| 31. |
- KC, Ashish, 1982, et al.
(författare)
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The burden of and factors associated with misclassification of intrapartum stillbirth: Evidence from a large scale multicentric observational study.
- 2020
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 99:3, s. 303-311
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Tidskriftsartikel (refereegranskat)abstract
- Global estimates suggest 2.6 million stillbirths and 2.5 million neonatal deaths occur annually worldwide. The majority of these deaths occur in low resource settings where analysis of health metrics and outcomes measurements may be challenging. We examined the misclassification of documented intrapartum stillbirth and factors associated with misclassification.A prospective observational study was performed in 12 public hospitals in Nepal. Data were extracted from the medical records of all births that occurred during the 6-month period of the study. For the study purpose, we classified birth outcome based on the presence of fetal heart sound (FHS) at admission and use of neonatal resuscitation. The health worker-documented intrapartum stillbirths were considered potentially misclassified when there were FHS present at admission and no resuscitation initiated after birth. The association between potentially misclassified intrapartum stillbirth and complications during labor, birthweight and gestational age was assessed using Pearson's chi-square test, bivariate and multivariate logistic regression.A total of 39 562 mother-infant dyads were enrolled in the study, all of whom had FHS at admission. Among the 391 intrapartum stillbirths recorded during the study, 180 (46.0%) of them had FHS at admission with no resuscitation initiated after birth and were considered potentially misclassified intrapartum stillbirths. Among these potentially misclassified intrapartum stillbirths, 170 (43.5%) had FHS present 15 minutes before birth and 10 had no FHS 15 minutes before birth Among the potentially misclassified intrapartum stillbirths, 23.3% had complications during labor, 93.3% had birthweight less than 2500 g and 90.0% were born preterm. The risk of intrapartum misclassification was nearly four times higher among low birthweight babies (adjusted odds ratio [aOR] 3.5, 95% confidence interval [CI] 1.8 to 7.0, P < 0.001) and five times higher among preterm babies (aOR 5.3, 95% CI 3.0 to 9.3, P < 0.001).We estimate that 46% of intrapartum stillbirths were potentially misclassified intrapartum stillbirths. Improving quality of both FHS monitoring and neonatal resuscitation as well as measurement of the care will reduce the risk of potentially misclassified intrapartum stillbirth and consequently intrapartum stillbirth.
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| 32. |
- KC, Ashish, 1982-, et al.
(författare)
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Usability and acceptability of an automated respiratory rate counter to assess childhood pneumonia in Nepal.
- 2020
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Ingår i: Acta paediatrica (Oslo, Norway : 1992). - : Wiley. - 1651-2227 .- 0803-5253. ; 109:6, s. 1207-1220
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Tidskriftsartikel (refereegranskat)abstract
- Pneumonia is the leading cause of child death after the neonatal period, resulting from late care seeking and inappropriate treatment. Diagnosis involves counting respiratory rate (RR); however, RR counting remains challenging for health workers and miscounting, and misclassification of RR is common. We evaluated the usability of a new automated RR counter, the Philips Children's Respiratory Monitor (ChARM), to Female Community Health Volunteers (FCHVs), and its acceptability to FCHVs and caregivers in Nepal.A cross-sectional study was conducted in Jumla district, Nepal. About 133 FCHVs were observed between September and December 2018 when using ChARM during 517 sick child consultations, 264 after training and 253 after 2 months of routine use of ChARM. Acceptability of the ChARM was explored using semi-structured interviews.FCHV adherence to guidelines after 2 months of using ChARM routinely was 52.8% (95% CI 46.6-58.9). The qualitative findings suggest that ChARM is acceptable to FCHVs and caregivers; however, capacity constraints such as older age and low literacy and impacted device usability were mentioned.Further research on the performance, cost-effectiveness and implementation feasibility of this device is recommended, especially among low-literate CHWs.
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| 33. |
- Kougioumtzis, Konstantin, 1966
(författare)
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Physical literacy in physically inactive children and adolescents
- 2022
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Ingår i: International Journal of Physical Education : A Review Publication. - 0341-8685. ; 59:1, s. 12-29
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Tidskriftsartikel (refereegranskat)abstract
- This study highlights physical literacy in a group of physically inactive children and adolescents in Greece. More specifically, the objective is to describe physical literacy in terms of motivation, competence, environment, the sense of the self, expression, interaction, and knowledge and understanding. Fifty-seven children and twelve adolescents participated in focus-group and one-to-one interviews, respectively. The interviews focused on four themes: leisure time, environment, parents, and previous experiences from physical activity. The analysis of the results revealed in-depth information and a general pattern. Concerning the in-depth information, the quotes, on the one hand, indicated the relatively good perceived competence and the knowledge and understanding of the premises and benefits of a physically active lifestyle. On the other hand, the children and adolescents articulated issues of damaged motivation, lack of appropriate facilities, and previous negative experiences from sports participation. Concerning the general pattern, motivational and environmental barriers were more frequent than, e.g., competence-associated issues. The prominent motivational barriers were lack of time and damaged motivation, while the environmental barriers concerned the lack of appropriate facilities. Physical activity enhancement in physically inactive youth requires individual-oriented strategies and systemic efforts. More specifically, interventions targeting peer groups and the school as a hub of the local community might provide extra possibilities for children and adolescents to engage in PA.
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| 34. |
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| 35. |
- Langegård, Ulrica, et al.
(författare)
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Internet-based support for informal caregivers to individuals with head and neck cancer (Carer eSupport): a study protocol for the development and feasibility testing of a complex online intervention.
- 2022
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 12:5
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Tidskriftsartikel (refereegranskat)abstract
- It is strongly recommended that randomised controlled trials are preceded with an exploration of the needs of the target population and feasibility testing of the intervention. The present study protocol is set out to describe these steps in the development of a complex intervention.The past decades' transition of care from inpatient to outpatient settings has increased the complexity of caregivers' responsibilities, which they may not be prepared for. There is a need to support informal caregivers (ICs) to prepare them for caregiving and decrease the caregiver burden. The main aim of this study is to describe the development of an internet-based intervention (Carer eSupport) to improve ICs' ability to support individuals with head and neck cancer and to describe the testing of the feasibility and acceptability of Carer eSupport.This is a multicentre study involving the ear, nose and throat clinics and the oncology and radiotherapy clinics at three university hospitals. The study protocol comprises two phases, development and feasibility testing, using the Medical Research Council framework for developing a complex intervention. Carer eSupport will be based on the results from focus group discussions with ICs and healthcare professionals (planned for n=6-8 in respective groups) and scientific evidence, the Social Cognitive Theory and the Theory of Acceptance and Use of Technology. The feasibility testing will include 30 ICs who will have access to Carer eSupport for 1 month. The feasibility testing will be evaluated with a mixed-method design.All procedures have been approved by the Ethics Committee at Uppsala University (Dnr: 2020-04650). Informed consent will be obtained before enrolment of patients, their ICs and healthcare staff. The feasibility testing is registered at Clinicaltrials.gov (Identifier: NCT05028452). Findings will be disseminated in peer-reviewed journal publications.Clinicaltrials.gov (Identifier: NCT05028452).
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| 36. |
- Litorp, Helena, et al.
(författare)
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Improved obstetric management after implementation of a scaled-up quality improvement intervention: A nested before-after study in three public hospitals in Nepal.
- 2023
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Ingår i: Birth (Berkeley, Calif.). - : Wiley. - 1523-536X .- 0730-7659. ; 50:3, s. 616-626
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Tidskriftsartikel (refereegranskat)abstract
- We assessed the change in obstetric management after implementation of a quality improvement intervention, the Nepal Perinatal Quality Improvement Package (NePeriQIP).The Nepal Perinatal Quality Improvement Package was a stepped-wedge cluster-randomized controlled trial conducted in 12 public hospitals in Nepal between April 2017 and October 2018. In this study, three hospitals allocated at different time points to the intervention were selected for a nested before-after analysis. We used bivariate and multivariate analyses to compare obstetric management in the control vs intervention group.There were 25 977 deliveries in the three hospitals during the study period: 10 207 (39%) in the control and 15 770 (61%) in the intervention group. After adjusting for maternal age, ethnicity, education, gestational age, stage of labor at admission, complications during labor, and birthweight, the intervention group had a higher proportion of fetal heart rate monitoring performed as per protocol (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.12-1.27), shorter time intervals between each fetal heart rate monitoring (aOR 2.09, 95% CI 1.96-2.23), a higher likelihood of abnormal fetal heart rate being detected (aOR 1.53, 95% CI 1.25-1.68), progress of labor more often being recorded immediately after per vaginal examination (aOR 2.73, 95% CI 2.55-2.93), and partograph filled as per standards (aOR 3.18, 95% CI 2.98-3.50). The cesarean birth rate was 2.5% in the control group and 8.2% in the intervention group (aOR 3.12, 95% CI 2.64-3.68).The NePeriQIP intervention has potential to improve obstetric care, especially intrapartum fetal surveillance, in similar low-resource settings.
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| 37. |
- Morand, Christine, et al.
(författare)
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Why interindividual variation in response to consumption of plant food bioactives matters for future personalised nutrition
- 2020
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Ingår i: Proceedings of the Nutrition Society. - 0029-6651 .- 1475-2719. ; 79:2, s. 225-235
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Konferensbidrag (refereegranskat)abstract
- Food phytochemicals are increasingly considered to play a key role in the cardiometabolic health effects of plant foods. However, the heterogeneity in responsiveness to their intake frequently observed in clinical trials can hinder the beneficial effects of these compounds in specific subpopulations. A range of factors, including genetic background, gut microbiota, age, sex and health status, could be involved in these interindividual variations; however, the current knowledge is limited and fragmented. The European network, European Cooperation in Science and Technology (COST)-POSITIVe, has analysed, in a systematic way, existing knowledge with the aim to better understand the factors responsible for the interindividual variation in response to the consumption of the major families of plant food bioactives, regarding their bioavailability and bioefficacy. If differences in bioavailability, likely reflecting differences in human subjects' genetics or in gut microbiota composition and functionality, are believed to underpin much of the interindividual variability, the key molecular determinants or microbial species remain to be identified. The systematic analysis of published studies conducted to assess the interindividual variation in biomarkers of cardiometabolic risk suggested some factors (such as adiposity and health status) as involved in between-subject variation. However, the contribution of these factors is not demonstrated consistently across the different compounds and biological outcomes and would deserve further investigations. The findings of the network clearly highlight that the human subjects' intervention studies published so far are not adequate to investigate the relevant determinants of the absorption/metabolism and biological responsiveness. They also emphasise the need for a new generation of intervention studies designed to capture this interindividual variation.
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| 38. |
- Nelin, Viktoria, et al.
(författare)
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Factors associated with timing of umbilical cord clamping in tertiary hospital of Nepal.
- 2018
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Ingår i: BMC research notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Delayed umbilical cord clamping (DCC) (≥ 60 s) is recognized to improve iron status and neurodevelopment compared to early umbilical cord clamping. The aim of this study is to identify current umbilical cord clamping practice and factors determining the timing of clamping in a low-resource setting where prevalence of anemia in infants is high.A cross-sectional study design including 128 observations of clinical practice in a tertiary-level maternity hospital in Kathmandu, Nepal. Overall 48% of infants received DCC. The mean and median cord clamping times were 61 ± 33 and 57 (38-79) s, respectively. Univariate analysis showed that infants born during the night shift were five times more likely to receive DCC (OR 5.6, 95% CI 1.4-38.0). Additionally, infants born after an obstetric complication were 2.5 times more likely to receive DCC (OR 2.5, 95% CI 1.2-5.3), and babies requiring ventilation had a 65% lower likelihood of receiving DCC (OR 0.35, 95% CI 0.13-0.88). Despite the existence of standard protocols for cord clamping and its proven benefit, the lack of uniformity in the timing of cord clamping reveals poor translation of clinical guidelines into clinical practice. Clinical trial registration ISRCTN97846009.
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| 39. |
- Nässen, Nina, et al.
(författare)
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Arcs on speedskating straightaways: forces, energy and angular momentum
- 2023
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Ingår i: Physics Education. - 0031-9120 .- 1361-6552. ; 58:1
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Tidskriftsartikel (refereegranskat)abstract
- The 10 000 m speedskating event during the 2022 winter Olympics brought a new world record at 12 min and 30.74 s. In a document released after the competitions, the gold medalist Nils van der Poel describes his technique, including a focus on horizontal forces and a rapid sideways motion in connection with stride changes on the straight sections of the track (the ‘straightaways’). Based on a video of the race, together with his written description, we suggest that van der Poel makes use of the properties of angular momentum to increase his speed during a stride by a rapid inwards shift of the centre of mass.
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| 40. |
- Paudel, Prajwal, et al.
(författare)
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Meconium aspiration syndrome: incidence, associated risk factors and outcome-evidence from a multicentric study in low-resource settings in Nepal.
- 2020
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Ingår i: Journal of paediatrics and child health. - : Wiley. - 1440-1754 .- 1034-4810. ; 56:4, s. 630-635
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to identify the incidence, risk factors and outcome associated with meconium aspiration syndrome (MAS).An observational study was conducted in 12 public hospitals in Nepal from 1 July 2017 to 29 August 2018. All babies born within the study period were included in the study. Babies who were diagnosed as MAS were designated as outcome. Data were analysed with bivariate analysis followed by multiple regression analysis.The overall incidence of MAS was 2.0 per 1000 livebirths. Babies born at post-term gestation (adjusted odds ratio (AOR) = 2.41; 95% confidence interval (CI): 1.05-5.55), nulliparity (AOR = 2.26; 95% CI: 1.20-4.28), instrumental delivery (AOR = 4.79; 95% CI: 2.52-9.10) and caesarean delivery (AOR = 3.67; 95% CI: 2.29-5.89) were significantly associated with MAS. Babies with MAS had a 10-fold risk for pre-discharge mortality (odds ratio = 9.87; 95% CI: 5.81-16.76).The findings in this study are consistent with that reported in other studies. MAS has a high risk of neonatal mortality. Thus, monitoring during pregnancy and labour is necessary for early identification of high-risk conditions associated with MAS. Strengthening of newborn care services is essential to curtail mortality.
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