Background Malaria during pregnancy can cause serious consequences including maternal anemia and low birthweight (LBW). Routine antenatal care (ANC) in Rwanda includes malaria symptom screening at each ANC visit. This cluster randomized controlled trial investigated whether adding intermittent screening with a malaria rapid diagnostic test (RDT) at each routine ANC visit and treatment of positives during pregnancy (ISTp) is more effective than routine ANC for reducing malaria prevalence at delivery. Methods Between September 2016- June 2018, pregnant women initiating ANC at 14 health centers in Rwanda were enrolled into ISTp or control arms. All women received an insecticide-treated bed net at enrolment. Hemoglobin concentration, placental and peripheral parasitemia, newborn outcome, birthweight, and prematurity were assessed at delivery. Results 975 were enrolled in ISTp and 811 in the control. Routine ANC plus ISTp did not significantly reduce PCR-confirmed placental malaria compared to control (adjusted relative risk [aRR] 0.94, 95% confidence interval [CI] 0.59–1.50, p=0.799). ISTp had no impact on anemia (aRR 1.08, 95% CI 0.57-2.04, p=0.821). The mean birthweight of singleton newborns was not significantly different between arms (3054gm vs 3096gm, p=0.395), however women in the ISTp arm had a higher proportion of LBW (aRR = 1.59, 95% CI 1.02-2.49, p=0.042). Conclusions This is the only study to compare ISTp to symptomatic screening at ANC in a setting where intermittent preventive treatment is not routinely provided. ISTp did not reduce the prevalence of malaria or anemia at delivery and was associated with an increased risk of LBW. Clinical Trials Registration NCT03508349
<b><i>Introduction:</i></b> Knowledge gaps regarding available treatment and social stigmatization are barriers to care in patients with overactive bladder (OAB). We assessed the feasibility of an OAB education program targeting older community-dwelling females. <b><i>Methods:</i></b> Community-dwelling women over 55 years old were recruited. Eligible participants underwent an education program covering continence-promotion strategies. The Overactive Bladder Questionnaire-Short Form and Short Form-12 were completed at baseline, 1 week, 3 months, and 6 months post-intervention to measure symptom bother and condition-specific and general quality of life (QoL). Data were analyzed using a linear mixed-effects model for repeated measures. <b><i>Results:</i></b> Thirty-seven female patients with OAB symptoms at baseline were assessed with the majority from Latino/Hispanic or Black/African American ethnic/racial backgrounds. For our youngest subgroup (≤68 years old), significant improvements were observed at 3 and 6 months compared to 1 week post-intervention for symptom bother (3 months, −22.75, <i>p</i> = 0.006; 6 months, −25.76; <i>p</i> = 0.001) and condition-specific and health-related QoL subscale scores for concern (3 months, +23.76, <i>p</i> = 0.006; 6 months, +22.15, <i>p</i> = 0.011) and social interaction (3 months, +21.11, <i>p</i> = 0.017; 6 months, +20.51; <i>p</i> = 0.021). For all age subgroups, improvements in general QoL measures for mental health were seen at 3 and 6 months compared to baseline (3 months, +7.57, <i>p</i> = 0.02; 6 months, +6.70; <i>p</i> = 0.048). <b><i>Conclusions:</i></b> Statistically significant improvements in symptom bother, condition-specific, and general QoL measures were observed following an OAB education program pilot study in a predominantly minority female population. Further studies are needed to support efficacy and optimize program design.
The reputation of the Normans is rooted in warfare, faith and mobility. They were simultaneously famed as warriors, noted for their religious devotion, and celebrated as fearless travellers. In the Middle Ages few activities offered a better conduit to combine warfare, religiosity, and movement than crusading and pilgrimage. However, while scholarship is abundant on many facets of the Norman world, it is a surprise that the Norman relationship with crusading and pilgrimage, so central in many ways to Norman identity, has hitherto not received extensive treatment.<BR> The collection here seeks to fill this gap. It aims to identify what was unique or different about the Normans and their relationship with crusading and pilgrimage, as well as how and why crusade and pilgrimage were important to the Normans. Particular focus is given to Norman participation in the First Crusade, to Norman interaction in later crusading initiatives, to the significance of pilgrimage in diverse parts of the Norman world, and finally to the ways in which crusading and pilgrimage were recorded in Norman narrative. Ultimately, this volume aims to assess, in some cases to confirm, and in others to revise the established paradigm of the Normans as crusaders <I>par excellence</I> and as opportunists who used religion to serve other agendas.<BR><BR> Dr Kathryn Hurlock is Senior Lecturer in Medieval History at Manchester Metropolitan University; Dr Paul Oldfield is Lecturer in Medieval History at the University of Manchester.<BR><BR> Contributors: Andrew Abram, William M. Aird, Emily Albu, Joanna Drell, Leonie Hicks, Natasha Hodgson, Kathryn Hurlock, Alan V. Murray, Paul Oldfield, David S. Spear, Lucas Villegas-Aristizábal.
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