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OBJECTIVE: Despite its worldwide use, reviews of oxytocin for labor augmentation include mainly studies from high-income countries. Meanwhile, oxytocin is a potentially harmful medication and risks may be higher in low-resource settings. We conducted a systematic review and meta-analysis of practices, benefits, and risks of oxytocin for labor augmentation in low- and lower-middle-income countries. DATA SOURCES: PubMed, Embase, PsycINFO, Index Medicus, Cochrane, and Google Scholar were searched for publications until January 1, 2022. STUDY ELIGIBILITY CRITERIA: All studies evaluating oxytocin augmentation rates were included. To investigate benefits and risks, randomized and quasi-randomized trials comparing oxytocin augmentation with placebo or no oxytocin were included. To explore risks more broadly, cohort and case–control studies were also included. METHODS: Data were extracted and quality-assessed by 2 researchers using a modified Newcastle–Ottawa scale. Generic inverse variance outcome and a random-effects model were used. Adjusted or crude effect measures with 95% confidence intervals were used. RESULTS: In total, 42 studies were included, presenting data from 885 health facilities in 25 low- and lower-middle-income countries (124,643 women). Rates of oxytocin for labor augmentation varied from 0.7% to 97.0%, exceeding 30% in 14 countries. Four studies investigated timing of oxytocin for augmentation and found that 89.5% (2745) of labors augmented with oxytocin did not cross the partograph's action line. Four cohort and 7 case–control studies assessed perinatal outcomes. Meta-analysis revealed that oxytocin was associated with: stillbirth and day-1 neonatal mortality (relative risk, 1.45; 95% confidence interval, 1.02–2.06; N=84,077; 6 studies); low Apgar score (relative risk, 1.54; 95% confidence interval, 1.21–1.96; N=80,157; 4 studies); neonatal resuscitation (relative risk, 2.69; 95% confidence interval, 1.87–3.88; N=86,750; 3 studies); and neonatal encephalopathy (relative risk, 2.90; 95% confidence interval, 1.87–4.49; N=1383; 2 studies). No studies assessed effects on cesarean birth rate and uterine rupture. CONCLUSION: This review discloses a concerning level of oxytocin use, including in labors that often did not fulfill criteria for dystocia. Although this finding is limited by confounding by indication, oxytocin seems associated with increased perinatal risks, which are likely mediated by inadequate fetal monitoring. We call for cautious use on clear indications and robust implementation research to support evidence-based guidelines for labor augmentation, particularly in low-resource settings.

An increasing number of individuals worldwide engage in online communication concerning human health and researchers have identified the need to gain further insights on how individuals and communities engage and respond to particular health topics discussed on social media. However, this type of research is not without ethical dilemmas. Though ethical guidelines on the conduct of online research do exist, there is a lack of practical tools and procedures for the initiation and implementation of research on social media platforms in a thoughtful and respectful manner. When carrying out research involving human subjects, three ethical concepts are central: 1) confidentiality; 2) anonymity; and 3) informed consent. These dimensions need rethinking when conducting research on social media platforms. For instance, a researcher stepping into a social media community would initially present herself, the objective of the research, and implications for participants – as in any other research project. However, it is a challenge to maintain informed consent to a study in a rapidly changing online community with a changing composition of members. Based on hands-on experiences from an ongoing research project in a Danish Facebook group of users and group administrators living with suicidal thoughts, we have encountered a range of challenges related to all three ethical concepts. These challenges have lead us to explore new paths and solutions. In this presentation, we will share our experiences and reflections.

Low-income communities will within the next decades undergo rapid changes. The burden of non-communicable diseases (NCDs), such as diabetes, cardio-vascular disease and cancer, will comprise an increasing proportion of the total disease burden. The results of projections indicate that the already constrained health systems will face a double burden of disease, in which HIV/AIDS and other common infectious diseases will co-exist with the new NCDs. In order for preventive measures directed towards NCD to be cost-effective, these have to be implemented within the next 10-20 years.

Lymphatic filariasis (LF), malaria and soil transmitted helminthiasis (STH) cause major health problems in Nepal, but in spite of this very few stud- ies have been carried out on these parasitic infections in Nepal. A cross sectional survey of all three categories of parasitic infections was carried out in Deuda- kala Village of Bardiya District, western Nepal. A total of 510 individuals aged 5 years and above were examined from finger prick blood for circulating filarial antigen (CFA), malaria antigen using a rapid diagnostic test (RDT), and malaria DNA using a PCR-based assay. In addition, 317 individuals were examined for soil-transmitted helminth (STH) eggs by the Kato-Katz technique. Prevalence of LF, malaria (antigen) and STH infection was 25.1%, 0.6% and 18.3%, respectively. PCR analysis did not detect any additional malaria cases. The prevalence of LF and STH infections differ significantly among different age groups and ethnic communities. The high prevalence of LF in the community studied indicates an immediate need for implementing a mass drug administration program for its control in this particular geographical area of Nepal.

Background Self-harm is a global public health problem. An increasing number of users engage in online communities designed to aid individuals living with suicidal thoughts. However, little is known about how individuals are affected by these social media groups. Aim To gain an understanding of the potential implications of a user controlled peer-to-peer social media community of individuals experiencing suicidal thoughts. Methods Content from a social media community for individuals experiencing suicidal thoughts was collected over a 4-month period. The content was imported into NVivo12 through NCapture. The analysis was data driven using Discursive Psychology. Findings The social media community was perceived as a safe space where it was socially acceptable to focus on the individual’s own situation. Here they could share their frustration, suicidal thoughts, specific events of self-harm and provide emotional support. Furthermore, they shared experiences of treatment and shortcomings of the health system. Although the forum clearly did not allow for sharing of information on means of suicide, it was a reoccurring phenomenon that individuals requested information on this topic. One event significantly violated the sense of a ‘safe space’ when an individual disclosed his suicidal thoughts in the group, which was subsequently shared with his family members by another user. Conclusion Preliminary findings suggest that the social media community had an important support function for individuals experiencing suicidal thoughts. However, the forum also entailed several potential risks. Findings from the study will help to better integrate social media communities in a cohesive health promotion approach for suicide prevention.