Explore the vast range of titles available.

Background The ‘Sankofa’ pediatric HIV disclosure study (2013–2017) was an intervention that aimed to address the low prevalence of disclosure of HIV status in Ghana. Methods We conducted a cross-sectional study at the intervention site in Kumasi, Ghana, in 2019, (2 years after study closure) and administered the 21-item Beck Depression Inventory (BDI) and the 10-item Child Depression Inventory (CDI) to caregiver-child dyads who received the intervention. Results We enrolled 65% ( N  = 157) of the original dyads in the present study. Between Sankofa enrollment baseline and the present study, both children and caregivers had significant ( p  < 0.0001) mean reductions in CDI scores and BDI scores, respectively. CDI scores of the children were significantly correlated with BDI scores of the caregivers ( r  = 0.019, p  = 0.019). No statistically significant associations between disclosure status and either CDI score or BDI score were found. Conclusions Our findings did not support caregivers’ fears that disclosure leads to depression. Trial registration ClinicalTrials.gov Identifier: NCT01701635 (date of registration Oct 5, 2012).

The primary objective of this study was to implement a same-day discharge pathway for patients undergoing minimally invasive gynecologic surgery at an urban, safety-net hospital. Prior to implementation, patients routinely spent one to two nights in the hospital postoperatively. This project was implemented on December 3, 2018. We utilized a screening tool to identify eligible patients for same-day discharge. The primary outcome measure was the percentage of patients discharged the same day of the surgery. We compared data between patients discharged home same day versus patients admitted to the hospital, as well as patients who underwent benign minimally invasive gynecologic surgery prior to and after project implementation. Of the 237 patients undergoing minimally invasive gynecologic surgery, 209 were eligible for same-day discharge. More than half (111, 53.1%) of the eligible patients were discharged home on the same day. Same-day discharge was not found to be associated with an increased risk of adverse events compared to patients who were not discharged same day. Same-day discharge after minimally invasive gynecologic surgery is safe and feasible in an urban safety-net hospital, especially with the addition of a screening tool to identify social determinants of health prior to surgery.

Primary classic Hodgkin lymphoma (HL) of the breast is a rare type of breast disease. The diagnosis is mostly confirmed by an excisional biopsy. The first line of treatment commonly used for Hodgkin lymphoma is doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Our case report is about a 48-year-old lady who was diagnosed with bilateral breast Hodgkin lymphoma following an excisional biopsy and was treated with brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (BV-AVD). The patient responded positively after the initiation of the regimen. There is scarce data on the classic Hodgkin lymphoma of the breast, and even with the wide use of first-line treatment using ABVD, the disease is still difficult to manage. Hence, patients with breast masses should be screened for classic HL of the breast, and larger studies are needed to establish specific treatment guidelines concerning HL of the breast to prevent relapse and other complications.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, often presenting with aggressive intrahepatic and extrahepatic spread. Extrahepatic metastasis occurs in a significant proportion of advanced HCC cases, most commonly affecting the lungs, regional lymph nodes, bones, and adrenal glands. However, metastasis to the chest wall is exceedingly rare and infrequently reported in the literature. We report an unusual case of a 71-year-old male with chronic hepatitis C infection and a history of HCC resection in 2019, who presented with abdominal distension, lower extremity edema, and a rapidly enlarging chest wall mass. Imaging and biopsy confirmed metastatic HCC, showing trabecular architecture and positive immunohistochemical staining for HepPar-1 and glypican-3, with portal vein thrombosis (PVT) and chest wall involvement - a rare metastatic pattern. This case highlights HCC's aggressive nature, the importance of early recognition of atypical metastases, and the value of multidisciplinary management - encompassing oncology, hepatology, radiology, and pathology - in improving patient outcomes.

Carcinoma of the ascending colon, especially the medullary type, is a rare and poorly differentiated form of colorectal cancer. This case report details a case of a 75-year-old woman with a background of cardiovascular issues, hypertension, and dementia who presented with complete large bowel obstruction and was found to have poorly differentiated carcinoma of the ascending colon with medullary features. The surgical approach involved an exploratory laparotomy followed by a right hemicolectomy. The pathological analysis confirmed a pT3N0M0, G3 stage II tumor, characterized by a loss of MLH1 and PMS2 protein expression, indicating microsatellite instability (MSI-H). Since there was no nodal involvement, adjuvant chemotherapy wasn't deemed necessary. The patient was encouraged to keep up with regular follow-ups, which would include monitoring carcinoembryonic antigen (CEA) levels, a complete metabolic panel (CMP), a complete blood count (CBC), and CT imaging every six months and annually. Although CEA is the most established tumor marker in colorectal cancer, it is still part of the follow-up plan, owing to its lack of sensitivity in the medullary subtype. In addition to this, the recommendation was for a surveillance colonoscopy every three years. This report sheds light on the case's pathological, clinical, and follow-up elements, emphasizing the need for personalized patient management.

Background: The ‘Sankofa’ pediatric HIV disclosure study (2013-2017) was an intervention that aimed to address the low prevalence of disclosure of HIV status in Ghana. Methods: We conducted a cross-sectional study at the intervention site in Kumasi, Ghana, in 2019, (2 years after study closure) and administered the 21-item Beck Depression Inventory (BDI) and the 10-item Child Depression Inventory (CDI) to caregiver-child dyads who received the intervention. Results: We enrolled 65% (N=157) of the original dyads in the present study. Between Sankofa enrollment baseline and the present study, both children and caregivers had significant (p <0.0001) mean reductions in CDI scores and BDI scores, respectively. CDI scores of the children were significantly correlated with BDI scores of the caregivers (r = 0.019, p = 0.019). No statistically significant associations between disclosure status and either CDI score or BDI score were found. Conclusions: Our findings did not support caregivers’ fears that disclosure leads to depression. Trial Registration: ClinicalTrials.gov Identifier: NCT01701635 (date of registration Oct 5, 2012)

Primary healthcare (PHC) facilities have become essential in promoting adolescent healthcare, yet they face resource limitations that hinder their effectiveness. Ensuring the efficient use of available resources has therefore become pertinent. This study assessed the technical efficiency of primary health care facilities in providing adolescent mental sexual and reproductive health (AMSRH) services. Data was collected from 53 PHC facilities drawn from rural and urban locations in four districts in the Greater Accra region using a multi-stage sampling design. Stochastic Frontier Analysis (SFA) was employed to estimate the technical efficiency of each facility in optimizing outputs given available inputs. The findings revealed significant variation in efficiency, ranging from 0.91 to 0.04 with an average score of 0.60. Rural facilities and government-owned health facilities were more efficient compared to their urban and private counterparts. Facilities offering a wider scope of services to adolescents were also more efficient. However, the provision of adolescent mental health services was limited. Efforts should improve efficiency in the use of AMSRH services by properly aligning resource allocation to needs while expanding the range of services available to adolescents.

Background Globally, adolescent health remains a public health priority given that adolescents often face unique vulnerabilities to health issues like mental disorders, substance abuse, and sexual health risks. In developing countries like Ghana, primary healthcare facilities (PHCs) are often the first point of contact for addressing these issues. However, there is a lack of literature examining the capacity of PHCs to address adolescent sexual and reproductive health (ASRH) issues. This study aims to fill this gap in the literature by assessing the availability and readiness of ASRH services within Ghana’s PHCs. Methods The study utilized a multi-stage sampling approach to select 67 PHCs across four districts in the Greater Accra region, reflecting Ghana's broad demographic diversity. We employed the WHO's Services Availability and Readiness Assessment (SARA) tool to measure the availability and readiness of ASRH services. This framework focused on key domains including service availability and readiness, assessing aspects such as HIV testing, family planning, and availability of contraceptives and necessary staff training. Data analysis was conducted using Stata version 17.0, analysing frequencies and percentages to capture the extent of service provision across the selected facilities. Results The study highlighted significant disparities in the availability and readiness of essential ASRH services (HIV services, family planning, contraceptive pills, IUCD provisions, and male condoms) across selected districts and facility types. In Shai Osudoku, 65% of facilities offered a full range of selected ASRH services, the highest among the districts, whereas Ningo Prampram had the lowest at just 16%. In terms of facility types, 57% of CHPS facilities, 59% of health centres, and 44% of clinics provided all the selected ASRH services. Urban areas reported a 51% provision rate of these services, slightly less than the 54% observed in rural areas. Additionally, readiness disparities were evident: only 21% of urban facilities had adequate service guidelines compared to 29% in rural areas, and a higher percentage of rural facilities (46%) had trained staff, compared to 23% in urban areas. Conclusion This study examined the availability and readiness of ASRH services in PHCs across the Greater Accra region, revealing significant disparities by location and facility type. Particularly, rural and public facilities demonstrated a higher availability of ASRH services compared to urban and private facilities. These findings suggest an uneven distribution of resources and highlight a potential urban underutilization of public health services. Moreover, the study identified a critical lack of service guidelines and trained staff across many facilities, emphasizing the need for enhanced training and resource allocation to improve service readiness. Targeted interventions are necessary to elevate the quality and accessibility of ASRH services, ensuring equitable health care delivery across all regions. Future research should expand to other regions to validate these findings and inform nationwide health strategies.

Background Adolescence is a critical phase of life, with sexual, reproductive, and mental health being essential to overall well-being. Despite global and national initiatives to improve adolescent health, substantial gaps persist in service delivery, especially in low-resource settings like Burkina Faso. Primary healthcare (PHC) facilities play a pivotal role in addressing adolescent mental, sexual, and reproductive health (AMSRH) needs. However, evidence on the technical efficiency of these facilities in delivering AMSRH services remains limited. This study evaluates the technical efficiency of PHC facilities in Burkina Faso in providing AMSRH services and identifies key factors influencing efficiency. Methods A cross-sectional survey was conducted in 132 PHC facilities across the West-Central and Hauts Bassins regions of Burkina Faso from September to October 2022. Data on facility characteristics, resource availability, and service delivery were collected. Technical efficiency of ASRH services was assessed using Stochastic Frontier Analysis (SFA) with a Translog production function, while a truncated regression identified determinants of efficiency. The analysis included inputs such as laboratory tests, consultation rooms, and trained providers, with efficiency scores ranging from 0 to 1. Data analysis was performed using STATA 16. Results Of the surveyed facilities, 77% were in rural areas, and 23% were in urban areas. While all facilities offered adolescent sexual and reproductive health (ASRH) services, only 42% provided adolescent mental health (AMH) services, which were excluded from efficiency analysis due to low adolescent consultation numbers. Average technical efficiency was 0.66, with urban facilities (0.73) and those with electricity (0.71) showing higher efficiency. Access to electricity (Coef. = 0.061, p  = 0.004) and laboratories (Coef. = 0.053, p  = 0.020) significantly enhanced efficiency. These findings highlight critical infrastructure gaps and the need for targeted investments to optimize service delivery. Conclusion This study highlights critical gaps in AMH service availability within PHC facilities in Burkina Faso. Key determinants of technical efficiency in delivering adolescent sexual and reproductive health ASRH services included access to electricity, laboratories, and trained providers. Conversely, longer facility manager tenure negatively impacted efficiency, emphasizing the need for dynamic leadership. Targeted investments in infrastructure, capacity-building initiatives, and digital health adoption are essential. Expanding AMH services and aligning with national guidelines are urgent priorities for optimizing AMSRH service delivery and improving adolescent health outcomes.

Background Adolescent mental health (AMH) is a critical issue worldwide, particularly in West Africa, where it is intensified by socio-economic, cultural, and security challenges. Insecurity and the presence of mining sites expose adolescents to hazardous environments, substance abuse, and adulterated alcohol, further aggravating their mental health. Despite these severe issues, research on AMH in this region remains limited. This study aims to analyze the provision of AMH services in Burkina Faso, Ghana, and Niger, highlighting the unique challenges these countries face within the broader West African healthcare context. Methods The study adopted a multi-stage, stratified sampling design to collect data from primary healthcare centers (PHCs) in the three countries. Using STATA.17, Descriptive analysis was conducted on the data related to availability of AMH services, types of mental health disorders treated, resources available, and OPD attendance rates. The analysis also incorporated factors such as the rural-urban divide and the presence of national guidelines for AMH services. Results The findings reveal a significant shortfall in the provision of AMH services across the region, with less than 30% of PHCs across all the countries offering these services. The study also highlights a pronounced rural-urban disparity in AMH service availability, a general absence of national guidelines for AMH care, and low OPD attendance rates. Conclusion The study highlights the urgent need for comprehensive policy reform and targeted interventions to enhance AMH services in West Africa. Key policy reforms should include the development and implementation of national guidelines for AMH care and integration of AMH services into primary healthcare. Additionally, efforts should focus on capacity building through the training of mental health professionals, increasing public awareness to reduce stigma, and ensuring equitable resource allocation across rural and urban areas. Improving AMH care is essential not only for the well-being of adolescents but also for driving broader socio-economic development in the region.