Severity and cost of unsafe abortion complications treated in Nigerian hospitals

CONTEXT: Each year, thousands of Nigerian women have unintended pregnancies that end in illegal abortion. Many such procedures occur under unsafe conditions, contributing to maternal morbidity and mortality. METHODS: In a 2002-2003 survey of women and their providers in 33 hospitals in eight states across Nigeria, 2,093 patients were identified as being treated for complications of abortion or miscarriage or seeking an abortion. Women's abortion experiences and the health consequences and associated costs were examined through bivariate analysis. Multivariate analysis was used to examine the characteristics of women by type of pregnancy loss and to compare characteristics among three groups of women who had induced abortions in differing circumstances. RESULTS: Among women admitted for abortion-related reasons, 36% had attempted to end the pregnancy before coming to the hospital (including 24% with and 12% without serious complications), 33% obtained an induced abortion at the facility (not withstanding the country's restrictive law) without having made a prior abortion attempt and 32% were treated for complications from a miscarriage. Of women with serious complications, 24% had sepsis, 21% pelvic infection and 11% instrumental injury; 22% required blood transfusion and 10% needed abdominal surgery. The women in this group were poorer and later in gestation than those who sought abortions directly from hospitals. They paid more for treatment (about 13,900 naira) than those who went directly to the hospital for an abortion (3,800 naira) or those treated for miscarriage (5,100 naira). CONCLUSIONS: Policy and program interventions are needed to improve access to contraceptive services and postabortion care in order to reduce abortion-related morbidity and mortality.     

Ambulante psychotherapeutische Versorgung depressiver Patienten

Background

The effectiveness of psychotherapeutic interventions in treating depressive disorders has been shown in manifold ways. However, information is missing from the point of view of psychotherapists concerning diagnostic and therapeutic procedures, their experienced difficulties and barriers, their self-assessment of their competence in the handling of depressive patients and the satisfaction with the cooperation in routine care.

Method

A cross-sectional survey of cognitive-behavioral (n=61) and psychodynamic psychotherapists (n=78) was carried out.

Results

The concordance of clinical diagnoses with diagnoses using the formal ICD-10 criteria was very low. Both groups feel themselves specifically responsible for early detection and differential diagnosis. They neither differ with regard to the frequency of cooperation contacts to other service providers nor with regard to their satisfaction with them or the experienced barriers in the care for depressed patients.

Conclusion

A good psychotherapeutic care exists with options for improvement concerning diagnostic procedures and a stronger connection network.     

Test Difficulty and Stereotype Threat on the GRE General Test1

This study investigated (a) the ability to minimize or eliminate stereotype threat by reducing the difficulty of items administered via a computer‐adaptive version of the Graduate Record Examinations General Test; and (b) the generalizability of these findings for Black students as well as women, and for verbal as well as quantitative sections of the test. Standard and easier versions of the test, and measures of stereotype threat and possible symptoms or sequelae of stereotype threat were administered to students bound for graduate school or already there. Reducing test difficulty did not have any differential effects on test performance or on explicit indexes of stereotype threat for White and Black students, and for men and women, that were statistically and practically significant. However, such effects did occur for some symptoms or sequelae, mainly for White students and women.     

Contracting From Epistemic Hell is Routine

I respond to Erik Olsson's critique of my account of contraction frominconsistent belief states, by admitting that such contraction cannot be rationalized as adeliberate decision problem. It can, however, be rationalized as a routine designed prior toinadvertent expansion into inconsistency when the deliberating agent embraces a consistent point of view.     

An automated apparatus for presenting depth-rotated three-dimensional objects in human and animal object recognition research

For practical reasons, research on the recognition of objects from different viewpoints has relied almost exclusively on the use of two-dimensional representations of three-dimensional objects. We describe an apparatus that enables the presentation of three-dimensional objects in a discrimination learning paradigm. Three chambers positioned on a movable table allow each of two objects to be presented on either the left or the right side; a viewing window exposes only two of the objects at a time. The objects can be arbitrarily designated as either an S+ or an S−. In addition, they can be placed precisely in any arbitrary Startposition and rotated in depth in 100 steps of 3.6° each. We have successfully used this apparatus to investigate recognition of depth-rotated objects by both pigeons and humans. By varying the stimuli, number of stimulus chambers, and software programs, the apparatus can be used for other types of tasks and to investigate other types of processes.     

A Joint Interactive Storybook Intervention Program for Preschool and Kindergarten Children

The effectiveness of a joint interactive storybook reading program delivered by class teachers to develop literacy skills is examined in Hebrew-speaking preschool and kindergarten children. Post-intervention, both groups achieved significantly higher gains in language and print concept skills than age-matched comparison groups that did not have the intervention. However, motivation to read improved significantly more in the experimental group than the comparison group in kindergarteners. Results suggest that intervention program using stories and embedded activities can enhance language and print concepts in young children. Also, motivation to read should be part of every intervention program aimed at enhancing literacy skills.     

The Relational Impact of Multiple Sclerosis: An Integrative Review of the Literature Using a Cognitive Analytic Framework

This integrative literature review uses cognitive analytic therapy (CAT) theory to examine the impact of a chronic illness, multiple sclerosis (MS), on relationships and mental health. Electronic searches were conducted in six medical and social science databases. Thirty-eight articles met inclusion criteria, and also satisfied quality criteria. Articles revealed that MS-related demands change care needs and alter relationships. Using a CAT framework, the MS literature was analysed, and five key patterns of relating to oneself and to others were identified. A diagrammatic formulation is proposed that interconnects these patterns with wellbeing and suggests potential “exits” to improve mental health, for example, assisting families to minimise overprotection. Application of CAT analysis to the literature clarifies relational processes that may affect mental health among individuals with MS, which hopefully will inform how services assist in reducing unhelpful patterns and improve coping. Further investigation of the identified patterns is needed.