OBJECTIVE: An in-depth evaluation of rural immunization services in Papua New Guinea was conducted to determine the reasons for poor immunization coverage, as well as to document the impact of recent efforts to strengthen the national immunization program. METHOD: A qualitative process was used to complement quantitative monitoring data. An interview process, based on open-ended questions, active listening and observation, was designed whereby a team of program supervisors collected information from rural health staff. The teams interviewed health staff in 30 health centres that were selected to provide examples of contrasting field situations. RESULTS: This qualitative review provided valuable detail about why immunization services were failing, encompassing locally specific weaknesses, such as logistic reasons for not conducting outreach, and generic systemic problems such as lack of access to funding. In addition, the information gathered provided details on local solutions developed by better-performing facilities. Both these aspects added significant value to quantitative measures of program performance (derived from national health information system data and analysis of supervision checklists). The review also captured a number of behavioural reasons that will need to be overcome before an improvement in the services can be expected. CONCLUSIONS AND IMPLICATIONS: This in-depth evaluation provided valuable information about problems in peripheral immunization clinics and identified local solutions. The high level of detail collected will be important for planning future strengthening of the health system. The study modelled a supportive form of supervision with the potential to improve outcomes from future supervisory visits. Some of the major barriers to improved immunization were locally specific organizational issues, as well as complex human problems. While some issues can be remedied through further strengthening of immunization systems, others lack easy, rapid solutions.
Immunization ; Evaluation ; Health ; Papua New Guinea ; Review [Publication Type]

In many low-resource settings an estimated one-third of all births take place unsupervised with traditional and non-traditional villager birth attendants the only providers of care during pregnancy and childbirth. The training of village birth attendants (VBAs) in Milne Bay Province began in 1991, and has continued during a period of significant shifts in national and international public health policy. As part of a wider provincial-wide review of the VBA program we undertook 6 focus group discussions, 13 in-depth interviews and 8 key informant interviews in three districts in Milne Bay Province in 2014. In this paper we describe the role, responsibilities and function of VBAs, and the challenges facing both VBAs and those involved in their training and in supporting their work in the community. In this setting, VBAs continue to assist women during childbirth, and are frequently having to try and manage difficult obstetric complications with little or no support from their communities or local health facilities. Some VBAs reported being called too late by the community, with insufficient time to refer women on to a health facility, resulting in maternal deaths. Many VBAs continued with their practice, motivated by a heartfelt desire to serve, despite feeling ‘neglected’ and ‘overlooked’, while others continued because of their religious convictions and dedication to help their communities. There is an urgent need to better define what VBAs can and should do in this setting, what communities can realistically expect of their VBAs, and how professional health care workers can work more constructively with this long-standing cadre of lay health workers. There is a need for all health facilities and VBA trainers to support their VBAs, and to fully recognize the often difficult situations VBAs are required to work in while continuing to advocate for supervised, health facility births.

Non-operative management of blunt liver injury has been demonstrated as a safe and effective treatment for most grades of injury. As the severity of liver injury increases, so does the risk of complications. A 21-year-old male was brought to the trauma center following a high speed motorbike accident. He underwent a laparotomy and angioembolization for a Grade 4 liver injury. A biloma was diagnosed on Day 18 post injury, and he underwent Endoscopic Retrograde Cholangiopancreatography and biliary stenting which were unsuccessful. There were 2 re-admissions for infected perihepatic collections. In this case, an Endoscopic Retrograde Cholangiopancreatography was not a helpful procedure due to a disconnected liver segment, and morbidity occurred due to instrumentation of the biliary tree (the likely cause of infected biloma). Hepatic resection should be considered for patients who fail non-operative management. Further assessment of efficacy using a larger dataset for analysis is required.

OBJECTIVE: In this five-year cohort study, we hypothesize that factors of temperament and character in professional baseball players predict the speed of obtaining success and the quality of success as well as anxiety control. METHODS: Participants included 120 male rookie players from the Korea Baseball Organization (KBO) and 107 male non-players with no history of playing baseball. The personality/characters and state/trait anxieties of participants were assessed with the Temperament and Character Inventory (TCI) and Spielberg's State-Trait Anxiety Inventory-Y (STAI-Y). Over the duration of five years, all the players were subsequently classified into either a success group (major leaguers) or a non-success group (non-major leaguers), depending on their status in the professional baseball league in Korea. RESULTS: The players in the group of starters had higher novelty seeking (NS) scores than those of non-starters. The reward dependence (RD) scores of the success group were higher than those of the non-success group. The state anxiety scores in the starter group were negatively correlated with NS scores. The state and trait anxieties in the non-success group were positively correlated with RD scores. CONCLUSION: The results of this study suggest that predictive temperamental factors for success in baseball players include traits of novelty seeking and reward dependence.
Anxiety ; Baseball* ; Cohort Studies ; Humans ; Korea ; Male ; Reward ; Temperament*

OBJECTIVE: To determine imaging features that may separate adamantinomatous and papillary variants of craniopharyngiomas given that tumors with adamantinomatous signature features are associated with higher recurrence rates, morbidity, and mortality. We specifically reviewed calcification on CT, T1 bright signal intensity, and cystic change on T2 weighted images for differentiating these two types. METHODS: We retrospectively reviewed the MRI and CT studies in 38 consecutive patients with pathologically proven craniopharyngiomas between January 2004 and February 2014 for the presence of calcification on CT scans, bright signal intensity on T1 weighted images, and cystic change on T2 weighted images. RESULTS: Of the 38 craniopharyngiomas, 30 were adamantinomatous type and 8 were papillary type. On CT scans, calcification was present in 25 of 38 tumors. All calcified tumors were adamantinomatous type. Twenty four of 38 tumors had bright signal intensity on T1 weighted images. Of these 24 tumors, 22 (91.7%) were adamantinomatous and 2 were papillary type. Cystic change on T2 weighted images was noted in 37 of 38 tumors; only 1 tumor with papillary type did not show cystic change. CONCLUSION: T1 bright signal intensity and calcification on CT scans uniformly favor the adamantinomatous type over papillary type of craniopharyngioma in children. However, these findings are more variable in adults where calcification and T1 bright signal intensity occur in 70.6% and 58.8% respectively of adult adamantinomatous types of craniopharyngiomas.
Adult ; Child ; Craniopharyngioma* ; Humans ; Magnetic Resonance Imaging ; Mortality ; Recurrence ; Retrospective Studies ; Tomography Scanners, X-Ray Computed ; Tomography, X-Ray Computed

Background::Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.Methods::Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed.Results::A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43–0.68; P <0.001). At discharge, the prescription rate of OAC was 45.2% (16,757/37,087) in eligible patients with high stroke risk and 60.7% (2778/4578) in eligible patients with low stroke risk. OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time (all P <0.001). Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies, including catheter ablation (adjusted odds ratio [OR] 11.63, 95% confidence interval [CI] 10.04–13.47; P <0.001), electronic cardioversion (adjusted OR 2.41, 95% CI 1.65–3.51; P <0.001), and anti-arrhythmic drug use (adjusted OR 1.45, 95% CI 1.38–1.53; P <0.001). Conclusions::In hospitals participated in the CCC-AF project, >70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration::ClinicalTrials.gov, NCT02309398.

BACKGROUND: Microplastics pose a significant environmental and health threat, yet the understanding and response of young adults to this issue remain underexplored. There is an increasing amount of microplastics in our environment and as the numbers grow, the danger that comes with it is still not fully understood. This study aimed to explore the knowledge, attitudes, and practices (KAP) of young adults in Muntinlupa, particularly students of a public university regarding microplastics and their health implications. METHODS: Employing a quantitative cross-sectional design, the research targeted college students aged 18 and older. RESULTS: Findings revealed that while students were knowledgeable about microplastics—particularly their harmful effects on health—attitudes and practices related to plastic disposal and recycling could be improved. Although the majority engaged in proper garbage disposal, only 41.5% consistently separated plastic waste from biodegradable materials. However, a weak positive correlation between knowledge and attitudes was observed, suggesting that increased awareness may enhance positive attitudes toward reducing microplastic pollution. CONCLUSION These results suggest that while students are aware of microplastics and generally responded positively, there remains a gap in the translation of knowledge into practices, highlighting the need for enhanced educational interventions.
Microplastics ; knowledge ; attitudes ; young adult