Oesophageal Cancer in Transkei
- Authors: Stepien, Andrzej
- Date: 2009
- Subjects: Esophagus -- Cancer -- South Africa Stomach -- Cancer Cancer -- Patients
- Language: English
- Type: text , Lectures
- Identifier: http://hdl.handle.net/11260/769 , vital:29751
- Description: The oesophagus is a part of the digestive canal between the pharynx and the stomach. It is about 25 cm. long in adults. From inside, it is covered by multilayered squamous epithelium, separated by a basement membrane from deeper tissues that include submucosa, muscle layer and adventitia from outside. Two functional sphincters are located at both ends of the oesophagus, and some glands are present within its wall, which lubricate the surface by its mucin product, contributing to easier swallowing. Knowledge of those structures makes an easier understanding as to the occurrence of squamous cell carcinoma developing in the oesophagus, its spread; it also helps to understand the signs and symptoms of oesophageal carcinoma.
- Full Text:
- Authors: Stepien, Andrzej
- Date: 2009
- Subjects: Esophagus -- Cancer -- South Africa Stomach -- Cancer Cancer -- Patients
- Language: English
- Type: text , Lectures
- Identifier: http://hdl.handle.net/11260/769 , vital:29751
- Description: The oesophagus is a part of the digestive canal between the pharynx and the stomach. It is about 25 cm. long in adults. From inside, it is covered by multilayered squamous epithelium, separated by a basement membrane from deeper tissues that include submucosa, muscle layer and adventitia from outside. Two functional sphincters are located at both ends of the oesophagus, and some glands are present within its wall, which lubricate the surface by its mucin product, contributing to easier swallowing. Knowledge of those structures makes an easier understanding as to the occurrence of squamous cell carcinoma developing in the oesophagus, its spread; it also helps to understand the signs and symptoms of oesophageal carcinoma.
- Full Text:
Potter's fingerprints: some prehistoric southern African utilityware in an intimate light.
- Authors: Steele, John
- Date: 2003
- Language: English
- Type: text , Article
- Identifier: http://hdl.handle.net/11260/945 , vital:30070
- Description: Extensive archaeological excavations in southern Africa during the past century have revealed a richly described heritage of widely distributed First-Millennium (C.E.) Agriculturist ceramics. In viewing both artefacts and assessments thereof it can be observed that ways of thinking shape ways of seeing, and explanations ofwhat is seen. Thus, because conceptual frameworks are inseparable from what is observed and explanations that result, consideration is given to some particular mindsets that have led to recent theories concenring local prehistoric material culture. In conclusion, a brief look at dialogues initiated by some contemporary potters who interrogate cherished lifeways and belief systems serve to elucidate current trends towards finding meaning in prehistoric southern African ceramics.
- Full Text:
- Authors: Steele, John
- Date: 2003
- Language: English
- Type: text , Article
- Identifier: http://hdl.handle.net/11260/945 , vital:30070
- Description: Extensive archaeological excavations in southern Africa during the past century have revealed a richly described heritage of widely distributed First-Millennium (C.E.) Agriculturist ceramics. In viewing both artefacts and assessments thereof it can be observed that ways of thinking shape ways of seeing, and explanations ofwhat is seen. Thus, because conceptual frameworks are inseparable from what is observed and explanations that result, consideration is given to some particular mindsets that have led to recent theories concenring local prehistoric material culture. In conclusion, a brief look at dialogues initiated by some contemporary potters who interrogate cherished lifeways and belief systems serve to elucidate current trends towards finding meaning in prehistoric southern African ceramics.
- Full Text:
Revisiting nomenclature: 'Early Iron Age', 'First-Millennium Agriculturist', or what?
- Authors: Steele, John
- Date: 2001
- Language: English
- Type: text , Article
- Identifier: http://hdl.handle.net/11260/934 , vital:30067
- Description: As an art historian who has recently become fascinated by First-Millennium Agriculturist ceramics, I have come across several attempts at dealing with an issue of appropriate nomenclature for desigrrating this era. Conceptual frameworks are articulated using words, yet an apparent discomfort with the term Early Iron Age has seemingly not led to a consistently used altemative. I have been wondering about this and, with respect, offer my thoughts on the matter in a hope that debate will be furthered. Hereunder I utilise aspects of the KwaZulu-Natal and Eastem Cape first millennium ceramic sequence to address some significances associated with such artefacts in interpretations of the past, and then discuss some ways in which ideas of particular social contexts are embedded in language. Thereafter introduction of the term Iron Age into South African archaeology is referred to with reference to past and current usage, and advantages/disadvantages of alternatives are suggested.
- Full Text:
- Authors: Steele, John
- Date: 2001
- Language: English
- Type: text , Article
- Identifier: http://hdl.handle.net/11260/934 , vital:30067
- Description: As an art historian who has recently become fascinated by First-Millennium Agriculturist ceramics, I have come across several attempts at dealing with an issue of appropriate nomenclature for desigrrating this era. Conceptual frameworks are articulated using words, yet an apparent discomfort with the term Early Iron Age has seemingly not led to a consistently used altemative. I have been wondering about this and, with respect, offer my thoughts on the matter in a hope that debate will be furthered. Hereunder I utilise aspects of the KwaZulu-Natal and Eastem Cape first millennium ceramic sequence to address some significances associated with such artefacts in interpretations of the past, and then discuss some ways in which ideas of particular social contexts are embedded in language. Thereafter introduction of the term Iron Age into South African archaeology is referred to with reference to past and current usage, and advantages/disadvantages of alternatives are suggested.
- Full Text:
Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries
- Talib, Zohray, van Schalkwyk, Susan, Cooper , I, Pattanaik , Swaha, Turay , Khadija, Sagay, Atiene S, Baingana , Rhona, Baird , Sarah, Gaede , Bernhard, Iputo, Jehu, Kibore , Minnie, Manongi , Rachel, Matsika , Antony, Mogodi , Mpho, Ramucesse , Jeremais, Ross, Heather, Simuyeba, Moses, Haile-Mariam, Damen
- Authors: Talib, Zohray , van Schalkwyk, Susan , Cooper , I , Pattanaik , Swaha , Turay , Khadija , Sagay, Atiene S , Baingana , Rhona , Baird , Sarah , Gaede , Bernhard , Iputo, Jehu , Kibore , Minnie , Manongi , Rachel , Matsika , Antony , Mogodi , Mpho , Ramucesse , Jeremais , Ross, Heather , Simuyeba, Moses , Haile-Mariam, Damen
- Date: 10-2017
- Subjects: Sub Sahara Africa Medical Education Health Care Medical Students Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5786 , vital:44644 , https://doi:10.1097/ACM.0000000000002003
- Description: Purpose: African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Method: Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. Results: The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Conclusions: Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.
- Full Text:
- Authors: Talib, Zohray , van Schalkwyk, Susan , Cooper , I , Pattanaik , Swaha , Turay , Khadija , Sagay, Atiene S , Baingana , Rhona , Baird , Sarah , Gaede , Bernhard , Iputo, Jehu , Kibore , Minnie , Manongi , Rachel , Matsika , Antony , Mogodi , Mpho , Ramucesse , Jeremais , Ross, Heather , Simuyeba, Moses , Haile-Mariam, Damen
- Date: 10-2017
- Subjects: Sub Sahara Africa Medical Education Health Care Medical Students Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5786 , vital:44644 , https://doi:10.1097/ACM.0000000000002003
- Description: Purpose: African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Method: Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. Results: The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Conclusions: Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.
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A Review of Arterial Stiffness and HIV Infection in Adult Africans
- Awotedu, Kofoworola Olajire, Iputo, Jehu
- Authors: Awotedu, Kofoworola Olajire , Iputo, Jehu
- Date: 09-06-2016
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/3484 , vital:43615 , https://www.hilarispublisher.com/open-access/a-review-of-arterial-stiffness-and-hiv-infection-in-adult-africans-2167-1095-1000221.pdf
- Description: Aim: To review the impact of the human immunodeficiency virus and antiretroviral therapy on the vasculature. Objectives: This review seeks to identify the burden which the human immunodeficiency virus and antiretroviral therapy have on the vasculature. Method: Medline/PubMed and Google scholar were searched. There were over 100 publications reviewed. Some people who worked in similar fields were also contacted. The present review summarized current understanding of Human immunodeficiency virus, antiretroviral therapy and effect on the vasculature such as arterial stiffness. Atherosclerosis, endothelial dysfunction, the strengths and weaknesses of current testing strategies, and their potential applications in clinical research and patient care. The association of inflammatory biomarkers, blood pressure and ageing with arterial stiffness were also reviewed. Conclusion: Available literature shows that HIV and antiretroviral agents have a great impact on the vasculature and its progression.
- Full Text:
- Authors: Awotedu, Kofoworola Olajire , Iputo, Jehu
- Date: 09-06-2016
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/3484 , vital:43615 , https://www.hilarispublisher.com/open-access/a-review-of-arterial-stiffness-and-hiv-infection-in-adult-africans-2167-1095-1000221.pdf
- Description: Aim: To review the impact of the human immunodeficiency virus and antiretroviral therapy on the vasculature. Objectives: This review seeks to identify the burden which the human immunodeficiency virus and antiretroviral therapy have on the vasculature. Method: Medline/PubMed and Google scholar were searched. There were over 100 publications reviewed. Some people who worked in similar fields were also contacted. The present review summarized current understanding of Human immunodeficiency virus, antiretroviral therapy and effect on the vasculature such as arterial stiffness. Atherosclerosis, endothelial dysfunction, the strengths and weaknesses of current testing strategies, and their potential applications in clinical research and patient care. The association of inflammatory biomarkers, blood pressure and ageing with arterial stiffness were also reviewed. Conclusion: Available literature shows that HIV and antiretroviral agents have a great impact on the vasculature and its progression.
- Full Text:
Iodine nutrition status in Africa: Potentially high prevalence of iodine deficiency in pregnancy even in countries classified as iodine sufficient
- Charles Bitamazire Businge, Benjamin Longo-Mbenza, Andre Pascal Kengne
- Authors: Charles Bitamazire Businge , Benjamin Longo-Mbenza , Andre Pascal Kengne
- Date: 03-8-2020
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/3377 , vital:43336 , https://www.cambridge.org/core/journals/public-health-nutrition/article/iodine-nutrition-status-in-africa-potentially-high-prevalence-of-iodine-deficiency-in-pregnancy-even-in-countries-classified-as-iodine-sufficient/B3DCB06E75CDDD8EAD410BE090198BA4
- Description: Objective: To assess the burden of iodine deficiency in pregnancy in Africa using estimated pregnancy median urinary iodine concentration (pMUIC). Design: pMUIC for each African country was estimated using a regression equation derived by correlating the school-age children (SAC) median UIC (mUIC) and pMUIC from countries around the globe, and the SAC mUIC data for African countries obtained from the Iodine Global Network (IGN) 2017 and 2019 Score cards. Setting: Iodine deficiency was endemic in many African countries before the introduction of iodine fortification, mainly through universal salt iodisation programmes about 25 years ago. There is a scarcity of data on the level of iodine nutrition in pregnancy in Africa. Women living in settings with pMUIC below 150 μg/l are at risk of iodine deficiency-related pregnancy complications. Participants: Fifty of the fifty-five African countries that had data on iodine nutrition status. Results: A cut-off school age mUIC ≤ 175 μg/l is correlated with insufficient iodine intake in pregnancy (pregnancy mUIC ≤ 150 μg/l). Twenty-two African countries had SAC mUIC less than 175 μg/l, which correlated with insufficient iodine intake during pregnancy (pMUIC less than 150 μg/l). However, nine of these twenty-two countries had adequate iodine intake based on SAC mUIC. Conclusions: There is likely a high prevalence of insufficient iodine intake in pregnancy, including in some African countries classified as having adequate iodine intake in the general population. A SAC mUIC ≤ 175 μ
- Full Text:
- Authors: Charles Bitamazire Businge , Benjamin Longo-Mbenza , Andre Pascal Kengne
- Date: 03-8-2020
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/3377 , vital:43336 , https://www.cambridge.org/core/journals/public-health-nutrition/article/iodine-nutrition-status-in-africa-potentially-high-prevalence-of-iodine-deficiency-in-pregnancy-even-in-countries-classified-as-iodine-sufficient/B3DCB06E75CDDD8EAD410BE090198BA4
- Description: Objective: To assess the burden of iodine deficiency in pregnancy in Africa using estimated pregnancy median urinary iodine concentration (pMUIC). Design: pMUIC for each African country was estimated using a regression equation derived by correlating the school-age children (SAC) median UIC (mUIC) and pMUIC from countries around the globe, and the SAC mUIC data for African countries obtained from the Iodine Global Network (IGN) 2017 and 2019 Score cards. Setting: Iodine deficiency was endemic in many African countries before the introduction of iodine fortification, mainly through universal salt iodisation programmes about 25 years ago. There is a scarcity of data on the level of iodine nutrition in pregnancy in Africa. Women living in settings with pMUIC below 150 μg/l are at risk of iodine deficiency-related pregnancy complications. Participants: Fifty of the fifty-five African countries that had data on iodine nutrition status. Results: A cut-off school age mUIC ≤ 175 μg/l is correlated with insufficient iodine intake in pregnancy (pregnancy mUIC ≤ 150 μg/l). Twenty-two African countries had SAC mUIC less than 175 μg/l, which correlated with insufficient iodine intake during pregnancy (pMUIC less than 150 μg/l). However, nine of these twenty-two countries had adequate iodine intake based on SAC mUIC. Conclusions: There is likely a high prevalence of insufficient iodine intake in pregnancy, including in some African countries classified as having adequate iodine intake in the general population. A SAC mUIC ≤ 175 μ
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Fundal pressure during the second stage of labour
- Hofmeyr, Georges Justus, Vogel, Joshua. P, Cuthbert, Anna, Singata, Mandisa
- Authors: Hofmeyr, Georges Justus , Vogel, Joshua. P , Cuthbert, Anna , Singata, Mandisa
- Date: 03-2017
- Subjects: South Africa Pregnancy Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5766 , vital:44640 , https://DOI:10.1002/14651858.CD006067.pub3
- Description: Background Fundal pressure during the second stage of labour (also known as the 'Kristeller manoeuvre') involves application of manual pressure to the uppermost part of the uterus directed towards the birth canal, in an attempt to assist spontaneous vaginal birth and avoid prolonged second stage orthe need for operative birth. Fundal pressure has also been applied using an inflatable belt. Fundal pressure is widely used, however methods of its use vary widely. Despite strongly held opinions in favour of and against the use of fundal pressure, there is limited evidence regarding its maternal and neonatal benefits and harms. There is a need for objective evaluation of the eGectiveness and safety of fundal pressure in the second stage of labour. Objectives To determine if fundal pressure is eGective in achieving spontaneous vaginal birth, and preventing prolonged second stage or the need for operative birth, and to explore maternal and neonatal adverse eGects related to fundal pressure. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register (30 November 2016) and reference lists of retrieved studies. Selection criteria Randomised and quasi-randomised controlled trials of fundal pressure (manual or by inflatable belt) versus no fundal pressure in women in the second stage of labour with singleton cephalic presentation. Data collection and analysis Two or more review authors independently assessed potential studies for inclusion and quality. We extracted data using a pre-designed form. We entered data into Review Manager 5 soAware and checked for accuracy. Main results Nine trials are included in this updated review. Five trials (3057 women) compared manual fundal pressure versus no fundal pressure. Four trials (891 women) compared fundal pressure by means of an inflatable belt versus no fundal pressure. It was not possible to blind women and staG to this intervention. We assessed two trials as being at high risk of attrition bias and another at high risk of reporting bias. All other trials were low or unclear for other risk of bias domains. Most of the trials had design limitations. Heterogeneity was high for the majority of outcomes. Manual fundal pressure versus no fundal pressure Manual fundal pressure was not associated with changes in: spontaneous vaginal birth within a specified time (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.71 to 1.28; 120 women; 1 trial; very low-quality evidence), instrumental births (RR 3.28, 95% CI 0.14 to 79.65; 197 women; 1 trial), caesarean births (RR 1.10, 95% CI 0.07 to 17.27; 197 women; 1 trial), operative birth (average RR 0.66, 95% CI 0.12 to 3.55; 317 women; 2 studies; I2 = 43%; Tau2 = 0.71; very low-quality evidence), duration of second stage (mean diGerence (MD) -0.80 minutes, 95% CI -3.66 to 2.06 minutes; 194 women; 1 study; very low-quality evidence), low arterial cord pH in newborn babies (RR 1.07, 95% CI 0.72 to 1.58; 297 women; 2 trials; very low-quality evidence), or Apgar scores less than seven at five minutes (average RR 4.48, 95% CI 0.28 to 71.45; 2759 infants; 4 trials; I2 = 89%; Tau2 = 3.55; very low-quality evidence). More women who received manual fundal pressure had cervical tears than in the control group (RR 4.90, 95% CI 1.09 to 21.98; 295 women; 1 trial). No neonatal deaths occurred in either of the two studies reporting this outcome (very low-quality evidence). No trial reported the outcome severe maternal morbidity or death. Fundal pressure by inflatable belt versus no fundal pressure Fundal pressure by inflatable belt did not reduce the number of women havinginstrumental births (average RR 0.73, 95% CI 0.52 to 1.02; 891 women; 4 trials; I2 = 52%; Tau2 = 0.05) or operative births (average RR 0.62, 95% CI 0.38 to 1.01; 891 women; 4 trials; I2 = 78%; Tau2 = 0.14; very low-quality evidence). Heterogeneity was high for both outcomes. Duration of second stage was reported in two trials, which both showed that inflatable belts shortened duration of labour in nulliparous women (average MD -50.80 minutes, 95% CI -94.85 to -6.74 minutes; 253 women; 2 trials; I2 = 97%; Tau2 = 975.94; very low-quality evidence). No data on this outcome were available for multiparous women. The inflatable belt did not make any diGerence to rates of caesarean births (average RR 0.56, 95% CI 0.14 to 2.26; 891 women; 4 trials; I2 = 70%; Tau2 = 0.98), low arterial cord pHin newborn babies (RR 0.47, 95% CI 0.09 to 2.55; 461 infants; 1 trial; low-quality evidence), or Apgar scores less than seven atfive minutes (RR 4.62, 95% CI 0.22 to 95.68; 500 infants; 1 trial; very low-quality evidence). Third degree perinealtears were increased in the inflatable belt group (RR 15.69, 95% CI 2.10 to 117.02; 500 women; 1 trial). Spontaneous vaginal birth within a specified time, neonatal death, andsevere maternal morbidity or death were not reported in any trial. Authors' conclusions There is insuGicient evidence to draw conclusions on the beneficial or harmful eGects of fundal pressure, either manually or by inflatable belt. Fundal pressure by an inflatable belt during the second stage of labour may shorten duration of second stage for nulliparous women, and lower rates of operative birth. However, existing studies are small and their generalizability is uncertain. There is insuGicient evidence regarding safety for the baby. There is no evidence on the use of fundal pressure in specific clinical settings such as inability of the mother to bear down due to exhaustion or unconsciousness. There is currently insuGicient evidence for the routine use of fundal pressure by any method on women in the second stage of labour. Because of current widespread use of the procedure and the potential for use in settings where other methods of assisted birth are not available, further good quality trials are needed. Further evaluation in other groups of women (such as multiparous women) will also be required. Future research should describe in detail how fundal pressure was applied and consider safety of the unborn baby, perineal outcomes, longer-term maternal and infant outcomes and maternal satisfaction.
- Full Text:
- Authors: Hofmeyr, Georges Justus , Vogel, Joshua. P , Cuthbert, Anna , Singata, Mandisa
- Date: 03-2017
- Subjects: South Africa Pregnancy Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5766 , vital:44640 , https://DOI:10.1002/14651858.CD006067.pub3
- Description: Background Fundal pressure during the second stage of labour (also known as the 'Kristeller manoeuvre') involves application of manual pressure to the uppermost part of the uterus directed towards the birth canal, in an attempt to assist spontaneous vaginal birth and avoid prolonged second stage orthe need for operative birth. Fundal pressure has also been applied using an inflatable belt. Fundal pressure is widely used, however methods of its use vary widely. Despite strongly held opinions in favour of and against the use of fundal pressure, there is limited evidence regarding its maternal and neonatal benefits and harms. There is a need for objective evaluation of the eGectiveness and safety of fundal pressure in the second stage of labour. Objectives To determine if fundal pressure is eGective in achieving spontaneous vaginal birth, and preventing prolonged second stage or the need for operative birth, and to explore maternal and neonatal adverse eGects related to fundal pressure. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register (30 November 2016) and reference lists of retrieved studies. Selection criteria Randomised and quasi-randomised controlled trials of fundal pressure (manual or by inflatable belt) versus no fundal pressure in women in the second stage of labour with singleton cephalic presentation. Data collection and analysis Two or more review authors independently assessed potential studies for inclusion and quality. We extracted data using a pre-designed form. We entered data into Review Manager 5 soAware and checked for accuracy. Main results Nine trials are included in this updated review. Five trials (3057 women) compared manual fundal pressure versus no fundal pressure. Four trials (891 women) compared fundal pressure by means of an inflatable belt versus no fundal pressure. It was not possible to blind women and staG to this intervention. We assessed two trials as being at high risk of attrition bias and another at high risk of reporting bias. All other trials were low or unclear for other risk of bias domains. Most of the trials had design limitations. Heterogeneity was high for the majority of outcomes. Manual fundal pressure versus no fundal pressure Manual fundal pressure was not associated with changes in: spontaneous vaginal birth within a specified time (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.71 to 1.28; 120 women; 1 trial; very low-quality evidence), instrumental births (RR 3.28, 95% CI 0.14 to 79.65; 197 women; 1 trial), caesarean births (RR 1.10, 95% CI 0.07 to 17.27; 197 women; 1 trial), operative birth (average RR 0.66, 95% CI 0.12 to 3.55; 317 women; 2 studies; I2 = 43%; Tau2 = 0.71; very low-quality evidence), duration of second stage (mean diGerence (MD) -0.80 minutes, 95% CI -3.66 to 2.06 minutes; 194 women; 1 study; very low-quality evidence), low arterial cord pH in newborn babies (RR 1.07, 95% CI 0.72 to 1.58; 297 women; 2 trials; very low-quality evidence), or Apgar scores less than seven at five minutes (average RR 4.48, 95% CI 0.28 to 71.45; 2759 infants; 4 trials; I2 = 89%; Tau2 = 3.55; very low-quality evidence). More women who received manual fundal pressure had cervical tears than in the control group (RR 4.90, 95% CI 1.09 to 21.98; 295 women; 1 trial). No neonatal deaths occurred in either of the two studies reporting this outcome (very low-quality evidence). No trial reported the outcome severe maternal morbidity or death. Fundal pressure by inflatable belt versus no fundal pressure Fundal pressure by inflatable belt did not reduce the number of women havinginstrumental births (average RR 0.73, 95% CI 0.52 to 1.02; 891 women; 4 trials; I2 = 52%; Tau2 = 0.05) or operative births (average RR 0.62, 95% CI 0.38 to 1.01; 891 women; 4 trials; I2 = 78%; Tau2 = 0.14; very low-quality evidence). Heterogeneity was high for both outcomes. Duration of second stage was reported in two trials, which both showed that inflatable belts shortened duration of labour in nulliparous women (average MD -50.80 minutes, 95% CI -94.85 to -6.74 minutes; 253 women; 2 trials; I2 = 97%; Tau2 = 975.94; very low-quality evidence). No data on this outcome were available for multiparous women. The inflatable belt did not make any diGerence to rates of caesarean births (average RR 0.56, 95% CI 0.14 to 2.26; 891 women; 4 trials; I2 = 70%; Tau2 = 0.98), low arterial cord pHin newborn babies (RR 0.47, 95% CI 0.09 to 2.55; 461 infants; 1 trial; low-quality evidence), or Apgar scores less than seven atfive minutes (RR 4.62, 95% CI 0.22 to 95.68; 500 infants; 1 trial; very low-quality evidence). Third degree perinealtears were increased in the inflatable belt group (RR 15.69, 95% CI 2.10 to 117.02; 500 women; 1 trial). Spontaneous vaginal birth within a specified time, neonatal death, andsevere maternal morbidity or death were not reported in any trial. Authors' conclusions There is insuGicient evidence to draw conclusions on the beneficial or harmful eGects of fundal pressure, either manually or by inflatable belt. Fundal pressure by an inflatable belt during the second stage of labour may shorten duration of second stage for nulliparous women, and lower rates of operative birth. However, existing studies are small and their generalizability is uncertain. There is insuGicient evidence regarding safety for the baby. There is no evidence on the use of fundal pressure in specific clinical settings such as inability of the mother to bear down due to exhaustion or unconsciousness. There is currently insuGicient evidence for the routine use of fundal pressure by any method on women in the second stage of labour. Because of current widespread use of the procedure and the potential for use in settings where other methods of assisted birth are not available, further good quality trials are needed. Further evaluation in other groups of women (such as multiparous women) will also be required. Future research should describe in detail how fundal pressure was applied and consider safety of the unborn baby, perineal outcomes, longer-term maternal and infant outcomes and maternal satisfaction.
- Full Text:
E LEARNING AND CONVENTIONAL LEARNING IN 21 ST CENTURY INFORMATION AGE A CASE STUDY OF STUDENTS FROM SELECTED UNIVERSITIES IN BUFFALO CITY METROPOLITAN EASTERN CAPE SOUTH AFRICA
- Authors: Adgei Fosu
- Subjects: E learning
- Language: English
- Identifier: http://hdl.handle.net/11260/1941 , vital:38903
- Full Text:
- Authors: Adgei Fosu
- Subjects: E learning
- Language: English
- Identifier: http://hdl.handle.net/11260/1941 , vital:38903
- Full Text: