Understanding factors influencing home pregnancy test use among women in western Kenya: A qualitative analysis

BackgroundThere are limited data on home pregnancy test use among women in low-and-middle-income countries. A prior survey found that only 20% of women in western Kenya used a home pregnancy test to confirm their pregnancies before going to antenatal care. This qualitative study aims to understand why women do not use home pregnancy tests in early pregnancy.MethodsFrom April 2021 to July 2021, we interviewed women from four antenatal care clinics in Homa Bay and Siaya counties. We recruited women previously enrolled in the PrEP Implementation for Mothers in Antenatal care (PrIMA) study, a cluster-randomized trial that evaluated the best approaches to implementing PrEP in maternal and child health clinics in Western Kenya (NCT03070600). Interviews were conducted via phone, audio recorded, translated, and transcribed verbatim. We coded and analyzed the transcripts to capture factors influencing women's capability, opportunity, and motivation to use home pregnancy tests.ResultsWe conducted 48 semistructured interviews with women aged 21–42 years. Twenty-seven women did not use a home pregnancy test in their most recent pregnancy. Seventeen of these women reported not using a home pregnancy test before. Lack of knowledge, mistrust in the accuracy of tests, preferring to rely on signs and symptoms of pregnancy or get a test from the health facility, cost, and accessibility were key barriers to home pregnancy test use.ConclusionImproving the uptake of home pregnancy testing during early pregnancy will require efforts to enhance community knowledge of test use and associated benefits and reduce cost burdens by making tests more affordable and accessible

Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease

Aims Coronary computed tomography angiography (CTA) has emerged as a non-invasive diagnostic method for patients with suspected coronary artery disease, but its usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the agreement between separate heart teams on treatment decision-making based on either coronary CTA or conventional angiography. Methods and results Separate heart teams composed of an interventional cardiologist, a cardiac surgeon, and a radiologist were randomized to assess the coronary artery disease with either coronary CTA or conventional angiography in patients with de novo left main or three-vessel coronary artery disease. Each heart team, blinded for the other imaging modality, quantified the anatomical complexity using the SYNTAX score and integrated clinical information using the SYNTAX Score II to provide a treatment recommendations based on mortality prediction at 4 years: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or equipoise between CABG and PCI. The primary endpoint was the agreement between heart teams on the revascularization strategy. The secondary endpoint was the impact of fractional flow reserve derived from coronary CTA (FFRCT) on treatment decision and procedural planning. Overall, 223 patients were included. A treatment recommendation of CABG was made in 28% of the cases with coronary CTA and in 26% with conventional angiography. The agreement concerning treatment decision between coronary CTA and conventional angiography was high (Cohen's kappa 0.82, 95% confidence interval 0.74-0.91). The heart teams agreed on the coronary segments to be revascularized in 80% of the cases. FFRCT was available for 869/1108 lesions (196/223 patients). Fractional flow reserve derived from coronary CTA changed the treatment decision in 7% of the patients. Conclusion In patients with left main or three-vessel coronary artery disease, a heart team treatment decision-making based on coronary CTA showed high agreement with the decision derived from conventional coronary angiography suggesting the potential feasibility of a treatment decision-making and planning based solely on this non-invasive imaging modality and clinical information

Decision-making processes of public sector accounting reforms in India—Institutional perspectives

While International Financial Reporting Standards (IFRS) convergence has been the face of the global accounting standardisation movement for the past few decades, accounting reforms in the public sector had started to gain momentum from the late 1990s. This paper examines the reasons for the adoption of public sector accrual accounting reforms in India. It explores the various sources of pressure influencing these reforms and the ways in which these pressures are balanced and addressed by key decisionmakers in the national and transnational contexts of an emerging economy like India. This study finds that demands for greater accountability from the public in the national context (demand pressures) as well as requests for greater transparency from international financial institutions in the transnational context (supply pressures) are two major sources of pressure that are balanced by the state in its quest for greater legitimacy. This is demonstrated through a triggering event such as political scandals evoking responses from the government to reinforce its weakened legitimacy by adopting public sector accounting reforms. Extant literature on public sector accounting reforms, mostly focuses on the phases where the standards are being actually implemented by the country. Studies exploring decision-making processes that lead to actual implementation of accrual accounting reforms are limited. This study contributes to existing literature by examining the decision-making process that ensues before the actual use of international standards in public sector accounting reforms and demonstrates the significant role that institutional influences play in defining such decision-making processes. The role of these institutional influences also draw attention to the probable disparities between rationales and actual reasons for government accounting reforms undertaken by developing countries

Crise de abastecimento de água em São Paulo e falta de planejamento estratégico

Embora a crise no abastecimento de água na Região Metropolitana de São Paulo (RMSP) tenha se manifestado de maneira mais intensa no verão de 2013-2014, ela revela um problema crônico que vem afetando toda a Região nos últimos dez anos. Esse problema foi gerado pela falta de um planejamento estratégico que considere questões climatológicas que podem indicar, com meses de antecedência, problemas de recomposição dos níveis dos mananciais, permitindo que ações sejam empreendidas com razoável antecedência, reduzindo os impactos para a população. Este estudo mostra como é possível utilizar informações climáticas na gestão estratégica do sistema de abastecimento da RMSP.Though the crisis in the water supplying system in the Metropolitan Region of São Paulo (RMSP) was more intensively felt in the 2013-2014 summer, it reveals a chronic problem that has been affecting the whole RMSP for the past ten years. This problem is originated from the lack of a strategic planning that takes into consideration climate issues that could, months before, foresee problems to restore the levels of water resources, allowing measures to be implemented within a reasonable anticipation, therefore reducing the impacts on the population. This study shows how it is possible to use climate information in the strategic management of the water supply in the RMSP

Familiarity among Adolescents and its Relationship with Psychological Compatibility of Students

This research aimed to study (familiarity among adolescents and its relationship with psychological compatibility among students), to identify familiarity and psychological compatibility among adolescents among intermediate school students by identifying the correlation between the characteristics of familiarity and psychological compatibility. The sample consisted of 100 intermediate school students, and the researchers used two scales (Khair 2010) and (Faroujah 2011). The research found that the attribute of familiarity is not present at the research sample, whereas the psychological compatibility feature was present. There was a difference between males and females in favor of females on the familiarity scale, while for the specialization (scientific - literary) on the familiarity scale, it appeared that there was a statistical difference in favor of the scientific specialization and not There is a statistical difference between males and females on the psychological compatibility scale. As for specialization (scientific - human), the difference was in favor of the scientific specialization, and there is a high positive correlation between the two variables to a large extent, and in light of these results, the researchers developed a number of recommendations and proposals.</jats:p