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Wilbur J, Scherer N, Mactaggart I, Shrestha G, Mahon T, Torondel B, Hameed S, Kuper H. Are Nepal's water, sanitation and hygiene and menstrual hygiene policies and supporting documents inclusive of disability? A policy analysis. Int J Equity Health 2021; 20:157. [PMID: 34238285 PMCID: PMC8268379 DOI: 10.1186/s12939-021-01463-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/29/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study assesses the inclusion of disability in Nepal's policy and guidance relevant to water, sanitation and hygiene (WASH), and menstrual hygiene management (MHM) in comparison to gender. We investigated both policy formulation and implementation, using the Kavrepalanchok district as a case study. MATERIALS AND METHODS We used the EquiFrame framework, adapted for disability and gender, and focusing on WASH and MHM. Ten Nepali policies and guidance documents were reviewed and scored for quality against the framework, which included 21 core concepts of human rights. We also interviewed key informants to consider the inclusion of disability in the implementation of MHM interventions. We applied stratified purpose sampling to 12 government officials and service providers working in Kathmandu and the Kavrepalanchock district; conducted in-depth interviews and analysed data thematically using Nvivo 11. RESULTS Disability was inadequately covered within the policy documents, and MHM policy commitments for disability were almost non-existent. Participation of people with disabilities in policy development was limited; within Kavrepalanchok, policy commitments were not implemented as intended and disability service providers were unable to allocate government resources. Inadequate data on disability and MHM resulted in limited professional understanding of the issues, as service providers had no training. A narrow WASH infrastructure approach to improving MHM for people with disabilities was prioritised. MHM interventions were delivered in schools; these failed to reach children with disabilities who are often out of school. Finally, there were indications that some caregivers seek sterilisation for people with disabilities who are unable to manage menstruation independently. CONCLUSION Though the Constitution of Nepal enshrines gender equality and disability inclusion, there are consistent gaps in attention to disability and MHM in policies and practice. These omit and exclude people with disabilities from MHM interventions. Investment is required to generate evidence on the MHM barriers faced by people with disabilities, which would then be drawn on to develop training on these issues for professionals to improve understanding. Subsequently, policy makers could include more concepts of human rights against disability in relevant policies and service providers could implement policy commitments as intended.
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Affiliation(s)
- Jane Wilbur
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Nathaniel Scherer
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Islay Mactaggart
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Govind Shrestha
- WaterAid Nepal, JM Road 10, Pabitra Tole Nakkhipot, 44700, Nepal
| | | | - Belen Torondel
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Shaffa Hameed
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Hennegan J, Winkler IT, Bobel C, Keiser D, Hampton J, Larsson G, Chandra-Mouli V, Plesons M, Mahon T. Menstrual health: a definition for policy, practice, and research. Sex Reprod Health Matters 2021; 29:1911618. [PMID: 33910492 PMCID: PMC8098749 DOI: 10.1080/26410397.2021.1911618] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The term “menstrual health” has seen increased use across advocacy, programming, policy, and research, but has lacked a consistent, self-contained definition. As a rapidly growing field of research and practice a comprehensive definition is needed to (1) ensure menstrual health is prioritised as a unified objective in global health, development, national policy, and funding frameworks, (2) elucidate the breadth of menstrual health, even where different needs may be prioritised in different sectors, and (3) facilitate a shared vocabulary through which stakeholders can communicate across silos to share learning. To achieve these aims, we present a definition of menstrual health developed by the Terminology Action Group of the Global Menstrual Collective. We describe the definition development process, drawing on existing research and terminology, related definitions of health, and consultation with a broad set of stakeholders. Further, we provide elaboration, based on current evidence, to support interpretation of the definition.
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Affiliation(s)
- Julie Hennegan
- Research Fellow, Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Adjunct Research Associate, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Inga T Winkler
- Lecturer in Human Rights, Institute for the Study of Human Rights, Columbia University, New York, NY, USA
| | - Chris Bobel
- Professor, Women's, Gender, and Sexuality Studies, College of Liberal Arts, Department of Women's, Gender, and Sexuality Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Danielle Keiser
- Founder & Executive Director, Menstrual Health Hub / MH Hub, Berlin, Germany
| | | | - Gerda Larsson
- Co-Founder and Managing Director, The Case for Her, Stockholm, Sweden
| | - Venkatraman Chandra-Mouli
- Scientist, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Marina Plesons
- Consultant, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Thérèse Mahon
- Regional Programme Manager South Asia, WaterAid, London, UK
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Wilbur J, Kayastha S, Mahon T, Torondel B, Hameed S, Sigdel A, Gyawali A, Kuper H. Qualitative study exploring the barriers to menstrual hygiene management faced by adolescents and young people with a disability, and their carers in the Kavrepalanchok district, Nepal. BMC Public Health 2021; 21:476. [PMID: 33691653 PMCID: PMC7944905 DOI: 10.1186/s12889-021-10439-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 02/15/2021] [Indexed: 02/15/2023] Open
Abstract
Background Menstrual hygiene management (MHM) is a recognised public health, social and educational issue, which must be achieved to allow the realisation of human rights. People with disabilities are likely to experience layers of discrimination when they are menstruating, but little evidence exists. Methods The study aims to investigate barriers to MHM that people with disabilities and their carers face in the Kavrepalanchok, Nepal, using qualitative methods. Twenty people with disabilities, aged 15–24, who menstruate and experience ‘a lot of difficulty’ or more across one or more of the Washington Group functional domains were included, as well as 13 carers who provide menstrual support to these individuals. Purposeful sampling was applied to select participants. Different approaches were used to investigating barriers to MHM and triangulate data: in-depth interviews, observation, PhotoVoice and ranking. We analysed data thematically, using Nvivo 11. Results Barriers to MHM experienced by people with disabilities differ according to the impairment. Inaccessible WASH facilities were a major challenge for people with mobility, self-care and visual impairments. People with intellectual impairments had difficulty accessing MHM information and their carers despaired when they showed their menstrual blood to others, which could result in abuse. No support mechanisms existed for carers for MHM, and they felt overwhelmed and isolated. Menstrual discomfort was a major challenge; these were managed with home remedies, or not at all. Most participants followed menstrual restrictions, which were widespread and expected; many feared they would be cursed if they did not. As disability is often viewed as a curse, this demonstrates the layers of discrimination faced. Conclusion Issues related to MHM for people with disabilities is more complex than for others in the population due to the additional disability discrimination and impairment experienced. Research exploring these issues must be conducted in different settings, and MHM interventions, tailored for impairment type and carers requirements,should be developed. Attention to, and resourcing for disability inclusive MHM must be prioritised to ensure ‘no one is left behind’. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10439-y.
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Affiliation(s)
- Jane Wilbur
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | | | - Belen Torondel
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Shaffa Hameed
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | | | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Sommer M, Caruso BA, Torondel B, Warren EC, Yamakoshi B, Haver J, Long J, Mahon T, Nalinponguit E, Okwaro N, Phillips-Howard PA. Menstrual hygiene management in schools: midway progress update on the "MHM in Ten" 2014-2024 global agenda. Health Res Policy Syst 2021; 19:1. [PMID: 33388085 PMCID: PMC7776301 DOI: 10.1186/s12961-020-00669-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/13/2020] [Indexed: 11/24/2022] Open
Abstract
Progress has been made in recent years to bring attention to the challenges faced by school-aged girls around managing menstruation in educational settings that lack adequate physical environments and social support in low- and middle-income countries. To enable more synergistic and sustained progress on addressing menstruation-related needs while in school, an effort was undertaken in 2014 to map out a vision, priorities, and a ten-year agenda for transforming girls' experiences, referred to as Menstrual Hygiene Management in Ten (MHM in Ten). The overarching vision is that girls have the information, support, and enabling school environment for managing menstruation with dignity, safety and comfort by 2024. This requires improved research evidence and translation for impactful national level policies. As 2019 marked the midway point, we assessed progress made on the five key priorities, and remaining work to be done, through global outreach to the growing network of academics, non-governmental organizations, advocates, social entrepreneurs, United Nations agencies, donors, and national governments. This paper delineates the key insights to inform and support the growing MHM commitment globally to maximize progress to reach our vision by 2024. Corresponding to the five priorities, we found that (priority 1) the evidence base for MHM in schools has strengthened considerably, (priority 2) global guidelines for MHM in schools have yet to be created, and (priority 3) numerous evidence-based advocacy platforms have emerged to support MHM efforts. We also identified (priority 4) a growing engagement, responsibility, and ownership of MHM in schools among governments globally, and that although MHM is beginning to be integrated into country-level education systems (priority 5), resources are lacking. Overall, progress is being made against identified priorities. We provide recommendations for advancing the MHM in Ten agenda. This includes continued building of the evidence, and expanding the number of countries with national level policies and the requisite funding and capacity to truly transform schools for all students and teachers who menstruate.
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, New York, NY, United States of America.
| | - Bethany A Caruso
- Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Belen Torondel
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elodie C Warren
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | | | - Jackie Haver
- Save the Children US, Washington, DC, United States of America
| | - Jeanne Long
- Save the Children US, Washington, DC, United States of America
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Sommer M, Torondel B, Hennegan J, Phillips-Howard PA, Mahon T, Motivans A, Zulaika G, Gruer C, Haver J, Caruso BA. How addressing menstrual health and hygiene may enable progress across the Sustainable Development Goals. Glob Health Action 2021; 14:1920315. [PMID: 34190034 PMCID: PMC8253211 DOI: 10.1080/16549716.2021.1920315] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022] Open
Abstract
There is increasing global attention to the importance of menstrual health and hygiene (MHH) for the lives of those who menstruate and gender equality. Yet, the global development community, which focuses on issues ranging from gender to climate change to health, is overdue to draw attention to how addressing MHH may enable progress in attaining the Sustainable Development Goals (SDGs). To address this gap, we undertook a collective exercise to hypothesize the linkages between MHH and the 17 SDGs, and to identify how MHH contributes to priority outcome measures within key sectoral areas of relevance to menstruating girls in low- and middle-income countries. These areas included Education, Gender, Health (Sexual and Reproductive Health; Psychosocial Wellbeing), and Water, Sanitation and Hygiene (WASH). These efforts were undertaken from February - March 2019 by global monitoring experts, together with select representatives from research institutions, non-governmental organizations, and governments (n = 26 measures task force members). Through this paper we highlight the findings of our activities. First, we outline the existing or potential linkages between MHH and all of the SDGs. Second, we report the identified priority outcomes related to MHH for key sectors to monitor. By identifying the potential contribution of MHH towards achieving the SDGs and highlighting the ways in which MHH can be monitored within these goals, we aim to advance recognition of the fundamental role of MHH in the development efforts of countries around the world.
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | | | | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | | | - Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
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Wilbur J, Mahon T, Torondel B, Hameed S, Kuper H. Feasibility Study of a Menstrual Hygiene Management Intervention for People with Intellectual Impairments and Their Carers in Nepal. Int J Environ Res Public Health 2019; 16:ijerph16193750. [PMID: 31590312 PMCID: PMC6801804 DOI: 10.3390/ijerph16193750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/27/2019] [Accepted: 09/29/2019] [Indexed: 11/16/2022]
Abstract
Background: The Bishesta campaign is a menstrual hygiene management (MHM) intervention developed to meet the specific needs of people with intellectual impairments and their carers. It was designed and delivered in the Kavre district, Nepal. This paper explores the campaign's feasibility and acceptability. Methods: The Bishesta campaign was delivered to ten people with an intellectual impairment and their eight carers. Data on the feasibility and acceptability of the intervention was collected through: Structured questionnaire to participants before and after the intervention, process monitoring data, post-intervention in-depth interviews with all carers, observation of people with intellectual impairments, key informant interviews with all facilitators and staff involved in the campaign, as well as ranking of the perceived appropriateness and acceptability of campaign components by carers and facilitators. Results: The Bishesta campaign was acceptable for the target groups, facilitators, and implementers. It was largely delivered with fidelity. Participants used most of the campaign components; these made the target behaviours attractive and enabled participants to carry them out with ease. There were improvements across all target behaviours. The focus of this study was feasibility, not limited-efficancy; however, indicative positive outcomes from this small sample were observed, such as an increase in young people's levels of confidence, comfort, and autonomy during menstruation. Conclusion: Within the sample, the Bishesta campaign appears to be a feasible intervention to ensure that one of the groups most vulnerable to exclusion from MHM interventions is not left behind.
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Affiliation(s)
- Jane Wilbur
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
| | - Thérèse Mahon
- WaterAid, 47-49 Durham Street, London, SE11 5JD, UK.
| | - Belen Torondel
- Environmental Health Group, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
| | - Shaffa Hameed
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
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Wilbur J, Torondel B, Hameed S, Mahon T, Kuper H. Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people. PLoS One 2019; 14:e0210974. [PMID: 30726254 PMCID: PMC6365059 DOI: 10.1371/journal.pone.0210974] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 01/05/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND One quarter of the global population is of menstruating age, yet menstruation is shrouded in discrimination and taboos. Disability also carries stigma, so disabled people may face layers of discrimination when they are menstruating. The objective of the review is to assess the menstrual hygiene requirements of disabled people, the barriers they face, and the available interventions to help them manage their menstruation hygienically and with dignity. METHODS Eligible studies, gathered across all countries, were identified by conducting searches across four databases (MEDLINE, PubMed, EMBASE, Global Health) in May 2017, with alerts set on each database to highlight new titles added until April 2018. Eligible studies incorporated analyses relevant to menstruating disabled people and/or how their carers provide support during their menstrual cycle. RESULTS The 22 studies included were published since 1976; the majority after 2010 (n = 12; 55%). One study was a quasi-experiment; all others were observational. Most studies (n = 15; 68%) were from high income countries and most (n = 17; 77%) focused on people with intellectual impairments, so the review findings focus on this group and their carers. Outcomes investigated include choice and preference of menstrual product, ability to manage menstrual hygiene and coping strategies applied. Barriers faced included a lack of standardised guidance for professional carers; a lack of menstruation training, information and support provided to people with intellectual impairments and their carers; a lack of understanding of severity of symptoms experienced by people with intellectual impairments, the high cost of menstrual products and lack of appropriate options for people with physical impairments. Few interventions were found, and strategies for menstrual hygiene management applied by carers of persons with intellectual impairments include limiting the disabled person's movements when menstruating and suppressing their menstruation. CONCLUSIONS Little evidence was identified on the requirements of disabled people and their carers in managing their menstruation, and only one intervention, but a range of barriers were identified. This gap in evidence is important, as the consequences of failing to meet menstrual hygiene needs of disabled people includes shame, social isolation, and even sterilisation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018095497.
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Affiliation(s)
- Jane Wilbur
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Belen Torondel
- Environmental Health Group, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shaffa Hameed
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Abstract
Current research points to an increase in the interest in and focus on the age at which the medial end of the clavicle begins and completes union in various populations worldwide. As it currently stands, no information exists for the South African population detailing the age at which this skeletal developmental marker commences or completes union. The aim of this study was to establish the age at which partial and complete unions occur and to find if there is any correlation between the age and the assigned stage score in a South African Black skeletal sample. Paired clavicles of 211 males and females (M = 101, F = 110) with ages ranging between 12 and 45 years from the Raymond A. Dart Collection of Human Skeletons were included. A strong correlation between age and the assigned stage score was observed for both males and females (rs = 0.73). No statistically significant differences between the stage of union at the left and right clavicles were observed (p = 0.9). In this sample, partial union was commonly observed in individuals in their third decade of life; while complete union occurred more often in individuals older than 30 years of age. Assessing and recording the degree of union at the medial end of the clavicle can be a helpful additional age-at-death indicator to use when establishing an age-at-death range. However, overlap and variability between the ages of individuals categorized as either displaying signs of partial or complete union were evident.
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Affiliation(s)
- T Mahon
- Department of Forensic Medicine and Pathology, University of the Witwatersrand, 25 A Hospital Street, Braamfontein, 2195, South Africa.
| | - L J Friedling
- Department of Human Biology, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
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Holt L, Liddy N, Bossi G, Harper J, Dukes J, Paston S, Mahon T, Molloy P, Sami M, Baston E, Cameron B, Powesland A, Johnson A, Hassan N, Vuidepot A, Coughlin C, Jakobsen B. Engineering high affinity, soluble T cell receptors for the treatment of cancer. Eur J Cancer 2018. [DOI: 10.1016/j.ejca.2018.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shingler W, Harper J, Bossi G, Barker D, Dukes J, Liddy N, Paston S, Mahon T, Molloy P, Sami M, Baston E, Cameron B, Johnson A, Vuidepot A, Hassan N, McGrath Y, Jakobsen B. 126 IMCgp100: A novel bi-specific biologic for the treatment of malignant melanoma. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70252-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mahon T, Fernandes M. Menstrual hygiene in South Asia: a neglected issue for WASH (water, sanitation and hygiene) programmes. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/13552071003600083] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kuluz JW, McLaughlin GE, Gelman B, Cantwell GP, Thomas J, Mahon T, Schleien CL. The fraction of inspired oxygen in infants receiving oxygen via nasal cannula often exceeds safe levels. Respir Care 2001; 46:897-901. [PMID: 11513761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVE Measure the fraction of inspired oxygen (F(IO(2))) in infants receiving supplemental oxygen via nasal cannula and identify clinical variables that affect F(IO(2)). METHODS Hypopharyngeal gas samples were obtained from 20 infants receiving oxygen via nasal cannula at flows between 0 and 4 L/min. F(IO(2)) was calculated using the alveolar gas equation and measurements of partial pressure of oxygen in the samples and the barometric pressure. RESULTS F(IO(2)) increased as oxygen flow was increased. F(IO(2)) exceeded safe levels (> 60%) in two thirds of samples when the oxygen flow was 2 L/min or higher. Tachypnea (respiratory rate > 40 breaths/min) was associated with lower F(IO(2)). CONCLUSION Infants receiving oxygen via nasal cannula at > or = 2 L/min may be at risk for hyperoxic lung injury. Therefore, we recommend using the lowest possible oxygen flow needed to maintain normoxia in infants requiring prolonged oxygen therapy via nasal cannula.
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Affiliation(s)
- J W Kuluz
- Division of Critical Care Medicine, Department of Pediatrics, University of Miami School of Medicine/Jackson Memorial Hospital, Miami, Florida 33101-6960, USA.
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Abstract
The objective of this study was to derive and test clinical scoring system in order to predict the presence of gallstones and to identify inappropriate referrals. The design of this scoring system comprised a prospective audit of all referrals with suspected gallstones and a prospective validation of the system on new patients. The subjects used in the study consisted of 300 inpatient, outpatient and general practitioner referrals to a radiology department with suspected gallstones during the period 1984-1986 (1st cohort) and 200 similar referrals from 1987 to 1988 (2nd cohort). The main outcome measures were gallstones as determined by oral cholecystogram and/or ultrasound of the gallbladder. 32.7% and 24.0% of referrals in the first and second cohorts, respectively, had gallstones. A scoring system to predict gallstones was derived on the first cohort based on age, Murphy's sign, duration and type of pain, presence or absence of flatulence, and source of referral. This scoring system discriminated well between those with and without stones in both cohorts. Low risk groups, comprising about 15% of the referrals in each cohort, were identified with a prevalence of gallstones of 4.5% (1st cohort) and 3.0% (2nd cohort). If these patients had not been referred the radiological workload would have dropped by 15%, with a very small reduction in diagnostic yield. We conclude that prior to radiological assessment it is possible, on the basis of source of referral and symptoms, to identify a group of patients with a low prevalence of gallstones. These cases, with a low diagnostic yield, contribute substantially to the workload of a radiological department.
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Affiliation(s)
- T Farrell
- Department of Radiology, St Vincent's Hospital, Dublin, Ireland
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Trestman RL, Lawrence TL, Coccaro EF, Harvey P, Bernstein D, Lawrence EK, Condello V, Mahon T, Yang RK, Knott P. Noradrenergic responses to clonidine in acute and remitted depressed male patients. Psychiatry Res 1992; 43:199-213. [PMID: 1332095 DOI: 10.1016/0165-1781(92)90053-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To investigate noradrenergic function in depression, plasma 3-methoxy-4-hydroxyphenylglycol (MHPG), plasma norepinephrine (NE), mean arterial pressure (MAP), and heart rate responses to intravenous clonidine (2 micrograms/kg), an alpha 2-adrenergic agonist, were measured in 27 acutely depressed patients, 18 remitted depressed patients, and 27 normal control subjects; a placebo infusion was administered to a subgroup. Clonidine compared with placebo, over a 150-minute time course, decreased plasma NE, MAP, and heart rate, but not plasma MHPG, in the control subjects. Plasma MHPG, plasma NE, MAP, and heart rate at baseline or in response to clonidine and placebo over 150 minutes did not indicate any group differences. The only significant plasma MHPG response to clonidine in the normal control subjects occurred 60 minutes after the infusion. A significantly diminished plasma MHPG response to clonidine at 60 minutes was found in the acutely depressed group compared with the normal control subjects. These results suggest that peripheral inhibitory noradrenergic responses to clonidine are normal in depressed patients, while plasma MHPG responses to clonidine, which have a limited central contribution, appear to be a weak reflection of central noradrenergic function and appear insufficiently robust for a meaningful evaluation of hypothetical group differences in central inhibitory alpha 2-adrenergic activity in this population.
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Bloomfield F, Stapleton P, Mahon T, Nowlan P, Rogers S. Modulation of the inflammatory response by taurine and hepes. Neurochem Int 1992. [DOI: 10.1016/0197-0186(92)91762-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Abstract
Malpositioned central venous catheters need to be repositioned so as to avoid local toxicity from chemotherapeutic and other agents and to prevent venous thrombosis. We describe a simple, safe and effective technique for repositioning silicone central venous catheters, by using a hand injection of sterile saline. It was successful in all nine patients in whom it was attempted, with no complications. Five catheters were single lumen and four were double lumen. We feel that this method should be attempted prior to the use of more invasive techniques.
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Affiliation(s)
- T Mahon
- Department of Diagnostic Radiology, University of Texas, M.D. Anderson Cancer Center, Houston
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18
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Abstract
The authors report a randomized, double-blind prospective trial comparing the effects of nonionic with ionic low-osmolar contrast media on erythrocyte aggregation. The study group comprised 40 consecutive patients with pathology necessitating selective angiography. Patients were examined using either ioxaglate 320, iohexol 350, or iopamidol 370. Erythrocyte aggregation was assessed both macroscopically and microscopically. Erythrocyte aggregation occurred more frequently in the iopamidol group (13 of 45 samples examined) than in the iohexol (4 of 46) or ioxaglate (5 of 51) groups (P = .002).
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Affiliation(s)
- R Hayes
- Department of Radiology, St. Vincent's Hospital, Dublin 4, Ireland
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19
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Coccaro EF, Gabriel S, Mahon T, Macaluso J, Siever LJ. Preliminary evidence of a serotonin (5-HT-1-like) component to the prolactin response to buspirone challenge in humans. Arch Gen Psychiatry 1990; 47:594-5. [PMID: 2161644 DOI: 10.1001/archpsyc.1990.01810180094013] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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20
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Siever LJ, Keefe R, Bernstein DP, Coccaro EF, Klar HM, Zemishlany Z, Peterson AE, Davidson M, Mahon T, Horvath T. Eye tracking impairment in clinically identified patients with schizotypal personality disorder. Am J Psychiatry 1990; 147:740-5. [PMID: 2343917 DOI: 10.1176/ajp.147.6.740] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Eye tracking accuracy, which has been found to be impaired in schizophrenic patients and their relatives, was assessed in 26 patients with schizotypal personality disorder, 17 control subjects with other non-schizophrenia-related personality disorders, 29 normal control subjects, and 44 schizophrenic patients. Both schizotypal and schizophrenic patients, but not control subjects with other personality disorders, demonstrated significantly more impaired tracking than the normal control subjects. These results suggest that patients with clinically defined schizotypal personality disorder may be biologically related to schizophrenic patients as part of a spectrum of schizophrenia-related disorders.
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Affiliation(s)
- L J Siever
- Department of Psychiatry, Mt. Sinai School of Medicine, Bronx, N.Y
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21
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Mahon T, Malone D, Griffin J, MacErlean D, Hyland J. Failure of ultrasound to detect extra-pancreatic abscesses in severe acute pancreatitis. Eur J Radiol 1989; 9:248-9. [PMID: 2686994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The development of intra-abdominal abscesses in patients with severe acute pancreatitis can be associated with a mortality as high as 100%. The clinical findings in these patients may be non specific and therefore imaging is essential. Computed tomography (CT) is the imaging modality of choice. However, a satisfactory ultrasound examination may be regarded as sufficient, particularly when there is limited availability of CT. A case of extra-pancreatic abscess complicating severe acute pancreatitis, in whom sonography was "normal", but CT demonstrated the abscess is presented. The importance of CT in these patients in whom an abscess is suspected and our experience with similar cases is discussed.
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Affiliation(s)
- T Mahon
- Department of Diagnostic Imaging, St. Vincent's Hospital, Dublin, Ireland
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22
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McGrath F, Healy MV, Lee MJ, Buckley JG, Fitzgerald P, Mahon T, Hayes R, Downey DB, Marshall R. Royal Academy of Medicine in Ireland Proceedings of Registrar’s Prize Meeting, Section of Radiology held on 20th November, 1986. Ir J Med Sci 1987. [DOI: 10.1007/bf02954047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Bewley TH, James IP, Le Fevre C, Maddocks P, Mahon T. Maintenance treatment of narcotic addicts (not British nor a system, but working now). Int J Addict 1972; 7:597-611. [PMID: 4659587 DOI: 10.3109/10826087209028113] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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