Understanding the Impact of the Economic Crisis on Child and Maternal Health among the Poor: Opportunities for South Asia

The economic crisis hit many countries in 2007 and the effects are still being felt, especially in poorer developing nations. Much of the debate surrounding the economic crisis and its impacts has focused on the financial and economic aspects—import/export impacts, economic growth losses, labor force cutbacks, and fiscal imbalances. The social impact, especially on poor and vulnerable groups, has received less mention. Yet, if countries are to address the overall impacts of the economic crisis, it is vital that they also consider investing time and money to deal with social impacts more effectively. There are fears, however, that a reduction in spending on vital sectors (including the healthcare sector) to ensure economic recovery could affect poor and vulnerable populations and, in turn, erase the progress that has been made thus far. The decision to reduce such spending could also come from donors, who tend to favor a market-led recovery process in economic crises, thereby neglecting vital social service sectors that cater to the needs of poor populations. This spending can supplement government services or fill resource gaps and as a result reductions could have negative impacts on beneficiary populations, particularly the poor and vulnerable. Addressing child and maternal health issues within the context of the economic crisis is one key area to consider given its short, medium, and long-term effects on populations in developing countries. In South Asian countries, child and maternal health-related indicators tend to be disturbing despite the rapid growth rates in many of these countries. The number of infant deaths is still quite high, nutrition of children and women continues to be problematic, and maternal health and pre/post natal care remains poor. This paper presents an overview of child and maternal health in the South Asia region, but also recommends that interventions take into account a series of factors if the impacts of the economic crisis are to be minimized: There is a need for more information and research on the impacts of the crisis; Investing in social protection and safety nets is imperative; Food security should be integrated into social protection; Vulnerable households require support to cope with the crisis despite their own efforts and coping strategies; State investments that support vulnerable populations should be protected in times of crisis.poverty reduction; economic crisis impact; social impact; child maternal health; south asia poverty; social protection

MADE YOU LOOK: NIQABS, THE MUSLIM CANADIAN CONGRESS, AND R V NS

R v NS was the first Canadian case to involve a niqab-wearing sexual assault complainant. At the Supreme Court of Canada, the Muslim Canadian Congress [MCC] was especially vocal in arguing it would be un-Canadian to allow NS to testify while wearing a niqab. This paper sets out to investigate the MCC’s depictions of Muslim women, Muslim men, and the mainstream public, with specific attention paid to the details of the MCC’s “clash of civilisations” framing, its impact on the Court’s reasons, and its implications for women combating sexual violence. R c NS a été la première cause canadienne où une plaignante, victime d’une agression sexuelle, portait le niqab. Dans ses interventions devant la Cour suprême du Canada, le Congrès musulman canadien [CMC] a souligné avec beaucoup d’insistance qu’il serait anti-canadien de permettre à NS de témoigner en portant son niqab. Le présent article vise à briser les stéréotypes que le CMC a véhiculé dans ses arguments concernant les femmes musulmanes, les hommes musulmans et le grand public, et porte une attention spéciale aux particularités de la conception par le CMC du choc des civilisations », leur impact sur les motifs de la Cour et leurs conséquences pour les femmes qui luttent contre la violence sexuelle

Choice of the Empirical Definition of Zero in the Translog Multiproduct Cost Functional Form

This study examines the impacts of empirical definition of zero output values on price elasticities, economy of scope, and scale using the Translog cost function. A system of cost and factor share equations with regularity conditions imposed is estimated. Results show that the choice of default values affects policy recommendations.Research Methods/ Statistical Methods,

PREDICTING HOUSEHOLD WATER CONSUMPTION UNDER A BLOCK PRICE STRUCTURE

This study focuses on estimating the variations in per-capita water consumption and predicting the shares of consumption by pricing blocks in eight Kansas regions. Previous studies have considered household or micro-level consumption, but few have focused on aggregate level consumption across different regions. A probit model was used to estimate the consumption shares in individual blocks for each region. Per-capita water consumption varies significantly across the regions and as we move from Western to Eastern Kansas, shares of lower consumption block decrease and higher consumption block likely to increase.Resource /Energy Economics and Policy,

Plexin-semaphorin signalling modifies neuromuscular defects in a Drosophila model of peripheral neuropathy

Dominant mutations in GARS, encoding the ubiquitous enzyme glycyl-tRNA synthetase (GlyRS), cause peripheral nerve degeneration and Charcot-Marie-Tooth disease type 2D (CMT2D). This genetic disorder exemplifies a recurring paradigm in neurodegeneration, in which mutations in essential genes cause selective degeneration of the nervous system. Recent evidence suggests that the mechanism underlying CMT2D involves extracellular neomorphic binding of mutant GlyRS to neuronally-expressed proteins. Consistent with this, our previous studies indicate a non-cell autonomous mechanism, whereby mutant GlyRS is secreted and interacts with the neuromuscular junction (NMJ). In this Drosophila model for CMT2D, we have previously shown that mutant gars expression decreases viability and larval motor function, and causes a concurrent build-up of mutant GlyRS at the larval neuromuscular presynapse. Here, we report additional phenotypes that closely mimic the axonal branching defects of Drosophila plexin transmembrane receptor mutants, implying interference of plexin signaling in gars mutants. Individual dosage reduction of two Drosophila Plexins, plexin A (plexA) and B (plexB) enhances and represses the viability and larval motor defects caused by mutant GlyRS, respectively. However, we find plexB levels, but not plexA levels, modify mutant GlyRS association with the presynaptic membrane. Furthermore, increasing availability of the plexB ligand, Semaphorin-2a (Sema2a), alleviates the pathology and the build-up of mutant GlyRS, suggesting competition for plexB binding may be occurring between these two ligands. This toxic gain-of-function and subversion of neurodevelopmental processes indicate that signaling pathways governing axonal guidance could be integral to neuropathology and may underlie the non-cell autonomous CMT2D mechanism

Post transplant lymphoproliferative disorder

Introduction: Post-transplant lymphoproliferative disorder (PTLD) is a recognized complication exclusive to solid organ transplant recipients and carries a high mortality. Methods: We retrospectively reviewed records of all renal transplant recipients under follow up at our institution over the last seven years (2005-2011). We reviewed the patient characteristics, immunosuppression regimen and risk factors for the development of PTLD and its outcomes in our transplant cohort. Results: Four out of 63 patients were diagnosed with PTLD. PTLD was incidentally diagnosed on a transplant biopsy that was performed for an unexplained rise in serum creatinine in three patients. The fourth patient presented with left submandibular lymphadenopathy. Majority presented within 18 months of renal transplantation. After the diagnosis of PTLD on graft biopsy, all patients were fully investigated and two patients had systemic involvement. In the patients with systemic involvement, reduction of immunosuppression and anti B cell therapy with Rituximab was used with good success. The patient with submandibular lymphadenopathy received chemotherapy in addition to reduction of immunosuppression. Three PTLD cases were polyclonal and diagnosed early whereas the fourth case was monoclonal. Conclusion: PTLD can sometimes be incidentally diagnosed on an allograft biopsy performed for rejection. The incidence of PTLD in our centre is higher than reports from other centres but our outcome is good if recognised and treated early

Progressive ataxia with oculo-palatal tremor and optic atrophy

The final publication is available at Springer via doi: 10.​1007/​s00415-013-7136-

Experiences with a universal mindfulness and wellbeing programme at a UK medical school

Evaluation of a universal, mental wellbeing and mindfulness programme in a UK graduate entry medical school Design: Mixed methods: measurement of mental wellbeing and mindfulness in 2 cohorts at 3 time points over 15mths; descriptive, regression and repeated measures analysis with post hoc pairwise comparisons; qualitative interviews with purposive sample of 13 students after 1yr analysed thematically; spontaneous anonymous feedback on the course. Findings: The course was a surprise to students, and reactions mixed. Respect for its contents grew over the first year. Most students had actively implemented a wellbeing strategy by the end of the course and an estimated quarter were practicing some mindful activity. In the context of an overall decline in wellbeing and limited engagement with mindfulness practice, increases in mindfulness were protective against this decline in both cohorts (p<001). A small minority of students thought the course was a waste of time. Their attitudes influenced engagement by their peers. The mindfulness and wellbeing practices of the facilitators were evident to students and influenced perceived effects. Research Limitations: The uncontrolled nature of this observational study and low response rates to the survey limit conclusions. Further research in other medical education settings is needed. Practice Implications: Results are encouraging, suggesting modest benefit in terms of changing attitudes and practices and a modest protective effect on the wellbeing of students who engaged. Originality/value: This is the first study of a universal wellbeing and mindfulness programme in a UK medical school. Universal programmes are rare and evaluation studies are scarce

Coupled plasma filtration adsorption (CPFA) plus continuous veno-venous haemofiltration (CVVH) versus CVVH alone as an adjunctive therapy in the treatment of sepsis

To compare the efficacy of Coupled Plasma Filtration and Adsorption (CPFA) plus Continuous Veno-Venous Haemofiltration (CVVH) versus CVVH alone as an adjunct treatment of sepsis in terms of haemodynamic stability, inotropic requirement and inflammatory mediators. Design and Methods: Prospective randomized controlled trial involving septic patients with/without acute kidney injury (AKI) whom were randomized to receive CPFA + CVVH or CVVH alone. Haemodynamic parameters including inotropic requirements and inflammatory mediators [procalcitonin (PCT) and C reactive protein (CRP)] were measured. Results: Twenty-three patients [CPFA + CVVH (n = 11), CVVH (n = 12)] were enrolled. Haemodynamic stability occurred earlier and sustained in the CPFA + CVVH group with an increase in diastolic blood pressure (p = 0.001 vs. p = 0.226) and mean arterial pressure (p = 0.001 vs. p = 0.575) at the end of treatment with no increment in inotropic requirement. Both groups had a reduction in PCT and CRP (CPFA + CVVH: p = 0.003, p = 0.026 and CVVH: p = 0.008, p = 0.071 respectively). The length of intensive care unit stay, hospital stay and 30 day outcomes were similar between the groups. There was an inverse association between serum albumin and CRP (p = 0.018). Serum albumin positively correlated with systolic blood pressure (p = 0.012) and diastolic blood pressure (p = 0.009). We found a trend between CRP and length of hospital stay (p = 0.056). Patients with a lower PCT at 24 h had a better outcome (survival) than those with a higher PCT (p = 0.045). Conclusion: CPFA is a feasible, albeit expensive adjunctive extracorporeal treatment that may be superior to CVVH alone in the treatment of severe sepsis

The effects of inspiratory muscle strengthening on MIP and quality of life of elderly nursing home patients. (Los efectos del beneficio de la fuerza del músculo inspiratorio en la PIM y la calidad de la vida de los pacientes mayores de la clínica de reposo.)

<b>Abstract</b><p align="justify">The objective of this study was to compare the effects of inspiratory muscle strengthening on maximal inspiratory pressure (MIP) and on quality of life among elderly nursing home patients. The study population was divided in two groups: experimental group- EG (n=21, 76.48 2.12 years) and control group- CG (n=13, 75.69 2.26 years). The World Health Organization Quality of Life Group (WHOQOL-100) questionnaire was used to evaluate the quality of life of the subjects. A Manovacuometer (analogical, with an operational interval of –150 to +150 cmH2O; Critical Med/USA-2002) was used to evaluate MIP. The study protocol consisted of a gradual increase in workload (50%-100%); the sessions lasted 20 minutes and were composed of 7 series of strengthening (2 minutes each) with a 1-minute interval between the series, 3 times a week for 10 weeks. Variance analysis of multivariate repeated measurements demonstrated significant differences only for MIP between CG (32,69±17,03 cmH2O versus 23,08±10,71 cmH2O) and EG (31,67±11,11 cmH2O versus 55,24±23,26 cmH2O), and the latter was higher than the former (p= 0,00000). Therefore, we concluded that inspiratory muscle strengthening led to an increase in MIP that did not improve quality of life. However, further studies should be done in this population to validate a quality of life questionnaire specific for the elderly.</p><b>Resumen</b><p align="justify">El objetivo de este estudio era comparar los efectos del músculo inspiratorio que consolidaban en la presión inspiratoria máxima (PIM) y en la calidad de la vida entre pacientes mayores de la clínica de reposo. Dividieron a la población del estudio en dos grupos: grupo experimental EG. (n=21,76.48 2.12 años) y grupo de control CG (n=13, 75.69 2.26 años). La calidad de la Organización Mundial de la Salud del cuestionario del grupo de la vida(WHOQOL-100) fue utilizada para evaluar la calidad de la vida de los temas. Un Manovacuometer (analógico, con un intervalo operacional - de 150 a +150 cmH2O; Med/USA-2002 crítico) fue utilizado para evaluar la MIP.El protocolo del estudio consistió en un aumento gradual en la carga de trabajo (50%-100%); las sesiones duraron 20 minutos y fueron compuestas de 7 series de consolidación (2 minutos cada uno) con un 1 intervalo minucioso entre la serie, 3 veces a la semana por 10 semanas. El análisis de variación de medidas repetidas multivariate demostró diferencias significativas solamente para la MIPS entre CG (32,69±17,03 cmH2O contra 23,08±10,71 cmH2O) y EG. (31,67±11,11 cmH2O contra 55,24±23,26 cmH2O), y el último era más alto que el anterior (p= 0.00000). Por lo tanto, concluimos que el músculo inspiratorio que consolidaba condujo a un aumento en la MIPS que no mejoró la calidad de la vida. Sin embargo, otros estudios se deben hacer en esta población para validar una calidad del específico del cuestionario de la vida para los ancianos.</p