina / Nakisige, Carolyn

Family medicine and community health

2022 Volume 10, Issue 2

Abstract: Objective: Understanding the side effects and acceptability of thermal ablation (TA) is necessary before large-scale application in screen-and-treat programmes can be justified in low-income and middle-income countries (LMICs).: Design: Articles were ...

Abstract	Objective: Understanding the side effects and acceptability of thermal ablation (TA) is necessary before large-scale application in screen-and-treat programmes can be justified in low-income and middle-income countries (LMICs). Design: Articles were selected for inclusion by two independent reviewers. Risk of bias was assessed using the Downs and Black's criteria. Summary data were extracted, and authors contacted for data when necessary. Proportions of interest and 95% CIs were estimated using a random effects model. Subgroup analysis was performed based on place of treatment and timing of post-treatment follow-up. Heterogeneity was estimated using the I Eligibility criteria: Studies that reported one or more side effects or patient acceptability measures after treatment of the cervix using TA in women living in LMICs who completed a cervical cancer screening test. Included articles were clinical trials or observational studies available in English and published before 18 December 2020. Information sources: Ovid MEDLINE, EMBASE, CINAHL, CAB Global Health and WHO Global Index Medicus were searched for this systematic review and meta-synthesis. Results: A total of 1590 abstracts were screened, 84 full text papers reviewed and 15 papers selected for inclusion in the qualitative review, 10 for meta-synthesis (N=2039). Significant heterogeneity was found in screening tests used to identify women eligible for TA and in methods to ascertain side effects. The most commonly reported side effect during treatment was pain (70%, 95% CI 52% to 85%; I Conclusions: TA results in a number of common side effects, though acceptability remains high among women treated in LMICs. Standardised side effect and acceptability reporting are needed as TA becomes more readily available. Prospero registration number: CRD42020197605.
MeSH term(s)	Developing Countries ; Drug-Related Side Effects and Adverse Reactions ; Early Detection of Cancer ; Female ; Humans ; Male ; Pain ; Poverty ; Uterine Cervical Neoplasms/surgery
Language	English
Publishing date	2022-05-29
Publishing country	England
Document type	Journal Article ; Review ; Systematic Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2986753-8
ISSN	2009-8774 ; 2305-6983
ISSN (online)	2009-8774
ISSN	2305-6983
DOI	10.1136/fmch-2021-001541
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Article ; Online: Understanding the association between informed choice and long-term reversible contraception among Ugandan women: Findings from the 2016 Demographic Health Survey.

Dau, Hallie / Kakaire, Othman / Karim, Mohammad Ehsanul / Nakisige, Carolyn / Vidler, Marianne / Payne, Beth A / Ogilvie, Gina

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

2022 Volume 160, Issue 3, Page(s) 978–985

Abstract: Objectives: To understand the relationship between informed choice and long-acting reversible contraceptive (LARC) use among women aged 15-49 years in Uganda after adjusting for potential confounding.: Methods: This cross-sectional study uses data ... ...

Abstract	Objectives: To understand the relationship between informed choice and long-acting reversible contraceptive (LARC) use among women aged 15-49 years in Uganda after adjusting for potential confounding. Methods: This cross-sectional study uses data from the 2016 Uganda Standard Demographic and Health Survey. Thomas-Rao corrections to a χ Results: In all, 3646 women were included in the analysis and 975 reported using a LARC. In the design-adjusted multivariable analysis, the odds of reporting LARC usage were 1.98 (95% confidence interval 1.61-2.43) times higher among women who reported informed choice compared with those who did not. The subsequent propensity score analysis reported similar findings. Conclusion: Providing informed choice can help to increase the number of women who use LARC in Uganda. As such, the Ugandan Ministry of Health should further expand access to family planning counseling as it could contribute to the reduction of unplanned pregnancies across Uganda with the use of LARC.
MeSH term(s)	Pregnancy ; Female ; Humans ; Uganda ; Cross-Sectional Studies ; Long-Acting Reversible Contraception ; Contraception ; Health Surveys ; Contraceptive Agents, Female ; Demography ; Contraception Behavior
Chemical Substances	Contraceptive Agents, Female
Language	English
Publishing date	2022-09-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	80149-5
ISSN	1879-3479 ; 0020-7292
ISSN (online)	1879-3479
ISSN	0020-7292
DOI	10.1002/ijgo.14432
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Zs.A 355: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The social and economic impacts of cervical cancer on women and children in low- and middle-income countries: A systematic review.

Dau, Hallie / Trawin, Jessica / Nakisige, Carolyn / Payne, Beth A / Vidler, Marianne / Singer, Joel / Orem, Jackson / Smith, Laurie / Ogilvie, Gina

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

2022 Volume 160, Issue 3, Page(s) 751–761

Abstract: Background: There is limited knowledge on the social and economic impacts of a diagnosis of cervical cancer on women and children in low- and middle-income countries (LMICs).: Objectives: To determine the social and economic impacts associated with ... ...

Abstract	Background: There is limited knowledge on the social and economic impacts of a diagnosis of cervical cancer on women and children in low- and middle-income countries (LMICs). Objectives: To determine the social and economic impacts associated with cervical cancer among women and children living in LMICs. Search strategy: The MEDLINE, PsychInfo, CINAHL, Pais International, and CAB Global Health databases were systematically searched to retrieve studies up to June 2021. Selection criteria: Studies were included if they reported on either the social or economic impacts of women or children in a LMIC. Data collection and analysis: Data was independently extracted by two co-authors. The authors performed a quality assessment on all included articles. Main results: In all, 53 studies were included in the final review. Social impacts identified included social support, education, and independence. Economic impacts included employment and financial security. No study reported the economic impact on children. Studies that utilized quantitative methods typically reported more positive results than those that utilized qualitative methods. Conclusions: Additional mixed-methods research is needed to further understand the social support needs of women with cervical cancer. Furthermore, research is needed on the impact of a mother's diagnosis of cervical cancer on her children.
MeSH term(s)	Child ; Female ; Humans ; Developing Countries ; Uterine Cervical Neoplasms/diagnosis ; Social Support
Language	English
Publishing date	2022-09-16
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	80149-5
ISSN	1879-3479 ; 0020-7292
ISSN (online)	1879-3479
ISSN	0020-7292
DOI	10.1002/ijgo.14395
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Zs.A 355: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Machine learning-enabled maternal risk assessment for women with pre-eclampsia (the PIERS-ML model): a modelling study.

Montgomery-Csobán, Tünde / Kavanagh, Kimberley / Murray, Paul / Robertson, Chris / Barry, Sarah J E / Vivian Ukah, U / Payne, Beth A / Nicolaides, Kypros H / Syngelaki, Argyro / Ionescu, Olivia / Akolekar, Ranjit / Hutcheon, Jennifer A / Magee, Laura A / von Dadelszen, Peter

The Lancet. Digital health

2024 Volume 6, Issue 4, Page(s) e238–e250

Abstract: Background: Affecting 2-4% of pregnancies, pre-eclampsia is a leading cause of maternal death and morbidity worldwide. Using routinely available data, we aimed to develop and validate a novel machine learning-based and clinical setting-responsive time- ... ...

Abstract	Background: Affecting 2-4% of pregnancies, pre-eclampsia is a leading cause of maternal death and morbidity worldwide. Using routinely available data, we aimed to develop and validate a novel machine learning-based and clinical setting-responsive time-of-disease model to rule out and rule in adverse maternal outcomes in women presenting with pre-eclampsia. Methods: We used health system, demographic, and clinical data from the day of first assessment with pre-eclampsia to predict a Delphi-derived composite outcome of maternal mortality or severe morbidity within 2 days. Machine learning methods, multiple imputation, and ten-fold cross-validation were used to fit models on a development dataset (75% of combined published data of 8843 patients from 11 low-income, middle-income, and high-income countries). Validation was undertaken on the unseen 25%, and an additional external validation was performed in 2901 inpatient women admitted with pre-eclampsia to two hospitals in south-east England. Predictive risk accuracy was determined by area-under-the-receiver-operator characteristic (AUROC), and risk categories were data-driven and defined by negative (-LR) and positive (+LR) likelihood ratios. Findings: Of 8843 participants, 590 (6·7%) developed the composite adverse maternal outcome within 2 days, 813 (9·2%) within 7 days, and 1083 (12·2%) at any time. An 18-variable random forest-based prediction model, PIERS-ML, was accurate (AUROC 0·80 [95% CI 0·76-0·84] vs the currently used logistic regression model, fullPIERS: AUROC 0·68 [0·63-0·74]) and categorised women into very low risk (-LR <0·1; eight [0·7%] of 1103 women), low risk (-LR 0·1 to 0·2; 321 [29·1%] women), moderate risk (-LR >0·2 and +LR <5·0; 676 [61·3%] women), high risk (+LR 5·0 to 10·0, 87 [7·9%] women), and very high risk (+LR >10·0; 11 [1·0%] women). Adverse maternal event rates were 0% for very low risk, 2% for low risk, 5% for moderate risk, 26% for high risk, and 91% for very high risk within 48 h. The 2901 women in the external validation dataset were accurately classified as being at very low risk (0% with outcomes), low risk (1%), moderate risk (4%), high risk (33%), or very high risk (67%). Interpretation: The PIERS-ML model improves identification of women with pre-eclampsia who are at lowest and greatest risk of severe adverse maternal outcomes within 2 days of assessment, and can support provision of accurate guidance to women, their families, and their maternity care providers. Funding: University of Strathclyde Diversity in Data Linkage Centre for Doctoral Training, the Fetal Medicine Foundation, The Canadian Institutes of Health Research, and the Bill & Melinda Gates Foundation.
MeSH term(s)	Pregnancy ; Female ; Humans ; Male ; Pre-Eclampsia/diagnosis ; Pregnancy Outcome ; Risk Factors ; Canada ; Maternal Health Services ; Risk Assessment/methods
Language	English
Publishing date	2024-03-20
Publishing country	England
Document type	Journal Article
ISSN	2589-7500
ISSN (online)	2589-7500
DOI	10.1016/S2589-7500(23)00267-4
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Article ; Online: Risk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic review.

Symonds, Nicola E / Vidler, Marianne / Wiens, Matthew O / Omar, Shazmeen / English, L Lacey / Ukah, U Vivian / Ansermino, J Mark / Ngonzi, Joseph / Bebell, Lisa M / Hwang, Bella / Christoffersen-Deb, Astrid / Kissoon, Niranjan / Payne, Beth A

BMC pregnancy and childbirth

2023 Volume 23, Issue 1, Page(s) 303

Abstract: Background: In low- and middle-income countries, approximately two thirds of maternal deaths occur in the postpartum period. Yet, care for women beyond 24 h after discharge is limited. The objective of this systematic review is to summarize current ... ...

Abstract	Background: In low- and middle-income countries, approximately two thirds of maternal deaths occur in the postpartum period. Yet, care for women beyond 24 h after discharge is limited. The objective of this systematic review is to summarize current evidence on socio-demographic and clinical risk factors for (1) postpartum mortality and (2) postpartum hospital readmission. Methods: A combination of keywords and subject headings (i.e. MeSH terms) for postpartum maternal mortality or readmission were searched. Articles published up to January 9, 2021 were identified in MEDLINE, EMBASE, and CINAHL databases, without language restrictions. Studies reporting socio-demographic or clinical risk factors for postpartum mortality or readmission within six weeks of delivery among women who delivered a livebirth in a low- or middle-income country were included. Data were extracted independently by two reviewers based on study characteristics, population, and outcomes. Included studies were assessed for quality and risk of bias using the Downs and Black checklist for ratings of randomized and non-randomized studies. Results: Of 8783 abstracts screened, seven studies were included (total N = 387,786). Risk factors for postpartum mortality included Caesarean mode of delivery, nulliparity, low or very low birthweight, and shock upon admission. Risk factors for postpartum readmission included Caesarean mode of delivery, HIV positive serostatus, and abnormal body temperature. Conclusions: Few studies reported individual socio-demographic or clinical risk factors for mortality or readmission after delivery in low- and middle-income countries; only Caesarean delivery was consistently reported. Further research is needed to identify factors that put women at greatest risk of post-discharge complications and mortality. Understanding post-discharge risk would facilitate targeted postpartum care and reduce adverse outcomes in women after delivery. Trial registration: PROSPERO registration number: CRD42018103955.
MeSH term(s)	Pregnancy ; Female ; Humans ; Patient Readmission ; Aftercare ; Developing Countries ; Maternal Mortality ; Patient Discharge ; Postpartum Period ; Risk Factors
Language	English
Publishing date	2023-04-29
Publishing country	England
Document type	Systematic Review ; Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-023-05459-y
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Article ; Online: Impact of free maternity services on outcomes related to hypertensive disorders of pregnancy at Moi Teaching and Referral Hospital in Kenya: a retrospective analysis.

Buitendyk, Marie / Kosgei, Wycliffe / Thorne, Julie / Millar, Heather / Alera, Joy Marsha / Kibet, Vincent / Bernard, Christian Ochieng / Payne, Beth A / Bernard, Caitlin / Christoffersen-Deb, Astrid

BMC pregnancy and childbirth

2023 Volume 23, Issue 1, Page(s) 98

Abstract: Background: Preeclampsia is a major contributor to maternal and neonatal mortality worldwide. Ninety-nine percent of these deaths occur in resource limited settings. One of the greatest barriers to women seeking medical attention remains the cost of ... ...

Abstract	Background: Preeclampsia is a major contributor to maternal and neonatal mortality worldwide. Ninety-nine percent of these deaths occur in resource limited settings. One of the greatest barriers to women seeking medical attention remains the cost of care. Kenya implemented a nation-wide policy change in 2013, offering free inpatient maternity services to all women to address this concern. Here, we explore the impact of this policy change on maternal and neonatal outcomes specific to the hypertensive disorders of pregnancy. Methods: We conducted a retrospective cross-sectional chart review of patients discharged or deceased with a diagnosis of gestational hypertension, preeclampsia, eclampsia or HELLP syndrome at a tertiary referral center in western Kenya one year before (June 1, 2012-May 31, 2013) and one year after (June 1, 2013-May 31, 2014) free maternity services were introduced at public facilities across the country. Demographic information, obstetric history, medical history, details of the current pregnancy, diagnosis on admission and at discharge, antepartum treatment, maternal outcomes, and neonatal outcomes were collected and comparisons were made between the time points. Results: There were more in hospital births after policy change was introduced. The proportion of women diagnosed with a hypertensive disorder of pregnancy was higher in the year before free maternity care although there was a statistically significant increase in the proportion of women diagnosed with gestational hypertension after policy change. Among those diagnosed with hypertensive disorders, there was no difference in the proportion who developed obstetric or medical complications. Of concern, there was a statistically significant increase in the proportion of women dying as a result of their condition. There was a statistically significant increase in the use of magnesium sulfate for seizure prophylaxis. There was no overall difference in the use of anti-hypertensives between groups and no overall difference in the proportion of women who received dexamethasone for fetal lung maturity. Conclusions: Free maternity services, however necessary, are insufficient to improve maternal and neonatal outcomes related to the hypertensive disorders of pregnancy at a tertiary referral center in western Kenya. Multiple complementary strategies acting in unison are urgently needed.
MeSH term(s)	Infant, Newborn ; Pregnancy ; Female ; Humans ; Pre-Eclampsia ; Hypertension, Pregnancy-Induced/epidemiology ; Hypertension, Pregnancy-Induced/therapy ; Retrospective Studies ; Kenya/epidemiology ; Cross-Sectional Studies ; Maternal Health Services ; Parturition ; Hospitals ; Referral and Consultation
Language	English
Publishing date	2023-02-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-023-05381-3
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Article ; Online: Community-integrated self-collected HPV-based cervix screening in a low-resource rural setting: a pragmatic, cluster-randomized trial.

Gottschlich, Anna / Payne, Beth A / Trawin, Jessica / Albert, Arianne / Jeronimo, Jose / Mitchell-Foster, Sheona / Mithani, Nadia / Namugosa, Ruth / Naguti, Priscilla / Pedersen, Heather / Rawat, Angeli / Simelela, Princess Nothemba / Singer, Joel / Smith, Laurie W / van Niekerk, Dirk / Orem, Jackson / Nakisige, Carolyn / Ogilvie, Gina

Nature medicine

2023 Volume 29, Issue 4, Page(s) 927–935

Abstract: Effective approaches to improve coverage of self-collected human papillomavirus (HPV)-based cervix screening (SCS) as well as attendance at treatment for HPV-positive participants are needed to inform policy on optimal integration of cervical cancer ... ...

Abstract	Effective approaches to improve coverage of self-collected human papillomavirus (HPV)-based cervix screening (SCS) as well as attendance at treatment for HPV-positive participants are needed to inform policy on optimal integration of cervical cancer screening programs within existing infrastructure in low-resource settings. ASPIRE Mayuge was a pragmatic cluster-randomized trial in rural Mayuge district, Uganda, comparing the superiority of two recruitment implementation strategies for SCS: Door-to-Door versus Community Health Day. Villages were randomized (unblinded) to a strategy, and participants aged 25-49 years with no previous history of hysterectomy or treatment for cervical cancer or pre-cancer were eligible. Participants completed a survey and participated in SCS. The primary outcome was rate of attendance at treatment after a positive SCS. The trial randomized 31 villages and 2,019 participants included in these analyses (Door-to-Door: 16 clusters, 1,055 participants; Community Health Day: 15 clusters, 964 participants). Among HPV-positive participants, attendance at treatment rates were 75% (Door-to-Door) and 67% (Community Health Day) (P = 0.049). Participants in the Community Health Day intervention were less likely to attend treatment compared to Door-to-Door (risk ratio = 0.78, 95% confidence interval: 0.64-0.96). No adverse events were reported. Policymakers in low-resource settings can use these results to guide implementation of SCS programs. ISRCTN registration: 12767014 . ClinicalTrials.gov registration: NCT04000503 .
MeSH term(s)	Female ; Humans ; Cervix Uteri ; Uterine Cervical Neoplasms/diagnosis ; Uterine Cervical Neoplasms/epidemiology ; Uterine Cervical Neoplasms/therapy ; Early Detection of Cancer/methods ; Papillomavirus Infections/diagnosis ; Mass Screening/methods ; Papillomaviridae
Language	English
Publishing date	2023-04-10
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1220066-9
ISSN	1546-170X ; 1078-8956
ISSN (online)	1546-170X
ISSN	1078-8956
DOI	10.1038/s41591-023-02288-6
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Article ; Online: Prognostic algorithms for post-discharge readmission and mortality among mother-infant dyads: an observational study protocol.

Wiens, Matthew O / Trawin, Jessica / Pillay, Yashodani / Nguyen, Vuong / Komugisha, Clare / Kenya-Mugisha, Nathan / Namala, Angella / Bebell, Lisa M / Ansermino, J Mark / Kissoon, Niranjan / Payne, Beth A / Vidler, Marianne / Christoffersen-Deb, Astrid / Lavoie, Pascal M / Ngonzi, Joseph

Frontiers in epidemiology

2023 Volume 3, Page(s) 1233323

Abstract: Introduction: In low-income country settings, the first six weeks after birth remain a critical period of vulnerability for both mother and newborn. Despite recommendations for routine follow-up after delivery and facility discharge, few mothers and ... ...

Abstract	Introduction: In low-income country settings, the first six weeks after birth remain a critical period of vulnerability for both mother and newborn. Despite recommendations for routine follow-up after delivery and facility discharge, few mothers and newborns receive guideline recommended care during this period. Prediction modelling of post-delivery outcomes has the potential to improve outcomes for both mother and newborn by identifying high-risk dyads, improving risk communication, and informing a patient-centered approach to postnatal care interventions. This study aims to derive post-discharge risk prediction algorithms that identify mother-newborn dyads who are at risk of re-admission or death in the first six weeks after delivery at a health facility. Methods: This prospective observational study will enroll 7,000 mother-newborn dyads from two regional referral hospitals in southwestern and eastern Uganda. Women and adolescent girls aged 12 and above delivering singletons and twins at the study hospitals will be eligible to participate. Candidate predictor variables will be collected prospectively by research nurses. Outcomes will be captured six weeks following delivery through a follow-up phone call, or an in-person visit if not reachable by phone. Two separate sets of prediction models will be built, one set of models for newborn outcomes and one set for maternal outcomes. Derivation of models will be based on optimization of the area under the receiver operator curve (AUROC) and specificity using an elastic net regression modelling approach. Internal validation will be conducted using 10-fold cross-validation. Our focus will be on the development of parsimonious models (5-10 predictor variables) with high sensitivity (>80%). AUROC, sensitivity, and specificity will be reported for each model, along with positive and negative predictive values. Discussion: The current recommendations for routine postnatal care are largely absent of benefit to most mothers and newborns due to poor adherence. Data-driven improvements to postnatal care can facilitate a more patient-centered approach to such care. Increasing digitization of facility care across low-income settings can further facilitate the integration of prediction algorithms as decision support tools for routine care, leading to improved quality and efficiency. Such strategies are urgently required to improve newborn and maternal postnatal outcomes. Clinical trial registration: https://clinicaltrials.gov/, identifier (NCT05730387).
Language	English
Publishing date	2023-11-29
Publishing country	Switzerland
Document type	Journal Article
ISSN	2674-1199
ISSN (online)	2674-1199
DOI	10.3389/fepid.2023.1233323
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