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By: Joseph P. Vande Griend, PharmD, FCCP, BCPS
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Efficacy of two intervals and two routes of administration of misoprostol for termination of early pregnancy: A randomised controlled equivalence trial arthritis pain in elbow cheap plaquenil 200 mg free shipping. Except for the rare case of an ongoing viable pregnancy rheumatoid arthritis fingers buy cheap plaquenil 200mg, intervention after a medical abortion should be based on clinical symptoms and not ultrasound findings arthritis urica definition generic plaquenil 200 mg without a prescription. Ultrasound findings at follow-up Endometrial thickening: After a successful medical abortion rheumatoid arthritis wrist mri plaquenil 200 mg mastercard, endometrial thickness varies and can be associated with a complex or heterogeneous appearance. Endometrial thickening Courtesy of Mary Fjerstad Multiple retrospective and prospective cohort studies have shown that endometrial thickness has a wide range in women after medical abortion, with significant overlap between women with successful and failed medical abortion (Cowett, Cohen, Lichtenberg, & Stika, 2004; Markovitch, Tepper, Klein, Fishman, & Aviram, 2006; Parashar, Iversen, Midbшe, Myking, & Bjшrge, 2007; Rшrbye, Nшrgaard, & Nilas, 2004; Tzeng, Hwang, Au, & Chien, 2013). Although the average endometrial thickness in women who require intervention tends to be higher, because of the range and overlap between successful and unsuccessful abortion, no study has found that there is a thickness above which a diagnosis of unsuccessful medical abortion can be made. The decision to intervene should be made on clinical signs and symptoms, such as ongoing or heavy bleeding, rather than on ultrasound findings. Persistent gestational sac: A persistent gestational sac, in which the sac is present but there is no viable embryonic tissue, occurs in less than 1% of medical abortions with the recommended mifepristone and misoprostol regimen (Creinin et al. In a study of women with a persistent gestational sac within 11 days of medical abortion, a second dose of misoprostol was found to lead to expulsion of a nonviable sac in 69% of women (Reeves, Kudva, & Creinin, 2008). Persistent gestational sac Courtesy of Mary Fjerstad Ongoing viable pregnancy: An ongoing pregnancy, in which a growing sac and/or embryo with cardiac activity are present, occurs in less than 1% of medical abortions with the recommended mifepristone and misoprostol regimen (Von Hertzen et al. Some women will be able to identify this outcome without ultrasound due to lack of bleeding or continued pregnancy symptoms. A woman with an ongoing pregnancy should be offered uterine evacuation as soon as possible with either vacuum aspiration or a second dose of misoprostol, depending on gestational age and local context. The success rate of misoprostol after failed medical abortion is 36% (Reeves et al. If a woman chooses a second dose of misoprostol, she must be followed to see if it is successful. A randomized comparison of misoprostol 6 to 8 hours versus 24 hours after mifepristone for abortion. Mifepristone and misoprostol administered simultaneously versus 24 hours apart for abortion: A randomized controlled trial. Sonographic appearance of the uterine cavity following administration of mifepristone and misoprostol for termination of pregnancy. Endometrial thickness following medical abortion is not predictive of subsequent surgical intervention. Medical abortion outcomes after a second dose of misoprostol for persistent gestational sac. Sonographic patterns of the endometrium in assessment of medical abortion outcomes. Two mifepristone doses and two intervals of misoprostol administration for termination of early pregnancy: A randomised factorial controlled equivalence trial. Two distinct oral routes of misoprostol in mifepristone medical abortion: A randomized controlled trial. Key information Women who present for abortion at 13 weeks of pregnancy or later are more likely than those who present at earlier gestations to be young or a victim of violence, have detected their pregnancy later, feel ambivalent about the abortion decision, and/or have financial and logistical barriers to care. Additionally, medical or fetal indications for an abortion may not be apparent until after 13 weeks. Reasons for presenting at or after 13 weeks gestation appear similar across countries and cultures and disproportionately affect underserved women. In more restrictive settings, or where safe abortion access is limited, presentation at or after 13 weeks gestation for postabortion care is more common. In Cambodia 17%, in Ethiopia 38%, and in Kenya 41% of women needing postabortion care present at or after 13 weeks gestation. Young age: Young women are disproportionately likely to seek abortion at or after 13 weeks. Smaller case-control and cohort studies in Ethiopia, India, Nepal, Singapore and the United States have found young age to be a risk factor for later presentation (Bonnen, Tuijje, & Rasch, 2014; Foster & Kimport, 2013; Lim, Wong, Yong, & Singh, 2012; Sowmini, 2013). Late detection of pregnancy: A common risk factor in all studies for presenting for abortion at or after 13 weeks is late recognition of pregnancy. Absence of pregnancy signs and symptoms, menstrual irregularity, contraceptive use, or amenorrhea after recent pregnancy can mask physical signs of pregnancy and delay pregnancy diagnosis (Drey et al.
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Many of the strategic results listed in the framework map to natural pain relief arthritis knee order plaquenil 200mg with mastercard strategic priorities arthritis pain use heat or cold cheap plaquenil 200mg line. Another 3 per cent of the costs is in demand creation; 62 per cent in service delivery; 3 per cent in programming for contraceptive security; 1 arthritis pain killer medicine order plaquenil 200mg fast delivery. In the case of a funding gap between resources required and those available arthritis diet the best foods to eat cheap plaquenil 200 mg without prescription, the strategic priority activities should be given precedence to ensure the greatest impact and progress towards the objectives laid out. Six Strategic Priorities · Priority # 1: Promote and nurture change in social and individual behaviour to address stigma, myths, misconceptions, and side effects; and improve acceptance and continued use of family planning to prevent unintended pregnancies through correct, consistent, and targeted social and behaviour change communications that focus on rights-based family planning. Priority # 3: Improve availability and access to a full method mix, quality of client-provider interactions, with a particular focus on improving counselling on delaying, spacing, and limiting for all clients of all ages and population groups. Priority # 4: Improve distribution and ensure full financing for commodity security in the public and private sectors. Priority # 5: Strengthen advocacy to build political will for rights-based family planning amongst community leaders, religious and cultural institutions, and policymakers at all levels, to leading to higher budget and expenditure levels for family planning from domestic sources and ensure implementation and accountability. Stewardship, management, and accountability the six strategic priorities are addressed through various activities under these six thematic areas. Champions and advocates can increase demand for family planning within communities-producing a supportive environment; reducing social, cultural, and religious barriers; and mobilising community support. The design of the campaign will be harmonised across interventions, so communications to the public about family planning are targeted accurately with evidence-based slogans and messages and include target market segmentation to increase demand. Innovative technology and multiple media outlets, such as mobile health platforms, will be piloted and evaluated. It is important to create campaigns that are adaptable for different cultural audiences. While men share responsibility for reproductive health, lack of focus on them might imply that family planning is not their concern. Dispelling myths and misconceptions amongst men is important for ensuring their support of family planning. Peer educators will be trained to help with information dissemination and linking young people to service delivery. Messaging will specifically target under-served and marginalised groups of young people (including those with disabilities) and men, and will address social, cultural, and regional variation. The capacity of young people to be peer educators will be built through technical and leadership training; peer education in schools and communities will be strengthened through organised groups at schools and in communities in 35 Ghana Family Planning Costed Implementation Plan collaboration with local health facilities. In addition, districts will be assisted to integrate youth programming into the existing health budget and put in place a system of incentive packages for peer educators. National campaigns to mobilise men in support of family planning will be conducted. Community durbars and festivals will be held, and other relevant occasions will be used to strengthen and dialogue on family planning, including for young people. Family Planning Week will be celebrated annually at the national, regional, district, and community levels. Implicit in this last condition are the rights of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services. Task shifting has been shown to help mitigate the human resource crisis in many countries, including Ghana. The rights of all groups to receive equitable services will be emphasised in programming. Improved participation of communities in service delivery will address issues of rights of participation by including young people, women, men, and people with disabilities in management and service delivery teams. Friendly services for young people in health facilities will be expanded to ensure privacy and confidentiality in corners for them. There will be improved participation of communities in service delivery, including young people, women, men, and people with disabilities, through including them in management teams and service delivery teams. Health worker training on postpartum family planning will be cascaded through supportive supervision to health facilities. A "lost to follow-up" client tracking mechanism to address missed opportunities will be implemented; health facilities will be facilitated in following up with clients. A national- and regional-level health worker motivation scheme will be implemented for good performers who provide high-quality rights-based services. An assessment of health worker demotivation will be conducted and recommendations implemented.
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The Effectiveness of MobileHealth Technologies to arthritis pain definition generic plaquenil 200mg free shipping Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis arthritis relief for shoulder cheap plaquenil 200mg without prescription. Effectiveness of mHealth Behavior Change Communication Interventions in Developing Countries: A Systematic Review of the Literature arthritis in feet how does it feel cheap plaquenil 200mg free shipping. Adolescent Sexual and Reproductive Health in Ghana: Results from the 2004 National Survey of Adolescents rheumatoid arthritis pain journal buy discount plaquenil 200mg on-line. What Does Not Work in Adolescent Sexual and Reproductive Health: A Review of Evidence on Interventions Commonly Accepted as Best Practices. Protecting the Next Generation in Ghana: New Evidence on Adolescent Sexual and Reproductive Health Needs. Sexual behaviour and contraception among unmarried adolescents and young adults in Greater Accra and Eastern regions of Ghana. Social Desirability Bias in Sexual Behavior Reporting: Evidence from an Interview Mode Experiment in Rural Malawi [. Effectiveness and Spillovers of Online Sex Education: Evidence from a Randomized Evaluation in Colombian Public Schools [Internet]. The effectiveness of adolescent reproductive health interventions in developing countries: a review of the evidence. Interventions Using New Digital Media to Improve Adolescent Sexual Health: A Systematic Review. Among the most striking trends observed are the rapid rate of urbanization and the often remarkably large gaps in fertility between rural and urban areas. We find that the completed fertility patterns of lifetime Accra residents are remarkably similar to those of residents who migrated. Our results suggest that recent migrants have an increased risk of pregnancy but not an increased risk of live birth in the first years postmove compared with those who had never moved. This gap seems to be largely explained by an increased risk of miscarriage or abortion among recent migrants. Increasing access to contraceptives for recent migrants has the potential to reduce the incidence of unwanted pregnancies, lower the prevalence of unsafe abortion, and contribute to improved maternal health outcomes. Keywords: Migration Abortion Fertility Reproductive health sub-Saharan Africa 32 2. Internal rural-to-urban migration accounts for more than one-half of the growth of cities in Africa . One of the most significant recent trends in migration has been the entry of women into migration streams that in previous decades had been primarily male, with an increasing number of female migrants moving on their own [3,4]. Many rural-to-urban migrants settle in slums, contributing to a projection of a doubling of slum settlements over the next 30 years . Over the past five decades, total fertility rates have declined across sub-Saharan Africa , with particularly rapid declines in urban areas. Although urban fertility rates have consistently been lower historically, the difference between urban and rural fertility rates has increased substantially from 0. Given that migrants from rural areas constitute an increasingly large fraction of the urban population, the increasing rural-urban gaps are rather remarkable. From an individual perspective, migration to urban centers constitutes a fundamental change in environment and lifestyle, which may be associated with increased risky sexual behavior, unintended pregnancies, and mistimed births . Most research in the area of migration and fertility has relied on the theoretical framework proposed by Goldstein and Goldstein (1982). The framework is based on three mechanisms: disruption, adaptation, and selection. In the context of reproductive health, each of the three factors may increase or decrease sexual activity and risk of pregnancy . For example, separation of spouses or a desire to delay childbearing until after the move may reduce fertility in the short term [11,12]. Women who migrate to cities to marry or to join husbands are less likely to live with their spouses in the first few months, potentially lowering the probability of fertility in those years [13,14].
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