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Background There is a growing number of adolescents and young adults living with HIV (YPLHIV) who require the transfer of care from pediatric/ adolescent clinics to adult Antiretroviral therapy (ART) clinics. A successful transition is critical for optimum health outcomes, yet facilities may lack infrastructure, human resources (with appropriate knowledge and skills), and a supportive environment, as only 3% of clinics in Uganda caring for YPLHIV have a process for supporting this critical transition from pediatric to adult care, and, facilitators and barriers of a successful transition are not well documented. The purpose of this study was to explore the facilitators and barriers of transitioning among adolescents from adolescent clinics to adult ART clinics. Method Eighteen focus group discussions were held in nine health facilities with 174 adolescents and YPLHIV to assess barriers and facilitators regarding transitioning to adult clinics. The focus group discussions were audio-recorded and transcribed. The Silences Framework using a thematic approach guided the analysis. Results The key emerging issues were: Unfriendly adults in adult clinics, Care provided in the adolescent clinics, fear of stigma from health care providers, Congestion and long waiting time, fear to lose friends were barriers to transitioning. Transitioning preparation is key to a successful transition, moving as a cohort facilitates transition, and care in adult clinics offers new opportunities, could facilitate readiness and transition. Conclusion YPLHIV expressed fear to transition to adult clinics mainly because of the perceived better care provided in the adolescent clinic, thus constituting a barrier to smooth transition A range of individual, social and health system and services-related factors hindered transitioning. The expectation of transitioning as a group, assurance of similar care as in the adolescent clinic, and guarantees of confidentiality, privacy, and autonomy in decision-making for care was perceived as facilitators. Understanding barriers and facilitators can enable the Ministry of Health to improve the quality of life of YPLHIV through linkage to care, adherence, retention, and viral suppression. There is a need to better planning and preparation for clinical providers and YPLHIV with a focus on age-appropriate and individualized case management transition as well as focus on improving both clinical and psychosocial support throughout the process.

Background Early discontinuation of implant contraceptive methods and reasons for discontinuation remains a major concern for family planning programs. Early discontinuation is related to higher rates of the overall fertility rate, unwanted pregnancies leading to possibly induced abortion. There is paucity of data on the practice of discontinuation of contraceptives in developing countries. The objective of the study was to determine the magnitude of early implants discontinuation among women receiving implants services in the study area and the factors associated with it. Methods A cross-sectional study was conducted from 2nd January to 3rd March 2020. Data were collected from 207 women who had come to remove implants on socio-demographic characteristics, obstetric history, duration of implant, and reasons for wanting to remove the implant. We computed the proportion of those who removed the implant before 18 months (early discontinuation). To assess the factors associated with early discontinuation, we estimated the prevalence ratios with a generalized linear model of the poisson family with a log link and robust error variance. Results The proportion of early implant discontinuation was 87/207(42%). Factor associated with early implant discontinuation included; experience of side effects (PR = 1.1; 95% CI 1.03–1.24; P = 0.001), not having received pre-insertion counseling about the benefits and side effects of contraceptive implants (PR = 1.5; 95% CI 1.02–1.30; P = 0.019) and staying in rural areas (PR = 1.1; 95% CI 1.03–1.27; P = 0.014). Conclusion Nearly one in every two mothers have early discontinuation of contraceptive implants. Factors associated with early implant removal include; experience of side effects, lack of counseling services, and staying in rural areas. There is a need for intervention to address high prevalence of early contraceptive removal through improving on counselling services about possible side effects.

Background/Aims The majority of maternal deaths occur during labour, delivery, or within the first 4 hours after birth. This can be reduced by the care that midwives provide. At Mulago Hospital, little is documented on midwives' current practice and their perception of care offered during labor and delivery. The number of maternal and neonatal deaths as a result of preventable causes such as postpartum haemorrhage, obstructed labour, ruptured uterus and sepsis remains high. The aim of this study was to document the current practice of midwives, explore midwives' perception towards practice and identify factors that influence practice during birth in Uganda, to identify possible areas for improvement. Methods A cross-sectional study was conducted of midwives working in the three labour wards at the Mulago National referral hospital: the general ward, the private ward and the midwifery-led ward. Midwives' perceptions were explored using a semi-structured questionnaire, which asked midwives about their current practice and their perception of the care offered. Findings Care was found to be lacking in several areas. Only one-fifth (20.0%) of midwives reported always checking temperature every 4 hours. Only 20.5% reported that women are always supported in being mobile during labour. Less than half of the midwives (44.4%) knew the recommended drugs for managing the third stage of labour. Infection prevention practices were poor. Only 54% of midwives knew how to prepare magnesium sulphate for management of severe pre-eclampsia and eclampsia. Overall, the general labour ward was found to have the most gaps in midwives' knowledge. Lack of continuing education, supplies, teamwork and clinical guidelines were reported to affect practice. Staff shortages and midwives' decisions being underlooked by obstetricians were also reported to affect practice. Conclusions Overall, the study found that midwifery practice is suboptimal in key areas such as infection prevention, use of a partograph, and management of pre-eclampsia and eclampsia. Continuous professional development, provision of resources, and strengthening teamwork are recommended to improve maternal health outcomes at Mulago Hospital.

Background Pelvic organ prolapse (POP) is a significant public health issue that negatively affects the Quality of Life (QOL) of women in both low and high-income countries. About 20% of women will undergo surgery for POP over their lifetime. However, there is a paucity of information on the effect of surgery on QOL especially in resource-limited settings. We therefore assessed the QOL among women with symptomatic POP living in rural southwestern Uganda and the impact of surgery on their quality of life. Methods We conducted a prospective cohort study among 120 women with symptomatic POP scheduled for surgery at the urogynecology unit of Mbarara Regional Referral Hospital. The QOL at baseline and at 1 year after surgery in the domains of physical performance, social interaction, emotional state, sexual life, sleep quality, personal hygiene and urinary bladder function was determined using a King’s Quality of Life questionnaire. A paired t-test was used to compare the difference in mean scores at baseline and at 1-year post-surgery. Results Of the 120 participants that were enrolled at baseline, 117(98%) completed the follow-up period of 1 year. The baseline QOL was poor. The domains with the poorest QOL were physical, social, sexual, emotional and sleep quality. The mean QOL scores in all the domains and the overall QOL significantly improved 1 year after surgery (p Conclusions The QOL was poor among women with symptomatic POP and surgery improved the QOL in all the domains of life. We recommend that surgery as an option for treatment of symptomatic POP should be scaled up to improve on the QOL of these women.

Introduction and hypothesis This study was aimed at determining the recurrence rate and risk factors for the recurrence of pelvic organ prolapse (POP), at 1 year post-vaginal reconstructive surgery in a resource-limited setting. Methods We enrolled women who underwent vaginal surgery for POP at the urogynecology unit of Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between December 2018 and February 2020. The surgeries that were performed include anterior colporrhaphy for cystocele, posterior colporrhaphy for rectocele, vaginal hysterectomy with vault suspension for uterine prolapse, and cervicopexy in those with uterine prolapse where uterine-sparing surgery was desired. The women were followed up for a period of 1 year after surgery. Pelvic examinations in lithotomy position under maximum strain were carried out to assess for recurrence using the Pelvic Organ Quantification (POP-Q) system. Recurrence was defined as a prolapse of ≥POP-Q stage II. Descriptive analyses and multivariate log binomial regression were performed to determine risk factors for recurrence. Results Of the 140 participants enrolled, 127 (90.7%) completed the follow-up at 1 year. The recurrence rate was 25.2% (32 out of 127). Most (56.3%) of the recurrences occurred in the anterior compartment and in the same site previously operated. Women aged p = 0.018) and those who had postoperative vaginal cuff infection (RR = 2.54; 95% CI: 1.5–4.3; p = 0.001) were at risk of recurrence. Conclusion Recurrence of POP was common. Younger women, and those with postoperative vaginal cuff infection, were more likely to experience recurrent prolapse after vaginal repair.

Background Transition readiness refers to a client who knows about his/her illness and oriented towards future goals and hopes, shows skills needed to negotiate healthcare, and can assume responsibility for his/ her treatment, and participate in decision-making that ensures uninterrupted care during and after the care transition to adult HIV care. There is a paucity of research on effective transition strategies. This study explored factors associated with adolescent readiness for the transition into adult care in Uganda. Methods A cross-sectional study was conducted among 786 adolescents, and young people living with HIV randomly selected from 9 antiretroviral therapy clinics, utilizing a structured questionnaire. The readiness level was determined using a pre-existing scale from the Ministry of Health, and adolescents were categorized as ready or not ready for the transition. Bivariate and multivariate analyses were conducted. Results A total of 786 adolescents were included in this study. The mean age of participants was 17.48 years (SD = 4). The majority of the participants, 484 (61.6%), were females. Most of the participants, 363 (46.2%), had no education. The majority of the participants, 549 (69.8%), were on first-line treatment. Multivariate logistic regression analysis found that readiness to transition into adult care remained significantly associated with having acquired a tertiary education (AOR 4.535, 95% CI 1.243–16.546, P = 0.022), trusting peer educators for HIV treatment (AOR 16.222, 95% CI 1.835–143.412, P = 0.012), having received counselling on transition to adult services (AOR 2.349, 95% CI 1.004–5.495, P = 0.049), having visited an adult clinic to prepare for transition (AOR 6.616, 95% CI 2.435–17.987, P = < 0.001) and being satisfied with the transition process in general (AOR 0.213, 95% CI 0.069–0.658, P = 0.007). Conclusion The perceived readiness to transition care among young adults was low. A series of individual, social and health system and services factors may determine successful transition readiness among adolescents in Uganda. Transition readiness may be enhanced by strengthening the implementation of age-appropriate and individualized case management transition at all sites while creating supportive family, peer, and healthcare environments.

Background Rwanda has a high unmet need for family planning which could be reduced by improving access to postpartum intrauterine contraceptives device (PPIUCD) insertion. The objective of the study was to assess the prevalence and factors associated with the uptake of PPIUCD among postpartum women in Muhima Hospital. Methods A concurrent mixed-method study was used. Three hundred eight three (383) immediate postpartum mothers, and 10 health services providers were interviewed using a structured questionnaire and in-depth interviews respectively. Logistics regression was done to assess for factors associated with PPIUCD uptake and thematic analysis was used for qualitative data. Results The prevalence for PPIUCD use was 28.1%, women who had spontaneous vaginal delivery were more likely to take up PPIUCD (Adjusted Odds Ratio (AOR) 2.623, 95% CI = 2.017–6.507 compared to those who had cesarean section; women who received PPIUCD counselling during the antenatal period were more likely to use PPIUCD ((AOR 2.072, 95% CI = 1.018–4.218) as compared to those who didn’t receive any form of counselling; mothers who received spouse approval were more likely to use PPIUCD (AOR 2.591,95% CI = 1.485–4.492); as compared to those who didn’t receive any spousal approval; women who had more than one child were more likely to use PPIUCD (AOR =2.265, 95% CI = 1.472–3.163) as compared to prime gravida; Mothers with birth to pregnancy interval less than two years were more likely to use PPIUCD (AOR =2.123, CI =1.477–2.706) as compared to those who had birth to pregnancy interval more than 2 years. From the qualitative findings, health education of mothers and partners on PPIUCD, training of health care providers, and availability of supplies to provide PPIUCD influenced the use of PPIUCD. Conclusion The acceptability to use for PPIUCD was high in this population. PPIUCD uptake was associated with normal birth, PPIUCD counselling, spousal approval, parity, birth interval, level of education. Health education of mothers and partners on PPIUCD, training of health providers, and availability of supplies to provide PPIUCD influenced uptake of PPIUCD.

This study reports on the development and assessment of a new 30-item Multidimensional Language Class Anxiety Scale which is designed to assess foreign language learners’ anxiety regarding four language skills (listening, reading, writing, and speaking) and testing. In Study 1, the initial items were piloted with 323 students studying English as a foreign language at three different universities in Turkey. This informed a revised version of the questionnaire which was subsequently administered to 701 students at three different Turkish universities. Confirmatory factor analyses revealed that a bifactor model with correlated residual variance yielded a better fit for the data in both studies than the other four models tested. The overall results provided preliminary evidence for the reliability and validity of the data collected using the new scale. Directions for future research and implications for foreign language teaching and learning are discussed.

As mobile phones have evolved into Smartphones, they have become more than simple communication tools; transforming into personal assistants, entertainment devices and information gateways. There is a need to understand how this rapid transformation and complexity of Smartphone uses have impacted on users relationship with their phones. This study presents a thematic analysis of three focus group discussions around attitudes and experiences of owning and using Smartphones. Themes that emerged included a bifurcation in attitudes to Smartphones as simultaneously materialistic objects, and ones which users express anthropomorphic and sentimental views about. Participant accounts reflected the evolution of Smartphones from functional communication devices, to informational and recreational tools. Participants discussed using Smartphones to alleviate boredom and that device usage had become habituated for some users. However, context determined Smartphone use with some participants using them to feel secure while away from familiar settings. Participant accounts provide rich insights into different Smartphones uses and infer numerous implications for understanding why some users develop strong psychological attachments to them. Findings also imply that users may not be attached to the device itself, but rather the affordances on offer. The implications of these findings, for example in the assessment of Smartphone addiction, are discussed. Qualitative account of young people's attitudes and experiences of smartphone use.Smartphone described simultaneously in materialistic and anthropomorphic terms.Smartphones help users feel secure when away from their familiar, home setting.Sheds light on reasons why some people may become attached to their smartphones.

Previous literature has found inconsistent relationships between online gaming engagement and psychosocial outcomes. To add clarity to this discussion, we explored these relationships though a multidimensional lens of gaming engagement. That is, we examined the role of gamer identity and online social capital as mediators of online gaming engagement and psychosocial outcomes (i.e. self-esteem, loneliness, social competence). We addressed this in a sample of Massively Multiplayer Online (MMOs) players (N = 708), via an online questionnaire to establish cross-sectional associations. Findings revealed positive relationships between MMO engagement (measured by a multidimensional measure), gamer identity, and online social capital. Additionally, gamer identity related positively to self-esteem and social competence, and negatively with loneliness. Differential outcomes were also found between social capital and loneliness. Specifically, loneliness was negatively related to online bonding, but positively with online bridging capital, highlighting the importance of exploring the constitution of gaming communities to assess their role in promoting varying dimensions of social capital and the associated psychological correlates. Taken together, we evidence the psychosocial benefits of MMO engagement, specifically in relation to the social value of identifying and connecting with others in MMOs. Additionally, we highlight the complexities surrounding the concept and measurement of gaming engagement.

Background: Contraceptive practices of perinatally HIV-infected adolescents (PHIAs) have implications related to pregnancy prevention, risks of HIV heterosexual transmission, reinfection, and vertical transmission. The study assessed contraceptive use among sexually active PHIAs in Uganda.\ud \ud Methods: Mixed methods consisting of a survey and in-depth interviews were employed among 213 sexually active PHIAs who were attending antiretroviral therapy (ART) clinics. The study was guided by Andersen's Behavioral Model of Health Service Use as a theoretical framework to identify factors that influence contraceptive use. These factors include health care factors, personal characteristics, enabling factors, and needs. The outcome was contraceptive use. Multivariable logistic regression was used to establish determinants of contraceptive use. Qualitative data were analyzed by thematic analysis.\ud \ud Results. Most PHIAs were female (67.6%); the mean (SD) and median (IQR) age was 17.5 (±1.4) and 18 (17-19) years. The mean age of sexual debut and at marriage were 15 (±1.7) and 17 (±1.1), respectively. Condoms were the most known method of family planning (indicated by 55.4%). Only 16.9% of the participants knew about dual protection (condom use for FP as well as HIV/STI prevention). Of the PHIAs, 43.6% had ever used modern contraception and 56.9% of the females had ever been pregnant. The odds of contraceptive ever-use were significantly higher among adolescents aged 17-19 years (OR 5.1, 95% CI: 2.1-13.3) compared to those aged 10-16 years, those in school (OR 1.8, 95% CI: 1.07-3.2) compared to those out of school, and those with perceived need to use FP (OR 2.0, 95% CI: 1.1-3.9) compared to their counterparts. The odds of contraceptive used were lower among females (OR 0.13, 95% CI: 0.06-0.28) compared to males. From the in-depth interviews, the attitude of health workers, availability of health workers, having a friend using family planning, and waiting time were viewed to affect contraceptive use.\ud \ud Conclusion. Contraceptive use among sexually active perinatally HIV-infected adolescents was (43.6%). However, out of those who used family planning majority were using short-term methods. The unmet need for family planning was high (47%) with high reports of pregnancy (56.9%). The factors associated with contraceptive use included education, age, sex (predisposing factors), and perceived need of family planning (need factors). Other factors that could affect contraceptive use from qualitative analysis included attitude of health workers, availability of health workers, having a friend using family planning (predisposing factors), and waiting time (health system factors). HIV care for adolescents should be promoted using SRH approach. There is a need to provide training for all providers to cater for SRH services. We should continue to provide youth-responsive adolescent sexual and reproductive health services across all ART facilities and build a supportive environment and continue to integrate SRH services into HIV care.

Letter to the editor. Cite as: Ellis, D. A., Davidson, B. I., and Kaye., L.K. (2019). Should smartphones be banned for children or does cyberpsychology have a bigger problem? Cyberpsychology, Behavior, and Social Networking. 22(7). DOI: 10.1089/cyber.2019.29152.lte

Social identity theory (SIT) has been widely applied to many contexts as a way of understanding group identity and the associated impacts. However, less research has explored the relevance of SIT to digital gaming. This paper outlines recent studies which have sought to establish a number of psychosocial outcomes associated with gaming identity across a number of gaming domains. Large-scale cross-sectional survey research in this area with varying gamer groups has generally found that positive identity to gaming groups is associated with positive aspects of well-being, such as lower loneliness and enhanced self-esteem and general well-being. Taken together, gamer identity appears to be a positive factor, which can go some way to support players on a psychological level.

The hypothesis of cerebral plasticity in psychiatric disorders has encouraged clinicians to develop cognitive remediation therapy (CRT), a new therapeutic approach based on attention, memory, planning, and mental flexibility tasks. The first cognitive remediation programs were developed and validated for adults with schizophrenia and were shown to have a positive impact on executive functions as well as on quality of life. In children and adolescents, researchers emphasized the existence of executive dysfunction in neurodevelopmental disorders such as autistic spectrum disorder, attention deficit disorder, and eating disorders. For these disorders, neuropsychological studies suggest that memory, planning, attention and mental flexibility are impaired. Despite the paucity of studies on cognitive remediation (CR) in children, preliminary results have suggested, as in adults with schizophrenia, good compliance and optimization of executive functioning. Consequently, programs dedicated to young subjects were developed in English-speaking countries, and the Department of Child and Adolescent Psychiatry of Sainte Anne Hospital (Paris) developed a new CR program for children with attention deficit disorder, academic problems, or eating disorders. These programs complete the field of CRT proposed by Sainte Anne Hospital's Remediation and Psychosocial Rehabilitation Reference Center, initially designed for adults with schizophrenia. Our team used and adapted validated tools such as Delahunty and Wykes's CRT program (translated and validated in French by Amado and Franck) and Lindvall and Lask's CRT Resource Pack. One program was developed for an adolescent with anorexia nervosa and applied to the subject and her family, but the purpose of this paper is to present a CR approach for children with attention deficit disorder or academic disorder, a 6-month program based on paper-pencil tasks and board and card games. The team was trained in different kinds of cognitive remediation, and the program was applied by a clinical nurse with the supervision of a child and adolescent psychiatrist and the department's neuropsychologists. Paper-pencil tasks were adapted from the CRT program for adults; the card and board games used were geometric figures, illusions, Rush Hour(®), Set(®), Jungle Speed(®), Color Addict(®), etc. These games are available in stores and the program can be applied at home, which helps families set aside their preoccupations with their child's academic performance. Diagnostic and neuropsychological evaluations were done before the beginning of the therapy and repeated at the end of the 6-month program. This program does not ignore the metapsychological impact of the therapy, and work on self-esteem is also done. The presence of the therapist is necessary, which seems better than a computer program, which cannot encourage the young subject in the same personalized and empathetic way. We therefore conducted the first clinical feasibility trial of cognitive remediation in young subjects and present a clinical case of a 6-year-old boy with attention deficit disorder and academic disorder. The results of neuropsychological evaluations before and after therapy suggest improvement in executive functions and better self-esteem. Satisfaction for the boy and his family was high. Even if these results need to be replicated, cognitive remediation appears to be a new therapeutic tool, complementary to classical approaches used in childhood psychiatric disorders. The Department of Child and Adolescent Psychiatry will submit this program to a research program conducted by the National Health Department to study the impact of this approach in a controlled study.

Contains fulltext : 190977.pdf (Publisher’s version ) (Open Access) We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization. 9 p.

Introduction: Knowledge of a person’s HIV status during pregnancy is critical for prevention of mother to child transmission of HIV.Objectives: To determine the prevalence and factors associated with unknown HIV status among women delivering in Mulago Hospital.Methods: This was a cross-sectional study of women that had just delivered. The women’s demographic characteristics, health seeking behaviour, health system-related factors and knowledge on PMTCT were collected. Fisher’s exact test, Wilcoxon rank sum test and logistic regression were used to test associations.Results: The prevalence of unknown HIV status was 2.6% (10/382). Attending ANC at higher level facilities (OR =0.1 95% CI 0.0 – 0.4) and having been counselled for HIV testing during ANC (OR=0.1, 95% CI 0.0 - 0.4) were associated with likelihood of having a known HIV status. Out of the ten women with unknown HIV status, 4/6 who attended ANC in public/ government accredited health facilities “opted out” of HIV testing due to personal reasons. Among the four who attended ANC in private clinics, two were not offered HIV testing and one “opted out”.Conclusion: Most participants had a known HIV status at labour (97%). Private clinics need to be supported to provide free quality HCT services in ANC.Keywords: Unknown HIV status, women delivering, Mulago National Referral Hospital, Kampala, Uganda

Introduction: Perinatally HIV-infected adolescents have the right to healthy sexual and reproductive lives like their HIV uninfected counterparts. The study assessed the quality of care of sexual and reproductive health (SRH) services in antiretroviral therapy (ART) clinics attended by perinatally-infected HIV adolescents. Methods: The study was guided by Judith Bruce and Anrudh Jain framework for conceptualizing quality as “client-oriented” care. Qualitative and quantitative methods were used to assess quality of care. We conducted facility assessment, evaluation of providers' perspectives regarding the quality of SRH care, and evaluation of experiences of perinatally-infected HIV adolescents about the quality of SRH care provided in the ART clinics. We conducted 24 in-depth interviews with adolescents and 12 interviews with service providers. Furthermore, a survey of 624 adolescents aged 10-19 y was conducted, where information on socio-demographic profiles and access and utilisation of RH services were collected. Survey data was analysed descriptively to provide frequencies and percentages while qualitative data was analyzed by content analysis. Results: Most adolescents (84.5%) were dissatisfied with SRH services provided by the clinics. None of the ART clinics offered comprehensive SRH services, which limited choices of clients. All units offered SRH information and education except post-abortion care and mental health. Only three units had trained their staff in SRH and adolescent friendly services which impacts on technical competence of the service providers in provision of SRH services. The structure of the clinics was based on adult and pediatric care implying there were no adolescentspecific services. Conclusion: The lack quality of care of SRH services in ART clinics is both an organisational and resource issue. For health systems to achieve universal access to high-quality sexual and reproductive health the ART clinics is dependent on rational decisions regarding investments in and allocation of human resources for health. There is need for in-service training of Health Workers in adolescent health. The Ministry of Health needs to engage partners for support to increase the numbers of health facilities which are adolescent friendly.

Since their popularization, video games have developed a reputation for being antisocial spaces. However, this is somewhat contrary to the wealth of social opportunities and functions which contemporary gaming offers, as well as what much of the research in the area suggests. This chapter will outline the key claims and draw on research findings from the academic literature, in order to debunk much of these anecdotal and old-fashioned conceptualizations of what gaming is and who gamers are. This will include a discussion of the various ways in which gaming can be experienced socially, the effects of social play, and how these effects may vary depending on the specific type of game and context of play.

Background In the last decade, Makerere University College of Health Sciences (MakCHS) has taken strides in research and training to improve healthcare through collaborative training and research programs. However, there is limited data on the trends of MakCHS faculty contributions to research and on faculty growth to take leading roles in health research. This paper reviews MakCHS faculty research publications over 15.5 years and outlines possible strategies to enhance faculty research outputs. Methods We used a mixed methods approach. A systematic review of research publications by faculty at MakCHS (PubMed and Google Scholar from January 1, 2000, to June 30, 2015) to quantify the number of research articles, areas researched, authorship contribution by MakCHS faculty, source of funding, as well as affiliated local and international collaborations. Graphs were used to shown trends in publications and leadership of authorship by faculty. Annual individual faculty research productivity was presented as publication per capita. Qualitative data on high priority needs to improve research outputs was collected through focus group discussions (FGDs) with faculty members, and analysed manually into emerging themes. Results Of 298 faculty at MakCHS at 2015, 89 (30%) were female and 229 (77%) were junior and mid-level faculty (senior lecturer and below). The PubMed and Google Scholar searches yielded 6927 published articles, of which 3399 (49%) full-text articles were downloaded for analysis, 426/3825 (11%) available as titles/abstracts only, and 598/4423 (14%) were excluded. Only 614 articles were published in 2014, giving a publication per capita of 2.1 for any authorship, and 0.3 for first and last authorship positions. MakCHS faculty increasingly contributed as first, second, third, and last authors. Up to 57% of research was in infectious diseases, followed by non-communicable diseases (20%) and non-communicable maternal child health (11%). Priority needs to improve research outputs, as expressed by faculty, were (1) an institutionally led faculty career development program, (2) skills building in research methods and scientific writing, (3) protected time for research related activities, (4) opportunities for collaborative research, and (5) use of individual development plans. Conclusion Faculty research productivity was low and dominated by infectious diseases and non-communicable disease research. There is a need for structured institutional support to optimise faculty research outputs. Only with increased research productivity will MakCHS and other academic institutions be able to make a significant contribution in addressing national health challenges. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0196-6) contains supplementary material, which is available to authorized users.

Objective To gain an understanding of how obstetric complications affect the lives and livelihoods of survivors. Methods A phenomenological study was conducted between April and August 2013 at Mulago Hospital, Kampala, Uganda. Data were collected through in-depth interviews among 36 women admitted with obstetric near miss. The interviews investigated perceptions, lived experiences, and meanings attached to such experiences by survivors. More specifically, the questions explored: self-rated health; anticipated social, sexual, and reproductive health challenges; and mitigating factors. Results The identified themes were prior expectations, vulnerability, body and social capital, and resilience. Women were found to approach childbirth with predetermined expectations that influenced their pregnancy and childbirth experience. Fatalism, expectations, and social insecurity markedly contributed to vulnerability. Resilience factors included ability to institute adaptations and to harness body and social capital. Conclusion Vulnerabilities and their determinants were found to be inter-related. Individuals’ social capital fluctuates over the acute crisis, necessitating multiple adaptations and coping strategies to reduce vulnerability or increase resilience. Although social and body capital may be mobilized to mitigate the effects of the obstetric crisis, they can either worsen vulnerability or increase resilience.

Objective: Women’s preferences for the mode of delivery provide clues on their knowledge and perceptions of anticipated risk of childbirth complications. The objective was toinvestigate incongruence between preferred mode of delivery and risk of adverse pregnancy outcomes. Methods: Through a cross-sectional study, data were collected from 327 women admitted to Mulago hospital. Data included socio-demographic characteristics, past medical, gynaecological and obstetric history, pregnancy complications, knowledge of pregnancy complications and preferred mode of delivery. The preferred mode of delivery and knowledge of related risks for adverse pregnancy outcomes were compared. Results: The mean age of participants was 24.7 years (±5.9), ranging 14 - 43 years, of whom 41.4% were nulliparous. The preferred mode of delivery was vaginal (84.1%). Incongruence (preference for a mode of delivery that did not correspond to expected or anticipated risks) occurred in 88 (26.9%) of the women, and was associated with having secondary school or higher level of education (OR 2.49, CI 1.52 - 4.08) and history of previous vaginal delivery (OR 3.82, CI 1.94 - 7.49). Conclusion: One in four women had incongruence between preferred mode of delivery and risks of adverse pregnancy outcomes, which called for urgent interventions to improve decision-making about intrapartum care.

Chirurgische Facelift-Techniken haben seit mehr als 20 Jahren ihren festen Platz in modernen Gesichtsverjungungskonzepten. Vielfaltige Techniken sind beschrieben worden. Die Tendenz der letzten zehn Jahre geht zu weniger invasiven Eingriffen und naturlichen Resultaten, die ein verjungtes, kein uberstrafftes Gesichtsbild vermitteln. Essenzieller Teil einer Gesichtsverjungung ist die Verjungung bzw. Erneuerung des Hautbildes, welches entscheidend zum Gesamteindruck beitragt. Die reine Repositionierung der Gesichtsvolumina und das Straffen einer gealterten Haut konnen keine umfassende und uberzeugende Verjungung erreichen. Fachubergreifende Kombinationstechniken dienen zur Erweiterung der Indikation des Facelifts und zur Verbesserung des asthetischen Outcomes. Ziel dieses Artikels ist es, Moglichkeiten und Grenzen von zeitgleich mit einer Gesichtsstraffung durchzufuhrenden Hautverjungungstechniken anhand des adjuvanten Einsatzes verschiedener Peelingtechniken und des autologen Fetttransfers im Rahmen unseres P.A.V.E.(„peeling assisted volume enhancing“)-Lift-Konzepts sowie die Effizienz und Sicherheit eines solchermasen erweiterten Behandlungsansatzes aufzuzeigen.

This article presents baseline data from the SASA! (this is the Swahili for ‘now’) Study, a cluster randomized trial of a community-mobilization intervention to prevent violence against women and HIV/AIDS in Kampala, Uganda. Logistic regression was used to explore associations between intimate partner violence (IPV) and sexual risk behaviors, among 1,206 ever-partnered men and women (18-49 years). Twenty-seven percent of women reported past-year experience of physical and/or sexual IPV. Female experience and male perpetration of IPV were strongly associated with sexual risk behaviors. Findings confirm the importance of the SASA! intervention in this setting and endorse integrated strategies for IPV and HIV prevention.

Background Obstructed labour remains a major cause of maternal morbidity and mortality whose complications can be reduced with improved quality of obstetric care. The objective was to assess whether criteria-based audit improves quality of obstetric care provided to women with obstructed labour in Mulago hospital, Uganda. Methods Using criteria-based audit, management of obstructed labour was analyzed prospectively in two audits. Six standards of care were compared. An initial audit of 180 patients was conducted in September/October 2013. The Audit results were shared with key stakeholders. Gaps in patient management were identified and recommendations for improving obstetric care initiated. Six standards of care (intravenous fluids, intravenous antibiotics, monitoring of maternal vital signs, bladder catheterization, delivery within two hours, and blood grouping and cross matching) were implemented. A re-audit of 180 patients with obstructed labour was conducted four months later to evaluate the impact of these recommendations. The results of the two audits were compared. In-depth interviews and focus group discussions were conducted among healthcare providers to identify factors that could have influenced the audit results. Results There was improvement in two standards of care (intravenous fluids and intravenous antibiotic administration) 58.9 % vs. 86.1 %; p

Introduction: Acquisition of sexually transmitted infections (STIs) is an epidemiological marker of high-risk sexual behavior in HIV-infected patients. We assessed the prevalence of STIs among patients attending an HIV care and support centre. Methodology: From January to August 2009, we assessed socio-demographic variables, sexuality, disclosure of sero-status and STI treatment for 400 patients attending the HIV care and support centre. Characteristics of those who had been treated and those who had never been treated for STIs were compared to identify factors independently associated with STIs. Results: Of the 400 respondents, 25.3% were male, 47.3% were aged 25-34 years, over 85% were currently married or had ever been married, and 62% had primary level of education or less. Though 82.5% were on antiretroviral drugs, only 53.1% disclosed their sero-status to their regular partners and only 41.9% knew the sero-status of their regular partners. Furthermore, 151 (37.7%) had been treated for STIs. The STIs were gonorrhoea (15; 9.7%), chlamydia (11; 7.1%), Trichomonas vaginalis (5; 3.3%), syphilis (99; 64.3%), and mixed infections (21; 13.6%). Factors associated with STI treatment on univariable analysis were age at sexual debut, whether the respondent had had sex in the previous six months, frequency of sexual intercourse, having changed sexual partners, number of sexual partners, and age when the respondent had a first child. Conclusion: Unprotected sexual intercourse and STIs are common among patients seeking HIV care in Uganda. Only the age of sexual debut (odds ratio0.82, confidence limits 0.71, 0.94) was independently (though inversely) associated with STIs.

Globally, HIV sero-discordance is a major public health problem, due to increased risk of HIV transmission to HIV-negative partners. From January to August 2009, we assessed the sexual behaviour of HIV-infected patients attending an HIV treatment centre in Uganda and analysed characteristics associated with HIV sero-discordance. Of the 278 respondents, 256 (92.1%) were female, 218 (78.1%) were on antiretroviral drugs and 107 (38.7%) belonged to a sero-discordant couple. In the prior 3 months, 238 (88.5%) had more than one sexual partner and 98 (35.8%) had acquired new sexual partners. Only 171 (61.5%) had ever disclosed sero-status to main sexual partners. Participants who had changed sexual partners in the previous 3 months were more likely to be sero-discordant (OR 1.87, 95% CI 1.13, 3.11). Respondents who used condoms during their last sexual intercourse and those currently on ARVs were significantly less likely to be sero-discordant (OR 0.52 95% CI 0.28, 0.96 and OR 0.52 95% CI 0.30, 0.94, respectively). Only disclosure of sero-status was independently though inversely associated with discordance (adjusted OR 0.41, 95% CI 0.20, 0.64). Our findings indicate that HIV patients continue exhibiting high risk behaviour characterised by changing sexual partners, having multiple sexual partners and non-use of condoms.

Information and communication technology (ICT) has been advocated as a powerful tool for improving health education in low-resource settings. However, few evaluations have been performed of ICT perceptions and user experiences in low-resource settings. During late 2009, an internet-based survey on ICT was administered to students, tutors, and faculty members associated with a Community-Based Education and Service (COBES) program in Uganda. 255 surveys were completed. Response rates varied (students, 188/684, 27.5%; tutors, 14/27, 51.9%; faculty, 53/335, 15.8%). Most respondents owned mobile phones (98%). Students were less likely (p < 0.001) to own laptops (25%) compared to tutors (71%) and faculty (85%). Internet access at rural sites was uncommon; mobile phone coverage was almost universally present. Laptop ownership and internet and mobile phone access was not associated with high valuation of students' COBES experiences. Free text responses found that respondents valued ICT access for research, learning, and communication purposes. In summary, ICT penetration in this population is primarily manifest by extensive mobile phone ownership. Internet access in rural educational sites is still lacking, but students and educators appear eager to utilize this resource if availability improves. ICT may offer a unique opportunity to improve the quality of teaching and learning for COBES participants.

Pregnancy decisions in women infected by HIV pose important public health and social problems, as they increase risk of both heterosexual and vertical HIV transmission. We sought to explore and gain deeper understanding of reasons why women conceive when they are HIV-positive. Through 22 in-depth interviews and 6 focus-group discussions, motivations for conception among HIV-positive women who came for delivery in Mulago Hospital, Uganda were explored. Participants were selected by maximum variation sampling; and personal, biological, situational and environmental factors were explored. Data was analysed by content analysis. Awareness and belief in vertical transmission risk reduction strategies; disclosure of HIV status; awareness of spouse's HIV sero-status; availability of antiretroviral therapy; gender issues with desire for parenthood; stigma of HIV and childlessness; influence of partners and family members; and the impact of the health of self and family members were factors that motivate HIV-positive women to conceive or influence pregnancy decisions in spite of their sero-status.

Conception among HIV-positive individuals is an important health and social issue. However, the proportion of HIV-positive women who conceive while being aware of their serostatus and the factors that influence this decision is not well documented. In a cross-sectional study, 385 HIV-positive women in the labour ward at Mulago Hospital, Uganda, were interviewed using a structured questionnaire. Data were collected on socio-demographic characteristics, contraception ever used, knowledge of antiretrovirals (ARVs), and ARVs ever used. To assess factors associated with conception among women who know their HIV-positive status, the variables were compared for women in two groups: those who conceived while knowing their HIV-positive status and those who discovered their HIV status during pregnancy. Bivariate and logistic regression analyses were used to assess confounding variables and interactions. The data show that one in every three HIV-positive women in the study population (37.1%) conceived despite being HIV-positive. Women who conceived while knowing they were HIV-positive differed from those who conceived without knowing their HIV status in regard to employment status, marital status, the employment status of their spouse/partner, and their intention to conceive. Logistic regression showed that factors independently associated with conception in this sample of HIV-positive women were: age below 25 years (odds ratio [OR] 2.06; 95% confidence interval [CI]: 1.18–3.62); unemployment (OR 2.7; 95% CI: 1.42–5.04); carrying a first pregnancy (OR 4.53; 95% CI: 2.02–9.94), being unaware of her partner’s HIV status (OR 0.26; 95% CI: 0.15–0.44); having an awareness of ARVs (OR 3.66; 95% CI: 2.15–6.25); and having regrets about conceiving while being HIV-positive (OR 0.21; 95% CI: 0.09–0.46).Keywords: Africa, contraception, contraceptive use, decision-making, fertility intentions, pregnancy, prevalence, womenAfrican Journal of AIDS Research 2009, 8(3): 255–260

Resume Dans le service de psychopathologie de l’Enfant et de l’Adolescent du centre hospitalier Sainte-Anne a Paris, les patients presentant un trouble autistique beneficient d’une prise en charge pluridisciplinaire, avec parfois la prescription de psychotropes. Pour l’un d’entre eux, une instabilite majeure, une hetero et autoagressivite severes ont conduit a la prescription successive de psychotropes sans amelioration clinique. Un traitement par naltrexone a ete instaure en reference a de nombreuses publications presentant l’interet de ce medicament dans le traitement de l’autisme. Pour obtenir le produit sous forme de sirop adapte a la prise chez un enfant, nous avons fait une demande d’autorisation temporaire d’utilisation aupres de l’Agence francaise de securite sanitaire des produits de sante (Afssaps). L’evolution des symptomes comportementaux a ete suivie a l’aide de l’echelle de Conners et l’echelle de Nisonger. Les questionnaires ont ete remplis une fois par semaine par les parents et le patient a ete revu tous les 15 jours. Le suivi a dure 12 semaines. Le debut de traitement et la posologie de 1 mg/kg par jour ont ete a l’origine d’une recrudescence transitoire des comportements a problemes. C’est a la posologie de 0,75 mg/kg par jour que des ameliorations significatives ont ete observees sur les deux echelles de Conners et Nisonger. Les automutilations ont cesse. Les effets secondaires observes ont ete une sedation transitoire a l’initiation du traitement puis l’apparition d’une constipation moderee. Ce cas clinique confirme que le traitement par naltrexone en suspension buvable dans le cadre d’un trouble autistique severe de l’enfant offre une alternative therapeutique interessante en cas de troubles du comportement resistants a une therapeutique medicamenteuse classique.

Background Maternal near misses occur more often than maternal deaths and could enable more comprehensive analysis of risk factors, short-term outcomes and prognostic factors of complications during pregnancy and childbirth. The study determined the incidence, determinants and prognostic factors of severe maternal outcomes (near miss or maternal death) in two referral hospitals in Uganda. Methods A prospective cohort study was conducted between March 1, 2013 and February 28, 2014, where cases of severe pregnancy and childbirth complications were included. The clinical conditions included abortion-related complications, obstetric haemorrhage, hypertensive disorders, obstructed labour, infection and pregnancy-specific complications such as febrile illness, anemia and premature rupture of membranes. Near miss cases were defined according to the WHO criteria. Multivariate logistic regression analysis was conducted to identify prognostic factors for severe maternal outcomes. Results Of 3100 women with severe obstetric complications, 130 (4.2 %) were maternal deaths and 695 (22.7 %) were near miss cases. Severe pre-eclampsia was the commonest morbidity (incidence ratio (IR) 7.0 %, case-fatality rate (CFR) 2.3 %), followed by postpartum haemorrhage (IR 6.7 %, CFR 7.2 %). Uterine rupture (IR 5.5 %) caused the highest CFR (17.9 %), followed by eclampsia (IR 0.4 %, CFR 17.8 %). The three groups (maternal deaths, near misses and non-life-threatening obstetric complications) differed significantly regarding gravidity and education level. The commonest diagnostic criteria for maternal near miss were admission to the high dependency unit (HDU) or to the intensive care unit (ICU). Thrombocytopenia, circulatory collapse, referral to a more specialized unit, intubation unrelated to anaesthesia, and cardiopulmonary resuscitation were predictive of maternal death (p

Objective: Why domestic violence survivors develop adverse outcomes following domestic violence during pregnancy is unclear, but may depend on how survivors cope with the stress of violence. The objective was to describe strategies pregnant adolescents employ in coping with domestic violence. Methods: This was a qualitative study involving 16 in-depth interviews with adolescent domestic violence survivors who attended the antenatal clinic in Mulago hospital, Kampala, Uganda, from January to May 2004. Theoretical sampling, necessitated by the emergent theory from sequential data collection and analysis, further provided diversity of experiences from adolescents of different ages, parity, pregnancy duration, and socioeconomic status until saturation was reached. Data were analyzed using grounded theory. Findings: Survivors described varied experiences of physical, sexual, and psychological violence. Coping strategies employed were analyzed as: Minimizing damage — decreasing impact and severity of violence, withdrawal — physical or social withdrawal, seeking help and retaliation (fighting back). Coping strategies were influenced by adolescence and pregnancy, and are explained in relation to theories of coping with stress. Conclusions: Coping strategies adopted by pregnant adolescent survivors range from problem-focused approaches to emotion-focused approaches. Coping strategies are influenced markedly by adolescence and pregnancy.

Background Hypertensive disorders of pregnancy are a major cause of morbidity and mortality. The objective was to estimate the disease burden attributable to hypertensive disorders of pregnancy in two referral hospitals in Uganda. Methods Through a prospective cohort study conducted in Jinja and Mulago hospitals in Uganda from March 1, 2013 and February 28, 2014, hypertension-related cases were analyzed. Maternal near miss cases were defined according to the WHO criteria. Maternal deaths were also analyzed. The maternal near miss incidence ratio, the case-specific severe maternal outcome ratio, the case-specific maternal mortality ratio and the case-fatality ratio were computed. Results Of 403 women with hypertensive disorders of pregnancy, 218 (54.1 %) had severe preeclampsia, 172 (42.7 %) had eclampsia, and 13 had chronic hypertension or Hemolysis, elevated liver enzymes or low platelets (HELLP) syndrome. The case-specific maternal near miss incidence ratios was 8.60 per 1,000 live births for all hypertensive disorders, 3.06 per 1,000 live births for severe preeclampsia and 5.11 per 1,000 live births for eclampsia. The case-specific severe maternal outcome ratio was 9.37 per 1,000 live births for all hypertensive disorders, and was 3.25 per 1,000 live births for severe preeclampsia and 5.61 per 1,000 live births for eclampsia. The case-specific maternal mortality ratio was 780 per 100,000 live births for all hypertensive disorders, and was 1940 per 100,000 live births for severe preeclampsia and 501 per 100,000 live births for eclampsia. The case-fatality ratio was 5.1 % overall (for all hypertensive disorders), but was 8 times higher for eclampsia compared to severe preeclampsia. Cyanosis, abnormal respiration, oliguria, circulatory collapse, coagulopathy, thrombocytopenia, and elevated serum lactate were significantly associated with severe maternal outcomes. Conclusion There is high morbidity attributable to hypertensive disorders in pregnancy. Since some of the complications associated with morbidity can be recognized early, it is possible to prevent severe morbidity through early intervention with delivery, antihypertensive therapy and prophylactic magnesium sulphate treatment. The findings highlight the feasibility of implementing a facility-based surveillance system for severe maternal morbidity due to hypertensive disorders.

Background Elective caesarean sections (ECS) have been implicated in increased risk of adverse neonatal outcomes. The primary objective was to assess the incidence and determinants of neonatal morbidity after elective caesarean section deliveries. The secondary objective was to describe the maternal morbidity associated with elective caesarean section. Methods This was a prospective cohort study of women admitted for ECS, as well as their newborns, conducted at Mulago hospital from March 1, 2013 to February 28, 2014. These were followed from the time of the operation until 6 weeks after hospitalization following the caesarean delivery. Data was collected using an interviewer-administered questionnaire and review of medical records for demographic characteristics, obstetric history, current pregnancy complications and pregnancy outcomes up to hospital discharge. Study outcomes were maternal and neonatal morbidity. The data was analyzed using Stata version 12. Results There were 25,846 deliveries during the study period, of which 20,083 (77.7 %) were vaginal deliveries or assisted deliveries, and 5763 (22.3 %) were caesarean sections. Of the caesarean sections, 920 (15.9 %) were ECS. The commonest maternal morbidity was hemorrhage (17.2 %). A birth weight less than 2500 g (aRR 11.0 [95 % CI 8.1–17.2]) or more than 4000 g (aRR 12.2 [95 % CI 10.6–23.2]), delivery at gestation age less than or equal to 38 weeks (aRR 1.62 [95 % 1.20–2.10]), multigravidity (aRR 1.70 [95 % CI 1.20–2.90]) and using general anaesthesia (aRR 2.43 [95 % CI 1.20–5.90]) were associated with risk of neonatal morbidity. The commonest neonatal morbidity is respiratory distress especially if delivery occurs at a gestation age of 37 weeks or lower, if the birth weight is less than 2500 g or more than 4000 g, and if general anesthesia is used. Conclusion Our study shows that at Mulago Hospital, ECS is associated with significant neonatal and maternal morbidity. We recommend that elective caesarean sections be performed after 39 weeks of gestation, and preferably avoid using general anaesthesia.

Background Neonatal near miss cases occur more often than neonatal deaths and could enable a more comprehensive analysis of risk factors, short-term outcomes and prognostic factors in neonates born to mothers with severe obstetric complications. The objective was to assess the incidence, presentation and perinatal outcomes of severe obstetric morbidity in two referral hospitals in Central Uganda. Methods A prospective cohort study was conducted between March 1, 2013 and February 28, 2014, in which all newborns from cases of severe pregnancy and childbirth complications were eligible for inclusion. The obstetric conditions included obstetric haemorrhage, hypertensive disorders, obstructed labour, chorioamnionitis and pregnancy-specific complications such as malaria, anemia and premature rupture of membranes. Still births, neonatal deaths and neonatal near miss cases (defined using criteria that employed clinical features, presence of organ-system dysfunction and management provided to the newborns were compiled). Stratified and multivariate logistic regression analysis was conducted to identify risk factors for perinatal death. Results Of the 3100 mothers, 192 (6.2%) had abortion complications. Of the remainder, there were 2142 (73.1%) deliveries, from whom the fetal outcomes were 257 (12.0%) still births, 369 (17.2%) neonatal deaths, 786 (36.7%) neonatal near misses and 730 (34.1%) were newborns with no or minimal life threatening complications. Of the 235 babies admitted to the neonatal intensive care unit (NICU), the main reasons for admission were prematurity for 64 (26.8%), birth asphyxia for 59 (23.7%), and grunting respiration for 26 (11.1%). Of the 235 babies, 38 (16.2%) died in the neonatal period, and of these, 16 died in the first 24 hours after admission. Ruptured uterus caused the highest case-specific mortality of 76.8%, and led to 16.9% of all newborn deaths. Across the four groups, there were significant differences in mean birth weight, p = 0.003. Conclusions Antepartum hemorrhage, ruptured uterus, severe preeclampsia, eclampsia, and the syndrome of Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP syndrome), led to statistically significant attributable risk of newborn deaths (still birth or neonatal deaths). Development of severe maternal outcomes, the mothers having been referred, and gravidity of 5 or more were significantly associated with newborn deaths.

Summary Objectives To investigate whether domestic violence during pregnancy is a risk factor for antepartum hospitalization or low birthweight (LBW) delivery. Methods A prospective cohort study was conducted in Mulago hospital, Kampala, Uganda, among 612 women recruited in the second pregnancy trimester and followed up to delivery, from May 2004 through July 2005. The exposure (physical, sexual or psychological violence during pregnancy) was assessed using the Abuse Assessment Screen. The relative and attributable risks of LBW and antepartum hospitalization were estimated using multivariate logistic regression analysis. Results The 169 women [27.7% 95% CI (24.3–31.5%)] who reported domestic violence during pregnancy did not differ significantly from the unexposed regarding sociodemographic characteristics, but differed significantly (P

The objective was to compare pregnancy intention and domestic violence among women with induced and spontaneous abortion. Case-control study in Mulago Hospital Uganda from September 2003 to June 2004 of 942 women seeking post-abortion care. Direct inquiry records review and clinical examination identified 333 with induced abortion (cases) and 609 with spontaneous abortion (controls) who were compared regarding socio-demographic characteristics contraceptive use domicile (rural or urban nuclear or extended families) pregnancy intention household decision-making and domestic violence. Data was analysed with EPI-INFO and STATA using Student t-test and analysis of variance for continuous and chi-square for categorical variables. Stratified and multivariate logistic regression analyses were used to adjust for confounding and interaction at the 95% confidence level. Cases significantly differed from controls as they were younger or more often single; had lower parity and education less household decision-making and fewer living children. They were similar to controls (P > 0.05) regarding employment spouses age years spent in marital relationship and domicile. Cases more frequently (P < 0.001) had mistimed unplanned or unwanted pregnancy at conception and presentation. Cases were more likely to have a recent history of domestic violence (physical sexual or psychological) [OR: 18.7 (95%CI: 11.2-31.0)] after adjusting for age pregnancy intention and marital status. Domestic violence is a risk factor for unwanted pregnancy and induced abortion among women seeking post-abortion care. (authors)

Introduction: Herpes simplex virus type 2 (HSV-2) acquired during pregnancy is associated with adverse outcomes such as perinatal HSV-2 transmission. HSV-2 seroconversion occurs within four weeks of HSV-2 acquisition. There was neither documented incidence nor risk factors for HSV-2 seroconversion during pregnancy in Uganda. The objective of this study was to determine the incidence and risk factors for HSV-2 seroconversion among pregnant women in Mulago Hospital, Uganda. Methodology: A prospective study of 200 consenting HSV-2-negative women between 26 and 28 weeks of gestation was done between November 2013 and October 2014. HSV-2 serostatus was determined using HerpeSelect HSV-2 enzyme-linked immunosorbent assay (ELISA). Interviewer-administered questionnaires were used to collect socio-demographic characteristics and sexual history. Human immunodeficiency virus (HIV) serostatus was obtained from antenatal records. A total of 191 women completed follow-up and repeat HSV-2 serology by 38 weeks. Negative binomial regression analysis was used to estimate risk ratios for risk factors for HSV-2 seroconversion. Results: Of 191 women, 15 (7.9%) seroconverted during pregnancy. Having multiple sexual partners, being in polygamous unions, and having HIV-positive serostatus were found to be risk factors for HSV-2 seroconversion. Conclusions: The incidence of HSV-2 seroconversion during pregnancy in Uganda was high. Multiple sexual partners, polygamy, and HIV-positive serostatus were risk factors for HSV-2 seroconversion during pregnancy. Strengthening health education on the avoidance of multiple sexual partners during pregnancy is paramount in prevention of HSV-2 seroconversion.

Background Severe obstetric complications have potential negative impact on the family and household of the survivors, with potential negative effects during (and in the aftermath of) the traumatic obstetric events. The objective was to gain deeper understanding of how severe obstetric complications are perceived by male partners, and their impact on the livelihoods of the family and community. Methods Data was collected through 25 in-depth narrative interviews with male partners of women with severe obstetric morbidity. The interviews occurred 4-12 months after the traumatic childbirth events. To gain a deeper understanding of the meanings and spouses attach to the experiences, we employed the notions of social capital and resilience. Results Male partners’ perceptions and experiences were mostly characterized by losses, dreams and dilemmas, disempowerment and alienation, seclusion and self isolation or reliance on the social networks. During the aftermath of the events, there was disruption of the livelihoods of the partners and the whole family. Conclusion While a maternal near miss obstetric event might appear as a positive outcome for the survivors, partners and caregivers of women who experience severe obstetric morbidity are deeply affected by the experiences of this life-threatening episode.

etiological research has been done in CMB or HRL Emergency Medicine (EM) departments, which both contributed to the initiation of a new EM residency program in 2010. Aim: To determine the type and frequency of illnesses presenting to the EM department from 2009-2013 in POP, Dominican Republic. Structure/Method/Design: Project Goals, Desired Outcomes: The desired outcomewas to quantify themost frequent illnesses in theER from 2009 to 2013 to determine where the EM departments should allocate their resources and training. Participants andStakeholders:Howwere they selected, recruited? Data were collected through General Administrative Information System (GAIS), Informix, and the HDRL database at CMB andHRL in POP from 2009-2013. The top forty causes of EM visits were found in the HRL database, and these illnesses were searched for in the CMB database. Capacity Building / Sustainability: No patient identifiers were used on the data obtained from the different hospital databases. This project was affiliated with UTMB global health tract. Outcomes & Evaluation: To date, what are the successes and outcomes achieved? We determined the etiologies of HRL 2011-2013 and CMB 2009-2013 EM departments. Monitoring & Evaluation Results: In CMB, the top 3 etiologies were headache, bronchospasm crisis, and trauma in 2009-2011 and 2013. In 2012, trauma was replaced by Asthmatic Crisis. Data for HRL was not available from 2009-2010. From 2011-2013 at HRL, the top 2 causes were fever and headache. In 2011, the third cause was bronchospasm crisis. In 2012 and 2013, the third cause was tonsillitis and lumbar pain respectively. Going Forward: What are the ongoing challenges? The CMB and HRL EM departments should take this information and integrate it into their EMresidency curriculum.Are there any unmet goals? The etiologies could not be determined in 2009 and 2010 in HRL due to a change in database and hospital staff. How are/may future program activities change as a result? The EM Residency program directors should focus their resources and training heavily on headache, bronchospasm crisis, trauma, asthmatic crisis, tonsillitis, and lumbar pain in order to best care for the most frequent causes of emergencies. Funding: No sources of funding. Abstract #: 01ETC066

Background Improved knowledge of obstetric danger signs, birth preparedness practices, and readiness for emergency complications are among the strategies aimed at both enhancing utilization of maternal health services and increasing access to skilled care during childbirth, particularly for women with obstetric complications. It is unclear whether knowledge of danger signs translates into improved birth preparedness and complication readiness. The objective was to assess the association between knowledge of danger signs and birth preparedness among women admitted with pregnancy complications. Methods The study included 810 women admitted in the antepartum period to Mulago hospital, Uganda. Data was collected on socio-demographic characteristics, reproductive history, pregnancy complications, knowledge of danger signs, and birth preparedness/complication readiness (BPCR). Logistic regression analyses were conducted to explore the relationship between knowledge of danger signs and birth preparedness. Results Only about 1 in 3 women were able to mention at least three of the five basic components of BPCR, and could be regarded as ‘knowledgeable on BPCR’. One in every 4 women could not mention any of the five components. Women with history of obstetric problems during the previous pregnancy were more likely to be knowledgeable on danger signs when compared to those who had no complications in prior pregnancy. Women who were knowledgeable on danger signs were four times more likely to be knowledgeable on BPCR as compared to those who were not knowledgeable. Conclusions Though awareness about danger signs was low, knowledge of danger signs was associated with knowledge of birth preparedness. More emphasis should be given to emergency/complication readiness during antenatal care sessions. There is a need to strengthen existing policy interventions to address birth preparedness and complication readiness for obstetric emergencies.

Background Intimate partner violence (IPV) and HIV are important and interconnected public health concerns. While it is recognized that they share common social drivers, there is limited evidence surrounding the potential of community interventions to reduce violence and HIV risk at the community level. The SASA! study assessed the community-level impact of SASA!, a community mobilization intervention to prevent violence and reduce HIV-risk behaviors. Methods From 2007 to 2012 a pair-matched cluster randomized controlled trial (CRT) was conducted in eight communities (four intervention and four control) in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, 18- to 49-years old, were undertaken at baseline (n = 1,583) and four years post intervention implementation (n = 2,532). Six violence and HIV-related primary outcomes were defined a priori. An adjusted cluster-level intention-to-treat analysis compared outcomes in intervention and control communities at follow-up. Results The intervention was associated with significantly lower social acceptance of IPV among women (adjusted risk ratio 0.54, 95% confidence interval (CI) 0.38 to 0.79) and lower acceptance among men (0.13, 95% CI 0.01 to 1.15); significantly greater acceptance that a woman can refuse sex among women (1.28, 95% CI 1.07 to 1.52) and men (1.31, 95% CI 1.00 to 1.70); 52% lower past year experience of physical IPV among women (0.48, 95% CI 0.16 to 1.39); and lower levels of past year experience of sexual IPV (0.76, 95% CI 0.33 to 1.72). Women experiencing violence in intervention communities were more likely to receive supportive community responses. Reported past year sexual concurrency by men was significantly lower in intervention compared to control communities (0.57, 95% CI 0.36 to 0.91). Conclusions This is the first CRT in sub-Saharan Africa to assess the community impact of a mobilization program on the social acceptability of IPV, the past year prevalence of IPV and levels of sexual concurrency. SASA! achieved important community impacts, and is now being delivered in control communities and replicated in 15 countries. Trial registration ClinicalTrials.gov #NCT00790959, Study protocol available at http://www.trialsjournal.com/content/13/1/96 Electronic supplementary material The online version of this article (doi:10.1186/s12916-014-0122-5) contains supplementary material, which is available to authorized users.

Background Maternal mortality is a major public health challenge in Uganda. Whereas uterine rupture remains a major cause of maternal morbidity and mortality, there is limited research into what happens to women who survive such severe obstetric complications. Understanding their experiences might delineate strategies to support survivors. Methods This qualitative study used a phenomenological approach to explore lived experiences of women who developed uterine rupture following obstructed labor. In-depth interviews initially conducted during their hospitalization were repeated 3–6 months after the childbirth event to explore their health and meanings they attached to the traumatic events and their outcomes. Data were analyzed using thematic analysis. Results The resultant themes included barriers to access healthcare, multiple “losses” and enduring physical, psychosocial and economic consequences. Many women who develop uterine rupture fail to access critical care needed due to failure to recognise danger signs of obstructed labor, late decision making for accessing care, geographical barriers to health facilities, late or failure to diagnose obstructed labor at health facilities, and failure to promptly perform caesarean section. Secondly, the sequel of uterine rupture includes several losses (loss of lives, loss of fertility, loss of body image, poor quality of life and disrupted marital relationships). Thirdly, uterine rupture has grim economic consequences for the survivors (with financial loss and loss of income during and after the calamitous events). Conclusion Uterine rupture is associated with poor quality of care due to factors that operate at personal, household, family, community and society levels, and results in dire physical, psychosocial and financial consequences for survivors. There is need to improve access to and provision of emergency obstetric care in order to prevent uterine rupture consequent to obstructed labor. There is also critical need to provide counselling and support to survivors to enable them cope with physical, social, psychological and economic consequences.

The aim of the present study was to investigate postoperative changes after vertical mammaplasty. Between 2002 and 2005, 72 consecutive patients aged 15 to 69 years with an average weight of 72 kg underwent bilateral vertical mammaplasty. Forty-two patients attended the regular follow-up one week, four weeks, three months, six months and one year after the operation. Nipple diameter, notch-to-nipple distance, scar length and the number of skin folds along the vertical scar were evaluated. Complications were recorded during the entire follow-up period. A questionnaire was used to document patient satisfaction 12 months after the operation. The main changes took place during the first three months after surgery. Nipple diameter showed an average increase of 28% after surgery, and the notch-to-nipple distance increased by an average of 17% over the intraoperative value. The average increase of the scar length after one year was 22%. The rate of complications was low, and patient satisfaction was high.