Knowledge and perceptions of quality of obstetric and newborn care of local health providers: a cross-sectional study in three districts in Malawi

Aim Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers’ knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided. Methods his study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC). Results Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians’ place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care. Conclusion Serious deficiencies in providers’ knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.

Effect of investigation intensity and treatment differences on prostate cancer survivor's physical symptoms, psychological well-being and health-related quality of life: a two country cross-sectional study.

Aim: To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations. Participants: PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI). Method: A cross-sectional postal questionnaire was sent to PCa survivors 2–18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into ‘late disease’ (stage III/IV and any Gleason grade (GG) at diagnosis) and ‘early disease’ (stage I/II and GG 2–7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression. Results: 3348 men responded (RoI n=2567; NI n=781; reflecting population sizes, response rate 54%). RoI responders were younger; less often had comorbidities (45% vs 38%); were more likely to present asymptomatically (66%; 41%) or with early disease (56%; 35%); and less often currently used androgen deprivation therapy (ADT; 2%; 28%). Current prevalence of incontinence (16%) and impotence (56% early disease, 67% late disease) did not differ between RoI and NI. In early disease, only current bowel problems (RoI 12%; NI 21%) differed significantly in multivariate analysis. In late disease, NI men reported significantly higher levels of gynaecomastia (23% vs 9%) and hot flashes(41% vs 19%), but when ADT users were analysed separately, differences disappeared. For HRQoL, in multivariate analysis, only pain (early disease: RoI 11.1, NI 19.4) and financial difficulties (late disease: RoI 10.4, NI 7.9) differed significantly between countries. There were no significant between-country differences in DASS-21 or index ED-5D-5L score. Conclusions: Treatment side effects were commonly reported and increased PCa detection in RoI has left more men with these side effects. We recommended that men be offered a PSA test only after informed discussion.

Outcropping reef ledges drive patterns of epibenthic assemblage diversity on cross-shelf habitats

Seafloor habitats on continental shelf margins are increasingly being the subject of worldwide conservation efforts to protect them from human activities due to their biological and economic value. Quantitative data on the epibenthic taxa which contributes to the biodiversity value of these continental shelf margins is vital for the effectiveness of these efforts, especially at the spatial resolution required to effectively manage theseecosystems. We quantified the diversity of morphotype classes on an outcropping reef system characteristic of the continental shelf margin in the Flinders Commonwealth Marine Reserve, southeastern Australia. The system is uniquely characterized by long linear outcropping ledge features in sedimentary bedrock that differ markedly from the surrounding low-profile, sand-inundated reefs. We characterize a reef system harboring rich morphotype classes, with a total of 55 morphotype classes identified from the still images captured by an autonomous underwater vehicle. The morphotype class Cnidaria/Bryzoa/Hydroid matrix dominated the assemblages recorded. Both a and b diversitydeclined sharply with distance from nearest outcropping reef ledge feature. Patterns of the morphotype classes were characterized by (1) morphotype turnover at scales of 5 to 10s m from nearest outcropping reef ledge feature, (2) 30 % of morphotype classes were recordedonly once (i.e. singletons), and (3) generally low levels of abundance (proportion cover) of the component morphotype class. This suggests that the assemblages in this region contain a considerable number of locally rare morphotype classes. This study highlights the particular importance of outcropping reef ledge features in this region, as they provide a refuge against sediment scouring and inundation common on the low profile reef that characterizes this region. As outcropping reef features, they represent a small fraction of overall reef habitat yet contain much of the epibenthic faunal diversity. This study has relevance to conservation planning for continental shelf habitats, as protecting a single, or few, areas of reef is unlikely to accurately represent the geomorphic diversity of cross-shelf habitats and the morphotype diversity that is associated with these features. Equally, whendesigning monitoring programs these spatially-discrete, but biologically rich outcropping reef ledge features should be considered as distinct components in stratified sampling designs.

The writings of George Eliot; Adam Bede

UANL

The inner life of George Eliot,

Mode of access: Internet.

The personal edition of George Eliot's works.

[v. 2] Daniel Deronda.--[v. 4] Felix Holt. Impressions of Theophrastus Such.--[v. 5-6] Life and letters.--[v. 7-8] Middlemarch.--[v. 9] The mill on the Floss.--[v. 10] Poems, Essays, and Leaves from a note.--[v. 12] Silas Marner. The lifted veil. Brother Jacob. Clerical life.

The works of George Eliot ...

[v. 1-2] Adam Bede.--[v. 3-5] Daniel Deronda.--[v. 6] Essays and Leaves from a note book.--[v. 7-8] Felix Holt.--[v. 9] Impressions of Theophrastis Such.--[v. 10] The legend of Jubal, and other poems.--[v. 11-13] George Eliot's life as related in her letters and journals, arranged and ed. by her husband, J. W. Cross.--[v. 14-16] Middlemarch.--[v. 17-18] Mill on the Floss.--[v. 19-20] Romola.--[v. 21-22] Scenes of clerical life.--[v. 23] Silas Marner. The lifted veil. Brother Jacob.--[v. 24] The Spanish gypsy.

The complete works of George Eliot...

v. 1 Adam Bede. The lifted veil.--v. 2 The Mill on the floss. Brother Jacob. Leaves from a note book.--v. 3 Scenes of clerical life. Essays. --v. 44 Romola.--v. 5 Middlemarch. pt.1 & pt.2.--v. 6 Middlemarch. pt.3. Silas Marner.. Daniel Deronda pt.1.--v.7 Daniel Deronda.--pt.2 & pt.3.--v. 8. Felix Holt. Theophrastus such.--v. 9 Poems. Life of George Eliot. pt.1.--v.10 Life of George Eliot. pt.2 & pt.3.

Wit and wisdom of George Eliot.

Mode of access: Internet.

Child-sketches from George Eliot : glimpses at the boys and girls in the romances of the great novelist /

Five of these sketches were originally published in St. Nicholas magazine.

Novels of George Eliot ...

Each volume has special t.-p.

The works of George Eliot.

Each volume has individual title page.

The personal edition of George Eliot's works.

Mode of access: Internet.

Writings of George Eliot.

Athenaeum edition.