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- Anderson, Rondi, et al.
(författare)
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Implementing midwifery services in public tertiary medical college hospitals in Bangladesh: A longitudinal study.
- 2023
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Ingår i: Women and birth : journal of the Australian College of Midwives. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 36:3, s. 299-304
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Tidskriftsartikel (refereegranskat)abstract
- A necessary precursor for quality maternity care provision is high quality education. The quality of care that students are exposed to during clinical education on maternity wards shapes their competencies and professional identities. In this study, we look at the introduction of midwives educated to international standards - with facility mentorship - deployed in tertiary level teaching hospitals in Bangladesh with the intention of improving the use of World Health Organization (WHO)-recommended birth practices.To examine the outcomes of introducing midwifery services into tertiary level care facilities in Bangladesh, on the use of WHO-recommended birth practices.A retrospective review of patient register data was carried out to understand level of changes in use of WHO-recommended birth practices after the introduction of a midwifery service. Multivariate linear regression was applied using an interrupted time series analysis, with and without a delayed effect, to assess both level and trend change following the introduction of the midwifery service.A significant increase (p < 0.001) in use of WHO-recommended birth practices was found, both immediately following the midwives' introduction and after one year. Quality improvement was observed not only in births attended by midwives, but also in those attended by doctors and nurses.By introducing quality maternity care provision through midwives in clinical sites, especially in tertiary-level care hospitals with large numbers of students, international standard midwives can improve the quality of clinical education in maternity wards, a critical priority for maternal health worldwide.
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- Bigdeli, TB, et al.
(författare)
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Contributions of common genetic variants to risk of schizophrenia among individuals of African and Latino ancestry
- 2020
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Ingår i: Molecular psychiatry. - : Springer Science and Business Media LLC. - 1476-5578 .- 1359-4184. ; 25:10, s. 2455-2467
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Tidskriftsartikel (refereegranskat)abstract
- Schizophrenia is a common, chronic and debilitating neuropsychiatric syndrome affecting tens of millions of individuals worldwide. While rare genetic variants play a role in the etiology of schizophrenia, most of the currently explained liability is within common variation, suggesting that variation predating the human diaspora out of Africa harbors a large fraction of the common variant attributable heritability. However, common variant association studies in schizophrenia have concentrated mainly on cohorts of European descent. We describe genome-wide association studies of 6152 cases and 3918 controls of admixed African ancestry, and of 1234 cases and 3090 controls of Latino ancestry, representing the largest such study in these populations to date. Combining results from the samples with African ancestry with summary statistics from the Psychiatric Genomics Consortium (PGC) study of schizophrenia yielded seven newly genome-wide significant loci, and we identified an additional eight loci by incorporating the results from samples with Latino ancestry. Leveraging population differences in patterns of linkage disequilibrium, we achieve improved fine-mapping resolution at 22 previously reported and 4 newly significant loci. Polygenic risk score profiling revealed improved prediction based on trans-ancestry meta-analysis results for admixed African (Nagelkerke’s R2 = 0.032; liability R2 = 0.017; P < 10−52), Latino (Nagelkerke’s R2 = 0.089; liability R2 = 0.021; P < 10−58), and European individuals (Nagelkerke’s R2 = 0.089; liability R2 = 0.037; P < 10−113), further highlighting the advantages of incorporating data from diverse human populations.
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- Butt, Jawad H., et al.
(författare)
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Efficacy and Safety of Dapagliflozin According to Frailty in Heart Failure With Reduced Ejection Fraction : A Post Hoc Analysis of the DAPA- HF Trial.
- 2022
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Ingår i: Annals of internal medicine. ; 175:6, s. 820-830
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Frailty may modify the risk-benefit profile of certain treatments, and frail patients may have reduced tolerance to treatments. OBJECTIVE: To investigate the efficacy of dapagliflozin according to frailty status, using the Rockwood cumulative deficit approach, in DAPA- HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure). DESIGN: Post hoc analysis of a phase 3 randomized clinical trial. (ClinicalTrials.gov: NCT03036124). SETTING: 410 sites in 20 countries. PATIENTS: Patients with symptomatic heart failure (HF) with a left ventricular ejection fraction of 40% or less and elevated natriuretic peptide. INTERVENTION: Addition of once-daily 10 mg of dapagliflozin or placebo to guideline-recommended therapy. MEASUREMENTS: The primary outcome was worsening HF or cardiovascular death. RESULTS: Of the 4744 patients randomly assigned in DAPA-HF, a frailty index (FI) was calculable in 4742. In total, 2392 patients (50.4%) were in FI class 1 (FI $<$/=0.210; not frail), 1606 (33.9%) in FI class 2 (FI 0.211 to 0.310; more frail), and 744 (15.7%) in FI class 3 (FI $>$/=0.311; most frail). The median follow-up time was 18.2 months. Dapagliflozin reduced the risk for worsening HF or cardiovascular death, regardless of FI class. The differences in event rate per 100 person-years for dapagliflozin versus placebo from lowest to highest FI class were -3.5 (95% CI, -5.7 to -1.2), -3.6 (CI, -6.6 to -0.5), and -7.9 (CI, -13.9 to -1.9). Consistent benefits were observed for other clinical events and health status, but the absolute reductions were generally larger in the most frail patients. Study drug discontinuation and serious adverse events were not more frequent with dapagliflozin than placebo, regardless of FI class. LIMITATION: Enrollment criteria precluded the inclusion of very high-risk patients. CONCLUSION: Dapagliflozin improved all outcomes examined, regardless of frailty status. However, the absolute reductions were larger in more frail patients. PRIMARY FUNDING SOURCE: AstraZeneca.
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- Desai, Nikita, et al.
(författare)
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Performance of four computer-coded verbal autopsy methods for cause of death assignment compared with physician coding on 24,000 deaths in low- and middle-income countries
- 2014
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Ingår i: BMC Medicine. - : BioMed Central. - 1741-7015. ; 12:1, s. 20-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Physician-coded verbal autopsy (PCVA) is the most widely used method to determine causes of death (CODs) in countries where medical certification of death is uncommon. Computer-coded verbal autopsy (CCVA) methods have been proposed as a faster and cheaper alternative to PCVA, though they have not been widely compared to PCVA or to each other.METHODS: We compared the performance of open-source random forest, open-source tariff method, InterVA-4, and the King-Lu method to PCVA on five datasets comprising over 24,000 verbal autopsies from low- and middle-income countries. Metrics to assess performance were positive predictive value and partial chance-corrected concordance at the individual level, and cause-specific mortality fraction accuracy and cause-specific mortality fraction error at the population level.RESULTS: The positive predictive value for the most probable COD predicted by the four CCVA methods averaged about 43% to 44% across the datasets. The average positive predictive value improved for the top three most probable CODs, with greater improvements for open-source random forest (69%) and open-source tariff method (68%) than for InterVA-4 (62%). The average partial chance-corrected concordance for the most probable COD predicted by the open-source random forest, open-source tariff method and InterVA-4 were 41%, 40% and 41%, respectively, with better results for the top three most probable CODs. Performance generally improved with larger datasets. At the population level, the King-Lu method had the highest average cause-specific mortality fraction accuracy across all five datasets (91%), followed by InterVA-4 (72% across three datasets), open-source random forest (71%) and open-source tariff method (54%).CONCLUSIONS: On an individual level, no single method was able to replicate the physician assignment of COD more than about half the time. At the population level, the King-Lu method was the best method to estimate cause-specific mortality fractions, though it does not assign individual CODs. Future testing should focus on combining different computer-coded verbal autopsy tools, paired with PCVA strengths. This includes using open-source tools applied to larger and varied datasets (especially those including a random sample of deaths drawn from the population), so as to establish the performance for age- and sex-specific CODs.
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| 10. |
- Dewan, Camelia
(författare)
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‘Climate Change as a Spice’ : Brokering Environmental Knowledge in Bangladesh’s Development Industry
- 2022
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Ingår i: Ethnos. - : Routledge. - 0014-1844 .- 1469-588X. ; 87:3, s. 538-559
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Tidskriftsartikel (refereegranskat)abstract
- This article examines whether the use of climate change as a ‘spice’ in order to attract donor funding may instead exacerbate existing environmental problems. The World Bank’s latest adaptation project in coastal Bangladesh aims to create higher and wider embankments against rising sea levels. This disregards a long history of how embankments, by stopping beneficial monsoon inundations, result in dying rivers and damaging floods that devastate rural livelihoods. Bangladeshi ‘development brokers’ must therefore balance their roles as project employees supporting embankments as adaptation, and as locals knowledgeable about their harmful effects. The article shows how donors, NGOs, consultants and government bodies with different agendas, priorities and knowledge backgrounds ‘translate’ climate change to legitimise their activities. It contributes to debates about the politics of environmental knowledge production by arguing that development brokerage helps explain why some climate adaptation projects increase environmental vulnerability, while others address local needs.
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