https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)60518-1.pdf

Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5.

Family planning: the unfinished agenda

The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and stabilisation of the macro- and microcirculations in order to optimise the patient’s tolerance to bleeding. Third, targeted procoagulant interventions to reduce the amount of bleeding, morbidity, mortality and costs. The purpose of these guidelines is to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific subcommittees and individual expert members of the ESA. Electronic databases were searched without language restrictions from the year 2000 until 2012. These searches produced 20 664 abstracts. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official position of the ESA changed to favour the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. This report includes general recommendations as well as specific recommendations in various fields of surgical interventions. The final draft guideline was posted on the ESA website for four weeks and the link was sent to all ESA members. Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

https://epub.ub.uni-muenchen.de/24023/1/oa_24023.pdf

Management of severe perioperative bleeding Guidelines from the European Society of Anaesthesiology

The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to

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Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016.

Family planning is hailed as one of the great public health achievements of the last century, and worldwide acceptance has risen to three-fifths of exposed couples. In many countries, however, uptake of modern contraception is constrained by limited access and weak service delivery, and the burden of unintended pregnancy is still large. This review focuses on family planning's efficacy in preventing unintended pregnancies and their health burden. The authors first describe an epidemiologic framework for reproductive behavior and pregnancy intendedness and use it to guide the review of 21 recent, individual-level studies of pregnancy intentions, health outcomes, and contraception. They then review population-level studies of family planning's relation to reproductive, maternal, and newborn health benefits. Family planning is documented to prevent mother-child transmission of human immunodeficiency virus, contribute to birth spacing, lower infant mortality risk, and reduce the number of abortions, especially unsafe ones. It is also shown to significantly lower maternal mortality and maternal morbidity associated with unintended pregnancy. Still, a new generation of research is needed to investigate the modest correlation between unintended pregnancy and contraceptive use rates to derive the full health benefits of a proven and cost-effective reproductive technology.

Family Planning and the Burden of Unintended Pregnancies

Contexte: Le rapport entre la perception individuelle du risque de contraction du VIH et l'usage du preservatif est mal compris. L'elaboration de strategies utiles a la lutte contre le VIH/sida exige indispensablement que soit elucide ce lien. Methodes: Les donnees de l'Adolescent and YoungAdult Reproductive Health and Behavior Risk Survey menee en 2001 au Mozambique servent a comparer les evaluations donnees par les 15 a 24 ans de leur risque de contraction du VIH avec celles basees sur leur comportement sexuel passe et present. L'analyse bivariee et de regression probit examine le rapport entre l'evaluation correcte du risque et la probabilite d'usage du preservatif aux derniers rapports sexuels. Resultats: Vingt-sept pour cent des femmes et 80% des hommes qui estimaient courir un risque nul ou faible de contracter le VIH se trouvaient en fait dans les categories de risque moyen ou eleve. Pour les hommes comme pour les femmes, la prevalence de l'usage du preservatif aux derniers rapports sexuels parmi ceux et celles qui avaient evalue correctement leur risque (30% et 16%, respectivement) a ete le double de la prevalence chez les autres (14% et 6%). L'analyse multivariee revele une association positive entre l'evaluation correcte et l'usage du preservatif. Ce lien etait le resultat de l'usage du preservatif parmi les celibataires jamais encore marie(e)s: cote masculin et feminin, respectivement, les celibataires non encore marie(e)s qui avaient evalue correctement leur risque etaient 18% et 17% plus susceptibles que les autres d'en avoir declare l'usage. Conclusions: Les messages de sensibilisation doivent aider l'individu a evaluer correctement son propre risque de contraction du VIH et encourager les changements comportementaux sur la base de l'auto-evaluation du risque.

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Relationship between HIV risk perception and condom use: Evidence from a population-based survey in Mozambique.

http://bixby.berkeley.edu/wp-content/uploads/2015/03/Controlling-PPH-after-home-births-in-Tanzania.pdf

Controlling postpartum hemorrhage after home births in Tanzania.

http://bixby.berkeley.edu/wp-content/uploads/2015/03/Prata-et-al_2009_-saving-maternal-lives_HEALTH-POLICY.pdf

Saving maternal lives in resource-poor settings: facing reality.

Background Acute alcohol withdrawal syndrome (AAWS) is encountered in patients presenting acutely to the Emergency Department (ED) and often requires pharmacologic management. Objective We investigated whether a single dose of intravenous (i.v.) phenobarbital combined with a standardized lorazepam-based alcohol withdrawal protocol decreases intensive care unit (ICU) admission in ED patients with acute alcohol withdrawal. Methods This was a prospective, randomized, double-blind, placebo-controlled study. Patients were randomized to receive either a single dose of i.v. phenobarbital (10 mg/kg in 100 mL normal saline) or placebo (100 mL normal saline). All patients were placed on the institutional symptom-guided lorazepam-based alcohol withdrawal protocol. The primary outcome was initial level of hospital admission (ICU vs. telemetry vs. floor ward). Results There were 198 patients enrolled in the study, and 102 met inclusion criteria for analysis. Fifty-one patients received phenobarbital and 51 received placebo. Baseline characteristics and severity were similar in both groups. Patients that received phenobarbital had fewer ICU admissions (8% vs. 25%, 95% confidence interval 4–32). There were no differences in adverse events. Conclusions A single dose of i.v. phenobarbital combined with a symptom-guided lorazepam-based alcohol withdrawal protocol resulted in decreased ICU admission and did not cause increased adverse outcomes.

https://emcrit.org/wp-content/uploads/2009/09/phenobarb-for-etoh-withdrawal.pdf

Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study.

Contexte: En Angola, le comportement sexuel des jeunes jouera un role important dans la propagation future du VIH. Peu de jeunes utilisent pourtant regulierement le preservatif et les taux d'usage declares sont faibles. Il importe d'identifier les determinants d'usage du preservatif parmi les adolescents et les jeunes adultes d'Angola. Methodes: Les donnees d'analyse proviennent de 1.995 jeunes sexuellement actifs de 15 a 24 ans ayant participe a un enquete sur les connaissances, attitudes et pratiques menee a Luanda, en Angola, en 2001. L'analyse de regression logistique a permis d'identifier les predicteurs d'usage regulier du preservatif en fonction du sexe et les determinants d'usage lors des derniers rapports en fonction du type de relation. Resultats: Pour les jeunes hommes et femmes, l'usage regulier du preservatif s'est revele positivement associe a de plus hauts niveaux d'instruction (rapports de probabilites 1,7-2,6) et a la croyance que la methode ne reduit pas le plaisir sexuel (1,8). Il s'est avere negativement associe au fait d'etre marie/e ou de vivre en concubinage (0,1-0,5). Les jeunes femmes qui associaient l'usage du preservatif a un manque de confiance etaient moins susceptibles d'y recourir regulierement (0,5). Les jeunes hommes qui le consideraient sur et ceux qui avaient plusieurs partenaires etaient en revanche plus susceptibles de pratiquer regulierement la methode (1,6 et 1,7, respectivement). Le lieu de residence urbain, un plus haut niveau d'instruction, la scolarisation et la non-association du preservatif a un manque de confiance se sont averes d'importants predicteurs d'usage lors des derniers rapports sexuels dans les relations ordinaires ou de passage, tandis que l'acces au preservatif etait le facteur le plus important dans les relations conjugales (4,5). Conclusions: Des programmes d'intervention ciblant les jeunes moins instruits, des espaces periurbains et sans emploi doivent faire partie d'une strategie de prevention efficace du VIH. Ces programmes doivent faire face aux perceptions erronees des jeunes a l'egard de l'usage du preservatif et du besoin de protection contre le VIH et les autres IST.

/pdf/gender-and-relationship-differences-in-condom-use-among-15-5rmxzl3bzs.pdf

Farnaz Vahidnia

Papers

Relationship between HIV risk perception and condom use: Evidence from a population-based survey in Mozambique.

Controlling postpartum hemorrhage after home births in Tanzania.

Saving maternal lives in resource-poor settings: facing reality.

Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study.

Gender and relationship differences in condom use among 15-24-year-olds in Angola.