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crimsonpublishersgynecoloogy · 3 years

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Psychological Health Status and Oral Health Outcomes of Pregnant Women: Practical Implications_ Crimson Publishers

Psychological Health Status and Oral Health Outcomes of Pregnant Women: Practical Implications by Irosha Perera in Womens Health Health

Opinion

Pregnancy marks an important milestone in the life cycle of a woman garnered by a milieu of physiological, psychological, emotional, social and even spiritual health needs [1]. Ensuring safe motherhoods and pregnancy outcomes for a healthy mother and a baby have become priorities for health policy makers and health care delivery models both in developed and developing country scenarios. Moreover, pregnancy denotes an opportune time for intergenerational investment in health outcomes. It is well known that physiological changes that are taking place during pregnancy could give rise to demanding psychological health concerns among pregnant women compounded by their social determinates such as i.e. level of education, marital status and satisfaction, level of income, parity, minority status, having health insurance, access to health care etc. [2]. Adverse life circumstances could contribute to negative psychological status of pregnant women such as stress, depression, anxiety and much more [3]. These could progress into sinister events such as post-partum depression and even to post-partum psychosis in the context of predisposing mental conditions [3].

There is sound evidence to substantiate that pregnancy increases the risk of common oral diseases such as dental caries due to altered dietary patterns with frequent consumption of cariogenic snacks and periodontal diseases due to hormonal changes associated with pregnancy and some difficulties in maintaining optimal oral hygiene [1]. Consequently, there could be worsening of existing oral diseases of a pregnant woman and a high oral disease burden. In general, 80-90% of pregnant women in developing countries present with untreated dental caries and periodontal disease [1]. Research evidence supports increased risk of adverse neonatal outcomes such as pre-eclampsia, low birth weight, pre-term births, intra-uterine growth retardation and pregnancy outcomes such as gestational diabetes associated with high periodontal disease burden of pregnant mothers [4]. The resemblance of oral microbiome of the pregnant women with her placental microbiome as revealed by recent metagenomic studies provides the biological plausibility of potential transmission of periodontopathic oral bacteria and their toxic metabolites to the fetus via placenta [5]. Furthermore, untreated dental caries of a pregnant woman gives rise to high salivary bacterial counts which increases the risk of cariogenic bacterial transmission to the baby thus increasing the burden of early childhood dental caries [6]. Against this backdrop, oral health is an important public health concern among pregnant women there by encouraging them to use preventive and curative oral health care services. Recent studies reported that there was 2-3-fold increased risk of tooth loss and non-utilization of oral health care services among pregnant mothers with life time diagnosis of anxiety. Pregnancy exposes a woman to a higher level of anxiety and depression compounded by her negative social determinants and life circumstances such as social disadvantage and lack of social support [7]. For example, recent meta-analysis revealed that the point prevalence estimates of prenatal depression were ranging from 8.5%-11% in different trimesters [8]. Therefore, mental health concerns and psychological well-being of pregnant mothers should be given a high priority. Poor oral health status and depression could coexist among pregnant mothers who belong to disadvantaged social backgrounds. Stress, anxiety and depression could increase the risk of poor oral health status by directly impacting on neuro-endocrinal and immune mechanisms as well as by stimulating risk habits which are not conducive for oral health such as cariogenic dietary habits, less optimal brushing habits etc. [7,9]. Hence, in the light of such evidence, it becomes important to consider the bi-directional relationship of psychological status and oral health status of pregnant mothers. Against this backdrop, screening for antenatal anxiety and depression as well as for oral diseases during pregnancy should be in place and oral health promotion and mental health promotion of pregnant women both in developed and developing country contexts especially targeted to women with social disadvantage become important. Primary Health Care Workers such as Public Health Midwives in Sri Lanka are providing field-based ante-natal and post-natal care for pregnant women with regard to mental health promotion and necessary referrals as well as for referral for oral health care.

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Urgent Care of Fetal Heart Rate Bradycardia_ Crimson Publishers

Urgent Care of Fetal Heart Rate Bradycardia by Kazuo Maeda in Womens Health Journal

Abstract

As fetal bradycardia is the sign of fetal hypoxia, emergency early caesarean section is usually indicated in fetal heartrate (FHR) in the labor, while in some cases simple lateral posture is recommended. Infantile cerebral palsy is prevented, if novel hypoxia index is 24 or less. Hypoxia index, FHR score and FHR curve frequency spectrum are update progress in automated computerized FHR diagnosis.

Keywords:FHR monitoring; Fetal bradycardia; Hypoxia index; FHR score; FHR frequency spectrum; Computer diagnosis

Introduction

As fetal heart rate decreases if fetal vagal nerve center is excited by the stimulation of low PaO2 lower than 50mmHg in fetal hypoxia, sudden transient or continuous fetal bradycardia, fetal hypoxic damage, particularly fetal brain damage followed by hypoxic ischemic encephalopathy (HIE) and infantile cerebral palsy in severe hypoxia, in the loss of fetal heart rate (FHR) variability, urgent care is needed in the labor. Fetal acoustic bradycardia listened after uterine contraction with stethoscope was warned to be dangerous to the beginner in old time, and also in modern fetal monitoring detected with various FHR monitor. Microbial infection with TORCH and syphilis also develop FHR change, e.g. cytomegalovirus.

Result & Discussion

Changing maternal posture to lateral one in intrapartum fetal bradycardia

As the late deceleration (transient bradycardia) is caused by the loss of placental blood flow due to the compression of maternal iliac artery with contracted pregnant uterus (Poseiro effect), lateral posture rejects uterine compression, then the deceleration disappears [1,2]. Also, fetal deceleration appears in maternal supine hypotension caused by the compression of maternal inferior vena cava with pregnant uterus in supine posture, resulting hypotension due to the reduction of returning blood to maternal heart. Lateral posture removes vena cava compression and blood pressure returns, then fetal bradycardia disappears. Umbilical cord compression causes fetal bradycardia due to fetal hypoxia, and further continuous bradycardia appears in the cord prolapse, entanglement, or heavy torsion of umbilical cord, where the bradycardia may be improved by changing maternal posture to lateral one, however, severe cord compression may need caesarean delivery.

Infantile cerebral palsy is prevented with novel hypoxia index

The cerebral palsy is prevented, if the novel hypoxia index is 24 or less in the fetal monitoring, while cerebral palsy appears when the hypoxia index was 25 or more. The hypoxia index is the sum of deceleration durations or continuous bradycardia (min) in fetal monitoring, divided by the lowest heart rate (bpm) and multiplied by 100．The idea is based on the fact that normal neonate was born after 3 connected typical late decelerations, and by the fact of severe asphyxia and brain damage of neonate in 50 minutes’ repetition of late decelerations, namely, fetal outcome was not influenced by the late appearance pattern of deceleration, but frequently repeated decelerations were effective to develop ominous outcome. The probability of wrong diagnosis was almost zero in Chi2 test of cerebral palsy case numbers in 25 or more and 24 or less hypoxia index cases, and it was significant difference, thus, it was concluded that cerebral palsy is prevented if the HI is 24 or less. Thus, hypoxia index should be always calculated continuously, after the first appearance of deceleration or bradycardia, to decide early cesarean delivery to prevent cerebral palsy. Fetal death is prevented also by keeping the HI below 24, because there was no fetal death in all 22 cases studied by hypoxia index in the present study, while it was also studied by the Apgar scores and UAPH predicted by FHR score [3].

FHR score

FHR score is calculated by the evaluation of FHR deceleration constructed parts in 5 minutes, according to the percentage of Apgar score lower than 7. The fetus is normal when FHR score was less than 10. The Apgar score and UAPH are predicted by their regression equations to FHR score, by FHR analysing computer. Fetal demise is predicted when estimated Apgar score is close to 0, where FHR score is 24 [3].

Frequency spectrum of fetal heart rate curve

Frequency spectrum of fetal heart rate curve is effective to automatically diagnose pathologic sinusoidal heart rate, which detects severe fetal anemia caused by geomaterial hemorrhage or ParvoB19-viral infection, which are close to fetal demise, where La/ Ta ratio was 39 or more %, and at the same time PPSD is 300 or more bpm2/Hz [4].

Conclusion

Lateral posture should be tried in parturient woman, when a transient or continuous fetal bradycardia appears, which means the presence of fetal hypoxia. Hypoxia index should be determined continuously in the appearance of bradycardia, keeping hypoxia index at 24 or less in the delivery to prevent cerebral palsy. Apgar score & UAPH are predicted even in the 1st stage of labor by automated computerized fetal monitoring using FHR score preventing fetal death. Baseline frequency spectrum is analyzed to detect pathologic sinusoidal heart rate to prevent fetal demise.

https://crimsonpublishers.com/igrwh/fulltext/IGRWH.000548.php

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Brazilian Butt Lifts: An Editorial_ Crimson Publishers

Brazilian Butt Lifts: An Editorial by Michael Naafs AB in Womens Health Journal

Abstract

In this editorial risks and benefits of buttock enhancement are discussed with a special emphasis on Brazilian butt lift procedures. Hopefully, brain enhancement is winning from buttock enhancement.

Introduction

It is rather strange to read at International Women’s Day the first report of a buttock implant leading to fatal lymphoma, a complication that we know until now only of breast implants [1,2] Buttock enhancement is mostly performed with autologous fat injection rather than with silicone implants. However, these Brazilian butt lift procedures are the deadliest in aesthetic surgery. One in every 3000 patients dies of a fat embolism. Injecting fat into the buttocks can easily lead to serious problems if done incorrectly [3]. Most of the 33 deaths have been attributed to unqualified doctors, but underreporting is very likely. Besides fatal fat embolism, sepsis and gangrene can also be fatal [3]. For those who have ever watched the TV series “Botched” may be surprised on the vast number of doctors that perform these types of surgeries who seem to have very questionable qualifications. In a celebrity and beauty obsessed society this practice continues. Hopefully, brain enhancement is winning from buttock enhancement.

Conclusion

It is obvious that the risks outweigh the benefits of buttock enhancement.

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Exploring Young People’s Views on Emergency Contraceptives_ Crimson Publishers

Exploring Young People’s Views on Emergency Contraceptives by Osei-Tutu EM in Womens Health Journal

Abstract

The study sought to ascertain whether respondents know the difference between regular and emergency contraceptives and solicit their views on emergency contraceptives. The participants for this study were 22 undergraduate students of the University of Ghana (15 males and 7 females) between the ages of 18 and 25 years who volunteered to participate in the study. This study is exploratory in nature and gathered qualitative data through semistructured interviews. The interviews were electronically recorded and transcribed. All the respondents could explain what regular contraceptives are, but only four were able to define what ECs are. Some students do not know the difference between regular and emergency contraceptives. Those students who were not able to define what ECs are knew that they are used for preventing unwanted pregnancies. Respondents had different views on emergency contraceptives; while generally they agreed that it was appropriate to be used to prevent unplanned pregnancies especially due to rape, some believed they were difficult to come by. Respondent’ views about EC suggest that there is still more to be done in educating the youth on EC.

Keywords: Emergency contraceptives; Regular contraceptives; University students; Young people; Unplanned pregnancy; Ghana

Introduction

Although women may have access to contraceptives, failure to use a method, switching of methods and discontinuation of methods suggest that available contraceptives are not meeting women’s needs. Women would therefore prefer methods that are effective, lack side effects and are affordable [1]. There is therefore a growing interest in the potential impact that emergency contraceptives (ECs) could have on unwanted pregnancies and unsafe abortions especially in sub-Saharan Africa. It has been estimated worldwide, that 41% of pregnancies are unintended, of which 38% result in unplanned births and 48% in abortions with the remaining 13% in miscarriages. It has also been observed that the decline in unintended pregnancies are associated with increase in contraceptive use [2]. Emergency contraception (EC) refers to methods of contraception that can be used to prevent pregnancy after unprotected sexual intercourse. They are recommended for use within five days but are more effective the sooner they are used after the act of intercourse [3].

According to the World Health Organization (WHO) EC is recommended for use when there is a contraceptive failure or incorrect use, including condom breakage, slippage, or three or more consecutively missed combined oral contraceptive pills [3]. In the view of WHO, all women and girls at risk of unintended pregnancies have a right to access EC, and these methods should be routinely included in all national family planning programmers. The use of EC could reduce the incidence of abortion and subsequently maternal mortality. Adolescent sexual activity exposes them to the risk of unintended pregnancies, induced or unsafe abortions and sexually transmitted infections among others. The risk of pregnancy increases with the decline in age at menarche and prolonged stay in school which tends to delay marriage. When young people stay in school for a long time, it increases the likelihood of engaging in sexual activity even though they may not be ready for childbearing. This is regarded as a crucial health, social and demographic issue in the developing world [4].

In Ghana, majority of university students especially at the undergraduate level fall within the age bracket of 17 and 25 years. Young people joining universities often become sexually active partly due to peer pressure, alcohol use, or as a result of a perceived sense of being in control of their social life [5]. Some researchers have found that “most female students are enrolled at the university at their young age, this exposes them to unplanned and unprotected sexual intercourse leading to unintended pregnancies, abortions and sexually transmitted infections” [6]. In a study on EC among University of Ghana students, it was observed that 55% of the male respondents stated that they would “certainly” or “probably” reduce the use of a condom if they knew EC was available [7]. This is contrary to the findings in Nigeria [8]. In the Nigerian study conducted in three tertiary universities, the participants believed that increased use of EC was associated with fear of infertility, anovulation, ill health and STIs. Also, about half of the respondents of university students believed that EC was the same as the abortion pill.

This current study used students of the University of Ghana who are young, some of whom may have never used any contraceptives. For this reason, the study seeks to achieve the following:

A. Ascertain whether students know the difference between regular and emergency contraceptives.

B. Identify students’ views on EC.

Material and Methods

The Standards for Reporting Qualitative Research (SRQR) [9] consisting of 21-item check list was followed. To obtain detailed information on students’ views about EC, qualitative method was used. This study is exploratory in nature, gathering qualitative data through in-depth semi-structured interviews. The use of this approach enabled the researchers to provide a holistic picture and understanding of the issue under consideration, where respondents expressed their own views within the context of their knowledge and experiences through the interview process [10]. The participants for this study were part of the first phase of a larger study involving 1,869 undergraduate students. During that phase, the participants completed a questionnaire indicating their views, knowledge and usage of EC. The participants were consequently asked to indicate their willingness to participate in the second phase of the study which involved interviews to have in-depth information about their knowledge, usage and views about EC. About 170 students volunteered to be interviewed for the research. Of these, 56 were purposively selected because information on their contacts was complete, of which 22 (15 males and 7 females) were available for the interview. The interview schedule was submitted to the Ethics Committee for the College of Humanities of the University of Ghana and approval was given before the interviews were done. The ethical issues related to the study were addressed by maintaining a high level of confidentiality of the information given by the respondents. Permission was sought from the interviewees before electronic audio recordings were made. The interviews were done at the convenience of the interviewees. The interviewees decided on the time and the venue for the interviews. The recorded interviews were later transcribed.

Results

To find out whether respondents know the difference between regular and emergency contraceptives they were asked to define them. The results show that in as much as students have heard about regular contraceptives and EC, it was interesting to note that they were not clear on the distinction between the two. All the 22 students interviewed could explain what regular contraceptives are, but only four were able to define what ECs are. Those students who were not able to define what ECs are, have either heard of them and know they are used for preventing unwanted pregnancies but could not differentiate them from regular contraceptives.

For example, one of the respondents indicated that: ‘all that I know is the normal contraceptives. I don’t know if some can be classified as emergency contraceptives. I think emergency contraceptives are more powerful than the normal ones’ (Male student). Similarly, another respondent also reported as follows: ‘I only heard of emergency contraceptives last year during the clinical practice but have not used it before and got to know more about its last semester during our pharmacology class’ (Female student). However, it was interesting to note that one of respondents who had ever used EC describe it this way: ‘These are the contraceptives that are taken within 72 hours of unprotected sex when you know that you are not safe and there is the likelihood of you getting pregnant then you take them after the sex or within 72 hours’ (Male student). One of the respondents indicated that he does not know much about the types of ECs, but he knows some friends who use Positron 2 and Lydia to prevent pregnancy. A male respondent had this to say: ‘students like us, if you impregnate someone, your parents will give you an ultimatum or ask you still to stop schooling. So far as we are human beings and we cannot do without sex, emergency contraceptives are important’ (Male student). One student attributed unplanned pregnancy to rape. Sometimes, when people are raped, they could become pregnant, and since this was not planned for, EC could be used. Others may also be naive and get pregnant. In such situations also, EC could be used. A female respondent put it thus: ‘Okay, I know it is good because you might be raped or not plan to have sex and you can become pregnant, and as students, the implications will be many. Parents will be disappointed and so I think it is good to use the emergency contraceptives in case of any unplanned sex so that you can use it to prevent unwanted pregnancy’ (Female student). Some students were of the view that EC is difficult to obtain. This becomes a big challenge since the repercussions of unprotected sex are enormous; one of which is getting pregnant. A male respondent put it this way: ‘If you can remember to do something before the intercourse to prevent pregnancy, then that will be better because there are times that you cannot get it to buy. There are times when you realize that the timing is wrong, you cannot get it to buy’ (Male student). EC being fake is also one of the reasons why people are not interested in using it. When one goes to the pharmacy shop to buy it, the cost varies, and the range is wide, and one would want to know why. Even if the brands are different, the price should not be so different. Authenticity is a big issue, and it is difficult to identify the original product. How will one not get pregnant if she buys the fake one unknowingly? One lady had this to say: ‘I have heard that now we have fake ones, so you buy them, and you feel really sick. The fake ones are cheaper as compared to the original ones. Sometime ago when I went to the pharmacy, and I asked for the pills, I was told one is like Ȼ15, so I was like, give me the original one. I think that may be the only problem. I have a friend who is currently going to give birth even though she used the pill. That means the fake ones are not safe’ (Female student). In addition to the issues raised, religion is one of the main reasons why people do not use ECs. Some religious groups as part of their doctrine, do not allow the usage of contraceptives. Students who belong to such groups may find it difficult to use ECs as their religion frowns on its usage. This is the view from a male respondent: ‘The issue that is bothering me with contraceptive is religion; I don’t know how you people can help. There are so many religions which do not believe in contraceptives. Like the Catholic Church. They don’t believe in contraceptives; they don’t preach or even allow it. They say God said we should multiply, and it should not be modified by using any family planning method’ (Male student).

Discussion

Although respondents claimed to know about EC, their responses to the difference between regular and emergency contraceptives indicated that they really do not know the difference between the two. Some respondents believed some regular methods could be referred to as emergency contraceptives. This should be a source of concern for all stakeholders in family planning education. Although family planning was introduced in Ghana as far back as the early 1970s with the establishment of the Ghana National Family Planning Programmed and EC was introduced in Ghana in 2000 [11] and given some media attention through advertisements on radio, some people are still not sure what they are. This is a very serious issue with regards to the sample in this present study who were mainly the youth. During this period of their lives, they are likely to involve themselves in sexual experimentation. Furthermore, although they tend to be sexually active, they do not use any contraceptives [12].

This puts them at the risk of unintended pregnancies. It is therefore important that measures are taken to provide information on short term contraceptives including EC to these young ones who may really need them. In doing this, their attention must be drawn to the fact that EC as the name suggests, should be used in emergency situations only and that they might do well to choose from the variety of different contraceptive methods available that may be suitable for them. The views of the youth on EC should be an issue of immense concern among stakeholders on reproductive health in our societies. Majority of these youth are sexually active, and they have the tendency of finding and using different methods to prevent unwanted pregnancies. In most cases, some of these youth are not aware of the appropriate methods to use. They stand a high risk of unintended pregnancies as well as the danger of not being able to complete their studies. According to the 2017 Ghana Maternal Health Surveys, 10% of pregnancies end up in induced abortions [13]. This is an indication that not all pregnancies are planned for and wanted. The main reasons given by women who had induced abortions were that they were not ready, were too young or wanted to delay child bearing [13]. It is for this reason that understanding the views of the youth on ECs is very important as this information would be useful in the activities and services provided by the family planning units of reproductive health centers.

Students’ views on EC are varied. This could be as a result of their own experiences or those of others [14]. Other issues that could be influencing the views of youth could be religion which opposes the use of certain contraceptives. However, despite religious opposition to the use of contraceptives, there is a success story in the US where private institutions merged with public health care facilities where compromises were reached [15]. This could be replicated in Ghana and other countries. Whatever be the case, this implies that young people may not feel the same way with the introduction of new things in this case, EC. Therefore, programmed on reproductive health in general and EC need to take into consideration the fact that young people are not necessarily a homogenous group and target each specific group with information that would be best suited for them. This is expected to help improve the reproductive health profile of the youth and thus reduce unintended pregnancies, induced abortions and maternal mortality.

Despite the importance and effectiveness of ECs, there is the need for them to be regulated so that users will be responsible enough and not misuse or abuse them. As highlighted by one of the respondents, some of these contraceptives are being sold in the market are fake. It is therefore worth noting that, there is the need for proper regulations of how these contraceptives are sold and proper training of how they should be administered. A strategy that could be adopted to provide accurate information to young people is use of peer providers. It has been observed that this strategy could provide young people with access to vital health information and services that would improve young people’s sexual and reproductive health [16]. This is because young people may be more comfortable with receiving information and services regarding their reproductive health from their peers.

Acknowledgement

The authors express their appreciation to the undergraduate students of the University of Ghana who participated in the study.

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crimsonpublishersgynecoloogy · 3 years

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Happy Thanksgiving Day!

Hope this season is filled with Lots of happiness and joy, wealth and prosperity. May your home be filled with love on this wonderful occasion of Thanksgiving!

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crimsonpublishersgynecoloogy · 3 years

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Cesarean Section Epidemic in Iranian Midwives_ Crimson Publishers

Cesarean Section Epidemic in Iranian Midwives by Somayeh M in Womens Health

Opinion

In the last century, caesarean section (C/S) has played a positive role in settling pregnancy complications and reducing the fetal and maternal mortality, but a worrying issue in modern midwifery is the high rate of C/S. According to the World Health Organization, the C/S rate should not exceed 10-15% of all births in any part of the world, but published statistics in many parts of the world, especially in Iran, differed greatly from this ratio and are very higher. C/S is a major operation that has complications such as maternal death, hemorrhage, infection, need for blood transfusion, dense internal adhesions, thromboembolic, urinary retention, bladder injury, and anesthetic complication. Furthermore, an increase in the rate of C/S in a country may cause a high cost to the health system. In recent decades, it seems that there is a general tendency for C/S among both health care givers and providers. Among midwifery personnel and students there are also those who believe that C/S is the most appropriate method of delivery, while others believe that C/S is a very large operation with many complications. It is obvious that awareness of the health care givers’ performance toward choosing a delivery method for their own pregnancies is important for health policies related to decrease C/S rate.

Because the performance of the medical staff, especially midwives, in choosing the type of delivery can directly affect the performance of pregnant mothers. The results of our recent study showed that only 22.5% of the midwives of an educational large hospital in Ahwaz, Iran had had normal vaginal delivery in all their own pregnancies. 66.3% of the midwives mentioned the history of one to three planned C/S and 11.2% of them had experienced the C/S after normal vaginal delivery. 33.8% of the cesareans were elective. 74.1% of those who were selected the C/S stated that if they return to the past, they will repeat that again. About 25% of the participants suggested that C/S is more appropriate than normal vaginal delivery to terminate uncomplicated pregnancies for mothers who will eventually have two to three pregnancies in their lifetime. According to these results it seems that even though midwives learn more about the complications of C/S, they tend to be more willing to do this for termination of their own pregnancies. The reason for this may be due to the experience of working in maternities and seeing the suffering of labor pain in clients. One of the other possible reasons may be this fact that the elective C/S is a clean operation and an effortless method of birth. Considerable findings of our study are a serious warning about the high rate of C/S among midwifery personnel in Iranian medical community. Trying to root these results is very necessary, because the midwives have a strong role in guiding pregnant women for decision making about mode of delivery.

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An Assessment of the Effect of Team Building on Team Performance in Gutu District, Masvingo Province, 2010_ Crimson Publishers

An Assessment of the Effect of Team Building on Team Performance in Gutu District, Masvingo Province, 2010 by Pomerai KW in Womens Health Journal

Abstract

Introduction: Lack of team work is a major problem in civil service in Zimbabwe. Poor team work leads to reduced performance in a team. Gutu district performed very little for the past three years and a baseline survey showed lack of team work. This study aimed to assess the effectiveness of team building on team performance.

Methods: A before and after quasi experimental study was conducted. District managers were study participants. A baseline survey was conducted to determine views on key leadership issues, such as convening meetings, managing conflict, planning and communication. Next, a five-day team building retreat was conducted in a secluded area away from the district. After the team building exercise, participants were observed for three months to assess improvement in planning, convening meetings, supervision, and outbreak response. A post intervention survey was conducted to after the intervention.

Results: All six district health managers participated, none of them had been trained in management, there was improvement in holding meetings, and writing reports reduced conflicts. All managers assisted other managers achieve their goals.

Conclusion: Team building has an effect on team performance on Gutu health managers

Keywords: Team building; District health executive; Gutu; Zimbabwe

Introduction

A team comprises a group of people or animals linked in a common purpose. Teams are especially appropriate for conducting tasks that are high in complexity and have many interdependent subtasks.

A group in itself does not necessarily constitutes a team. Teams normally have members with complementary skills and generate synergy through a coordinated effort which allows each member to maximize his or her strengths and minimize his or her weaknesses. Team members need to learn how to help one another, help other team members realize their true potential, and create an environment that allows everyone to go beyond their limitations [1]. Thus, teams of sports players can form (and re-form) to practice their craft. Transport logistics executives can select teams of horses, dogs or oxen for the purpose of conveying goods. Teams, such as in medical fields, may be interdisciplinary or multidisciplinary. Multidisciplinary teams involve several professionals who independently treat various issues a patient may have, focusing on the issues in which they specialize. The problems that are being treated may or may not relate to other issues being addressed by individual team members. Interdisciplinary team approach involves all members of the team working together towards the same goal. In an interdisciplinary team approach, there can often be role blending by members of the core team, who may take on tasks usually filled by other team members [2]. In the Ministry of Health and Child Welfare (MOHCW) the district public health activities are run by a team called District Health Executive (DHE). This team comprises of the District Medical Officer (DMO) who is the team leader or manager and chairs the DHE meeting. Other members are the District Nursing officer (DNO) who is a senior nurse or nursing manager, District Environmental Health Officer (DEHO) who is a health inspector, District Health Services Administrator (DHSA) who heads administration department, Health Promotion Officer (HPO), Pharmacist, Lab Scientist, Nutritionist. Other members can be co-opted members chosen by the DMO. The DHE came into being so that there can be decentralization of health services management. Under the guidance and leadership of the DMO the DHE runs the entire district health services delivery and reporting to the Provincial Medical Director (PMD). The PMD heads a Provincial Health Executive (PHE) team comprising of the same professions as in DHE and reports to the Permanent Secretary of the Ministry of Health [3].

The functions of the DHE are among many other budgeting, planning, decision making and policy implementation at district level. If DHE is not functional, then the vision and mission of the Ministry of Health will not be accomplished as the DHE must guide and direct the District Health Team (DHT). The DHT comprises every health worker in the district; DHEs came into being to improve service delivery by decentralization [3]. Creating an effective team is a challenging exercise in every organization and this process is called team building. Team building involves a wide range of activities presented to organization for improving team performance. Team building ranges from simple bonding exercises to complex simulations and multi day to day team building retreats, team building can also mean selecting or creating a team from scratch [4]. Gutu District was performing the worst out of the seven districts in Masvingo Province. In 2010 the district failed to hold a single of the following meetings: DHE meeting, Heads of Department meeting, Transport meeting, District Health Team meeting held once quarterly, disease surveillance meeting held once weekly, procurement meeting and a budgeting meeting. They failed to come up with a costed Results Based Management (RBM) plan. No progress reports were written from the district. All activities are not properly coordinated. The PHE team had provided support and supervision to the DHE six times that year but no improvement was realized. We implemented a team building exercise as an intervention and determined its effect on the performance of the DHE.

Materials and Methods

A quasi experimental study (before and after) was carried out with the Gutu District Health Executive. The DHE was blinded to the reason of the team building exercise in order to prevent artificial behavior during the observation period.

Pre-intervention survey

A pre-intervention survey (situational analysis) was conducted using a questionnaire that was administered to the DHE members. This survey elicited problems related to how the team was functioning. The issues identified were then used to design a team building training package to address causes of team malfunction observed.

Description of the intervention

Two skilled team building experts facilitated the team building exercise. A five-day team building retreat was done. DHE members were taken away from the usual workplace to a private place where they were alone with team building facilitators. During the exercise the team was taken through trust building by leading each other while blind folded, they were paired and made to play simple games that involved novel complex tasks, cooked for each other and made each other’s beds. They went for ropes courses, cooperate drumming and physical exercises. Activities geared to improve communication skills were conducted through exercises and games that highlighted the need for good, strategic and effective communication in team performance or potential problems with communication. Problem solving and decision-making exercises were done, and this focused on groups working together to solve hypothetical complex problems or make complex decisions. Psychological analysis of team roles and training on how to work better together were done and going through each member’s job description. Budgeting, planning, and communication trainings were done, and time created so that the team will have time to know each other better in a friendly environment. The DHE was then observed for a period of three months (January to March 2010) for changes in performance.

Post-intervention survey

A post-intervention survey was conducted using the same instrument for the pre-intervention survey after 3 months of observation. The changes in performance of the DHE were then computed.

Outcomes of interest

The outcomes of interest were completing plans, holding meetings (e.g. DHE, DHT, HOD), conducting support and supervision as DHE team, writing reports, using purchase plans, transport schedules and controlling outbreak as a team.

Hypothesis

H0: μd≤0 Team building does not increase number of meetings

H1: μd>0 Team Building effective in increasing number of meetings

All six DHE members in Gutu were recruited and participated in the study.

Microsoft Excel was used to generate frequencies and means and calculate intervention impact size

Results

The demographic characteristics of study participants are shown in Table 1. Two of them had degrees and four had diplomas, the median years in services was 29 years [Q1=; Q3=]and four were substantively appointed on their posts. All (6) DHE members knew the composition and roles of the DHE roles was very high among the members, some of the roles that were reported were: planning and coordinating public health activities(6), Formulation and implementation of polices(6), budgeting for the district(6), Control of resources(6) , Monitoring and evaluation of public health activities(6), and bidding for staff(6) though all the DHE members reported that the DHE was not performing its duties. All team members reported lack of team work as a reason for failure of the DHE to perform its tasks as shown in Table 1. All DHE members reported that the problems the DHE was facing can be solved and could be solved through team building. None of the DHE members knew the other members roles in the DHE and none were inducted when assuming their posts. Only one member reported assisting other team members attain their goals.

Table 1:Assessment of effect of intervention on the members in gutu district 2011.

The team was now making decisions and agreeing on them and implement them for example they agreed on purchasing airtime for surveillance in the district, discussed and agreed to service motorcycles, the issue of motorcycle servicing was a stalemate since 2009. Transport schedules were now being used as they were never in use before, consolidated district purchase plan was formulated and used in 2011 this plan was last drafted in 2006. CBU and PTC meeting were now being used to adjudicate tenders and identify reputable suppliers unlike before when they were no CBU and PTC meetings (Table 2). Ten conflicts were reported in the first quarter the number of conflicts reported to the province was reduced to zero unlike in 2010. The DHE supervised health centers in its jurisdiction once that quarter unlike before when the supervision was individual, and no reports written (Table 3). The DHE wrote 3 consolidated monthly reports to the province as compared to 2010 when they failed to write a report to the province. No outbreak was reported during the observation phase Table 4.

Table 2:Assessment of the effectiveness of team building on holding meetings on gutu DHE in 2011.

Table 3:Assessment of team building on report writing and submission to province by gutu DHE 2011.

Table 4:Comparison of management meetings held by Gutu DHE before and after team building 2011.

Paired t test for management meetings held by Gutu DHE before and after team building. Degrees of freedom shown in Table 4.

Decision rule: α 0,1, (n-1) =(9-1)=8

Therefore: t crit=1,397

Therefore, reject H0 if t cal ≥t critic which is ≥1,397

d=12+12+9+9+3+1+1+3+3+3/9

=55/9

=6.11

Sd2=Σ(di-d)2/(n-1)

=34,69+34.69+8,35+8,35+9,67+26,11+9,67+9,67+9,67/8

=150.87/8

=18.86

T=d-μd/sd =6.11-0/square root of 18.86

=6.11/4.34

=1.4078(t-calc) is greater than >t crit 1.3971 reject H0 in favour of H1 and conclude that team building is effective in increasing number of meetings and the results are statistically significant with a p value less than 0,1.

Discussion

Knowledge on the roles and composition of the DHE was high among, this could be since majority of the members had long years in service and could have heard about them in workshops and other literature at the workplace. Majority of the members had not been inducted on the job post they were occupying; this may have led to frequent frictions between the DHE members and may have led to poor team work. Induction would have helped the team members know their roles and as well as the other members roles. It is the responsibility of the members to come together and plan out a way that would lead them to their target successfully [5]. During the team building exercise the members were taught of importance of holding meetings, how to hold successful meeting and time management, these lectures might have led to the constant holding of meetings by the team and participation is reflected by the minutes that are sent to the PMD office were all members are taking part in discussions and decision making. The use of purchase plans and adhering to procurement procedures that is being experienced in Gutu might be attributed to the lectures on effective and cost cutting procurement that the team received while at team building. The improved decision making that was not seen in Gutu that is being experienced now can be attributed to the solving hypothetical complex problems games that the team carried out during the team building activity. Time management lectures may have led to the production and use of work plans by the team members as this was done before.

The formulation of transport schedules and combining trips that is being done in Gutu may be attributed to the lectures the team received on effective transport management in health delivery and all the members reported that they are now comfortable with travelling with one another since they got used to it during the team building activity of tour drives which made the team members interact on social basis during drives to view nature and animals at recreational parks. Combining trips saves fuel and mileage of vehicles which we may later translate to money saving. Team members must work in unity to achieve targets that have been set for them. Lack of leadership was reported by all the members. The team leader is supposed to provide technical and professional expertise to the team members so that they achieve their goals, but when leadership is seen as lacking by the team members, they begin to undermine the leader and start to operate in an unorganized manner that may be detrimental to the organization. One thing the leader and the team members have to understand is that human beings by nature have different personalities and attitudes and while working in a team these opinions and personalities may clash and give rise to conflicts within the team.

Communication was reported to be another factor that affected team work in Gutu, we noted that this was lacking and was reported as another reason for poor team work. For the success of any team communication is essential, the team leader is the one who makes decisions but this does not mean that he/she must no listen to any other team members the team leader should encourage participation by other team members ion discussions and come up with a collective way to follow so that they achieve their goal, regular meetings should be held to review development and every member should contribute ideas for the success of the team [5-7]. This helps boost the morale of the team members and understand their progress at work. There were several conflicts that were reported from Gutu in 2009 and 2010 and this may have led to the poor team work that was reported by the team members, this is supported by a study that was conducted in Kenya which revealed that conflict made teams ineffective and sloppy [8].

Effective communication lectures may be attributed to the improved horizontal and vertical communications that are being done by the members through reports, memo and phone calls as well as meeting. There has not been a conflict reported from the team to the province since the intervention. The reduction in friction and conflicts among members may be attributed to the likes and dislike activity were the teams had to mention what they like and dislike both at work and in social life [9]. The members might now approach each other knowing what the other member likes and dislikes, reduction in conflicts reported to province may also be due to the communication training that was done and still being reinforced between the members. The other change though difficult to objectively measure was the improved trust among the members which may have been improved by blind folding games and the cooking and dishing food for each other the team members did during team building. We recommended maintaining post intervention support and observation for the DHE team in Gutu DHE for one year.

Conclusion

Team building was effective on team performance in Gutu. Therefore, we reject Null hypothesis which state that team building has no effect on improving performance on Gutu DHE 2011 in favour of Alternative hypothesis which sated that team building improves team performance on Gutu DHE 2011.

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Text

Human Infertility is Disease. What People Should Know About Her?_ Crimson Publishers

Human Infertility is Disease. What People Should Know About Her? by Siniša Franjić in Gynecology Journal_Gynecology Open access Journal

Abstract

Infertility is an absence of clinical pregnancy after two years of trying to reach it. According to World Health Organization data, between 7% and 26% of people have problems with infertility. Medical assistance is sought by 50% of infertile couples, and only about 22% are subjected to treatment. Infertility is a disease which can be cure, and this fact gives hope to couples who want to become parents.

Keywords: Infertility; Man; Woman; Medically assisted insemination

Introduction

While a number of couples use different methods to limit their fertility and prevent new life, on the other hand a number of them - and it is constantly growing - has only one desire: to acquire own child [1]. To accomplish this desire, them no price is too high. Own desires, social pressures, as well as scientific-technical optimism and promises of reproductive medicine encourage them to constantly new attempts. The results do not remotely monitor all efforts, suffering and expenses incurred. Some of today’s conventional medical methods are, morally speaking, problematic and contrary to human dignity. The acceptance of the technical capabilities may at first glance mean relief and re-gaining control over the problem of infertility and their own bodies, and thus of life plans. In reality, such a decision is an admission of its own helplessness; control over the body entrusted to experts. For the person it means subjecting extensive tests, the control of hormones, the daily blood tests, ultrasound scans, hospital stays for taking eggs or expressed words of one directly affected person, “... the constant hopes and fears and infinitely many disappointments”. This regime shall be subject to the overall life of the person concerned, and often the spouse. So much investment of time to solve the problem of infertility is lack of time for other areas of life, profession and social relations, even among the married and cohabiting partners.

Determining the number of children, they want to have and the time of their birth, women and men in natural procreation realize the right to reproductive choices and carry out a plan on the size of their own family [2]. In other words, they plan their lives in the family community and exercise their right to family establishment. However, if the nature abandoned by a woman or a man (or both) their procreative ability, the possibility of family establishment depends on adopting regulations or on medical assisted insemination and their realization in practice. The decision to birth offspring’s gives the marriage additional meaning and quality and in most cases enhances and enriches the relationship between women and men. It is more likely that misunderstandings and disagreements in marriages will cause a different view of women and men in other ways of establishing a family because difficulties with natural procreativity. The lack of agreement on any issue in common life, and especially on procreation and establishment of the family, and the wishes, needs and interests that each spouse’s expectation in the life community which has founded, can be a cause to marital disputes and devastatingly affect to marital relations.

Reproductive Health and Health Care

The term “reproductive rights” encompasses a broad range of issues involving reproduction and reproductive health [3]. In the USA, the discussion of rights generally includes the choice to have or not have children, the timing and spacing of childbirth, and the freedom to make these decisions without coercion or threats of violence. The primary issues at stake in the discussion of reproductive rights include the right to birth control, abortion, sterilization, and, more recently, the right to obtain fertility treatments. Controversy over the right to birth control, abortion, and sterilization is not new, and the current debates over these issues reflect many of the same themes regarding the right to life, the rights of individuals, and freedom from coercion.

The conclusion to be drawn from this rather lengthy discussion of the treatment of childlessness is that, perhaps inevitably, the law has settled on a form of compromise - and a compromise between what can be extreme views [4]. Thus, on the one hand, we have a body of opinion which holds that the manipulation of what are seen as human beings in the Petri dish is morally wrong and should be prohibited absolutely. Diametrically opposed are those who believe that reproduction is an intensely personal matter which should be free from bureaucratic interference and left to the discretion of the individuals concerned. Clearly, it is an area where, in the words of the late President Franklin Roosevelt, you cannot please all the people all the time. The question is - does the current legislation please most of the people most of the time?

We believe that it probably does. Respect for the embryo, as, at least, a potential human being, is maintained by strict general rules which limit the uses to which it can be put, while the interests of those who have contributed to the genetic structure of the embryos are protected by a comprehensive system of consent to their destiny. Limitation of treatment to licensed clinics may appear restrictive of personal autonomy, but it can be seen as little more than ensuring that the childless are treated by the best clinicians available rather than by potential mavericks. Certainly, Parliament has been adamant in excluding commercial elements from the provision of the building blocks of infertility treatments; this is to be expected in the light of a long-standing national opposition to trading in body parts or tissues of any sort.

What is infertility?

Medical advances offer greater treatment possibilities, and the social climate fosters a direct approach to problems previously considered shameful or embarrassing [5]. Although infertility usually is not a problem of sexual dysfunction, its relation to the reproductive organs causes many people to associate it with sexual problems. Since it has become more acceptable to discuss sexual matters freely, it has become easier for infertile people to acknowledge and discuss their problems. Also, as aware consumers of medical services, people demand and expect help in the area of infertility, as in other health-related matters.

Infertility has received research attention across disciplines, including a substantial amount from health psychology [6]. One of the many reasons for this attention is the public face of this private condition. Pronatalism across the globe is the norm, and expectations of individuals to reproduce are unquestioned. Women particularly spend a third of their lifetime having menstrual cycles, and under natural circumstances are likely to have one or more children if they are sexually active. However, many women and men do not have children, and many of those are not childless by choice but are infertile. Infertility is usually defined as the ‘inability to conceive or bring a pregnancy to term after twelve months or more of regular intercourse, without the use of contraception’. According to a recent systematic review of the prevalence of infertility, researchers appear to have used varied definitions depending on when, where and on what populations the research was carried out. They propose standardizing a definition used in clinical practice based upon two key factors that can be used universally: duration of length of time of trying to get pregnant, adjusted for female age. Infertility and childlessness are often used interchangeably, but there is a distinction. Infertile people are involuntarily childless, whereas childlessness can be voluntary which is not accompanied by the same psychological effects.

Infertility affects up to 10-15% of couples of reproductive ages worldwide, or 48.5 million women worldwide [7]. The cause may be attributed to male factor, female factor or both. For a significant proportion the cause will be unexplained. Social factors such as delayed childbearing age in women and lifestyle factors (smoking, obesity) coupled with an increased awareness of treatments available have resulted in an unprecedented demand for fertility services. Only recently have such services started to explore the psychosocial aspects of infertility: its mental health burden on patients, their psychological needs and effective psychotherapeutic interventions.

Diagnosing infertility

A thorough history is usually the key in determining the cause of infertility during a new patient evaluation [8]. It is important to assess the previous fertility history of each partner. Clues to the diagnosis of tubal factor infertility include a history of pelvic inflammatory disease, history of ectopic pregnancy, or one or more male partners who have conceived pregnancies with other partners. A hysterosalpingogram with bilaterally obstructed fallopian tubes confirms this diagnosis. Clues to the diagnosis of severe male factor infertility include secondary infertility in a female patient, where the only new variable is a different partner. Semen analysis results with a total motile count of < 10 million (after processing) or normal morphology < 4% is associated with poor fertilization, and IVF is indicated in these situations.

The inability to become pregnant and give birth can create a whole spectrum of reactions for each couple, which can result in a sense of life failure and a crisis and stress experience [9]. The very high pressure of infertility diagnosis leads to a re-examination of the desire for biological parenting and adaptation to the unrealized expectations that the couples had in relation to personal and family development. Therefore, it is not surprising that anxiety and depression is common in couples who are facing with this problem. It should also be noted that research shows that women experience more negative reactions than men, which is reflected in high levels of stress assessment.

The problem of infertility and its complex treatment crosses the boundaries of medicine and enters into many peripheral areas [10]. Fertility treatments are a physical and emotional burden for both partners. Psychological problems such as depression, anxiety, and stress-induced changes are predictive of a decreased probability of achieving a healthy pregnancy. A couple that is trying to conceive will very often experience prolonged feelings of frustration and disappointment if a pregnancy is not easily achieved. Three types of relationships have been hypothesized between psychological factors and infertility. These include: (1) psychological factors are risk factors of subsequent infertility; (2) the experience of the diagnosis and treatment of infertility causes subsequent psychological distress; (3) a reciprocal relationship exists between psychological factors and infertility. Psychological aspects of infertility indicate a need of a more systematic involvement of psychological treatment methods, and psychological treatable procedures are referring to the terms of psychotherapeutic approaches or psychotherapy ranging from support and counseling to psychoanalytic psychotherapeutic procedures.

Medically assisted insemination

Medically assisted insemination means biomedical procedures to heal proven infertility of one or both partners and the application of modern, scientifically proven biomedical achievements enables connection of male and female gametes to achieve pregnancy and childbirth [11]. Methods of medically assisted insemination is now treated 70-80% of all causes of infertility. Apply only when all other methods of infertility treatment proved unsuccessful. The right to medically assisted insemination are of legal age and legal capacity of women and men who are married or in common-law and that due to the age and general health condition capable of parenting a child [12]. The right to medically assisted insemination has adult, legally capable woman who does not live in marriage, commonlaw or same-sex unions, whose previous fertility treatment proves unsuccessful or hopeless, and that is due to the age and general health condition capable of parenting a child. The right to medically assisted insemination and the person who has the decision on deprivation of legal capacity is not restricted to making statements concerning personal status.

What includes the procedure of medically assisted insemination?

Assisted reproductive technologies (ART) encompass fertility treatments, which involve manipulations of both oocyte and sperm in vitro [13]. ART including indications for treatment, ovarian reserve testing, selection of controlled ovarian hyperstimulation (COH) protocols, laboratory techniques of ART including in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), embryo transfer techniques, and luteal phase support.

The most commonly performed ART procedure is IVF. IVF involves a sequence of events starting with COH with exogenous administration of gonadotropins to stimulate the development of ovarian follicles, followed by transvaginal ultrasound (US)-guided retrieval of oocytes, fertilization of oocytes with sperm in vitro, culture of the resultant embryos, and transfer of embryos to the recipient. An important innovation in ART is assisted fertilization by intracytoplasmic sperm injection (ICSI), which involves the injection of a single sperm into the cytoplasm of a mature oocyte. Other modalities of ART include embryo assisted hatching (AH), autologous endometrial coculture (AECC), preimplantation genetic diagnosis (PGD) or screening (PGS), cryopreservation of gametes, embryos, and ovarian tissue, frozen-thawed embryo transfer (FET), the use of donor gametes and gestational carriers. Prior to the advent of ART, other less often utilized procedures include laparoscopic tubal transfer of gametes (gamete intrafallopian transfer; GIFT), zygotes (zygote intrafallopian transfer; ZIFT), and embryos (tubal embryo transfer; TET). Due to their invasiveness and the necessity to utilize general anesthesia during these procedures, they have become almost obsolete. They are only utilized when transcervical embryo transfer is technically difficult to perform.

Confidentiality

Ever since the Hippocratic Oath was first taken 2500 years ago, confidentiality has been recognized by the medical profession as a cornerstone of good clinical practice [14]. In 1947, the Declaration of Geneva (amended in 1968) strongly reinforced the declaration of confidentiality in the Hippocratic Oath. The Declaration states: I will respect the secrets which are confided in me, even after the patient has died.

In recent times legal, social, and technological advances have brought increasingly complex obligations and challenges for healthcare professionals who wish to safeguard patient confidentiality. Under the common law, confidentiality may be enforced by a patient through an injunction or with an action for damages in a civil court, but in the absence of any demonstrable harm, it is likely that the damages awarded would be limited, and civil claims are very rare. Confidentiality is also important because human beings deserve respect [15]. One important way of showing them respect is by preserving their privacy. In the medical setting, privacy is often greatly compromised, but this is all the more reason to prevent further unnecessary intrusions into a person’s private life. Since individuals differ regarding their desire for privacy, we cannot assume that everyone wants to be treated as we would want to be. Care must be taken to determine which personal information a patient wants to keep secret and which he or she is willing to have revealed to others. Trust is an essential part of the physicianpatient relationship. In order to receive medical care, patients have to reveal personal information to physicians and others who may be total strangers to them - information that they would not want anyone else to know. They must have good reason to trust their caregivers not to divulge this information. The basis of this trust is the ethical and legal standards of confidentiality that healthcare professionals are expected to uphold. Without an understanding that their disclosures will be kept secret, patients may withhold personal information. This can hinder physicians in their efforts to provide effective interventions or to attain certain public health goals.

Conclusion

One of the principles of medical ethics is that the doctor must keep all the information which receives during the treatment and he or she not allowed to speak of them in public. Patient health records are the intimate things of each individual and doctors must be adhering to it. By doing his job, the doctor has come up with this information, and can also find out many important health information from conversation with patient. This creates trust between the patient and the doctor no matter what kind of health problem does. Doctors cannot share this information with others. Infertility and medically assisted insemination represent serious problems to the people which are covered by it, and it is only the matter of an individual that will acquaint with them members of own family, friends, colleagues at work, neighbors, etc. For couples covered by this issue, the most important facts are that is a disease which can be cure, and, with the help of medical assisted insemination, they can become parents. Modern medicine on this way can help couples who want to become parents.

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