Koch, Elard; Chireau, Monique; Pliego, Fernando; Stanford, Joseph; Haddad, Sebastian; Calhoun, Byron; Aracena, Paula; Bravo, Miguel; Gatica, Sebastián; Thorp, John
Objective To test whether there is an association between abortion legislation and maternal mortality outcomes after controlling for other factors thought to influence maternal health. Design Population-based natural experiment. Setting and data sources Official maternal mortality data from 32 federal states of Mexico between 2002 and 2011. Main outcomes Maternal mortality ratio (MMR), MMR with any abortive outcome (MMRAO) and induced abortion mortality ratio (iAMR). Independent variables Abortion legislation grouped as less (n=18) or more permissive (n=14); constitutional amendment protecting the unborn (n=17); skilled attendance at birth; all-abortion hospitalisation ratio; low birth weight rate; contraceptive use; total fertility rates (TFR); clean water; sanitation; female literacy rate and intimate-partner violence. Main results Over the 10-year period, states with less permissive abortion legislation exhibited lower MMR (38.3 vs 49.6; pabortion hospitalisation ratio (β=−0.566 to −0.962), clean water (β=−0.048 to −0.730), sanitation (β=−0.052 to −0.758) and intimate-partner violence (β=0.085 to 0.755). TFR showed an inverse association with MMR (β=−14.329) and MMRAO (β=−1.750) and a direct association with iAMR (β=1.383). Altogether, these factors accounted for (R2) 51–88% of the variance among states in overall mortality rates. No statistically independent effect was observed for abortion legislation, constitutional amendment or other covariates. Conclusions Although less permissive states exhibited consistently lower maternal mortality rates, this finding was not explained by abortion legislation itself. Rather, these differences were explained by other independent factors, which appeared to have a more favourable distribution in these states. PMID:25712817
This bulletin contains information about activities of the Nuclear Regulatory Authority of the Slovak Republic (UJD). In this leaflet the legislation activities of the UJD are presented. The Nuclear Regulatory Authority (UJD) of the Slovak Republic, as the central body, performs legislative activities within its competence and defines binding criteria in the area of nuclear safety. In the area of nuclear safety the Act No.130/1998 Coll. 'on peaceful use of nuclear energy' (Atomic Act) is the principal document which came into force on July 1, 1998. Based on the Atomic Act UJD issued decrees on special materials and installations, limits for maximum quantities of nuclear materials at which nuclear damage is not presumed. Furthermore, the regulations are issued which deal with provision of physical protection of nuclear material and radioactive waste, professional ability of employees at nuclear installations, registration and control of nuclear materials, emergency planning for the case of an incident or an events on nuclear installations at their decommissioning, transportation of nuclear materials and radioactive waste. Simultaneously, other 6 regulations are just before the before the completion and they are in various stages of the of the legislative process. In addition, UJD performs remarkable activities in legislative area by preparation of comments to drafts of other relating generally binding legal provisions of the Slovak Republic. UJD also acts as the participant of the review procedure in the area of technical standards and publication. UJD also issues documents which have character of the recommendations, so called safety guides. These guides contain methods and approach how to meet safety requirements presented in binding documents, as acts and decrees. In accordance with the Atomic act it is possible to use nuclear energy or make business in the area of nuclear energy only the basis of the authorisation issued by UJD. Authorisations are following
Koch, Elard; Chireau, Monique; Pliego, Fernando; Stanford, Joseph; Haddad, Sebastian; Calhoun, Byron; Aracena, Paula; Bravo, Miguel; Gatica, Sebastián; Thorp, John
To test whether there is an association between abortion legislation and maternal mortality outcomes after controlling for other factors thought to influence maternal health. Population-based natural experiment. Official maternal mortality data from 32 federal states of Mexico between 2002 and 2011. Maternal mortality ratio (MMR), MMR with any abortive outcome (MMRAO) and induced abortion mortality ratio (iAMR). Abortion legislation grouped as less (n=18) or more permissive (n=14); constitutional amendment protecting the unborn (n=17); skilled attendance at birth; all-abortion hospitalisation ratio; low birth weight rate; contraceptive use; total fertility rates (TFR); clean water; sanitation; female literacy rate and intimate-partner violence. Over the 10-year period, states with less permissive abortion legislation exhibited lower MMR (38.3 vs 49.6; peffect sizes (β-coefficients) for mortality outcomes showed independent associations (p values between 0.001 and 0.055) with female literacy (β=-0.061 to -1.100), skilled attendance at birth (β=-0.032 to -0.427), low birth weight (β=0.149 to 2.166), all-abortion hospitalisation ratio (β=-0.566 to -0.962), clean water (β=-0.048 to -0.730), sanitation (β=-0.052 to -0.758) and intimate-partner violence (β=0.085 to 0.755). TFR showed an inverse association with MMR (β=-14.329) and MMRAO (β=-1.750) and a direct association with iAMR (β=1.383). Altogether, these factors accounted for (R(2)) 51-88% of the variance among states in overall mortality rates. No statistically independent effect was observed for abortion legislation, constitutional amendment or other covariates. Although less permissive states exhibited consistently lower maternal mortality rates, this finding was not explained by abortion legislation itself. Rather, these differences were explained by other independent factors, which appeared to have a more favourable distribution in these states. Published by the BMJ Publishing Group Limited. For
Full Text Available The aim of this study was to assess the main factors related to maternal mortality reduction in large time series available in Chile in context of the United Nations' Millennium Development Goals (MDGs.Time series of maternal mortality ratio (MMR from official data (National Institute of Statistics, 1957-2007 along with parallel time series of education years, income per capita, fertility rate (TFR, birth order, clean water, sanitary sewer, and delivery by skilled attendants were analysed using autoregressive models (ARIMA. Historical changes on the mortality trend including the effect of different educational and maternal health policies implemented in 1965, and legislation that prohibited abortion in 1989 were assessed utilizing segmented regression techniques.During the 50-year study period, the MMR decreased from 293.7 to 18.2/100,000 live births, a decrease of 93.8%. Women's education level modulated the effects of TFR, birth order, delivery by skilled attendants, clean water, and sanitary sewer access. In the fully adjusted model, for every additional year of maternal education there was a corresponding decrease in the MMR of 29.3/100,000 live births. A rapid phase of decline between 1965 and 1981 (-13.29/100,000 live births each year and a slow phase between 1981 and 2007 (-1.59/100,000 live births each year were identified. After abortion was prohibited, the MMR decreased from 41.3 to 12.7 per 100,000 live births (-69.2%. The slope of the MMR did not appear to be altered by the change in abortion law.Increasing education level appears to favourably impact the downward trend in the MMR, modulating other key factors such as access and utilization of maternal health facilities, changes in women's reproductive behaviour and improvements of the sanitary system. Consequently, different MDGs can act synergistically to improve maternal health. The reduction in the MMR is not related to the legal status of abortion.
Goldstein, Adam O; Grant, Ernest; McCullough, Anna; Cairns, Bruce; Kurian, Ann
Advocates who work for tobacco control legislation through coalition-based policy advocacy have access to a broad base of support and resources that are critical to overcoming the tobacco industry lobby. This article provides an example of how a coalition-based advocacy strategy that engaged a diverse group of stakeholders and was supported by a national coordinating movement achieved state level fire-safe cigarette legislation in a tobacco-producing and manufacturing state.
Full Text Available An anomaly in legislation is absence of completeness, consistency and other desirable properties, caused by different semantic, syntactic or pragmatic reasons. In general, the detection of anomalies in legislation comprises validation and verification. The basic idea of research, as presented in this paper, is modelling legislation by capturing domain knowledge of legislation and specifying it in a generic way by using commonly agreed and understandable modelling concepts of the Unified Modelling Language (UML. Models of legislation enable to understand the system better, support the detection of anomalies and help to improve the quality of legislation by validation and verification. By implementing model-based approach, the object of validation and verification moves from legislation to its model. The business domain of legislation has two distinct aspects: a structural or static aspect (functionality, business data etc., and a behavioural or dynamic part (states, transitions, activities, sequences etc.. Because anomalism can occur on two different levels, on the level of a model, or on the level of legislation itself, a framework for validation and verification of legal regulation and its model is discussed. The presented framework includes some significant types of semantic and syntactic anomalies. Some ideas for assessment of pragmatic anomalies of models were found in the field of software quality metrics. Thus pragmatic features and attributes can be determined that could be relevant for evaluation purposes of models. Based on analogue standards for the evaluation of software, a qualitative and quantitative scale can be applied to determine the value of some feature for a specific model.
Chan, Sophia Siu Chee; Cheung, Yee Tak Derek; Leung, Doris Yin Ping; Mak, Yim Wah; Leung, Gabriel M; Lam, Tai Hing
Smokefree legislation may protect children from secondhand smoke (SHS) in the home from smoking parent(s). We examined the effect of the 2007 smokefree legislation on children's exposure to SHS in the home and maternal action to protect children from SHS exposure in Hong Kong. Families with a smoking father and a non-smoking mother were recruited from public clinics before (2005-2006, n = 333) and after the legislation (2007-2008, n = 742) which led to a major extension of smokefree places in Hong Kong. Main outcomes included children's SHS exposure in the home, nicotine level in mothers' and children's hair and home environment, mothers' action to protect children from SHS, and their support to the fathers to quit. Fewer mothers post-legislation reported children's SHS exposure in the home (87.2% versus 29.3%, pchildren away from cigarette smoke (6.3% versus 92.2%; pchildren from SHS increased after the 2007 smokefree legislation. Maternal support to fathers to quit showed moderate improvement. Cessation services for smokers and specific interventions for smoking families should be expanded together with smokefree legislation.
Sophia Siu Chee Chan
Full Text Available BACKGROUND: Smokefree legislation may protect children from secondhand smoke (SHS in the home from smoking parent(s. We examined the effect of the 2007 smokefree legislation on children's exposure to SHS in the home and maternal action to protect children from SHS exposure in Hong Kong. METHODS: Families with a smoking father and a non-smoking mother were recruited from public clinics before (2005-2006, n = 333 and after the legislation (2007-2008, n = 742 which led to a major extension of smokefree places in Hong Kong. Main outcomes included children's SHS exposure in the home, nicotine level in mothers' and children's hair and home environment, mothers' action to protect children from SHS, and their support to the fathers to quit. RESULTS: Fewer mothers post-legislation reported children's SHS exposure in the home (87.2% versus 29.3%, p<0.01, which was consistent with their hair nicotine levels (0.36 ng/mg versus 0.04 ng/mg, p<0.01. More mothers post-legislation in the last month took their children away from cigarette smoke (6.3% versus 92.2%; p<0.01 and advised fathers to quit over 3 times (8.3% versus 33.8%; p<0.01. No significant change was found in the content of smoking cessation advice and the proportion of mothers who took specific action to support the fathers to quit. CONCLUSIONS: SHS exposure in the home decreased and maternal action to protect children from SHS increased after the 2007 smokefree legislation. Maternal support to fathers to quit showed moderate improvement. Cessation services for smokers and specific interventions for smoking families should be expanded together with smokefree legislation.
Chan, Sophia Siu Chee; Cheung, Yee Tak Derek; Leung, Doris Yin Ping; Mak, Yim Wah; Leung, Gabriel M.; Lam, Tai Hing
Background Smokefree legislation may protect children from secondhand smoke (SHS) in the home from smoking parent(s). We examined the effect of the 2007 smokefree legislation on children’s exposure to SHS in the home and maternal action to protect children from SHS exposure in Hong Kong. Methods Families with a smoking father and a non-smoking mother were recruited from public clinics before (2005–2006, n = 333) and after the legislation (2007–2008, n = 742) which led to a major extension of smokefree places in Hong Kong. Main outcomes included children’s SHS exposure in the home, nicotine level in mothers’ and children’s hair and home environment, mothers’ action to protect children from SHS, and their support to the fathers to quit. Results Fewer mothers post-legislation reported children’s SHS exposure in the home (87.2% versus 29.3%, plegislation in the last month took their children away from cigarette smoke (6.3% versus 92.2%; plegislation. Maternal support to fathers to quit showed moderate improvement. Cessation services for smokers and specific interventions for smoking families should be expanded together with smokefree legislation. PMID:25166507
September. Pipeline & Gas Journal, 1982a. "Sheep Mountain CO2 Pipeline Involvei; Intensive Design Effort." Energy Publications, HBJ , Dallas, June, p. 61...Pipeline & Gas Journal, 1982b. "Legislative Moves Will Help Slurry Pipeline Project Prospects." Energy Publications, HBJ , Dallas, June, p. 27. Pister
The Transportation Legislative Data Base (TLDB) is a computer-based information service containing summaries of federal, state and certain local government statutes and regulations relating to the transportation of radioactive materials in the United...
Janghorban, Roksana; Taghipour, Ali; Latifnejad Roudsari, Robab; Abbasi, Mahmoud
Women's empowerment can be defined as a change in the circumstances of a woman's life, which enables her to raise her capacity to manage more enriched and rewarding life. Improvement in women's empowerment is a salient issue to achieve the Millennium Development Goals. National laws are influential factors in promoting women's empowerment. Lack of awareness of legal and constitutional provisions and failure to recognize it, is a factor that hinders the process of empowerment. This paper provides a review based on Iranian legislations which have considered various aspects of women's empowerment. Although this work has specifically dealt with women's needs, it encompasses a right-based approach to women's empowerment suggested by the United Nations Fund for Population Activities. However, there is still a great need for further inquiries in the area of legislations concerning women's empowerment around the world in general and Iran in particular.
Following the United Nations Declaration on the Rights of Persons with Mental Illness (1991), the Australian Government released the National Mental Health Policy in 1992. Pointedly, the Report of the National Inquiry into the Rights of People with a Mental Illness in 1993 was critical of the failure of a number of Australian jurisdictions to adequately protect the rights of people with mental illness. A subsequent critique of the capacity of mental health law and policy to respond to current and future challenges of community-based care suggested that while Australian legislation and policies may pass human rights scrutiny in principle, there was insufficient focus on the monitoring processes to ensure implementation and adherence to those measures. The new Commonwealth Attorney-General has foreshadowed the development of a Charter of Rights to create a framework for legislators and regulators when drafting legislation to cover "aspirations" such as the recognition of fundamental human rights. However, it is argued that the dilemma of how best to care for and protect those afflicted with mental illness as well as the public who may be affected by violence or offending by those persons with untreated mental illness, will not be resolved by resort to a didactic Charter of Rights, however idealistic or well intentioned.
The Transportation Legislative Data Base (TLDB) is a computer-based information service containing summaries of federal, state and certain local government statutes and regulations relating to the transportation of radioactive materials in the United States. The TLDB has been operated by the National Conference of State Legislatures (NCSL) under cooperative agreement with the US Department of Energy's (DOE) Office of Civilian Radioactive Waste Management since 1992. The data base system serves the legislative and regulatory information needs of federal, state, tribal and local governments, the affected private sector and interested members of the general public. Users must be approved by DOE and NCSL. This report is a state statute compilation that updates the 1989 compilation produced by Battelle Memorial Institute, the previous manager of the data base. This compilation includes statutes not included in the prior compilation, as well as newly enacted laws. Statutes not included in the prior compilation show an enactment date prior to 1989. Statutes that deal with low-level radioactive waste transportation are included in the data base as are statutes from the states of Alaska and Hawaii. Over 155 new entries to the data base are summarized in this compilation
Hvingel, Line; Baaner, Lasse
In general, digital society challenges traditional modes of legislation and rulings. Dissimilar compositions of the legislation and non-comparable spatial representations of the legal content makes traditional legislation unfit for e-Government. Lacking attention may lead to the undermining...... of the trustworthiness of administration systems. On the other hand, a successful adaption of legislation to a digital setup could help promote good service towards citizens and businesses, and according to land administration theories maybe even promote societal sustainability in large. Based on studies on Denmark......, different challenges within digital land administration solutions are demonstrated. This paper discusses how legislation needs to change in order to be ‘e-Ready’....
Full Text Available Global financial crisis in 2008 posted numerous questions about the reasons and triggers. In past three years world’s economic literature has been full of academic articles analysing each reason or trigger and scientific explanations of possible connections. Majority outcome was, that key factor was excessive use of derivatives and synthetic financial products, which were under regulated or not regulated at all. The outcome was that countries with developed financial markets introduced new regulations and controls in the field of derivatives and synthetic financial products. Term “systemic risk” was introduced in global financial market. But will this approach really prevent such global crisis? Submission is divided in three parts. First part deals with the theory of principle based regulation. Principle based regulation was firstly introduced in UK and latter accepted by European Union in the field of capital markets. It was a way, together with the Lamfalussy process, to make EU regulation acceptable for all member states. Instead of detailed prescribed behaviour, legislation texts prescribe only desirable goals. Implementation is left to each state or, even worse, to each supervised subject. So the implementation should depend on the capital market’s development, capital product’s structure, tradition, investment companies’ size etc. From a distant view, principle based legislation could be seen as a great legislation writing’s technique. It could be seen as an effective solution to regulate a fast developing field without need to change the regulation. But is it true? Second part of the submission addresses the legal questions and problems, connected to the principle based regulation starting with the validity of regulations. Broad definitions in Market in financial instruments Directive (MiFID, introduced for fast adaptation to new financial products and instruments, are now turning into dinosaurs. Contrary to US’s fast
LAVINIA MIHAELA VLĂDILĂ
Full Text Available The article continues our last year article, presented in the same conference, on the evolution of the legislation on domestic violence in Spain and in Romania. This new study shall approach only the legislative modifications of the Law No 217/2003 inserted in March 2012 after the shooting at “Perla” Hairdresser in Bucharest, which influenced not only the lives of those involved, but also legislative changes, as an attempt from the Government to offer a better protection for women, who are usually the victims of this type of violence. The present study is dedicated to these new modifications ad their social and legal impact.
Excessive alcohol consumption is a major public health issue internationally, with alcohol consumption being recognised as a leading cause of preventable illness and major social burden. To help ameliorate the risks and harms associated with alcohol consumption, all levels of governments have explored various legislative and regulatory provisions to support responsible alcohol consumption, service and promotion. In this article, using Australia as a case study, the legislative environment around responsible alcohol promotion and consumption across the Australian retail, entertainment and media sectors will be explored, with a focus on pricing and volume-based discounts. Whilst the potential harm and effect of both the licensed and non-licensed sectors appears to be widely acknowledged as similar in both scope and size of effect, legislative protections overwhelmingly focus solely on reducing the risks associated with alcohol consumption in licensed premises. This article explores the legislative provisions around preventing excessive alcohol consumption through promotional and marketing activities, and notes that whilst the licensed premises sector is facing increasing legislative restrictions, the off-premises sector remains unregulated and in some cases has even had existing restrictions removed, despite forming an increasing part of the alcohol chain in Australia. There appear to be inconsistencies and regulatory gaps in relation to price-based and volume-based discount alcohol promotions. Regulatory loopholes allow the retail sector in particular to use discounted alcohol as a promotional tool, in a way that is inconsistent with the goals of public health alcohol legislation, and in a way which would be illegal in any other sector. There appears to be a compelling case for introducing new restrictions, or extending existing restrictions, on these forms of promotion across all sectors involved in alcohol promotion, and there is considerable evidence that there
Carmen B. De Los Santos
Perception of the ecological status of European seagrasses varied greatly among species and countries. Z. noltei and Z. marina got low scores in most of the countries whereas P. oceanica was rated from “moderate” to “very good” and Cymodocea nodosa got very dissimilar scores (Fig 1. Coastal development and eutrophication were reported as the mayor threats to seagrasses (Fig 2, in agreement with recent global or regional assessments (Grech et al., 2012, Marbà et al., 2014. Some of the respondent underlined the limited research background to score seagrass threats or their local particularity. Seagrasses have been reported as uncharismatic ecosystems (Duarte et al., 2008 and this was reflected in our results: scores were low for the public and policy makers and variable for managers (Fig 1. Some respondents highlighted a differential awareness among species (higher for P. oceanica than for other co-existing species. Several management and conservation instruments are, however, increasing the seagrass awareness in Europe, such as the use of seagrasses as indicators in the Water Framework Directory (WFD and the existence of volunteer-based monitoring programmes, which typically include outreach initiatives for the general public and interactions with managers (e.g. www.lifeposidoniandalucia.es, www.famar.wordpress.com. Borum et al. (2004 stated that “several countries already have established comprehensive and advanced monitoring programmes for seagrasses, but in many European countries programmes are virtually absent”. After a decade, our survey showed that seagrass monitoring effort, although increasing, is still variable or absent in some countries (Figs 2 & 3. Similarly, the mapped area of seagrass beds is very poor in many countries (Fig 2, or only presence/absence data or roughly theoretical estimations of total area are available. Seagrass mapping and/or monitoring were reported to be unorganised (specially when various local groups and/or regional
Kennedy, Lynn M.
This dissertation is a study of the impact of federal legislative proposals considered between 1997 and 2004 that offer protection to databases. It investigates the effect that the proposals had on the balance between the economic interests of owners and the right of the public to unfettered access to information. This identified legislation…
Abdillah, Leon Andretti
The information technology applications in cyberspace (the internet) are currently dominated by social media. The author investigates and explores the advantages of social media implementation of any political party in Indonesian general legislative elections 2014. There are twelve national political parties participating in the election as contestants plus three local political parties in Aceh. In this research, author focus on national political parties only. The author visited, analyzed, a...
Li, Ruilin; Frasch, Martin G; Wu, Hau-Tieng
There is a need for affordable, widely deployable maternal-fetal ECG monitors to improve maternal and fetal health during pregnancy and delivery. Based on the diffusion-based channel selection, here we present the mathematical formalism and clinical validation of an algorithm capable of accurate separation of maternal and fetal ECG from a two channel signal acquired over maternal abdomen. The proposed algorithm is the first algorithm, to the best of the authors' knowledge, focusing on the fetal ECG analysis based on two channel maternal abdominal ECG signal, and we apply it to two publicly available databases, the PhysioNet non-invasive fECG database (adfecgdb) and the 2013 PhysioNet/Computing in Cardiology Challenge (CinC2013), to validate the algorithm. The state-of-the-art results are achieved when compared with other available algorithms. Particularly, the F 1 score for the R peak detection achieves 99.3% for the adfecgdb and 87.93% for the CinC2013, and the mean absolute error for the estimated R peak locations is 4.53 ms for the adfecgdb and 6.21 ms for the CinC2013. The method has the potential to be applied to other fetal cardiogenic signals, including cardiac doppler signals.
Full Text Available There is a need for affordable, widely deployable maternal-fetal ECG monitors to improve maternal and fetal health during pregnancy and delivery. Based on the diffusion-based channel selection, here we present the mathematical formalism and clinical validation of an algorithm capable of accurate separation of maternal and fetal ECG from a two channel signal acquired over maternal abdomen. The proposed algorithm is the first algorithm, to the best of the authors' knowledge, focusing on the fetal ECG analysis based on two channel maternal abdominal ECG signal, and we apply it to two publicly available databases, the PhysioNet non-invasive fECG database (adfecgdb and the 2013 PhysioNet/Computing in Cardiology Challenge (CinC2013, to validate the algorithm. The state-of-the-art results are achieved when compared with other available algorithms. Particularly, the F1 score for the R peak detection achieves 99.3% for the adfecgdb and 87.93% for the CinC2013, and the mean absolute error for the estimated R peak locations is 4.53 ms for the adfecgdb and 6.21 ms for the CinC2013. The method has the potential to be applied to other fetal cardiogenic signals, including cardiac doppler signals.
Algert Charles S
Full Text Available Abstract Background Maternal mortality is too rare in high income countries to be used as a marker of the quality of maternity care. Consequently severe maternal morbidity has been suggested as a better indicator. Using the maternal morbidity outcome indicator (MMOI developed and validated for use in routinely collected population health data, we aimed to determine trends in severe adverse maternal outcomes during the birth admission and in particular to examine the contribution of postpartum haemorrhage (PPH. Methods We applied the MMOI to the linked birth-hospital discharge records for all women who gave birth in New South Wales, Australia from 1999 to 2004 and determined rates of severe adverse maternal outcomes. We used frequency distributions and contingency table analyses to examine the association between adverse outcomes and maternal, pregnancy and birth characteristics, among all women and among only those with PPH. Using logistic regression, we modelled the effects of these characteristics on adverse maternal outcomes. The impact of adverse outcomes on duration of hospital admission was also examined. Results Of 500,603 women with linked birth and hospital records, 6242 (12.5 per 1,000 suffered an adverse outcome, including 22 who died. The rate of adverse maternal outcomes increased from 11.5 in 1999 to 13.8 per 1000 deliveries in 2004, an annual increase of 3.8% (95%CI 2.3–5.3%. This increase occurred almost entirely among women with a PPH. Changes in pregnancy and birth factors during the study period did not account for increases in adverse outcomes either overall, or among the subgroup of women with PPH. Among women with severe adverse outcomes there was a 12% decrease in hospital days over the study period, whereas women with no severe adverse outcome occupied 23% fewer hospital days in 2004 than in 1999. Conclusion Severe adverse maternal outcomes associated with childbirth have increased in Australia and the increase was
Recent State legislation on HIV-related issues is summarized. Connecticut enacted a bill imposing penalties when public servants and health care workers are deliberately exposed to body fluids. Louisiana passed a bill mandating HIV testing for each incoming State prison inmate. New York has several bills under consideration related to guardianship, confidentiality of crime victims who are potentially exposed to HIV, and disability benefits for firefighters and police officers who contract HIV, tuberculosis, or hepatitis in the line of duty. North Carolina has a new law aimed at serving additional clients in the State=s AIDS drug assistance program. Oregon is working on a bill authorizing HIV testing for all defendants who may have transmitted body fluids to a crime victim.
The status of the House legislation, the major differences between the House and Senate legislation and a preview of what is likely to take place during the lame duck session in December are presented. The House legislation provides: long-term program leading toward permanent disposal of nuclear waste; an interim program for storage and for expansion of storage space for spent fuel; provides an R and D component through what is called a test and evaluation facility; an alternative long-term storage program based on a proposal to be completed by the Department of Energy on what's called Monitored Retrievable Storage; full upfront financing of the program through user fees based on contracts between the government and the users of the nuclear waste disposal services
Andersen, Anne-Marie Nybo; Wohlfahrt, J; Christens, P
To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history.......To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history....
A maternal death was defined according to ICD-10 criterion. The variables reviewed included socio-demographic, obstetric characteristics, reasons for admission, causes of death and contributing factors. We estimated maternal mortality ratio for each year and overall for the four year period using a standard equation and ...
Puhl, R M; Suh, Y; Li, X
The prevalence of weight discrimination in the United States has led to increasing calls for legal measures to address weight-based inequities on a broader scale. This study examined public support in 2014 and 2015 for three proposed laws prohibiting weight discrimination, and compared findings with public attitudes towards the same laws from 2011 to 2013. An online survey was completed by a diverse national sample of US adults (N=2411) in June-July of 2014 and 2015 to assess their support for anti-discrimination legislation. Public support increased for the anti-discrimination laws from 2014 to 2015, and at least 71% of participants expressed support for each of the laws in both years. Compared with public support documented in 2011-2013, there was a significant increase in support in 2014-2015 for legislation to extend disability protections to individuals with obesity and for laws that would include body weight in existing state civil rights statutes. Consistently, high levels of support (78%) were documented across this 5-year period for laws to address weight-based discrimination in employment. As public approval is a powerful catalyst motivating political will needed to make policy changes, these findings provide important insights and implications for advancing policy-level discourse about remedies for weight discrimination.
Maternal mortality is still very high in Africa, despite progress in control efforts at the global level. One elemental link is the question of autonomy in maternal health, especially at the household level where intrinsic human rights are undermined. A rights-based consideration in bioethics is an approach that holds the centrality of the human person, with a compelling reference to the fundamental human rights of every person. A philosophical and sociological engagement of gender and the notion of autonomy within the household reveals some fundamental rights-based perplexities for bioethical considerations in maternal health. The right to self-determination is undermined, and therefore women's dignity, freedom and autonomy, capacities, and choices are easily defiled. This study applies a rights-based approach to maternal health and demonstrates how rights concerns are associated with negative outcomes in maternal health in Africa. The discussion is situated at the household level, which is the starting point in health care. The paper submits that beyond legal and political rights within the context of the state, rights-based issues manifest at the household level. Many of those rights issues, especially relating to women's autonomy, are detrimental to maternal health in Africa. Therefore, a rights-based approach in the social construction of maternal health realities will contribute to alleviating the burden of maternal mortality in Africa.
Background: Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy. Nigeria is among the six countries that record over 50% of all maternal deaths in the world. There are few papers on autopsy based causes of ...
Mar 5, 2016 ... Background: Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy. Nigeria is among the six countries that record over 50% of all maternal deaths in the world. There are few papers on autopsy based ...
Luit RJ; Waaijers-van der Loop SL; Heugens EHW; ICH; VSP
The Dutch National Institute for Public Health and the Environment (hereafter: RIVM) recently investigated how the bio-based economy, more specifically the bio-based chemistry sector, relates to the EU REACH Regulation on chemicals. From this investigation, RIVM learnt that REACH may actually be an
Katikireddi, Srinivasa Vittal; Der, Geoff; Roberts, Chris; Haw, Sally
Smoke-free legislation has been a great success for tobacco control but its impact on smoking uptake remains under-explored. We investigated if trends in smoking uptake amongst adolescents differed before and after the introduction of smoke-free legislation in the United Kingdom. Prevalence estimates for regular smoking were obtained from representative school-based surveys for the four countries of the United Kingdom. Post-intervention status was represented using a dummy variable and to allow for a change in trend, the number of years since implementation was included. To estimate the association between smoke-free legislation and adolescent smoking, the percentage of regular smokers was modeled using linear regression adjusted for trends over time and country. All models were stratified by age (13 and 15 years) and sex. For 15-year-old girls, the implementation of smoke-free legislation in the United Kingdom was associated with a 4.3% reduction in the prevalence of regular smoking (P = .029). In addition, regular smoking fell by an additional 1.5% per annum post-legislation in this group (P = .005). Among 13-year-old girls, there was a reduction of 2.8% in regular smoking (P = .051), with no evidence of a change in trend post-legislation. Smaller and nonsignificant reductions in regular smoking were observed for 15- and 13-year-old boys (P = .175 and P = .113, respectively). Smoke-free legislation may help reduce smoking uptake amongst teenagers, with stronger evidence for an association seen in females. Further research that analyses longitudinal data across more countries is required. Previous research has established that smoke-free legislation has led to many improvements in population health, including reductions in heart attack, stroke, and asthma. However, the impacts of smoke-free legislation on the rates of smoking amongst children have been less investigated. Analysis of repeated cross-sectional surveys across the four countries of the United Kingdom
Nederlof, M.; de Walle, H.E.K.; van Poppel, M.N.M.; Vrijkotte, T.G.M.; Gademan, M.G.J.
Objective The maternal lipid profile could be of importance in congenital anomaly development. This study therefore investigates whether the maternal lipid profile during early pregnancy is associated with major nonsyndromic congenital anomalies (MNCA). Design Prospective community-based cohort
Recent studies indicate that death certificate-based single-cause-of-death diagnoses can substantially underestimate the contribution of sepsis to mortality in the general population and among maternal decedents. There are no population-based data in the United States on the patterns of the contribution of sepsis to pregnancy-associated deaths. We studied the Texas Inpatient Public Use Data File to identify pregnancy-associated hospitalizations with reported hospital death during 2001-2010. We then examined the annual reporting of sepsis, and that of other reported most common causes of maternal death, including hemorrhage, embolism, preeclampsia/eclampsia, cardiovascular conditions, cardiomyopathy, cerebrovascular accidents, and anesthesia complications. The annual rate of sepsis among decedents, its trend over time, and changes of its annual rank among other examined potential causes of maternal death were assessed. There were 557 pregnancy-associated hospital deaths during study period. Sepsis was reported in 131 (23.5%) decedents. Sepsis has been increasingly reported among decedents, rising by 9.1%/year (P = 0.0025). The rank of sepsis, as compared to the other examined potential causes of maternal death rose from the 5th in 2001 to 1st since 2008. At the end of the last decade, sepsis has been reported in 28.1% of pregnancy-associated deaths. More than one potential cause of maternal death was reported in 39% of decedents. Sepsis has become the most commonly reported potential cause of death among maternal decedents in the present cohort, noted in over 1 in 4 fatal hospitalizations by the end of the last decade. Although causality cannot be inferred from administrative data, given its known contribution to maternal death, it is likely that sepsis plays an increasing role in fatal maternal hospital outcomes. The prevalent co-reporting of multiple potential causes of maternal death in the present cohort underscores the complexity of determining the sources of
Full Text Available Review of evidence based research indicates that there are best practice principles that can be applied to the design of the built environment with regard to the reduction of the risk of cross infection from airborne diseases in health facilities...
Turcan, Romeo V.; Bugaian, Larisa; Niculita, Angela
the objectives of the legislative proposals; discusses risks and challenges that HE in Moldova faces today and in the next 10-15 years; identifies expected outcomes; identifies basic principles on which the process will be founded; proposes a new structure for the HE sector; offers an example...... and responsibilities; suggests a distinct separation between governance and management; suggests teaching and research funding formulae based on inputs and outputs; and outlines a new National Qualifications Framework....
Objectives: Provision of skilled health care during pregnancy, childbirth and the early postpartum period is an effective strategy to reduce maternal mortality. This study was done to determine and compare the utilization of antenatal and delivery services in an urban and rural area of Lagos State. Methods: A community ...
of the duration of pregnancy, from any cause related to or aggravated by the pregnancy or its management ... understand why women die during maternity (6). Among many risk factors, early marriage puts women at ... antenatal care attended; gestation at time of death; died delivered or undelivered; place of delivery; main.
Shaffer, Anne; Whitehead, Monica; Davis, Molly; Morelen, Diana; Suveg, Cynthia
In a diverse community sample of mothers (N = 108) and their preschool-aged children (M age = 3.50 years), this study conducted person-oriented analyses of maternal emotion regulation (ER) based on a multimethod assessment incorporating physiological, observational, and self-report indicators. A model-based cluster analysis was applied to five indicators of maternal ER: maternal self-report, observed negative affect in a parent-child interaction, baseline respiratory sinus arrhythmia (RSA), and RSA suppression across two laboratory tasks. Model-based cluster analyses revealed four maternal ER profiles, including a group of mothers with average ER functioning, characterized by socioeconomic advantage and more positive parenting behavior. A dysregulated cluster demonstrated the greatest challenges with parenting and dyadic interactions. Two clusters of intermediate dysregulation were also identified. Implications for assessment and applications to parenting interventions are discussed. © 2017 Family Process Institute.
Janse van Rensburg, A B; Jassat, W
This is the second of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). Objectives for the review were to provide realistic estimates of cost for unit activities and to establish a quality assurance cycle that may facilitate cost centre management. The study described and used activity-based costing (ABC) as an approach to analyse the recurrent cost of acute in-patient care for the financial year 2007-08. Fixed (e.g. goods and services, staff salaries) and variable recurrent costs (including laboratory' 'pharmacy') were calculated. Cost per day, per user and per diagnostic group was calculated. While the unit accounted for 4.6% of the hospital's total clinical activity (patient days), the cost of R8.12 million incurred represented only 2.4% of the total hospital expenditure (R341.36 million). Fixed costs constituted 90% of the total cost. For the total number of 520 users that stayed on average 15.4 days, the average cost was R1,023.00 per day and R15748.00 per user. Users with schizophrenia accounted for the most (35%) of the cost, while the care of users with dementia was the most expensive (R23,360.68 per user). Costing of the application of World Health Organization norms for acute care staffing for the unit, projected an average increase of 103% in recurrent costs (R5.1 million), with the bulk (a 267% increase) for nursing. In the absence of other guidelines, aligning clinical activity with the proportion of the hospital's total budget may be an approach to determine what amount should be afforded to acute mental health in-patient care activities in a general regional hospital such as HJH. Despite the potential benefits of ABC, its continued application will require time, infrastructure and staff investment to establish the capacity to maintain routine annual cost analyses for different cost centres.
Montgomery, Tiffany M; Folken, Lori; Seitz, Melody A
Adolescent pregnancy is a concern among many women's health practitioners. While it is practical and appropriate to work to prevent adolescent pregnancy by educating adolescents in health care clinics, schools and adolescent-friendly community-based organizations, suggesting and supporting legislative efforts to reduce adolescent pregnancy can help address the issue on an even larger scale. This article aims to help nurses better understand current legislation that addresses adolescent pregnancy, and to encourage support of future adolescent pregnancy prevention legislation. © 2014 AWHONN.
Bicking Kinsey, Cara; Hupcey, Judith E
to provide a principle-based analysis of the concept of maternal-infant bonding. principle-based method of concept analysis for which the data set included 44 articles published in the last decade from Pubmed, CINAHL, and PyschINFO/PsychARTICLES. literature inclusion criteria were English language, articles published in the last decade, peer-reviewed journal articles and commentary on published work, and human populations. after a brief review of the history of maternal-infant bonding, a principle-based concept analysis was completed to examine the state of the science with regard to this concept. The concept was critically examined according to the clarity of definition (epistemological principle), applicability of the concept (pragmatic principle), consistency in use and meaning (linguistic principle), and differentiation of the concept from related concepts (logical principle). Analysis of the concept revealed: (1) Maternal-infant bonding describes maternal feelings and emotions towards her infant. Evidence that the concept encompasses behavioural or biological components was limited. (2) The concept is clearly operationalised in the affective domain. (3) Maternal-infant bonding is linguistically confused with attachment, although the boundaries between the concepts are clearly delineated. despite widespread use of the concept, maternal-infant bonding is at times superficially developed and subject to confusion with related concepts. Concept clarification is warranted. A theoretical definition of the concept of maternal-infant bonding was developed to aid in the clarification, but more research is necessary to further clarify and advance the concept. nurse midwives and other practitioners should use the theoretical definition of maternal-infant bonding as a preliminary guide to identification and understanding of the concept in clinical practice. Copyright © 2013 Elsevier Ltd. All rights reserved.
Ekeland, Anne G; Skipenes, Eva; Nyheim, Beate; Christiansen, Ellen K
The University Hospital of North Norway selected a web-based ulcer record used in Denmark, available from mobile phones. Data was stored in a common database and easily accessible. According to Norwegian legislation, only employees of the organization that owns an IT system can access the system, and use of mobile units requires strong security solutions. The system had to be changed. The paper addresses interactions in order to make the system legal, and assesses regulations that followed. By addressing conflicting scripts and the contingent nature of knowledge, we conducted a formative evaluation aiming at improving the object being studied. Participatory observation in a one year process, minutes from meetings and information from participants, constitute the data material. In the technological domain, one database was replaced by four. In the health care delivery domain, easy access was replaced by a more complicated log on procedure, and in the domain of law and security, a clarification of risk levels was obtained, thereby allowing for access by mobile phones with today's authentication mechanisms. Flexibility concerning predefined scripts was important in all domains. Changes were made that improved the platform for further development of legitimate communication of patient data via mobile units. The study also shows the value of formative evaluations in innovations.
Li, Zhongguo; Zhao, Fu
Annually, a large number of used plastic shopping bags are released into the environment, posing significant threats to public health and wildlife. Owing to these concerns, many local, regional, and national governments around the world have passed legislation to ban or restrict the use of plastic shopping bags. However, in the USA there are only 18 states that have approved plastic bag bans/fees, and even within these states these regulations do not cover all cities or counties. There are many factors that could affect the development and implementation of these regulations. This article employs an analytical hierarchy process to analyse the factors that could impact the enactment of plastic bag regulations. Five impact factors are identified based on statistical data, that is, geographical location, interest of industry achievable, cost of living, level of economic development, and educational level of population. The weights of the five impact factors are determined and it is found that the possibility of banning or restricting plastic bags in general follows a certain pattern among all states.
Varol, Nesrin; Hall, John J; Black, Kirsten; Turkmani, Sabera; Dawson, Angela
The physical and psychological impact of female genital mutilation / cutting (FGM/C) can be substantial, long term, and irreversible. Parts of the health sector in Australia have developed guidelines in the management of FGM/C, but large gaps exist in community and professional knowledge of the consequences and treatment of FGM/C. The prevalence of FGM/C amongst Australian women is unknown. Our article reviews the literature on research on FGM/C in Australia, which focuses on health system response to women and girls with FGM/C. Recommendations are made for policy reform in health, legislation, and community programs to provide the best healthcare, protect children, and help communities abandon this harmful practice. Midwives and doctors in Australia acknowledged a lack of knowledge on FGM/C, clinical guidelines and consequences for maternity care. In a metropolitan Australian hospital with specialised FGM/C care, women with FGM/C had similar obstetric outcomes as women without FGM/C, underlining the importance of holistic FGM/C clinics. Greater focus on integration of refugee and migrant populations into their new cultures may be an important way of facilitating the abandonment of this practice, as is education of communities that practise FGM/C, and experts involved in the care and protection of children. Men could be important advocates for protecting women and girls from violence and FGM/C through a man-to-man strategy with programs focussing on men's health and other personal issues, education, and communication. The Australian Government has identified gender-based violence as an area of priority and has been implementing a National plan to reduce violence against women and their children 2010-2022. A multidisciplinary network of experts on FGM/C could be established within this taskforce to develop well-defined and rapid referral pathways to care for and protect these children, as well as coordinate education and prevention programs to help communities
Full Text Available Severe maternal morbidity conditions such as sepsis, embolism and cardiac arrest during the delivery hospitalization period can lead to extended length of hospital stays, life-long maternal health problems, and high medical costs. Most importantly, these conditions also contribute to the risk of maternal death. This population-based observational study proposed and evaluated the impact of expanding the Centers for Disease Control and Prevention (CDC measure of severe maternal morbidity by including additional comorbidities and intensive care admissions during delivery hospitalizations and examined associated factors. A New York State linked hospitalization and birth record database was used. Study participants included all New York State female residents, ages 10 to 55 years, who delivered a live infant in a New York acute care hospital between 2008 and 2013, inclusive. Incidence trends for both severe maternal morbidity measures were evaluated longitudinally. Associations between covariates and the two severe maternal morbidity measures were examined with logistic regression models, solved using generalized estimating equations and stratified by method of delivery. The New York expanded severe maternal morbidity measure identified 34,478 cases among 1,352,600 hospital deliveries (estimated incidence 2.55% representing a 3% increase in the number of cases compared to the CDC measure. Both estimates increased over the study period (p 1.5 included most measured comorbidities (e.g., pregnancy-induced hypertension, placentation disorder, multiple births, preterm birth, no prenatal care, hospitalization prior to delivery, higher levels of perinatal care birthing facilities and race/ethnicity. Expanding the measure for severe maternal morbidity during delivery to capture intensive care admissions provides a more sensitive estimate of disease burden. Perinatal regionalization in New York appears effective in routing high risk pregnancies to higher
Gaines, Gale F., Comp.
The "2011 Legislative Briefing" is a topical summary of state budget and legislative actions that affect elementary, secondary and higher education across the Southern Regional Education Board (SREB) region. It outlines actions in areas such as tax and spending legislation, assistance to local districts, tuition and fees, student…
AJRH Managing Editor
One of the most important ways to address some of the key factors ... services, facility-based delivery, facility delivery, institutional delivery ..... Percent of women reporting delivering in a health facility. Quintile* ranking of facility- based delivery. Maternal. Mortality. Ration. (MMR) per. 1000 Live. Births. African. MMR quintile*.
Kranti Suresh Vora
Full Text Available Background: India continues to face challenges in improving key maternal health indicators with about 1/3rd of global maternal deaths happening in India. Utilization of health care services is an important issue in India with significant proportion of home deliveries and majority of mothers not receiving adequate antenatal care. Mortality among poor rural women is the highest with lowest utilization. To make maternal healthcare more equitable, numerous schemes such as Janani Suraksha Yojana, Chiranjeevi Yojana, Kasturba Poshan Sahay Yojana have been introduced. Studies suggest that utilization of such schemes by target population is low and there is a need to understand factors affecting maternal health care utilization in the context of these schemes. Current community based study was done in rural Gujarat to understand characteristics of women who utilize such schemes and predictors of utilization. Methodology: Data collection was done in two districts of Gujarat from June to August, 2013 as a pilot phase of MATIND project. Community based cross-sectional study included 827 households and socio-demographic details of 1454 women of 15-49 years age groups were collected. 265 mothers, who had delivered after 1st January, 2013 are included in the regression analyses. The data analysis carried out with R version 3.0.1 software. Results: The analysis indicates socioeconomic variables such as caste, maternal variables such as education and health system variables such as use of government facility are important predictors of maternal health scheme utilization. Results suggest that socioeconomic and health system factors are the best predictors for availing scheme. Conclusion: Health system variables along with individual level variables are important predictors for availing maternal health schemes. The study indicates the need to examine all levels of predictors for utilizing government health schemes to maximize the benefit for underserved
Kranti Suresh Vora
Full Text Available Background: India continues to face challenges in improving key maternal health indicators with about 1/3rd of global maternal deaths happening in India. Utilization of health care services is an important issue in India with significant proportion of home deliveries and majority of mothers not receiving adequate antenatal care. Mortality among poor rural women is the highest with lowest utilization. To make maternal healthcare more equitable, numerous schemes such as Janani Suraksha Yojana, Chiranjeevi Yojana, Kasturba Poshan Sahay Yojana have been introduced. Studies suggest that utilization of such schemes by target population is low and there is a need to understand factors affecting maternal health care utilization in the context of these schemes. Current community based study was done in rural Gujarat to understand characteristics of women who utilize such schemes and predictors of utilization. Methodology: Data collection was done in two districts of Gujarat from June to August, 2013 as a pilot phase of MATIND project. Community based cross-sectional study included 827 households and socio-demographic details of 1454 women of 15-49 years age groups were collected. 265 mothers, who had delivered after 1st January, 2013 are included in the regression analyses. The data analysis carried out with R version 3.0.1 software. Results: The analysis indicates socioeconomic variables such as caste, maternal variables such as education and health system variables such as use of government facility are important predictors of maternal health scheme utilization. Results suggest that socioeconomic and health system factors are the best predictors for availing scheme. Conclusion: Health system variables along with individual level variables are important predictors for availing maternal health schemes. The study indicates the need to examine all levels of predictors for utilizing government health schemes to maximize the benefit for underserved
Bacci, A; Wyn Huws, D; Baltag, V
Familiarity with Evidence-Based Medicine (EBM) concepts is low amongst key maternal and newborn care clinicians in Moldova. Simple interventions can increase the knowledge of EBM concepts there.......Familiarity with Evidence-Based Medicine (EBM) concepts is low amongst key maternal and newborn care clinicians in Moldova. Simple interventions can increase the knowledge of EBM concepts there....
In Mali and Burkina Faso, maternal and child mortality rates remain high. The governments of both countries are trying to increase access to and use of health care for women and children. They have adopted policies to remove financial barriers and are now piloting results-based financing, which gives financial incentives ...
Very small changes in pH may significantly affect the function of various fetal organ systems, such as the central nervous system, and the cardiovascular system with associated fetal distress and poor Apgar score. Review of existing data on maternal-fetal acid-base balance in pregnancy highlight the factors that are ...
Very small changes in pH may significantly affect the function of various fetal organ systems, such as the central nervous system, and the cardiovascular system with associated fetal distress and poor Apgar score. Review of existing data on maternal-fetal acid-base balance in pregnancy highlight the factors that are associated with derangements of the acid-base status and the impact of the derangements on fetal outcome. Extensive search of electronic databases and manual search of journals for relevant literature on maternal and fetal acid chemistry, clinical studies and case studies were undertaken. There is a substantial reduction in the partial pressure of carbon dioxide (pCO2) in pregnancy. Adequate buffering prevents significant changes in maternal arterial pH. Normal fetal metabolism results in the production of acids which are buffered to maintain extracellular pH within a critical range. Fetal hypoxia can occur when maternal oxygenation is compromised, maternal perfusion of the placenta is reduced, or delivery of oxygenated blood from the placenta to the fetus is impeded. When adequate fetal oxygenation does not occur, metabolisms proceed along with an anaerobic pathway with production of organic acids, such as lactic acid. Accumulation of lactic acid can deplete the buffer system and result in metabolic acidosis with associated low fetal pH, fetal distress and poor Apgar score. There is a significant reduction in pCO2 in pregnancy. This change, however, does not result in a corresponding significant reduction in maternal arterial pH, because of adequate buffering. Very small changes in pH may cause significant derangement in fetal function and outcome.
Full Text Available Since the introduction of the Building and Construction Industry Security of Payment Act into New South Wales in 1999, construction industry payment legislation has progressively been enacted on a jurisdiction-by-jurisdiction basis throughout Australia. Of the eight Australian Acts, two distinct legislative models can be discerned – what have been termed the ‘East Coast’ and ‘West Coast’ models. This article compares the two models with respect to their payment systems and adjudication schemes, procedural justice afforded, incursion upon freedom of contract, uptake rates and efficiency. From this comparison, the strengths and weaknesses of the two models are identified. Finally, a dual process of adjudication based on progress payment claim size is proposed for a harmonised model, developed from previous proposals put forward by other authors, which aims to combine the strengths of the two existing models.
Henry Foulds; Magda Huisman; Gunther R. Drevin
Privacy is regarded as a fundamental human right and it is clear that the study of digital privacy is an important field. Digital privacy is influenced by new and constantly evolving technologies and this continuous change makes it hard to create legislation to protect people's privacy from being exploited by misuse of these technologies. This study aims to benefit digital privacy legislation efforts by evaluating the awareness and perceived importance of digital privacy legislation among...
AJRH Managing Editor
In Senegal, only 60% of mothers in rural areas deliver in health facilities. Mothers' satisfaction with their facility-based childbirth experience is one of the factors in their choosing to deliver in such facilities in subsequent pregnancies. The objective of this study was to assess whether compliance with childbirth care based on ...
Nederlof, M.; de Walle, H. E. K.; van Poppel, M. N. M.; Vrijkotte, T. G. M.; Gademan, M. G. J.
ObjectiveThe maternal lipid profile could be of importance in congenital anomaly development. This study therefore investigates whether the maternal lipid profile during early pregnancy is associated with major nonsyndromic congenital anomalies (MNCA). DesignProspective community-based cohort study.
This document presents the fulfilling of the Brazilian obligations under the Convention on Nuclear Safety. The Chapter 3 of the document contains some details about the Brazilian legislation and regulation, the legislative and regulatory framework, regulatory body and responsibility of the license holder.
Grove, Jeffrey; Gaines, Gale F., Comp.
"The 2007 Legislative Briefing" is a topical summary of actions during the 2006 legislative sessions that affect education in the 16 SREB states. Topics include state budgets and the economy, tax and revenue, school finance, teacher compensation, licensure, certification and evaluation of teachers, strengthening elementary and secondary…
Usynina, Anna A; Postoev, Vitaly A; Grjibovski, Andrej M; Krettek, Alexandra; Nieboer, Evert; Odland, Jon Øyvind; Anda, Erik Eik
Globally, about 11% of all liveborn infants are preterm. To date, data on prevalence and risk factors of preterm birth (PTB) in Russia are limited. The aims of this study were to estimate the prevalence of PTB in Murmansk County, Northwestern Russia and to investigate associations between PTB and selected maternal factors using the Murmansk County Birth Registry. We conducted a registry-based study of 52 806 births (2006-2011). In total, 51 156 births were included in the prevalence analysis, of which 3546 were PTBs. Odds ratios with 95% confidence intervals of moderate-to-late PTB, very PTB and extremely PTB for a range of maternal characteristics were estimated using multinomial logistic regression, adjusting for potential confounders. The overall prevalence of PTB in Murmansk County was 6.9%. Unmarried status, prior PTBs, spontaneous and induced abortions were strongly associated with PTB at any gestational age. Maternal low educational level increased the risk of extremely and moderate-to-late PTB. Young (Murmansk County, Russia was comparable with data on live PTB from European countries. Adverse prior pregnancy outcomes, maternal low educational level, unmarried status, alcohol abuse, and diabetes mellitus or gestational diabetes were the most common risk factors for PTB. © 2016 John Wiley & Sons Ltd.
de Paula Silva, Neimar; de Souza Reis, Rejane; Garcia Cunha, Rafael; Pinto Oliveira, Júlio Fernando; Santos, Marceli de Oliveira; Pombo-de-Oliveira, Maria S; de Camargo, Beatriz
Several maternal and birth characteristics have been reported to be associated with an increased risk of many childhood cancers. Our goal was to evaluate the risk of childhood embryonal solid tumors in relation to pre- and perinatal characteristics. A case-cohort study was performed using two population-based datasets, which were linked through R software. Tumors were classified as central nervous system (CNS) or non-CNS-embryonal (retinoblastoma, neuroblastoma, renal tumors, germ cell tumors, hepatoblastoma and soft tissue sarcoma). Children aged confidence intervals (CI) were computed by unconditional logistic regression analysis using SPSS. Males, high maternal education level, and birth anomalies were independent risk factors. Among children diagnosed older than 24 months of age, cesarean section (CS) was a significant risk factor. Five-minute Apgar ≤8 was an independent risk factor for renal tumors. A decreasing risk with increasing birth order was observed for all tumor types except for retinoblastoma. Among children with neuroblastoma, the risk decreased with increasing birth order (OR = 0.82 (95% CI 0.67-1.01)). Children delivered by CS had a marginally significantly increased OR for all tumors except retinoblastoma. High maternal education level showed a significant increase in the odds for all tumors together, CNS tumors, and neuroblastoma. This evidence suggests that male gender, high maternal education level, and birth anomalies are risk factors for childhood tumors irrespective of the age at diagnosis. Cesarean section, birth order, and 5-minute Apgar score were risk factors for some tumor subtypes.
Harper, Lorie M.; Caughey, Aaron B.; Roehl, Kimberly A.; Odibo, Anthony O.; Cahill, Alison G.
OBJECTIVE The objective of the study was to determine the threshold for defining abnormal labor that is associated with adverse maternal and neonatal outcomes. STUDY DESIGN This study consisted of a retrospective cohort of all consecutive women admitted at a gestation of 37.0 weeks or longer from 2004 to 2008 who reached the second stage of labor. The 90th, 95th, and 97th percentiles for progress in the first stage of labor were determined specific for parity and labor onset. Women with a first stage above and below each centile were compared. Maternal outcomes were cesarean delivery in the second stage, operative delivery, prolonged second stage, postpartum hemorrhage, and maternal fever. Neonatal outcomes were a composite of the following: admission to level 2 or 3 nursery, 5 minute Apgar less than 3, shoulder dystocia, arterial cord pH of less than 7.0, and a cord base excess of −12 or less. RESULTS Of the 5030 women, 4534 experienced first stage of less than the 90th percentile, 251 between the 90th and 94th percentiles, 102 between the 95th and 96th percentiles, and 143 at the 97th percentile or greater. Longer labors were associated with an increased risk of a prolonged second stage, maternal fever, the composite neonatal outcome, shoulder dystocia, and admission to a level 2 or 3 nursery (P shoulder dystocia. CONCLUSION Although women who experience labor dystocia may ultimately deliver vaginally, a longer first stage of labor is associated with adverse maternal and neonatal outcomes, in particular shoulder dystocia. This risk must be balanced against the risks of cesarean delivery for labor arrest. PMID:24361789
This paper presents the author's view that the coal industry should develop a strategy to respond to the global warming issue. A few weeks ago a speaker stated that the global warming issue placed coal at the crossroads. He stated that global warming legislation, could reduce the consumption of coal by approximately twenty-five percent, without global warming legislation coal would continue to grow at a approximately three percent per year. It is believed there is a path to be traveled between the two options, legislation or no legislation, that can result in coal obtaining the position as the primary fuel source for electrical generating throughout the world. This is a path the coal industry can define and should follow
Kansas Data Access and Support Center — Each coverage contains a COVER-ID field that defines the House or Senate district number. Kansas House and Senate districts were created by the Legislative Research...
UJD as the central body of state administration prepares legislation within their competency and sets also binding criteria in the field of nuclear safety. Based on provisions of the 'Atomic Act' the preparation of rest regulations has continued. Following drafts of 5 were prepared regulations in 2001 and then they were sent for comments to various ministries by UJD: (a) Regulation on safety requirements for design of nuclear installations; (b) Regulation on safety requirements for commissioning and operation of nuclear installations; (c) Regulation on safety documentation; (d) Regulation on periodic safety assessment; (e) Regulation on safety requirements for siting of nuclear installations. Two following UJD safety guides were published in 2001 as the part of edition 'Safety of Nuclear Installations': (a) BNS I. 11.2/1999 'Requirements for performance of safety analyses for ATWS' (b) BNS II.3.1/2000 'Evaluation of acceptability of faults detected during the operation inspection of nuclear installation selected equipment'. As UJD is responsible for performance of such reviews according to law No. 264/1999 Coll. on conformance assessment of products about 10 drafts of technical standards were reviewed. UJD provided documentation to the Slovak Republic position document related to Chapter 14 - Energy which was submitted to the European Union (EU). The set of recommendations related to nuclear safety was elaborated by the special working group on atomic question which was established by the EU Council. Their implementation is required as a prerequisite to close negotiations on Chapter 14 - Energy. The schedule of necessary safety related measures was agreed in co-operation with the SE a.s. and the Ministry of Economy and submitted as additional information for negotiations to the EC. The negotiations on Chapter 14 - Energy were successfully closed in October 2001. The activities in the area of Chapter 22 - Environment were concentrated on submission of necessary data
Abstract. In Malawi the maternal mortality ratio is extremely high. Since almost all maternal deaths are avoidable, maternal mortality is also an issue of human rights. This paper examines the root causes of high maternal mortality in Malawi and applies a human rights-based approach to the reduction of maternal mortality.
Roč. 5, č. 3 (2015), s. 162-183 ISSN 1805-8396 Institutional support: RVO:68378122 Keywords : legislation * quantitative description of legislation * structure and development of the legislation in the CR Subject RIV: AG - Legal Sciences
Eggebø, Tørbjorn Moe; Wilhelm-Benartzi, Charlotte; Hassan, Wassim A; Usman, Sana; Salvesen, Kjell A; Lees, Christoph C
Accurate prediction of whether a nulliparous woman will have a vaginal delivery would be a major advance in obstetrics. The objective of the study was to develop such a model based on maternal characteristics and the results of intrapartum ultrasound. One hundred twenty-two nulliparous women in the first stage of labor were included in a prospective observational 2-centre study. Labor was classified as prolonged according to the respective countries' national guidelines. Fetal head position was assessed with transabdominal ultrasound and cervical dilatation by digital examination, and transperineal ultrasound was used to determine head-perineum distance and the presence of caput succedaneum. The subjects were divided into a testing set (n = 61) and a validation set (n = 61) and a risk score derived using multivariable logistic regression with vaginal birth as the outcome, which was dichotomized into no/cesarean delivery and yes/vaginal birth. Covariates included head-perineum distance, caput succedaneum, and occiput posterior position, which were dichotomized respectively into the following: ≤40 mm, >40 mm, <10 mm, ≥10 mm, and no, yes. Maternal age, gestational age, and maternal body mass index were included as continuous covariates. Dichotomized score is significantly associated with vaginal delivery (P = .03). Women with a score above the median had greater than 10 times the odds of having a vaginal delivery as compared with those with a score below the median. The receiver-operating characteristic curve showed an area under the curve of 0.853 (95% confidence interval, 0.678-1.000). A risk score based on maternal characteristics and intrapartum findings can predict vaginal delivery in nulliparous women in the first stage of labor. Copyright © 2015 Elsevier Inc. All rights reserved.
Cheng, Han-Tsung; Wang, Yu-Chun; Lo, Hung-Chieh; Su, Li-Ting; Soh, Khay-Seng; Tzeng, Chia-Wei; Wu, Shih-Chi; Sung, Fung-Chang; Hsieh, Chi-Hsun
Laparoscopic appendectomy (LA) is the standard treatment of acute appendicitis for the general population; however, there is still some doubt regarding its safety for pregnant patients. Therefore, the purpose of this study is to investigate and compare the maternal outcome of pregnant patients with acute appendicitis following either an open appendectomy (OA) or LA from a population-based database. This study is based on the National Health Insurance Research Database. Patients with both ICD-9-CM codes for appendicitis (540.9, 540.0, and 540.1) and pregnancy (V22) in the same admission were considered to have acute appendicitis during pregnancy. These patients were divided into three groups according to the type of treatment: LA, OA, and non-operative treatment. Outcome measures that were compared between the groups included maternal complications such as preterm labor, abortion, and the need of cesarean section. Besides, the differences of medical expenditure and length of hospital stay between the groups were also analyzed. From 2005 to 2010, a total of 859 pregnant women who had acute appendicitis were identified. They had increased risks for preterm labor, abortion, and increased requirement of cesarean section compared to the control group (i.e., those without acute appendicitis). Among the three groups, the non-operated group has the highest risk of preterm labor. Patients who underwent LA did not have any increased risk of maternal complications compared to the OA group. Furthermore, LA patients had shorter hospital stay than OA. Compared to non-operative treatment, appendectomy is the preferred treatment for pregnant patients who have acute appendicitis. LA can be performed safely in pregnant patients without bringing additional maternal complications compared to OA.
Full Text Available BACKGROUND: Gaps in quality of care are seriously affecting maternal and neonatal health globally but reports of successful quality improvement cycles implemented at large scale are scanty. We report the results of a nation-wide program to improve quality of maternal and neonatal hospital care in a lower-middle income country focusing on the role played by standard-based participatory assessments. METHODS: Improvements in the quality of maternal and neonatal care following an action-oriented participatory assessment of 19 areas covering the whole continuum from admission to discharge were measured after an average period of 10 months in four busy referral maternity hospitals in Uzbekistan. Information was collected by a multidisciplinary national team with international supervision through visit to hospital services, examination of medical records, direct observation of cases and interviews with staff and mothers. Scores (range 0 to 3 attributed to over 400 items and combined in average scores for each area were compared with the baseline assessment. RESULTS: Between the first and the second assessment, all four hospitals improved their overall score by an average 0.7 points out of 3 (range 0.4 to 1, i.e. by 22%. The improvements occurred in all main areas of care and were greater in the care of normal labor and delivery (+0.9, monitoring, infection control and mother and baby friendly care (+0.8 the role of the participatory action-oriented approach in determining the observed changes was estimated crucial in 6 out of 19 areas and contributory in other 8. Ongoing implementation of referral system and new classification of neonatal deaths impede the improved process of care to be reflected in current statistics. CONCLUSIONS: Important improvements in the quality of hospital care provided to mothers and newborn babies can be achieved through a standard-based action-oriented and participatory assessment and reassessment process.
Full Text Available Coronary heart disease (CHD is the leading cause of death, and smoking its strongest modifiable risk factor. Our aim was to determine the impact of the Spanish 2006 partial smoke-free legislation on acute myocardial infarction (AMI incidence, hospitalization and mortality rates, and 28-day case-fatality in Girona, Spain.Using a population-based registry (the REGICOR Study, we compared population incidence, hospitalization, and mortality rates, and 28-day case-fatality in the pre- and post-ban periods (2002-2005 and 2006-2008, respectively by binomial regression analysis adjusted for confounding factors. We also analyzed the ban's impact on the outcomes of interest using the AMI definitions of the American Heart Association (AHA/European Society of Cardiology (ESC and the World Health Organization (WHO-Monitoring trends and determinants in cardiovascular diseases (MONICA.In the post-ban period, AMI incidence and mortality rates significantly decreased (relative risk [RR] = 0.89; 95% confidence interval [CI] = 0.81-0.97 and RR = 0.82; 95% CI = 0.71-0.94, respectively. Incidence and mortality rates decreased in both sexes, especially in women, and in people aged 65-74 years. Former and non-smokers (passive smokers showed diminished incidence rates. Implementation of the ban was not associated with AMI case-fatality. Models tended to be more significant with the WHO-MONICA than with the AHA/ESC definition.The 2006 Spanish partial smoke-free legislation was associated with a decrease in population AMI incidence and mortality, particularly in women, in people aged 65-74 years, and in passive smokers. These results clarify the association between AMI mortality and the enactment of a partial smoke-free legislation and reinforce the effectiveness of smoking regulations in preventing CHD.
Full Text Available Background: Home-based records (HBRs are globally implemented as the effective tools that encourage pregnant women and mothers to timely and adequately utilise maternal and child health (MCH services. While availability and utilisation of nationally representative HBRs have been assessed in several earlier studies, the reality of a number of HBRs subnationally implemented in a less coordinated manner has been neither reported nor analysed. Objectives: This study is aimed at estimating the prevalence of HBRs for MCH and the level of fragmentation of and overlapping between different HBRs for MCH in Vietnam. The study further attempts to identify health workers’ and mothers’ perceptions towards HBR operations and utilisations. Design: A self-administered questionnaire was sent to the provincial health departments of 28 selected provinces. A copy of each HBR available was collected from them. A total of 20 semi-structured interviews with health workers and mothers were conducted at rural communities in four of 28 selected provinces. Results: Whereas HBRs developed exclusively for maternal health and exclusively for child health were available in four provinces (14% and in 28 provinces (100%, respectively, those for both maternal health and child health were available in nine provinces (32%. The mean number of HBRs in 28 provinces (=5.75 indicates over-availability of HBRs. All 119 minimum required items for recording found in three different HBRs under nationwide scale-up were also included in the Maternal and Child Health Handbook being piloted for nationwide scaling-up. Implementation of multiple HBRs is likely to confuse not only health workers by requiring them to record the same data on several HBRs but also mothers about which HBR they should refer to and rely on at home. Conclusions: To enable both health workers and pregnant women to focus on only one type of HBR, province-specific HBRs for maternal and/or child health need to be
This section gathers the following national legislative and regulatory activities sorted by country: Bulgaria: General legislation; Czech Republic: General legislation; France: General legislation, Regulatory infrastructure and activity; Germany: General legislation; India: Liability and compensation, Organisation and structure; Ireland: Radiation protection, General legislation; Korea (Republic of): Organisation and structure; Lithuania: Regulatory infrastructure and activity, Radioactive waste management, Radiation protection, international cooperation, Nuclear safety; Poland: General legislation; Romania: Environmental protection; Russian Federation: Radioactive waste management; Slovenia: Nuclear safety; Spain: Liability and compensation, Nuclear security; Sweden: Nuclear safety; Turkey: Radiation protection, Regulatory infrastructure and activity, Nuclear safety, Liability and compensation; United States: General legislation
Neimar de Paula Silva
Full Text Available Several maternal and birth characteristics have been reported to be associated with an increased risk of many childhood cancers. Our goal was to evaluate the risk of childhood embryonal solid tumors in relation to pre- and perinatal characteristics.A case-cohort study was performed using two population-based datasets, which were linked through R software. Tumors were classified as central nervous system (CNS or non-CNS-embryonal (retinoblastoma, neuroblastoma, renal tumors, germ cell tumors, hepatoblastoma and soft tissue sarcoma. Children aged <6 years were selected. Adjustments were made for potential confounders. Odds ratios (OR with 95% confidence intervals (CI were computed by unconditional logistic regression analysis using SPSS.Males, high maternal education level, and birth anomalies were independent risk factors. Among children diagnosed older than 24 months of age, cesarean section (CS was a significant risk factor. Five-minute Apgar ≤8 was an independent risk factor for renal tumors. A decreasing risk with increasing birth order was observed for all tumor types except for retinoblastoma. Among children with neuroblastoma, the risk decreased with increasing birth order (OR = 0.82 (95% CI 0.67-1.01. Children delivered by CS had a marginally significantly increased OR for all tumors except retinoblastoma. High maternal education level showed a significant increase in the odds for all tumors together, CNS tumors, and neuroblastoma.This evidence suggests that male gender, high maternal education level, and birth anomalies are risk factors for childhood tumors irrespective of the age at diagnosis. Cesarean section, birth order, and 5-minute Apgar score were risk factors for some tumor subtypes.
Gottlieb, Nell H; Goldstein, Adam O; Flynn, Brian S; Cohen, E Joanna E; Bauman, Karl E; Solomon, Laura J; Munger, Michael C; Dana, Greg S; McMorris, Laura E
Better understanding of the cognitive framework for decision making among legislators is important for advocacy of health-promoting legislation. In 1994, the authors surveyed state legislators from North Carolina, Texas, and Vermont concerning their beliefs and intentions related to voting for a hypothetical measure to enforce legislation preventing the sale of tobacco to minors, using scales based on the theory of planned behavior. Attitude (importance), subjective norm (whether most people important to you would say you should or should not vote for the law), perceived behavioral control (ability to cast one's vote for the law), and home state were independently and significantly related to intention to vote for the law's enforcement. The results, including descriptive data concerning individual beliefs, suggest specific public health strategies to increase legislative support for passing legislation to restrict youth tobacco sales and, more generally, a framework for studying policy making and advocacy.
The Senate passed 69 to 6 legislation to provide a comprehensive nuclear waste policy. This legislation restates some things the Department of Energy is already doing. It modifies some others, and in some cases it provides new authorities, principally in those areas of state participation and in the area of financing of the program. Some of the provisions of the Senate bill are: schedule for a number of items in the disposal of nuclear waste, the first being an area referred to as away-from reactor storage; a timetable for geologic disposal; a plan for the long-term storage of nuclear waste for spent fuels; a financing mechanism; and states participation
Leon Silverstrom explained how nuclear waste disposal legislation would be implemented. The legislation provides a framework that recognizes the tremendous number of views and opinions on the subject and provides a mechanism that will allow all these interests to be expressed before final decisions are reached. Implementing procedures are outlined for: (1) the final repository; (2) interim or last resort storage; (3) research and development; (4) the monitored retrievable storage phases. The whole process will involve: environmental assessments and licensing requirements for each phase; construction of a test and evaluation facility; provision for sharing information with the states and interested parties; and procedures for public hearings and state rejection of propoped sites
Bin, Yu Sun; Cistulli, Peter A.; Ford, Jane B.
Study Objectives: To examine the association between sleep apnea and pregnancy outcomes in a large population-based cohort. Methods: Population-based cohort study using linked birth and hospital records was conducted in New South Wales, Australia. Participants were all women who gave birth from 2002 to 2012 (n = 636,227). Sleep apnea in the year before pregnancy or during pregnancy was identified from hospital records. Outcomes of interest were gestational diabetes, pregnancy hypertension, planned delivery, caesarean section, preterm birth, perinatal death, 5-minute Apgar score, admission to neonatal intensive care or special care nursery, and infant size for gestational age. Maternal outcomes were identified using a combination of hospital and birth records. Infant outcomes came from the birth record. Modified Poisson regression models were used to examine associations between sleep apnea and each outcome taking into account maternal age, country of birth, socioeconomic disadvantage, smoking, obesity, parity, pre-existing diabetes and hypertension. Results: Sleep apnea was significantly associated with pregnancy hypertension (adjusted RR 1.43; 95% CI 1.18–1.73), planned delivery (1.15; 1.07–1.23), preterm birth (1.50; 1.21–1.84), 5-minute Apgar apnea is associated with higher rates of obstetric complications and intervention, as well as preterm delivery. Future research should examine if these are independent of obstetric history. Citation: Bin YS, Cistulli PA, Ford JB. Population-based study of sleep apnea in pregnancy and maternal and infant outcomes. J Clin Sleep Med 2016;12(6):871–877. PMID:27070246
Sakurai, Takayuki; Kamiyoshi, Akiko; Kawate, Hisaka; Mori, Chie; Watanabe, Satoshi; Tanaka, Megumu; Uetake, Ryuichi; Sato, Masahiro; Shindo, Takayuki
The CRISPR/Cas9 system is capable of editing multiple genes through one-step zygote injection. The preexisting method is largely based on the co-injection of Cas9 DNA (or mRNA) and guide RNAs (gRNAs); however, it is unclear how many genes can be simultaneously edited by this method, and a reliable means to generate transgenic (Tg) animals with multiple gene editing has yet to be developed. Here, we employed non-inheritable maternal Cas9 (maCas9) protein derived from Tg mice with systemic Cas9...
A view on legislative events in the US from the outside is presented. The author comments on the general principles and advantages of free trade against the possibility of an embargo into the US on uranium, on the issue of sanctions against South Africa, and Namibia, and how these issues affect the world market for uranium
This compilation of statutes and material pertaining to nuclear regulatory legislation through the 97th Congress, 2nd Session, has been prepared by the Office of the Executive Legal Director, U.S. Nuclear Regulatory Commission, with the assistance of staff, for use as an internal resource document
this study is a relatively new and important area in victimology known as "Notoriety For Profit Legislation". The study contains descrip- tions...in the area of victimology require further study. I BIBLIOGRAPHY Books Bard, Morton, and Dawn Sangrey. The Crime Victims Book. New York: Basic Books
Full Text Available Abstract Background Preeclampsia is a frequent syndrome and its cause has been linked to multiple factors, making prevention of the syndrome a continuous challenge. One of the suggested risk factors for preeclampsia is advanced maternal age. In the Western countries, maternal age at first delivery has been steadily increasing, yet few studies have examined women of advanced maternal age with preeclampsia. The purpose of this registry-based study was to compare the obstetric outcomes in primiparous and preeclamptic women younger and older than 35 years. Methods The registry-based study used data from three Finnish health registries: Finnish Medical Birth Register, Finnish Hospital Discharge Register and Register of Congenital Malformations. The sample contained women under 35 years of age (N = 15,437 compared with those 35 and over (N = 2,387 who were diagnosed with preeclampsia and had their first singleton birth in Finland between 1997 and 2008. In multivariate modeling, the main outcome measures were Preterm delivery (before 34 and 37 weeks, low Apgar score (5 min., small-for-gestational-age, fetal death, asphyxia, Cesarean delivery, induction, blood transfusion and admission to a Neonatal Intensive Care Unit. Results Women of advanced maternal age (AMA exhibited more preeclampsia (9.4% than younger women (6.4%. They had more prior terminations (25 ( Conclusions Preeclampsia is more common in women with advanced maternal age. Advanced maternal age is an independent risk factor for adverse outcomes in first-time mothers with preeclampsia.
Background: Maternal deaths are often unrecognized and improperly documented in the health system. Objective: To identify causes of maternal death occurring in hospitals and determine avoidability of maternal death. Methods: The study assessed each death for the cause and surrounding circumstances as well as ...
Shakya, Yogendra; Gagnon, Anita J; Cole, Donald C; Rashid, Meb; Blake, Jennifer; Dastoori, Parisa; Moineddin, Rahim; Ray, Joel G; Urquia, Marcelo L
Objectives Immigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes. Design This is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data. Setting and participants Refugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014. Primary outcomes Numerous adverse maternal and perinatal health outcomes. Results Refugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers. Conclusions Refugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further refining refugee status based on migration
Bin, Yu Sun; Cistulli, Peter A; Ford, Jane B
To examine the association between sleep apnea and pregnancy outcomes in a large population-based cohort. Population-based cohort study using linked birth and hospital records was conducted in New South Wales, Australia. Participants were all women who gave birth from 2002 to 2012 (n = 636,227). Sleep apnea in the year before pregnancy or during pregnancy was identified from hospital records. Outcomes of interest were gestational diabetes, pregnancy hypertension, planned delivery, caesarean section, preterm birth, perinatal death, 5-minute Apgar score, admission to neonatal intensive care or special care nursery, and infant size for gestational age. Maternal outcomes were identified using a combination of hospital and birth records. Infant outcomes came from the birth record. Modified Poisson regression models were used to examine associations between sleep apnea and each outcome taking into account maternal age, country of birth, socioeconomic disadvantage, smoking, obesity, parity, pre-existing diabetes and hypertension. Sleep apnea was significantly associated with pregnancy hypertension (adjusted RR 1.43; 95% CI 1.18-1.73), planned delivery (1.15; 1.07-1.23), preterm birth (1.50; 1.21-1.84), 5-minute Apgar apnea is associated with higher rates of obstetric complications and intervention, as well as preterm delivery. Future research should examine if these are independent of obstetric history. © 2016 American Academy of Sleep Medicine.
Campbell, Patricia Therese; McVernon, Jodie; Geard, Nicholas
Rising pertussis incidence has prompted a number of countries to implement maternally targeted vaccination strategies to protect vulnerable infants, but questions remain about the optimal design of such strategies. We simulated pertussis transmission within an individual-based model parameterized to match Australian conditions, explicitly linking infants and their mothers to estimate the effectiveness of alternative maternally targeted vaccination strategies (antenatal delivery vs. postnatal delivery) and the benefit of revaccination over the course of multiple pregnancies. For firstborn infants aged less than 2 months, antenatal immunization reduced annual pertussis incidence by 60%, from 780 per 100,000 firstborn children under age 2 months (interquartile range (IQR), 682-862) to 315 per 100,000 (IQR, 260-370), while postnatal vaccination produced a minimal reduction, with an incidence of 728 per 100,000 (IQR, 628-789). Subsequent infants obtained limited protection from a single antenatal dose, but revaccinating mothers during every pregnancy decreased incidence for these infants by 58%, from 1,878 per 100,000 subsequent children under age 2 months (IQR, 1,712-2,076) to 791 per 100,000 (IQR, 683-915). Subsequent infants also benefited from household-level herd immunity when antenatal vaccination for every pregnancy was combined with a toddler booster dose at age 18 months; incidence was reduced to 626 per 100,000 (IQR, 548-691). Our approach provides useful information to aid consideration of alternative maternally targeted vaccination strategies and can inform development of outcome measures for program evaluation. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
The Nuclear Regulatory Authority of the Slovak Republic (UJD) as central body of state administration prepares legislation within their competency and sets also binding criteria in the filed of nuclear safety. Based on provisions of the 'Atomic Act' there are 16 binding regulations under preparation. In 199 the following regulations were issued by UJD (1) Regulation No. 29/1999 Collection laws (Coll. l.) by which a list special materials and equipment is published. It came into force on 1 March 1999; (2) ) Regulation No. 30/1999 Coll. l. which defines details on maximum limits on quantities for nuclear materials for which there is no presumption of causing nuclear damage. It came into force on 1 March 1999; (3) Regulation No. 186/1999, which determines details to assure physical protection of nuclear installations, nuclear materials and radioactive waste. It came into force on 1 August 1999; (4) Regulations No. 187/1999 Coll. l. on professional competence of employees of nuclear installations. It came into force on 1 August 1999; (5) Regulation No. 198/1999 Coll. l. on accounting and inspection of nuclear materials. It came into force on 1 September 1999; (6) Regulation No. 245/1999 Coll. l. on emergency planning in case in incident or accident. It came into force on 1 October 1999; (7) Regulation No. 246/1999 Coll. l. on documentation of nuclear installations for decommissioning. It came into force on 1 October; (8) Regulation No. 284/1999 Coll. l. on details on transportation of nuclear materials and radioactive waste. It came into force on 15 November 1999. Six UJD safety guide were published last year as the part of edition 'Safety of Nuclear Installations'. UJD provides documentation for screening process of Energy sector and Environment sector as contribution to the accession process to the European Union. The most important subject within the negotiations with the European Commission were safety and operation of the NPP V-1 Bohunice. UJD grants
This compilation of statutes and material pertaining to nuclear regulatory legislation through the 100th Congress, 2nd Session, has been prepared by the Office of the General Counsel, US Nuclear Regulatory Commission, with the assistance of staff, for use as an internal resource document. Persons using this document are placed on notice that it may not be used as an authoritative citation in lieu of the primary legislative sources. Furthermore, while every effort has been made to ensure the completeness and accuracy of this material, neither the United States Government, the Nuclear Regulatory Commission, nor any of their employees makes any expressed or implied warranty or assumes liability for the accuracy or completeness of the material presented in this compilation
Full Text Available Abstract Background The need to promote maternal health in Ghana has committed the government to extend maternal healthcare services to the door steps of rural families through the community-based Health Planning and Services. Based on the concerns raised in previous studies that male spouses were indifferent towards maternal healthcare, this study sought the views of men on their involvement in maternal healthcare in their respective communities and at the household levels in the various Community-based Health Planning and Services zones in Awutu-Senya West District in the Central Region of Ghana. Methods A qualitative method was employed. Focus groups and individual interviews were conducted with married men, community health officers, community health volunteers and community leaders. The participants were selected using purposive, quota and snowball sampling techniques. The study used thematic analysis for analysing the data. Results The study shows varying involvement of men, some were directly involved in feminine gender roles; others used their female relatives and co-wives to perform the women's roles that did not have space for them. They were not necessarily indifferent towards maternal healthcare, rather, they were involved in the spaces provided by the traditional gender division of labour. Amongst other things, the perpetuation and reinforcement of traditional gender norms around pregnancy and childbirth influenced the nature and level of male involvement. Conclusions Sustenance of male involvement especially, husbands and CHVs is required at the household and community levels for positive maternal outcomes. Ghana Health Service, health professionals and policy makers should take traditional gender role expectations into consideration in the planning and implementation of maternal health promotion programmes.
Full Text Available To shift health professions regulation from traditional to ‘collaborative’ self-regulation, Nova Scotia has adopted legislation which will: make all self-regulating health professions members of the Regulated Health Professions Network; mandate the Network to facilitate voluntary collaboration among its members; and enable regulators to work together on investigations of patient complaints, to adjust scopes of practice on an ongoing basis and to adjudicate appeals of unsuccessful applicants for registration. The goals are to give health professions regulation the capacity to enable and support the functioning of interprofessional teams. The legislation was adopted primarily for two reasons: collaborative development and unanimous support by all of the province’s self-regulating professions; and alignment with the government’s health care reform agenda and its emphasis on collaborative team-based care. Contrary to the approach of several other provinces, the legislation will enable but not require regulators to collaborate on the premise that consensual collaboration is more likely to happen, to be meaningful and to yield tangible benefits. Support for this approach can be taken from the impressive collaborative work on which the legislation is based. Evaluation will be critical, and the five-year review required by the legislation will give Nova Scotia the opportunity to test not only the legislation but the ideas on which it is based. The extent of the legislation’s reliance on voluntary process will prove to be either its greatest strength or its greatest weakness.
Mills, James L; Troendle, James; Conley, Mary R; Carter, Tonia; Druschel, Charlotte M
Background: Obesity affects almost one-third of pregnant women and causes many complications, including neural tube defects. It is not clear whether the risk of congenital heart defects, the most common malformations, is also increased. Objective: This study was conducted to determine whether obesity is associated with an increased risk of congenital heart defects. Design: A population-based, nested, case-control study was conducted in infants born with congenital heart defects and unaffected controls from the cohort of all births (n = 1,536,828) between 1993 and 2003 in New York State, excluding New York City. The type of congenital heart defect, maternal body mass index (BMI; in kg/m2), and other risk factors were obtained from the Congenital Malformations Registry and vital records. Mothers of 7392 congenital heart defect cases and 56,304 unaffected controls were studied. Results: All obese women (BMI ≥ 30) were significantly more likely than normal-weight women (BMI: 19–24.9) to have children with a congenital heart defect [odds ratio (OR): 1.15; 95% CI: 1.07, 1.23; P congenital heart defects with increasing maternal obesity (P congenital heart defects, and the risk increases with increasing BMI. Weight reduction as a way to reduce risk should be investigated. PMID:20375192
Full Text Available Background: weight of the baby at birth is considered to be a major determinant of future health and survival of the child. It is one of the important factors which determine the readiness with which the newborn baby adjusts to its surrounding. Many maternal socio-biological factors influence birth weight. Objective: To determine maternal socio-biological factors influencing birth weight of newborn. Methodology: Hospital based cross- sectional study undertaken in Obstetrics and Gynaecology ward of Nehru hospital, Gorakhpur. The study period extended from July 2011 to August 2012. The study subject included recently delivered mothers and data was collected on semi-structured interview schedule to know various socio-biological variables such as mother’s age, parity, inter-pregnancy interval etc, influencing the low birth weight of newborn. Chi-Square test was applied to observe the significance of association. Results: The overall proportion of low birth weight baby came out to be 32.06%. Out of various socio-biological factors taken the factors which came out to be statistically significant were age of mother, parity, inter-pregnancy interval, SLI, education. The factors which were not statistically significant were father’s education, religion. Conclusions: It was concluded that teenage pregnancy, non-utilization of antenatal care practices, anaemia, illiteracy are unfavorable predictors of birth weight of newborn babies.
Herrera, Tania T; Garcia, Jillian L; Britton, Gabrielle B
Increasing maternal weight has been shown to predict adverse perinatal outcome, including increases in the relative risk of fetal death, stillbirth, neonatal death, perinatal death and infant death. In order to better understand the pathophysiological factors associated with obesity during pregnancy, the role of biomarkers associated with adverse outcomes in obese pregnant women is under investigation. The purpose of this review study was to examine potential biomarkers that could serve as effective screening strategies in obese pregnant women to reduce fetal and neonatal morbidity, as well as maternal morbidity. Electronic databases (Pubmed, Embase) were searched for previously published research studies that investigated biomarkers associated with perinatal outcomes in obese pregnant women and the putative mechanisms underlying biomarker effects on pregnancy outcomes. It is evident that while several biomarkers predict perinatal complications in obese pregnant women, none fulfilled the criteria to be considered clinically useful. There is a critical need for reliable blood-based biomarkers associated with an increased risk of adverse perinatal outcomes in obese pregnant women.
Zenzmaier, Christoph; Leitner, Hermann; Brezinka, Christoph; Oberaigner, Willi; König-Bachmann, Martina
To evaluate maternal and neonatal outcomes at and beyond term associated with induction of labor compared to spontaneous onset of labor stratified by week of gestational age. In this retrospective cohort study, data form 402,960 singleton pregnancies from the Austria Perinatal Registry were used to estimate odds ratios of secondary cesarean delivery, operative vaginal delivery, epidural analgesia, fetal scalp blood testing, episiotomy, 3rd/4th-degree lacerations, retained placenta, 5-min APGAR neonatal intensive care unit. Multivariate logistic regression models based on deliveries with gestational age ≥37 + 0 were applied for adjustment for possible confounders. Induction of labor was associated with increased odds for cesarean delivery (adjusted OR; 99% confidence interval: 1.53; 1.45-1.60), operative vaginal delivery (1.21; 1.15-1.27), epidural analgesia (2.12; 2.03-2.22), fetal scalp blood testing (1.40; 1.28-1.52), retained placenta (1.32; 1.22-1.41), 5-min APGAR neonatal intensive care unit (1.41; 1.31-1.51). In a subgroup of induction of labor with the indication, "post-term pregnancy" induction was similarly associated with adverse outcomes. In Austria, induction of labor is associated with increased odds of adverse maternal and neonatal outcomes. However, due to residual confounding, currently, no recommendations for treatment can be derived.
This section treats of the following National legislative and regulatory activities: 1 - Canada: Liability and compensation; 2 - France: Liability and compensation; Nuclear safety and radiological protection; 3 - Greece: Organisation and structure; 4 - Hungary: General legislation; 5 - India: Liability and compensation; 6 - Japan: Liability and compensation; 7 - Korea: Liability and compensation; 8 - Lithuania: General legislation; Transport of radioactive material; 9 - Slovak Republic: International co-operation; Liability and compensation; 10 - Slovenia: General legislation; 11 - Switzerland: Liability and compensation; 12 - United States: Radioactive waste management
Legislation that would consent to the Central Interstate Low-Level Radioactive Waste Compact has been introduced into Congress as H.R. 3002. Similar legislation is expected to be introduced into the Senate soon. This is the second compact consent legislation to be introduced into Congress this year - the first was the Northwest Compact, introduced in January. States in the Central Compact are AR, KS, LA, NE and OK. Enacted and introduced radioactive waste management legislation in various states is summarized
Proelss, Alexander (ed.) [Trier Univ. (Germany)
The book on international environmental legislation includes the following contributions: Development, sources and actors concerning the international environmental legislation, cross-national environmental justice, principles of the international environmental legislation, environmental protection by lawsuit, environmental protection and human right, environmental protection and trading, responsibility and liability, peaceful settlement of disputes, climatic change, preservation and sustainable use of the biodiversity, protection of air and space, oceanic protection, protection of inland waters, protection of the Antarctic and Arctic environment, waste and hazardous materials legislation.
Full Text Available Abstract Objective Prior to 2007, forced sex with male children in South Africa did not count as rape but as "indecent assault", a much less serious offence. This study sought to document prevalence of male sexual violence among school-going youth. Design A facilitated self-administered questionnaire in nine of the 11 official languages in a stratified (province/metro/urban/rural last stage random national sample. Setting Teams visited 5162 classes in 1191 schools, in October and November 2002. Participants A total of 269,705 learners aged 10–19 years in grades 6–11. Of these, 126,696 were male. Main outcome measures Schoolchildren answered questions about exposure in the last year to insults, beating, unwanted touching and forced sex. They indicated the sex of the perpetrator, and whether this was a family member, a fellow schoolchild, a teacher or another adult. Respondents also gave the age when they first suffered forced sex and when they first had consensual sex. Results Some 9% (weighted value based on 13915/127097 of male respondents aged 11–19 years reported forced sex in the last year. Of those aged 18 years at the time of the survey, 44% (weighted value of 5385/11450 said they had been forced to have sex in their lives and 50% reported consensual sex. Perpetrators were most frequently an adult not from their own family, followed closely in frequency by other schoolchildren. Some 32% said the perpetrator was male, 41% said she was female and 27% said they had been forced to have sex by both male and female perpetrators. Male abuse of schoolboys was more common in rural areas while female perpetration was more an urban phenomenon. Conclusion This study uncovers endemic sexual abuse of male children that was suspected but hitherto only poorly documented. Legal recognition of the criminality of rape of male children is a first step. The next steps include serious investment in supporting male victims of abuse, and in prevention of
Since the introduction of the Building and Construction Industry Security of Payment Act into New South Wales in 1999, construction industry payment legislation has progressively been enacted on a jurisdiction-by-jurisdiction basis throughout Australia. Of the eight Australian Acts, two distinct legislative models can be discerned – what have been termed the ‘East Coast’ and ‘West Coast’ models. This article compares the two models with respect to their payment s...
The Nuclear Regulatory Authority of the Slovak Republic (UJD) as the central authority of state administration prepares legislation within their competency and sets also binding criteria in the field of nuclear safety. Based on provisions of the 'Atomic Act' a preparation of remaining 8 decrees have continued. In 2000 the following decrees were issued by UJD: (1) Decree No. 31/2000 Coll on events at nuclear installations. It came into force on 15 February 2000. (2) Decree No. 190/2000 Coll by which details of radioactive waste management and spent fuel management are regulated. It came into force on 1-st July 2000. The following six decrees are at the process of preparation: (a) Decree on quality assurance of nuclear installations, (b) Decree on safety requirements for design of nuclear installations, (c) Decree on safety requirements for commissioning and operation of nuclear installations, (d) Decree on safety documentation, (e) Decree on periodic safety assessment, (f) Decree on safety requirements for siting of nuclear installations. Following five UJD safety guides were published in 2000 as the part of edition 'Safety of Nuclear Installations': (1) BNS I.9.1/1999 Safety of nuclear facilities during decommissioning (issued in April 2000). (2) BNS III.4.1/2000 Requirements on UJD SR permit issue for fuel use in WWER 440 reactors (issued in September 2000). (3) BNS III.4.3/2000 Requirements on assessment of fuel loading for WWER 440 reactors (issued in September 2000). (4) BNS I.2.6/2000 UJD SR requirements on chapter 4 of Safety analysis report 'Core design' (issued in September 2000). (5) NS I.4.2/1996 Use of PSA methodology in the process of regulation by regulatory authority (issued in September 2000). About thirty-five drafts of technical standards were reviewed as UJD is responsible for performance such review according to the law No. 264/1999 Coll. on conformance assessment of products. UJD provided necessary documentation for negotiation positions of the
Huang, W.M.; Lee, Grace W.M.
Taiwan has drafted a Greenhouse Gas (GHG) Reduction Bill in 2006, which is currently undergoing the legislative process in the Congress. The purpose of this study is to reexamine the legal framework and contents of this Bill, evaluate potential problems and propose recommendations. This study advocates that setting the GHG reduction targets should be settled in this Bill. In addition, based on the analysis of international experiences, it is recommenced that emissions trading scheme in the Bill should be focused on large emission sources and the share of allowance auction should be increased to reduce gratis allocation. Furthermore, from the calculation results based on the long-range energy alternative planning (LEAP) model, a conflict is observed for the existing energy policy and GHG reduction efforts in Taiwan. That is, coal-burning power plants will be the most important source of energy for Taiwan in the future. In order to reduce this conflict, the authors have recommended that the Bill should also be integrated with other relevant existing legislation to achieve a complementary effect.
Plana-Ripoll, Oleguer; Olsen, Jørn; Andersen, Per Kragh; Gómez, Guadalupe; Cnattingius, Sven; Li, Jiong
The decline in birth rates is a concern in public health. Fertility is partly determined before birth by the intrauterine environment and prenatal exposure to maternal stress could, through hormonal disturbance, play a role. There has been such evidence from animal studies but not from humans. We aimed to examine the association between prenatal stress due to maternal bereavement following the death of a relative and childbirths in the offspring. This population-based cohort study included all subjects born in Denmark after 1968 and in Sweden after 1973 and follow-up started at the age of 12 years. Subjects were categorized as exposed if their mothers lost a close relative during pregnancy or the year before and unexposed otherwise. The main outcomes were age at first child and age-specific mean numbers of childbirths. Data was analyzed using Cox Proportional Hazards models stratified by gender and adjusted for several covariates. Subanalyses were performed considering the type of relative deceased and timing of bereavement. A total of 4,121,596 subjects were followed-up until up to 41 years of age. Of these subjects, 93,635 (2.3%) were exposed and 981,989 (23.8%) had at least one child during follow-up time. Compared to unexposed, the hazard ratio (HR) [95% confidence interval] of having at least one child for exposed males and females were 0.98 [0.96-1.01] and 1.01 [0.98-1.03], respectively. We found a slightly reduced probability of having children in females born to mothers who lost a parent with HR = 0.97 [0.94-0.99] and increased probability in females born to mothers who lost another child (HR = 1.09 [1.04-1.14]), the spouse (HR = 1.29 [1.12-1.48]) or a sibling (HR = 1.13 [1.01-1.27]). Our results suggested no overall association between prenatal exposure to maternal stress and having a child in early adulthood but a longer time of follow-up is necessary in order to reach a firmer conclusion.
Full Text Available The decline in birth rates is a concern in public health. Fertility is partly determined before birth by the intrauterine environment and prenatal exposure to maternal stress could, through hormonal disturbance, play a role. There has been such evidence from animal studies but not from humans. We aimed to examine the association between prenatal stress due to maternal bereavement following the death of a relative and childbirths in the offspring.This population-based cohort study included all subjects born in Denmark after 1968 and in Sweden after 1973 and follow-up started at the age of 12 years. Subjects were categorized as exposed if their mothers lost a close relative during pregnancy or the year before and unexposed otherwise. The main outcomes were age at first child and age-specific mean numbers of childbirths. Data was analyzed using Cox Proportional Hazards models stratified by gender and adjusted for several covariates. Subanalyses were performed considering the type of relative deceased and timing of bereavement.A total of 4,121,596 subjects were followed-up until up to 41 years of age. Of these subjects, 93,635 (2.3% were exposed and 981,989 (23.8% had at least one child during follow-up time. Compared to unexposed, the hazard ratio (HR [95% confidence interval] of having at least one child for exposed males and females were 0.98 [0.96-1.01] and 1.01 [0.98-1.03], respectively. We found a slightly reduced probability of having children in females born to mothers who lost a parent with HR = 0.97 [0.94-0.99] and increased probability in females born to mothers who lost another child (HR = 1.09 [1.04-1.14], the spouse (HR = 1.29 [1.12-1.48] or a sibling (HR = 1.13 [1.01-1.27].Our results suggested no overall association between prenatal exposure to maternal stress and having a child in early adulthood but a longer time of follow-up is necessary in order to reach a firmer conclusion.
The first postpartum week is a high-risk period for mothers and newborns. Very few community-based studies have been conducted on patterns of maternal morbidity in resource-poor countries in that first week. An intervention on postpartum care for women within the first week after delivery was initiated in a rural area of Rajasthan, India. The intervention included a rigorous system of receiving reports of all deliveries in a defined population and providing home-level postpartum care to all women, irrespective of the place of delivery. Trained nurse-midwives used a structured checklist for detecting and managing maternal and neonatal conditions during postpartum-care visits. A total of 4,975 women, representing 87.1% of all expected deliveries in a population of 58,000, were examined in their first postpartum week during January 2007-December 2010. Haemoglobin was tested for 77.1% of women (n=3,836) who had a postnatal visit. The most common morbidity was postpartum anaemia--7.4% of women suffered from severe anaemia and 46% from moderate anaemia. Other common morbidities were fever (4%), breast conditions (4.9%), and perineal conditions (4.5%). Life-threatening postpartum morbidities were detected in 7.6% of women--9.7% among those who had deliveries at home and 6.6% among those who had institutional deliveries. None had a fistula. Severe anaemia had a strong correlation with perinatal death [pcaste or tribe [p<0.000, AOR=2.47 (95% CI 1.83-3.33)], and parity of three or more [p<0.000, AOR=1.52 (95% CI 1.18-1.97)]. The correlation with antenatal care was not significant. Perineal conditions were more frequent among women who had institutional deliveries while breast conditions were more common among those who had a perinatal death. This study adds valuable knowledge on postpartum morbidity affecting women in the first few days after delivery in a low-resource setting. Health programmes should invest to ensure that all women receive early postpartum visits after
Koshida, Shigeki; Ono, Tetsuo; Tsuji, Shunichiro; Murakami, Takashi; Arima, Hisatomi; Takahashi, Kentaro
Fetal movement is the most common method to evaluate fetal well-being. Furthermore, maternal perception of decreased fetal movements is associated with perinatal demise. Previously, we showed that perception of decreased fetal movements was the most common reason for mothers visiting the outpatient department among those who had stillbirths in our region. Further investigation of stillbirths with decreased fetal movements is essential to find a possible way of preventing stillbirth. To investigate maternal reaction time after their perceiving decreased fetal movements among stillbirths in our region of Japan. This is a population-based study of stillbirths in Shiga Prefecture, Japan conducted from 2007 to 2011. We sent a questionnaire to each obstetrician who had submitted the stillbirth certificate. We reviewed and evaluated the questionnaires returned from the obstetricians. There were 66 cases (35%) with decreased fetal movements among 188 stillbirths in Shiga during the study period. The number of maternal visits to outpatient department after perception of decreased fetal movements within 24h was only seven (11%) among 64 stillbirths diagnosed at outpatient department. We conclude that delayed maternal visit after perceiving decreased fetal movements is frequently observed in stillbirths. Promoting more thorough maternal education on fetal movements, including emphasizing earlier visitation after perceiving decreased fetal movements, may prevent stillbirths. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
This article analyzes the relevance of autopsy issues for German Federal Republic transplantation legislation until 1997 against the background of legal traditions and the distribution of constitutional legislative powers. It is based on Federal Ministry of Justice records and German Parliament documents on transplantation legislation. Transplantation and autopsy legislation started with close ties in the 1970s. Viewing transplantation legislation as relevant for future autopsy regulation contributed to the decision to stall transplantation legislation, because the interests of the federal government and the medical profession converged to avoid subsequent restrictions on the practice of conducting autopsies and procuring tissues for transplantation. Sublegal norms were insufficient for the prosecution of the organ trade and area-wide transplantation regulation after the reunification of Germany. In contrast to autopsy issues, legislative power for transplantation issues was extended to the federal level by an amendment to the constitution, allowing decision making for Germany as a whole.
Full Text Available Performance-based financing (PBF programs are increasingly implemented in low and middle-income countries to improve health service quality and utilization. In April 2011, a PBF pilot program was launched in Boulsa, Leo and Titao districts in Burkina Faso with the objective of increasing the provision and quality of maternal health services. We evaluate the impact of this program using facility-level administrative data from the national health management information system (HMIS. Primary outcomes were the number of antenatal care visits, the proportion of antenatal care visits that occurred during the first trimester of pregnancy, the number of institutional deliveries and the number of postnatal care visits. To assess program impact we use a difference-in-differences approach, comparing changes in health service provision post-introduction with changes in matched comparison areas. All models were estimated using ordinary least squares (OLS regression models with standard errors clustered at the facility level. On average, PBF facilities had 2.3 more antenatal care visits (95% CI [0.446–4.225], 2.1 more deliveries (95% CI [0.034–4.069] and 9.5 more postnatal care visits (95% CI [6.099, 12.903] each month after the introduction of PBF. Compared to the service provision levels prior to the interventions, this implies a relative increase of 27.7 percent for ANC, of 9.2 percent for deliveries, and of 118.7 percent for postnatal care. Given the positive results observed during the pre-pilot period and the limited resources available in the health sector, the PBF program in Burkina Faso may be a low-cost, high impact intervention to improve maternal and child health.
Huth-Bocks, Alissa C.; Muzik, Maria; Beeghly, Marjorie; Earls, Lauren; Stacks, Ann M.
There is growing evidence that ‘secure-base scripts’ (Waters & Waters, 2006) are an important part of the cognitive underpinnings of internal working models of attachment. Recent research in middle class samples has shown that secure-base scripts are linked to maternal attachment-oriented behavior and child outcomes. However, little is known about the correlates of secure base scripts in higher-risk samples. Participants in the current study included 115 mothers who were oversampled for child...
MORAR IOAN DAN
Full Text Available Taxation is a fairly important field in the relationship between taxpayers and tax authorities, especially given the frequent changes in specific legislation. Legislative changes affect the patrimonial position of the taxpayers, but also their behavior, therefore this phenomenon is important to advise those interested and also to analyze the changes resulting from changes in tax legislation. This paper aims to meaningfully present the latest legislative changes and to analyze their influences on taxpayers and on budget revenues from taxes subject to change. The research methodology is based on comparison and inference, based on previous analyzes for such studies on the tax system. In the literature there are known ways and methods of increasing the tax burden and, based on these variables, in the present paper we will highlight the particular influences on the taxpayer’s , loaded by weight imposed by the official distribution of the tax burden. The implications of legislative changes in tax matters should be sought in the innermost chord of taxpayers and also in the increasingly large and patched pockets of the modern state. In the first place, we will point out the implications on changing tax procedures, in terms of the workload for the taxpayer and the tax collectors. By accurately and relevantly analyzing the influences generated by such changes, the author aims to demonstrate the harmful influences of some changes in terms of discouraging investments and honest labor.
This review of governance distinguishes between ends and means and, by highlighting the complexity and differing definitions of the concept, defines its scope and focuses discussion on its characteristics in order to establish an interrelationship between veterinary legislation and governance. Good governance must be backed by legislation, and good legislation must incorporate the principles and instruments of good governance. This article lists some of the main characteristics of governance and then reviews them in parallel with the methodology used to draft veterinary legislation, emphasising the importance of goal-setting and stakeholder participation. This article describes the criteria developed by the Veterinary Legislation Support Programme (VLSP) of the World Organisation for Animal Health (OIE) for assessing the quality of veterinary legislation. It then makes a comparison between the quality assurance process and the good governance process in order to demonstrate that the introduction and proper use of the tools for developing veterinary legislation offered by the OIE VLSP leads to a virtuous circle linking legislation with good governance. Ultimately, the most important point remains the implementation of legislation. Consequently, the author points out that satisfactory implementation relies not only on legislation that is technically and legally appropriate, acceptable, applicable, sustainable, correctly drafted, well thought through and designed for the long term, but also on the physical and legal capacity of official Veterinary Services to perform their administrative and enforcement duties, and on there being the means available for all those involved to discharge their responsibilities.
Sakurai, Takayuki; Kamiyoshi, Akiko; Kawate, Hisaka; Mori, Chie; Watanabe, Satoshi; Tanaka, Megumu; Uetake, Ryuichi; Sato, Masahiro; Shindo, Takayuki
The CRISPR/Cas9 system is capable of editing multiple genes through one-step zygote injection. The preexisting method is largely based on the co-injection of Cas9 DNA (or mRNA) and guide RNAs (gRNAs); however, it is unclear how many genes can be simultaneously edited by this method, and a reliable means to generate transgenic (Tg) animals with multiple gene editing has yet to be developed. Here, we employed non-inheritable maternal Cas9 (maCas9) protein derived from Tg mice with systemic Cas9 overexpression (Cas9 mice). The maCas9 protein in zygotes derived from mating or in vitro fertilization of Tg/+ oocytes and +/+ sperm could successfully edit the target genome. The efficiency of such maCas9-based genome editing was comparable to that of zygote microinjection-based genome editing widely used at present. Furthermore, we demonstrated a novel approach to create "Cas9 transgene-free" gene-modified mice using non-Tg (+/+) zygotes carrying maCas9. The maCas9 protein in mouse zygotes edited nine target loci simultaneously after injection with nine different gRNAs alone. Cas9 mouse-derived zygotes have the potential to facilitate the creation of genetically modified animals carrying the Cas9 transgene, enabling repeatable genome engineering and the production of Cas9 transgene-free mice.
Sakurai, Takayuki; Kamiyoshi, Akiko; Kawate, Hisaka; Mori, Chie; Watanabe, Satoshi; Tanaka, Megumu; Uetake, Ryuichi; Sato, Masahiro; Shindo, Takayuki
The CRISPR/Cas9 system is capable of editing multiple genes through one-step zygote injection. The preexisting method is largely based on the co-injection of Cas9 DNA (or mRNA) and guide RNAs (gRNAs); however, it is unclear how many genes can be simultaneously edited by this method, and a reliable means to generate transgenic (Tg) animals with multiple gene editing has yet to be developed. Here, we employed non-inheritable maternal Cas9 (maCas9) protein derived from Tg mice with systemic Cas9 overexpression (Cas9 mice). The maCas9 protein in zygotes derived from mating or in vitro fertilization of Tg/+ oocytes and +/+ sperm could successfully edit the target genome. The efficiency of such maCas9-based genome editing was comparable to that of zygote microinjection–based genome editing widely used at present. Furthermore, we demonstrated a novel approach to create “Cas9 transgene-free” gene-modified mice using non-Tg (+/+) zygotes carrying maCas9. The maCas9 protein in mouse zygotes edited nine target loci simultaneously after injection with nine different gRNAs alone. Cas9 mouse-derived zygotes have the potential to facilitate the creation of genetically modified animals carrying the Cas9 transgene, enabling repeatable genome engineering and the production of Cas9 transgene-free mice. PMID:26817415
Page, Amy Dellinger; Hill, Julie Sprinkle; Gilbert, Griff
Current legislation at the state and federal level is largely based on the premise that we can best protect children by prohibiting sexual offenders' access to children through the use of residency restrictions, employment sanctions, and community notification. While well intentioned, these policies are short sighted and based more on public…
Felisbino-Mendes, Mariana Santos; Villamor, Eduardo; Velasquez-Melendez, Gustavo
Although child undernutrition and stunting has been decreasing worldwide while obesity rates increase, these extreme conditions might coexist in families from low- and middle-income countries. We examined the association between maternal and child anthropometric indicators using a population representative sample. 4,258 non-pregnant women and their children nutritional indexes of children, height-for-age (HAZ) and body mass index-for age (BAZ) z-scores, by categories of maternal height, body mass index (BMI), and waist circumference (WC). Adjusted mean differences and 95% confidence intervals (95% CI) were estimated from linear regression, taking into account the complex survey design. We also examined the associations of maternal anthropometry with the prevalence of child stunting (HAZ2). HAZ was positively associated with maternal height and WC in a linear fashion. After adjustment, for sociodemographic characteristics, children whose mothers' height wasmaternal height and maternal BMI, children of mothers with a waist circumference ≥88 cm had 0.3 higher HAZ than those of mothers with WCmaternal height (maternal BMI and WC. We observed a strong, positive association of maternal and child nutritional status. Mothers of low stature had children with lower stature, mothers with central obesity had taller children, and mothers with overall or abdominal obesity had children with higher BAZ.
Verweij, Marcel; Lambach, Philipp; Ortiz, Justin R.; Reis, Andreas
There has been increased interest in the potential of maternal immunisation to protect maternal, fetal, and infant health. Maternal tetanus vaccination is part of routine antenatal care and immunisation campaigns in many countries, and it has played an important part in the reduction of maternal
It is proposed that there should be a legislation to address climate change and Greenhouse Gas Emission Reduction Bill. South Australian Government Greenhouse Strategy and climate change legislation in light of the far-reaching implications this legislation could have on clients, who face the impacts of climate change in the business and natural environment. It is a commitment to reduce greenhouse gas emissions in South Australia by 2050 to 60 per cent of 1990 levels
Luke C Mullany
Full Text Available BACKGROUND: Access to essential maternal and reproductive health care is poor throughout Burma, but is particularly lacking among internally displaced communities in the eastern border regions. In such settings, innovative strategies for accessing vulnerable populations and delivering basic public health interventions are urgently needed. METHODS: Four ethnic health organizations from the Shan, Mon, Karen, and Karenni regions collaborated on a pilot project between 2005 and 2008 to examine the feasibility of an innovative three-tiered network of community-based providers for delivery of maternal health interventions in the complex emergency setting of eastern Burma. Two-stage cluster-sampling surveys among ever-married women of reproductive age (15-45 y conducted before and after program implementation enabled evaluation of changes in coverage of essential antenatal care interventions, attendance at birth by those trained to manage complications, postnatal care, and family planning services. RESULTS: Among 2,889 and 2,442 women of reproductive age in 2006 and 2008, respectively, population characteristics (age, marital status, ethnic distribution, literacy were similar. Compared to baseline, women whose most recent pregnancy occurred during the implementation period were substantially more likely to receive antenatal care (71.8% versus 39.3%, prevalence rate ratio [PRR] = 1.83 [95% confidence interval (CI 1.64-2.04] and specific interventions such as urine testing (42.4% versus 15.7%, PRR = 2.69 [95% CI 2.69-3.54], malaria screening (55.9% versus 21.9%, PRR = 2.88 [95% CI 2.15-3.85], and deworming (58.2% versus 4.1%, PRR = 14.18 [95% CI 10.76-18.71]. Postnatal care visits within 7 d doubled. Use of modern methods to avoid pregnancy increased from 23.9% to 45.0% (PRR = 1.88 [95% CI 1.63-2.17], and unmet need for contraception was reduced from 61.7% to 40.5%, a relative reduction of 35% (95% CI 28%-40%. Attendance at birth by those trained to
Maternal work has been identified as one of the factors that affect exclusive breastfeeding in the first six months of life. In Ghana, mothers engaged in the formal sector of employment are unable to exclusively breastfeed after maternity leave because facilities at their work places and conditions of work do not support exclusive breastfeeding. Even though maternal work and exclusive breastfeeding does not seem well matched, not all maternal work are incompatible with the practice of exclusive breastfeeding. This study seeks to identify the features of maternal work associated with exclusive breastfeeding in Effutu Municipal in the Central Region of Ghana. To achieve the above aim, I discuss the different types of maternal work, their characteristics, and how the work may influence exclusive breastfeeding. The study is a community based cross-sectional study involving 225 mother-infant pairs attending community based Child Welfare Clinics in Effutu Municipal, Ghana. Data were collected through face-to-face structured interviews and focus group discussions over a period of five months in 2015. Data on breastfeeding is based on the breastfeeding practice in the 24 h preceding the survey. Chi-square test is used to identify strength of association between the features of maternal work and exclusive breastfeeding practice. The exclusive breastfeeding rate among mothers with infants between the ages of 0 - 5 months is 72%. The mean and median number of breastfeeds per day is 11 ± 2.7 and 13.5 respectively. A significant difference in exclusive breastfeeding was established between mothers in the formal (16%) and informal (84%) sectors of employment ( p = 0.020). The study also established a significant difference in breastfeeding frequency between mothers in the formal (9%) and informal (91%) sectors of employment ( p = 0.001). There was also a significant difference in breastfeeding frequency among respondents that go to work with their infant (64
Huth-Bocks, Alissa C; Muzik, Maria; Beeghly, Marjorie; Earls, Lauren; Stacks, Ann M
There is growing evidence that "secure-base scripts" are an important part of the cognitive underpinnings of internal working models of attachment. Recent research in middle class samples has shown that secure-base scripts are linked to maternal attachment-oriented behavior and child outcomes. However, little is known about the correlates of secure base scripts in higher-risk samples. Participants in the current study included 115 mothers who were oversampled for childhood maltreatment and their infants. Results revealed that a higher level of secure base scriptedness was significantly related to more positive and less negative maternal parenting in both unstructured free play and structured teaching contexts, and to higher reflective functioning scores on the Parent Development Interview-Revised Short Form. Associations with parent-child secure base scripts, specifically, indicate some level of relationship-specificity in attachment scripts. Many, but not all, significant associations remained after controlling for family income and maternal age. Findings suggest that assessing secure base scripts among mothers known to be at risk for parenting difficulties may be important for interventions aimed at altering problematic parental representations and caregiving behavior.
Parpinelli Mary A
Full Text Available Abstract Background To evaluate the performance of the WHO criteria for defining maternal near miss and identifying deaths among cases of severe maternal morbidity (SMM admitted for intensive care. Method Between October 2002 and September 2007, 673 women with SMM were admitted, and among them 18 died. Variables used for the definition of maternal near miss according to WHO criteria and for the SOFA score were retrospectively evaluated. The identification of at least one of the WHO criteria in women who did not die defined the case as a near miss. Organ failure was evaluated through the maximum SOFA score above 2 for each one of the six components of the score, being considered the gold standard for the diagnosis of maternal near miss. The aggregated score (Total Maximum SOFA score was calculated using the worst result of the maximum SOFA score. Sensitivity, specificity, positive and negative predictive values of these WHO criteria for predicting maternal death and also for identifying cases of organ failure were estimated. Results The WHO criteria identified 194 cases of maternal near miss and all the 18 deaths. The most prevalent criteria among cases of maternal deaths were the use of vasoactive drug and the use of mechanical ventilation (≥1 h. For the prediction of maternal deaths, sensitivity was 100% and specificity 70.4%. These criteria identified 119 of the 120 cases of organ failure by the maximum SOFA score (Sensitivity 99.2% among 194 case of maternal near miss (61.34%. There was disagreement in 76 cases, one organ failure without any WHO criteria and 75 cases with no failure but with WHO criteria. The Total Maximum SOFA score had a good performance (area under the curve of 0.897 for prediction of cases of maternal near miss according to the WHO criteria. Conclusions The WHO criteria for maternal near miss showed to be able to identify all cases of death and almost all cases of organ failure. Therefore they allow evaluation of the
Mitsuhashi, Toshiharu; Suzuki, Etsuji; Takao, Soshi; Doi, Hiroyuki
There has been a growing concern that maternal employment could have adverse or beneficial effects on children's health. Although recent studies demonstrated that maternal employment was associated with a higher risk of childhood overweight, the evidence remains sparse in Asian countries. We sought to examine the relationship between maternal working hours and early childhood overweight in a rural town in Okayama Prefecture. In February 2008, questionnaires were sent to parents of all preschool children aged ≥3 yr in the town to assess maternal working status (working hours and form of employment), children's body mass index, and potential confounders. Childhood overweight was defined following the age and sex-specific criteria of the International Obesity Task Force. Odds ratios (ORs) and 95% confidence intervals (CIs) for childhood overweight were estimated in a logistic regression. We used generalized estimating equations with an exchangeable correlation matrix, considering the correlation between siblings. We analyzed 364 preschool children. Adjusting for each child's characteristics (age, sex), mother's characteristics (age, obesity, educational attainment, smoking status, and social participation), and family's characteristics (number of siblings), children whose mothers work children of non-working mothers, whereas the relationship was less pronounced among children whose mothers work ≥8 h/day (OR: 0.71, 95% CI: 0.19, 2.68). We observed similar patterns in a stratified analysis by the form of maternal employment. Short maternal working hours are associated with a lower odds of early childhood overweight.
In November 2006, the German Federal Ministry of Economics sent a ministerial draft bill on combating price abuses in the energy supply and food trade sectors to the trade associations for comment. The bill must be seen as part of a set of measures of the federal government seeking to improve conditions for more competition in the energy sector. An omnibus law is to add a new Section 29 to the Act against Restrictions on Competition (Antitrust Act). The addition is to bear the heading of 'Power Economy' and has been designed to prevent a utility (vendor of electricity, gas, and district heat) from abusing its position on a market which it dominates either alone or together with other utility companies. Depending on the interests involved, comments on the draft bills differ. On the whole, this tightening up of antitrust legislation is preceived more as a repair job. Stricter antitrust provisions absolutely must also be seen in their European dimension. European firms not falling under this stricter antitrust law enjoy advantages over German firms. (orig.)
Park, Eun Young; Yun, E Hwa; Lim, Min Kyung; Lee, Do-Hoon; Yang, Wonho; Jeong, Bo Yoon; Hwang, Sang-Hyun
In some countries with high smoking prevalence, smoke-free legislation has only been implemented in specific public places, as opposed to a comprehensive ban on smoking in all public places. The purpose of this study was to provide valid data on second-hand smoke (SHS) exposure that reflect the consequences of incomplete smoke-free legislation, and provide a rationale for expanding this legislation. Indoor and outdoor environmental exposure (fine particulate matter [PM2.5], air nicotine, and dust 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone [NNK]) was monitored in 35 public places where smoking is prohibited by law in Goyang, Republic of Korea. Biomarkers of SHS exposure (urinary cotinine, hair nicotine, and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) were measured in 37 non-smoking employees. Geometric means and standard deviations were used in comparison of each measure. Considerable exposure of SHS was detected at all indoor monitoring sites (PM2.5, 95.5 μg/m(3) in private educational institutions; air nicotine, 0.77 μg/m(3) in large buildings; and dust NNK, 160.3 pg/mg in large buildings); environmental measures were higher in private or closed locations, such as restrooms. Outdoor measures of SHS exposure were lowest in nurseries and highest in government buildings. Biochemical measures revealed a pattern of SHS exposure by monitoring site, and were highest in private educational institutions. The evidence of SHS exposure in legislative smoke-free places in Korea suggests that incomplete smoke free legislation and lack of enforcement of it might not protect people from exposure to smoke. Therefore, active steps should be taken toward a comprehensive ban on smoking in all public places and its enforcement.
Mann, Carsten; Pouta, Eija; Gentin, Sandra
The benefists of outdoor recreation and the need for recreation inventories and monitoring are described in various policy and legislation documents at the European level. The objective of this paper is to analyse how these recreational aspects are reflected at the national level in core forest...... indicates that a consistent forest recreation monitoring system, linked to sustainable forest management, as describes for example in the Helsinki process, should be better transferred into national policuy and legislation. Compareable data across Europe could then provide a sound base for making decisions...
Borghetto, Enrico; Mäder, Lars Kai
European Union research has made great strides in understanding the dynamics of the European Union decision-making process. In contrast to this progress, the dynamics unfolding after the enactment of a European Union secondary legislative act has largely been ignored. Some of these acts remain...... revisions of European Union legislative acts are more likely to occur. Based on an analysis of the revision histories of 158 major European Union acts in the time period between 1958 and 2003, we find significant support for this hypothesis....
Arendt, Linn Håkonsen; Lindhard, Morten Søndergaard; Henriksen, Tine Brink; Forman, Axel; Olsen, Jørn; Ramlau-Hansen, Cecilia Høst
To investigate the association between maternal endometriosis and occurrence of the genital anomalies cryptorchidism and hypospadias in sons. Population-based cohort study. Not applicable. All live-born singleton boys born from 1978 to 2012. None. Cryptorchidism and hypospadias in boys based on information from the Danish National Patient Register. The study included 1,073,026 live-born singleton boys. A total of 6,443 boys were sons of women diagnosed with endometriosis before pregnancy. Altogether, 27,342 boys were diagnosed with cryptorchidism, of whom 16,446 had corrective surgery. Hypospadias was diagnosed in 4,853 boys. As compared with unexposed boys, a tendency towards a slightly higher occurrence of cryptorchidism was observed among boys of women with endometriosis (adjusted hazard ratio [aHR] 1.18; 95% confidence interval [CI], 0.97, 1.44). When stratified by medically assisted reproduction (MAR) technologies, the association was slightly stronger among boys born to women with endometriosis who had conceived via MAR, yet it remained moderate and statistically insignificant (aHR 1.27; 95% CI, 0.97, 1.70). When women who conceived with MAR were excluded, the association between endometriosis and cryptorchidism disappeared. For hypospadias, we observed no association, either in the main analysis or the stratified analysis. The findings from this register-based study do not provide strong evidence for a higher occurrence of the studied genital anomalies among boys of women with endometriosis. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
The test for determining whether judicial independence is safeguarded is an objective one based on public confidence in the structure of the court and the ... in the analysis of the application of the principles of judicial independence to specific legislative schemes where the structure of the tribunal thereby established had ...
Turner, J.L.; Gill, J.R.
The impact of medicines legislation for radiopharmaceuticals is discussed with regard to product licensing, production and quality control, marketing authorisation within the EC, licensing exemptions and authorisation for administration. As regards safety legislation for radiopharmaceuticals the requirements of the Ionising Radiations Regulations 1985 are outlined. (UK)
Gribnau, J.L.M.; Soeteman, A.
Instrumentalist legislation usually underestimates the importance of legal principles in modern law. Legal principles are the normative core of a value oriented conception of law. They function as essential criteria of evaluation for lawmaking by the legislator and the executive. In fact,
George H. Siehl
The two decades which have passed since the era of the Outdoor Recreation Resources Review Commission (ORRRC) have been active and fruitful in terms of Federal recreation legislation. The Commission and its final report "Outdoor Recreation for America" strongly influenced the burst of recreation legislation in the 1960's. Even today, the studies prepared...
Becker, Louise Giovane
Reviews computer applications in judicial, legal, and legislative information activities being used to support litigation and court administration, assist in searching for legislation and laws, aid criminal justice information systems, and provide appropriate bibliographic and reference assistance. Management issues in automating systems are…
Full Text Available Abstract Background In the past fifteen years there has been a wave of closures of small maternity services in Canada and other developed nations which results in the need for rural parturient women to travel to access care. The purpose of our study is to systematically document newborn and maternal outcomes as they relate to distance to travel to access the nearest maternity services with Cesarean section capabililty. Methods Study population is all women carrying a singleton pregnancy beyond 20 weeks and delivering between April 1, 2000 and March 31, 2004 and residing outside of the core urban areas of British Columbia. Maternal and newborn data was linked to specific geographic catchments by the B.C. Perinatal Health Program. Catchments were stratified by distance to nearest maternity service with Cesarean section capabililty if greater than 1 hour travel time or level of local service. Hierarchical logistic regression was used to test predictors of adverse newborn and maternal outcomes. Results 49,402 cases of women and newborns resident in rural catchments were included. Adjusted odds ratios for perinatal mortality for newborns from catchments greater than 4 hours from services was 3.17 (95% CI 1.45-6.95. Newborns from catchments 2 to 4 hours, and 1 to 2 hours from services generated rates of 179 and 100 NICU 3 days per thousand births respectively compared to 42 days for newborns from catchments served by specialists. Conclusions Distance matters: rural parturient women who have to travel to access maternity services have increased rates of adverse perinatal outcomes.
Nederlof, M; de Walle, H E K; van Poppel, M N M; Vrijkotte, T G M; Gademan, M G J
The maternal lipid profile could be of importance in congenital anomaly development. This study therefore investigates whether the maternal lipid profile during early pregnancy is associated with major nonsyndromic congenital anomalies (MNCA). Prospective community-based cohort study. Amsterdam Born Children and their Development (ABCD) study. A cohort of 3074 pregnant women recruited in 2003-2004 and their offspring. Non-fasting blood samples from pregnant women participating in the ABCD-study (median 12.9 weeks of gestation) were analysed for triglycerides (TG), cholesterol (TC), free fatty acids (FFA), apolipoprotein B (ApoB), and apolipoprotein A1 (ApoA) (n = 3074). The perinatal outcome (MNCA) was obtained from the Youth Health Care Registration and two questionnaires. Adjustment was made for ethnicity. MNCA prevalence. The prevalence of MNCA was 2.2% (n = 68: 20 cardiovascular, 25 bone and muscle, and 23 other single anomalies). A nonlinear association was found between maternal TG levels and MNCA prevalence. With a lower or higher level of maternal TG, the estimated probability increased: a TG level of 0.73 mmol/l (5th percentile), of 1.28 mmol/l (50th percentile), and of 2.35 mmol/l (95th percentile) corresponded with an estimated probability of 3.6, 2.1, and 2.9%, respectively. Unadjusted subgroup analyses showed that the U-shaped association was most prominent for cardiovascular congenital anomalies. Other lipids were not associated with MNCA. Both low and high maternal TG levels during early pregnancy were associated with an increased risk of MNCA in offspring. This suggests that an attempt should be made to normalise TG levels before or during early pregnancy; however, replication of our results is necessary before clinical practice recommendations can be made. © 2015 Royal College of Obstetricians and Gynaecologists.
Verdejo S, M.
The standing legislation in Mexico on food irradiation matter has its basis on the Constitutional Policy of the Mexican United States on the 4 Th. article by its refers to Secretary of Health, 27 Th. article to the Secretary of Energy and 123 Th. of the Secretary of Work and Social Security. The laws and regulations emanated of the proper Constitution establishing the general features which gives the normative frame to this activity. The general regulations of Radiological Safety expedited by the National Commission for Nuclear Safety and Safeguards to state the specifications which must be fulfill the industrial installations which utilizing ionizing radiations, between this line is founded, just as the requirements for the responsible of the radiological protection and the operation of these establishments. The project of Regulation of the General Health Law in matter of Sanitary Control of Benefits and Services, that in short time will be officialized, include a specific chapter on food irradiation which considers the International Organizations Recommendations and the pertaining harmonization stated for Latin America, which elaboration was in charge of specialized group where Mexico was participant. Additionally, the Secretary of Health has a Mexican Official Standard NOM-033-SSA1-1993 named 'Food irradiation; permissible doses in foods, raw materials and support additives' standing from the year 1995, where is established the associated requirements to the control registers, service constancies and dose limits for different groups of foods, moreover of the specific guidelines for its process. This standard will be adequate considering the updating Regulation of Benefits and Services and the limits established the Regulation for Latin America. The associated laws that cover in general terms it would be the requirements for food irradiation although such term is not manageable. (Author)
Lassi, Zohra S; Bhutta, Zulfiqar A
While maternal, infant and under-five child mortality rates in developing countries have declined significantly in the past two to three decades, newborn mortality rates have reduced much more slowly. While it is recognised that almost half of the newborn deaths can be prevented by scaling up evidence-based available interventions (such as tetanus toxoid immunisation to mothers, clean and skilled care at delivery, newborn resuscitation, exclusive breastfeeding, clean umbilical cord care, and/or management of infections in newborns), many require facility-based and outreach services. It has also been stated that a significant proportion of these mortalities and morbidities could also be potentially addressed by developing community-based packaged interventions which should also be supplemented by developing and strengthening linkages with the local health systems. Some of the recent community-based studies of interventions targeting women of reproductive age have shown variable impacts on maternal outcomes and hence it is uncertain if these strategies have consistent benefit across the continuum of maternal and newborn care. To assess the effectiveness of community-based intervention packages in reducing maternal and neonatal morbidity and mortality; and improving neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2014), World Bank's JOLIS (25 May 2014), BLDS at IDS and IDEAS database of unpublished working papers (25 May 2014), Google and Google Scholar (25 May 2014). All prospective randomised, cluster-randomised and quasi-randomised trials evaluating the effectiveness of community-based intervention packages in reducing maternal and neonatal mortality and morbidities, and improving neonatal outcomes. Two review authors independently assessed trials for inclusion, assessed trial quality and extracted the data. Data were checked for accuracy. The review included 26 cluster-randomised/quasi-randomised trials
Gunawardena, Nathali; Bishwajit, Ghose; Yaya, Sanni
For exploring maternal death, supply and demand-side factors can be characterized by the three delays model developed by Thaddeus and Maine (1994). The model comprises delay in deciding to seek care (delay 1), delay in reaching the health facility (delay 2), and delay in receiving quality care once at the health facility (delay 3). Few studies have comprehensively dealt with the health systems delays that prevent the receipt of timely and appropriate obstetric care once a woman reaches a health facility (phase III delays). The objective of the present study was to identify facility-level barriers in West African health facilities. Electronic databases (Medline, cumulative index to nursing and allied health literature, Centre for Agriculture and Biosciences International Global Health, EMBASE) were searched to identify original research articles from 1996 to 2016. Search terms (and synonyms) related to (1) maternal health care (e.g., obstetric care, perinatal care, maternal health services); (2) facility level (e.g., maternity unit, health facility, phase III, hospital); and (3) Western Africa (e.g., Nigeria, Burkina Faso) were combined. This review followed the preferred reporting items for systematic reviews and meta-analyses. Of the 2103 citations identified, 13 studies were eligible. Studies were conducted in Nigeria, Burkina Faso, Gambia, Guinea, Senegal, and Sierra Leone. 30 facility-level barriers were identified and grouped into 6 themes (human resources, supply and equipment, referral-related, infrastructure, cost-related, patient-related). The most obvious barriers included staff shortages, lack of maternal health services and procedures offered to patients, and lack of necessary medical equipment and supplies in the health-care facilities. This review emphasizes that phase I and phase II barriers are not the only factors preventing women from accessing proper emergency obstetric care. Health-care facilities in Western Africa are inadequately equipped to
Lee, Hsin-Chien; Lin, Herng-Ching
To investigate pregnancy outcomes, including low birthweight, preterm births, and small-for-gestational-age (SGA) among women with bipolar disorder, schizophrenia compared with women with no history of mental illness using nationwide population-based data. This study linked the Taiwan National Health Insurance Research Dataset with the national birth certificate registry. A total of 528,398 singleton births between 2001 and 2003 were included; 337 were diagnosed with bipolar disorder. Multivariate logistic regression analyses were carried out to examine the relationship between maternal bipolar disorder, schizophrenia and the odds of low birthweight, preterm births, and SGA, after adjusting for characteristics of infant, mother and father. It shows that pregnant women with bipolar disorder were more likely to have LBW infants (9.8% vs. 5.7%), preterm births (14.2% vs. 6.9%) and SGA (22.3% vs. 15.7%) than pregnant women with no history of mental illness. The adjusted odds of low birthweight for women with bipolar disorder was 1.66 times (95% CI, 1.16-2.38) that of women with no history of mental illness. In terms of preterm births and SGA, the adjusted odds ratios were 2.08 (95% CI, 1.53-2.83) and 1.47 (95% CI, 1.14-1.91) respectively, for women with bipolar disorder, compared to their counterparts with no history of mental illness. We conclude that women with bipolar disorder had increased risk of low birthweight, preterm births, and SGA than women without a history of mental illness. More active monitoring and early intervention to counter potential adverse pregnancy outcomes for pregnant women with bipolar disorder should be initiated. 2009 Elsevier B.V. All rights reserved.
This paper gives some basic data about nuclear installations in Slovenia, reviews Slovenian national legislation in the field of third-party liability for nuclear damage, applicability of the international nuclear liability treaties in the Slovenian legal system and outlines some main provisions of national legislation. It also aims to give some facts about history and present status of nuclear insurance pool and the insurance of nuclear risks in Slovenia. Paper finally indicates also some future legislative steps with respect to nuclear third party liability, at national and international level. (author)
Law, Wing-Wah; Pan, Su-Yan
This article presents a game theory analysis of legislating private education in China, based on set of primary and secondary documents related to this issue. The article argues that shaping educational legislation is a dynamic, repeated game of negotiation, cooperation, and/or competition on multiple occasions among various interested actors,…
De Luis, Edurne Chocarro
This article reviews the journey of special education in Spain by considering the legal frameworks. It examines the extent to which legislation has tapped into the feelings of society in general towards people with disabilities who wish to secure inclusion in both education and society. It tracks the evolution of legislation, originally based on a…
The paper intent is to present an update on the Romanian legislative and regulatory framework in the area of radioactive waste management. Based on the experiences gained by the National Commission for Nuclear Activities Control in the past years, the recent legislative initiatives related to the coherent radwaste management policy at the national level are presented. (author)
Embo, M; Helsloot, K; Michels, N; Valcke, M
workplace learning plays a crucial role in midwifery education. Twelve midwifery schools in Flanders (Belgium) aimed to implement a standardised and evidence-based method to learn and assess competencies in practice. This study focuses on the validation of competency-based criteria to guide and assess undergraduate midwifery students' postnatal care competencies in the maternity ward. an online Delphi study was carried out. During three consecutive sessions, experts from workplaces and schools were invited to score the assessment criteria as to their relevance and feasibility, and to comment on the content and their formulation. A descriptive quantitative analysis, and a qualitative thematic content analysis of the comments were carried out. A Mann-Whitney U-test was used to investigate differences between expert groups. eleven competencies and fifty-six assessment criteria were found appropriate to assess midwifery students' competencies in the maternity ward. Overall median scores were high and consensus was obtained for all criteria, except for one during the first round. Although all initial assessment criteria (N=89) were scored as relevant, some of them appeared not feasible in practice. Little difference was found between the expert groups. Comments mainly included remarks about concreteness and measurability. this study resulted in validated criteria to assess postnatal care competencies in the maternity ward. Copyright © 2017 Elsevier Ltd. All rights reserved.
Dejene Ermias Mekango
Full Text Available In Ethiopia, 20,000 women die each year from complications related to pregnancy, childbirth and post-partum. For every woman that dies, 20 more experience injury, infection, disease, or disability. "Maternal near miss" (MNM, defined by the World Health Organization (WHO as a woman who nearly dies, but survives a complication during pregnancy, childbirth or within 42 days of a termination, is a proxy indicator of maternal mortality and quality of obstetric care. In Ethiopia, few studies have examined MNM. This study aims to identify determinants of MNM among a small population of women in Tigray, Ethiopia.Unmatched case-control study was conducted in hospitals in Tigray Region, Northern Ethiopia, from January 30-March 30, 2016. The sample included 103 cases and 205 controls recruited from among women seeking obstetric care at six (6 public hospitals. Clients with life-threatening obstetric complications, including hemorrhage, hypertensive diseases of pregnancy, dystocia, infection, and anemia or clinical signs of severe anemia (in women without hemorrhage were taken as cases and those with normal obstetric outcomes were controls. Cases were selected based on proportion to size allocation while systematic sampling was employed for controls. Binary and multiple variable logistic regression ("odds ratio" analyses were calculated at 95% CI.Roughly 90% of cases and controls were married and 25% experienced their first pregnancy before the age of 16 years. About two-thirds of controls and 45.6% of cases had gestational ages between 37-41 weeks. Among cases, severe obstetric hemorrhage (44.7%, hypertensive disorders (38.8%, dystocia (17.5%, sepsis (9.7% and severe anemia (2.9% were leading causes of MNM. Histories of chronic maternal medical problems like hypertension, diabetes were reported in 55.3% of cases and 33.2% of controls. Women with no formal education [AOR = 3.2;95%CI:1.24, 8.12], being less than 16 years of age at first pregnancy [AOR = 2
Kullinger, Merit; Wesström, Jan; Kieler, Helle; Skalkidou, Alkistis
Gestational age is estimated by ultrasound using fetal size as a proxy for age, although variance in early growth affects reliability. The aim of this study was to identify characteristics associated with discrepancies between last menstrual period-based (EDD-LMP) and ultrasound-based (EDD-US) estimated delivery dates. We identified all singleton births (n = 1 201 679) recorded in the Swedish Medical Birth Register in 1995-2010, to assess the association between maternal/fetal characteristics and large negative and large positive discrepancies (EDD-LMP earlier than EDD-US and 10th percentile in the discrepancy distribution vs. EDD-LMP later than EDD-US and 90th percentile). Analyses were adjusted for age, parity, height, body mass index, smoking, and employment status. Women with a body mass index >40 kg/m 2 had the highest odds for large negative discrepancies (-9 to -20 days) [odds ratio (OR) 2.16, 95% CI 2.01-2.33]. Other factors associated with large negative discrepancies were: diabetes, young maternal age, multiparity, body mass index between 30 and 39.9 kg/m 2 or +1 SD), and unemployment. Several maternal and fetal characteristics were associated with discrepancies between dating methods. Systematic associations of discrepancies with maternal height, fetal sex, and partly obesity, may reflect an influence on the precision of the ultrasound estimate due to variance in early growth. © 2016 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
Arendt, Linn Håkonsen; Ramlau-Hansen, Cecilia Høst; Lindhard, Morten Søndergaard; Henriksen, Tine Brink; Olsen, Jørn; Yu, Yongfu; Cnattingius, Sven
Overweight and obese pregnant women face higher risk of several critical birth outcomes, including an overall increased risk of congenital abnormalities. Only few studies have focused on associations between maternal overweight and the genital anomalies in boys, cryptorchidism and hypospadias, and results are inconclusive. We performed a population-based cohort study and assessed the associations between maternal body mass index (BMI) in early pregnancy and occurrence of cryptorchidism and hypospadias. All live-born singleton boys born in Sweden from 1992 to 2012 were included. From the Swedish Patient Register, information on cryptorchidism and hypospadias was available. Data were analysed using Cox proportional hazards regression adjusted for potential confounders. Mediation analyses were performed to estimate how much of the association between BMI and genital anomalies were mediated through obesity-related diseases. Of the 1 055 705 live-born singleton boys born from 1992 to 2012, 6807 (6.4 per 1000) were diagnosed with hypospadias and 16 469 (15.6 per 1000) were diagnosed with cryptorchidism, of which 9768 (9.3 per 1000) underwent corrective surgery for cryptorchidism. We observed dose-response associations between maternal BMI and hypospadias and cryptorchidism. Boys of mothers with BMI ≥40.0 kg/m 2 had the highest adjusted hazard ratios for hypospadias (HR 1.35, 95% confidence interval [CI] 1.04, 1.76) and cryptorchidism (HR 1.25, 95% CI 1.00, 1.58). A substantial proportion of the associations between BMI and the genital anomalies were mediated through preeclampsia. This large register-based study adds to the current literature and indicates that the occurrence of hypospadias and cryptorchidism increase with maternal overweight and obesity severity. © 2017 John Wiley & Sons Ltd.
Posada, German; Trumbell, Jill; Noblega, Magaly; Plata, Sandra; Peña, Paola; Carbonell, Olga A.; Lu, Ting
This study tested whether maternal sensitivity and child security are related during early childhood and whether such an association is found in different cultural and social contexts. Mother-child dyads (N = 237) from four different countries (Colombia, Mexico, Peru, and the United States) were observed in naturalistic settings when children were…
Full Text Available This study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post–Ebola health systems reconstruction and for general rural health system planning in sub–Saharan Africa.
While Ethiopia has successfully reduced under-five childhood mortality, there have been slower gains in reducing neonatal (newborn) and maternal mortality rates. About 220,000 children and mothers die every year in Ethiopia. For most, the causes of death are unknown as fewer than 30% of Ethiopia's births and deaths ...
This is part of Canada's contribution to the work being undertaken through the Global Financing Facility focusing on the challenges facing many high burden countries to improve maternal, newborn, child, and adolescent health. The project will provide Ethiopia with its first-ever representative data on the causes of neonatal ...
D'Onofrio, Brian M; Singh, Amber L; Iliadou, Anastasia; Lambe, Mats; Hultman, Christina M; Grann, Martin; Neiderhiser, Jenae M; Långström, Niklas; Lichtenstein, Paul
The association between maternal smoking during pregnancy (SDP) and offspring disruptive behaviors has been well documented, but it is unclear whether exposure to SDP or the effects of factors correlated with SDP account for the increased risk. To test whether the association between SDP and offspring criminal convictions was consistent with a causal connection or due to familial background factors by controlling for measured covariates and using a quasi-experimental approach. We used a population-based study of children born in Sweden from 1983 to 1989 (N = 609,372) to examine the association between SDP and offspring criminal convictions while controlling for measured traits of both parents. We also compared siblings differentially exposed to SDP (n = 50,339) to account for unmeasured familial factors that could account for the association. Population-based study of all children born in Sweden from 1983 to 1989 with information on maternal SDP and offspring criminal convictions based on national registries collected by the Swedish government. Children born in Sweden from 1983 to 1989 (N = 609,372) and siblings differentially exposed to SDP (n = 50,339). Violent and nonviolent convictions, based on the Swedish National Crime Register, a register with detailed information on all convictions in the country. Moderate (hazard rate [HR], 2.47; 95% confidence interval [CI], 2.34-2.60) and high (HR, 3.43; 95% CI, 3.25-3.63) levels of maternal SDP were associated with an increased risk for offspring violent convictions, even when controlling for maternal and paternal traits. There was no association between SDP and violent convictions, however, when comparing differentially exposed siblings (HR(moderate), 1.02; 95% CI, 0.79-1.30; HR(high), 1.03; 95% CI, 0.78-1.37). Smoking during pregnancy also was associated with nonviolent convictions in the entire population (HR(moderate), 1.62; 95% CI, 1.58-1.66; HR(high), 1.87; 95% CI, 1.82-1.92) and when controlling for covariates
Montgomery County of Maryland — The Council enacts local public laws for the ‘peace, good government, health, and welfare of the county’. The bills dataset contains all legislation considered by...
Summaries of laws enacted by states, during 1982, dealing with the management of low-level radioactive wastes are presented in this report. Also included are adopted resolutions, introduced legislation and introduced resolutions
The Swiss Permanent Mission in Geneva has requested CERN to inform the members of its personnel that a notice relating to Swiss legislation on dog ownership has been published on-line at the following address: http://www.eda.admin.ch/eda/en/home/topics/intorg/un/unge/gepri/pet.html This legislation is applicable to all international civil servants who own a dog. Relations with the Host States Service mailto:email@example.com http://www.cern.ch/relations/
This part gathers the national legislative and regulatory activities. The subjects tackled are as follow: radiological protection (Belgium), transport of radioactive materials (Belgium, France), general legislation (Brazil, Ireland, Republic of Moldova, Serbia, Turkey), third part liability (Japan), radioactive waste management (Korea, Romania, Slovenia, Usa), regime of radioactive materials (Romania), organisation and structure (Switzerland), regime of nuclear installations (Usa), regulations on nuclear trade (Usa). (N.C)
Umubyeyi, Aline; Persson, Margareta; Mogren, Ingrid; Krantz, Gunilla
Despite its burden on a person's life, Intimate Partner Violence (IPV) is known to be poorly recognised and managed in most countries and communities. This study aimed to explore health care professionals' experiences of the health care seeking processes of women exposed to intimate partner violence in Rwanda. Six focus group discussions were conducted in three district hospitals and three mental health units in Rwanda. A sample of 43 health care professionals with various professions and length of work experience, who regularly took care of patients subjected to IPV, was selected for focus group discussions. The analysis was performed using qualitative content analysis. The theme "Gendered norms and values defeat the violence legislation in women's health care seeking when women are abused" expressed the health care professionals' experiences of the double-faced situation which women exposed to IPV met in their help seeking process. Positive initiatives to protect women were identified, but the potential for abused women to seek help and support was reduced because of poverty, gender inequality with prevailing strong norms of male superiority, and the tendency to keep abuse as a private family matter. Legislative measures have been instituted to protect women from abuse. Still many Rwandan women do not benefit from these efforts. The role of the health care services needs to be reinforced as an important and available resource for help and support for abused women but further legislative changes are also needed. Initiatives to further improve gender equality, and institutionalised collaboration between different sectors in society would contribute to protecting women from IPV.
Full Text Available Despite its burden on a person's life, Intimate Partner Violence (IPV is known to be poorly recognised and managed in most countries and communities. This study aimed to explore health care professionals' experiences of the health care seeking processes of women exposed to intimate partner violence in Rwanda.Six focus group discussions were conducted in three district hospitals and three mental health units in Rwanda. A sample of 43 health care professionals with various professions and length of work experience, who regularly took care of patients subjected to IPV, was selected for focus group discussions. The analysis was performed using qualitative content analysis.The theme "Gendered norms and values defeat the violence legislation in women's health care seeking when women are abused" expressed the health care professionals' experiences of the double-faced situation which women exposed to IPV met in their help seeking process. Positive initiatives to protect women were identified, but the potential for abused women to seek help and support was reduced because of poverty, gender inequality with prevailing strong norms of male superiority, and the tendency to keep abuse as a private family matter.Legislative measures have been instituted to protect women from abuse. Still many Rwandan women do not benefit from these efforts. The role of the health care services needs to be reinforced as an important and available resource for help and support for abused women but further legislative changes are also needed. Initiatives to further improve gender equality, and institutionalised collaboration between different sectors in society would contribute to protecting women from IPV.
MacKinnon, Karen; Marcellus, Lenora; Rivers, Julie; Gordon, Carol; Ryan, Maureen; Butcher, Diane
Although maternal-child care is a pillar of primary health care, there is a global shortage of maternal-child health care providers. Nurse educators experience difficulties providing undergraduate students with maternal-child learning experiences for a number of reasons. Simulation has the potential to complement learning in clinical and classroom settings. Although systematic reviews of simulation are available, no systematic reviews of qualitative evidence related to maternal-child simulation-based learning (SBL) for undergraduate nursing students and/or educators have been located. The aim of this systematic review was to identify the appropriateness and meaningfulness of maternal-child simulation-based learning for undergraduate nursing students and nursing educators in educational settings to inform curriculum decision-making. The review questions are: INCLUSION CRITERIA TYPES OF PARTICIPANTS: Pre-registration or pre-licensure or undergraduate nursing or health professional students and educators. Experiences of simulation in an educational setting with a focus relevant to maternal child nursing. Qualitative research and educational evaluation using qualitative methods. North America, Europe, Australia and New Zealand. A three-step search strategy identified published studies in the English language from 2000 until April 2016. Identified studies that met the inclusion criteria were retrieved and critically appraised using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) by at least two independent reviewers. Overall the methodological quality of the included studies was low. Qualitative findings were extracted by two independent reviewers using JBI-QARI data extraction tools. Findings were aggregated and categorized on the basis of similarity in meaning. Categories were subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings. Twenty-two articles from 19 studies were included in the review
Full Text Available Abstract Background Auditing of sentinel health events based on best-practice protocols has been recommended. This study describes a population-based investigation on adverse perinatal events including severe acute maternal morbidity (near-miss, maternal and perinatal mortality, as a health intervention to help improve the surveillance system. Methods From October to December 2005, all cases of maternal death (MD, near-miss (NM, fetal deaths (FD, and early neonatal deaths (END, occurring in Campinas, Brazil, were audited by maternal mortality committees. Results A total of 4,491 liveborn infants (LB and 159 adverse perinatal events (35.4/1000 LB were revised, consisting of 4 MD (89/100.000 LB and 95 NM (21.1/1000 LB, 23.7 NM for each MD. In addition, 32 FD (7.1/1000 LB and 28 END (6.2/1000 LB occurred. The maternal death/near miss rate was 23.7:1. Some delay in care was recognized for 34%, and hypertensive complications comprised 57.8% of the NM events, followed by postpartum hemorrhage. Conclusion Auditing near miss cases expanded the understanding of the spectrum from maternal morbidity to mortality and the importance of promoting adhesion to clinical protocols among maternal mortality committee members. Hypertensive disorders and postpartum hemorrhage were identified as priority topics for health providers training, and organization of care.
Full Text Available Maternity care is an integrated care process, which consists of different services, involves different professionals and covers different time windows. To measure performance of maternity care based on clients' experiences, we developed and validated a questionnaire.We used the 8-domain WHO Responsiveness model, and previous materials to develop a self-report questionnaire. A dual study design was used for development and validation. Content validity of the ReproQ-version-0 was determined through structured interviews with 11 pregnant women (≥28 weeks, 10 women who recently had given birth (≤12 weeks, and 19 maternity care professionals. Structured interviews established the domain relevance to the women; all items were separately commented on. All Responsiveness domains were judged relevant, with Dignity and Communication ranking highest. Main missing topic was the assigned expertise of the health professional. After first adaptation, construct validity of the ReproQ-version-1 was determined through a web-based survey. Respondents were approached by maternity care organizations with different levels of integration of services of midwives and obstetricians. We sent questionnaires to 605 third trimester pregnant women (response 65%, and 810 women 6 weeks after delivery (response 55%. Construct validity was based on: response patterns; exploratory factor analysis; association of the overall score with a Visual Analogue Scale (VAS, known group comparisons. Median overall ReproQ score was 3.70 (range 1-4 showing good responsiveness. The exploratory factor analysis supported the assumed domain structure and suggested several adaptations. Correlation of the VAS rating and overall ReproQ score (antepartum, postpartum supported validity (r = 0.56; 0.59, p<0.001 Spearman's correlation coefficient. Pre-stated group comparisons confirmed the expected difference following a good vs. adverse birth outcome. Fully integrated organizations performed
Cristiani Cortez Mendes
Full Text Available CONTEXT AND OBJECTIVE: Polymorphisms in genes involved in folate metabolism may modulate the maternal risk of Down syndrome (DS. This study evaluated the influence of a 19-base pair (bp deletion polymorphism in intron-1 of the dihydrofolate reductase (DHFR gene on the maternal risk of DS, and investigated the association between this polymorphism and variations in the concentrations of serum folate and plasma homocysteine (Hcy and plasma methylmalonic acid (MMA. DESIGN AND SETTING: Analytical cross-sectional study carried out at Faculdade de Medicina de São José do Rio Preto (Famerp. METHODS: 105 mothers of individuals with free trisomy of chromosome 21, and 184 control mothers were evaluated. Molecular analysis on the polymorphism was performed using the polymerase chain reaction (PCR through differences in the sizes of fragments. Folate was quantified by means of chemiluminescence, and Hcy and MMA by means of liquid chromatography and sequential mass spectrometry. RESULTS: There was no difference between the groups in relation to allele and genotype frequencies (P = 0.44; P = 0.69, respectively. The folate, Hcy and MMA concentrations did not differ significantly between the groups, in relation to genotypes (P > 0.05. CONCLUSIONS: The 19-bp deletion polymorphism of DHFR gene was not a maternal risk factor for DS and was not related to variations in the concentrations of serum folate and plasma Hcy and MMA in the study population.
Khashan, A S
BACKGROUND: Adverse pregnancy outcomes have been associated with maternal celiac disease (CD). In this study, we investigate the effect of treated and untreated maternal CD on infant birthweight and preterm birth. METHODS: A population-based cohort study consisted of all singleton live births in Denmark between 1 January 1979 and 31 December 2004 was used. A total of 1,504,342 babies were born to 836,241 mothers during the study period. Of those, 1105 babies were born to women with diagnosed CD and 346 were born to women with undiagnosed CD. Women with diagnosed CD were considered as treated with a gluten free diet while women with undiagnosed CD were considered as untreated. The outcome measures were: birthweight, small for gestational age (SGA: birthweight <10th centile), very small for gestational age (VSGA: birthweight <5th centile) and preterm birth. We compared these measures in treated and untreated women with those of a reference group (no history of CD). RESULTS: Women with untreated CD delivered smaller babies [difference = -98 g (95% CI: -130, -67)], with a higher risk of SGA infants [OR = 1.31 (95% CI: 1.06, 1.63)], VSGA infants [OR = 1.54 (95% CI: 1.17, 2.03)] and preterm birth [OR = 1.33 (95% CI: 1.02, 1.72)] compared with women without CD. Women with treated CD had no increased risk of reduced mean birthweight, risk of delivering SGA and VSGA infants or preterm birth compared with women without CD. CONCLUSION: Untreated maternal CD increases the risk of reduced birthweight, the risk of delivering SGA and VSGA infants and preterm birth. Diagnosis and presumed treatment of maternal CD with a gluten-free diet appeared to result in a birthweight and preterm birth rate similar to those in women without CD.
Kutbi, Hebah; Wehby, George L; Moreno Uribe, Lina M; Romitti, Paul A; Carmichael, Suzan; Shaw, Gary M; Olshan, Andrew F; DeRoo, Lisa; Rasmussen, Sonja A; Murray, Jeffrey C; Wilcox, Allen; Lie, Rolv T; Munger, Ronald G
Evidence on association of maternal pre-pregnancy weight with risk of orofacial clefts is inconsistent. Six large case-control studies of orofacial clefts from Northern Europe and the USA were included in analyses pooling individual-level data. Cases included 4943 mothers of children with orofacial clefts (cleft lip only: 1135, cleft palate with cleft lip: 2081, cleft palate only: 1727) and controls included 10 592 mothers of unaffected children. Association of orofacial cleft risk with pre-pregnancy maternal weight classified by level of body mass index (BMI, kg/m 2 ) was evaluated using logistic regression adjusting for multiple covariates. Cleft palate, both alone and with cleft lip (CP+/-CL), was associated with maternal class II+ pre-pregnancy obesity (≥ 35)compared with normal weight [adjusted odds ratio (aOR) = 1.36; 95% confidence interval (CI) = 1.16, 1.58]. CP+/-CL was marginally associated with maternal underweight (aOR = 1.16; 95% CI = 0.98, 1.36). Cleft lip alone was not associated with BMI. In this largest population-based study to date, we found an increased risk of cleft palate, with or without cleft lip, in class II+ obese mothers compared with normal-weight mothers; underweight mothers may also have an increased risk, but this requires further study. These results also suggest that extremes of weight may have a specific effect on palatal development. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association
Miller, Suellen; Abalos, Edgardo; Chamillard, Monica; Ciapponi, Agustin; Colaci, Daniela; Comandé, Daniel; Diaz, Virginia; Geller, Stacie; Hanson, Claudia; Langer, Ana; Manuelli, Victoria; Millar, Kathryn; Morhason-Bello, Imran; Castro, Cynthia Pileggi; Pileggi, Vicky Nogueira; Robinson, Nuriya; Skaer, Michelle; Souza, João Paulo; Vogel, Joshua P; Althabe, Fernando
On the continuum of maternal health care, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). TLTL describes care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity. TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. As facility births increase, so does the recognition that TMTS causes harm and increases health costs, and often concentrates disrespect and abuse. Although TMTS is typically ascribed to high-income countries and TLTL to low-income and middle-income ones, social and health inequities mean these extremes coexist in many countries. A global approach to quality and equitable maternal health, supporting the implementation of respectful, evidence-based care for all, is urgently needed. We present a systematic review of evidence-based clinical practice guidelines for routine antenatal, intrapartum, and postnatal care, categorising them as recommended, recommended only for clinical indications, and not recommended. We also present prevalence data from middle-income countries for specific clinical practices, which demonstrate TLTL and increasing TMTS. Health-care providers and health systems need to ensure that all women receive high-quality, evidence-based, equitable and respectful care. The right amount of care needs to be offered at the right time, and delivered in a manner that respects, protects, and promotes human rights. Copyright © 2016 Elsevier Ltd. All rights reserved.
Marozio, Luca; Picardo, Elisa; Filippini, Claudia; Mainolfi, Erika; Berchialla, Paola; Cavallo, Franco; Tancredi, Annalisa; Benedetto, Chiara
Increased risk for adverse pregnancy outcomes with advancing maternal age has been described but the strength of association remains debated, particularly in presence of confounding factors such as parity, twin pregnancy and pregnancy from assisted reproductive technologies. The aim of this study was to evaluate pregnancy outcomes in a large cohort of women aged over 40 years. The hypothesis was that advanced maternal age may be an independent risk factor for adverse pregnancy outcome. We reviewed the clinical records of 56,211 women who delivered at Sant'Anna University Hospital, Turin, Italy, in the period between 2009 and 2015. Of these, 3798 women aged over 40 years were divided into two age groups (40 - 44 years and ≥45 years). Women of any parity, with singleton or twin pregnancies, or with assisted reproductive technology pregnancies were included. Women aged less than 40 years were considered as controls. Primary outcome measures were maternal and perinatal complications. Comparisons were performed using Chi-square test and Fisher's exact test. Univariate analysis and logistic regression analysis were performed to test the possible independent role of maternal age as a risk factor for adverse pregnancy outcome. Maternal age was an independent risk factor for gestational diabetes (age 40-44 years: odds ratios (OR) 2.10, 95% CI 1.80-2.45; age ≥45 years: OR 2.83, 95% CI 1.79-4.46) and early-onset preeclampsia (age 40-44 years: OR 2.10, 95% CI 1.63-2.70; age ≥45 years: OR 3.16, 95% CI 1.68-5.94). The risk for placenta praevia was higher in the women aged 40-44 years (OR 1.87, 95% CI 1.36-2.57). Neonatal outcomes were similar among groups, except for the rate of birth weight less than 2500 g, which was higher in women aged 40-44 years (OR 1.27, 95% CI 1.12-1.42). However, older women showed an overall higher incidence of preterm birth. Maternal age over 40 years is an independent risk factor for adverse pregnancy outcomes, particularly for the mother
Full Text Available BackgroundFor exploring maternal death, supply and demand-side factors can be characterized by the three delays model developed by Thaddeus and Maine (1994. The model comprises delay in deciding to seek care (delay 1, delay in reaching the health facility (delay 2, and delay in receiving quality care once at the health facility (delay 3. Few studies have comprehensively dealt with the health systems delays that prevent the receipt of timely and appropriate obstetric care once a woman reaches a health facility (phase III delays. The objective of the present study was to identify facility-level barriers in West African health facilities.MethodsElectronic databases (Medline, cumulative index to nursing and allied health literature, Centre for Agriculture and Biosciences International Global Health, EMBASE were searched to identify original research articles from 1996 to 2016. Search terms (and synonyms related to (1 maternal health care (e.g., obstetric care, perinatal care, maternal health services; (2 facility level (e.g., maternity unit, health facility, phase III, hospital; and (3 Western Africa (e.g., Nigeria, Burkina Faso were combined. This review followed the preferred reporting items for systematic reviews and meta-analyses.ResultsOf the 2103 citations identified, 13 studies were eligible. Studies were conducted in Nigeria, Burkina Faso, Gambia, Guinea, Senegal, and Sierra Leone. 30 facility-level barriers were identified and grouped into 6 themes (human resources, supply and equipment, referral-related, infrastructure, cost-related, patient-related. The most obvious barriers included staff shortages, lack of maternal health services and procedures offered to patients, and lack of necessary medical equipment and supplies in the health-care facilities.ConclusionThis review emphasizes that phase I and phase II barriers are not the only factors preventing women from accessing proper emergency obstetric care. Health-care facilities in Western
Belarus: general legislation with amendments to laws on the use of atomic energy (2009) and criminal law on acts concerning the use of radioactive sources and administrative law for non criminal violations of radiation safety requirement (2009). Egypt: general legislation with law on activities in the nuclear and radiation field (2010). France: radioactive waste management with a decree establishing a committee on industrial co-ordination of radioactive waste (2010) and third part liability with a law on the recognition and indemnification of victims of nuclear tests conducted by France (2010). Germany: general legislation with a tenth amendment to the atomic energy act (2010), and act on environmental impact assessment (2009) concerning organisation and structure we find a revised version of statutes of the Radiation Protection Commission (2009), about radiation protection we find an act on the protection against non-ionizing radiation (2009), and for transport of radioactive materials we have an ordinance on the international transport of dangerous goods by road (2009). Ireland: In radiation protection we have an order to amend Regulations on active implantable medical devices (2010). Italy: general legislation we have a decree setting out rules for the sitting, construction and operation of nuclear installations (2010). Romania: general legislation with a law on the reorganisation of public authorities (2009). Slovak Republic: general legislation with an amendment of the atomic act (2009). spain: radioactive waste management with a law regulation limited investment companies quoted on the real estate market (2009). Ukraine: general legislation with an overview of recent amendments to laws in the field of nuclear energy (2009). (N.C.)
Full Text Available Aim To evaluate the correlation between the success of pregnancy through in vitro fertilization and maternal age. Methods Assessment of pregnancy was performed in eight in vitro fertilization centers in Indonesia: Harapan Kita Pediatric and Obstetric Hospital from 1997 to 2001, and seven in vitro fertilization centers in Indonesia. Follicular induction was performed through the long protocol, short protocol and natural cycle. Insemination was performed through ICSI (intra cytoplasmic sperm injection on petri dish. Spermatozoa were obtained through masturbation, testicular biopsy and epididimical biopsy. A successful pregnancy was indicated chemically, with the presence of fetal heart beat and the birth of a baby (take home baby. Results There was a 34% pregnancy rate for the age group below 30 years, 33.75% for those between 31 and 35 years olds, and 26% for the age group 36 to 40 years old, and 8% for the age group above 40 years. Conclusion The higher the maternal age, the lower pregnancy rate. In other words, the higher the maternal age, the higher the rate of miscarriage. (Med J Indones 2009; 18: 244-8Keywords: pregnancy, in vitro fertilization
Fried, Susanna; Harrison, Brianna; Starcevich, Kelly; Whitaker, Corinne; O'Konek, Tiana
Maternal mortality and morbidity (MMM) and HIV represent interlinked challenges arising from common causes, magnifying their respective impacts and producing related consequences. Accordingly, an integrated response will lead to the most effective approach for both. Shared structural drivers include gender inequality; gender-based violence (including sexual violence); economic disempowerment; and stigma and discrimination in access to services or opportunities based on gender and HIV. Further, shared system-related drivers also contribute to a lack of effective access to acceptable, high-quality health services and other development resources from birth forward. HIV and MMM are connected in both outcomes and solutions: in sub-Saharan Africa, HIV is the leading cause of maternal death, while the most recent global report on HIV identifies prevention of unintended pregnancy and access to contraception as two of the most important HIV-related prevention efforts.1 Both are central to reducing unsafe abortion--another leading cause of maternal death globally, and particularly in Africa. A human rights-based framework helps to identify these shared determinants. A human rights-based approach works to establish the health-related human rights standards to which all women are entitled, as well to outline the indivisible and intersecting human rights principles which inform and guide efforts to prevent, protect from, respond to, and provide remedy for human rights violations-in this case related to HIV and maternal mortality and morbidity.The Millennium Declaration and Development Goals (MDGs) help to both set quantifiable goals for achieving the components identified within the human rights-based framework and document the international consensus that no single goal--such as those addressing HIV and MMM--can be achieved without progress on all development goals. Copyright © 2012 Fried et al.. This is an open access article distributed under the terms of the Creative
Dr. Daisy R Singla, PhD; Elias Kumbakumba, MMed; Prof. Frances E Aboud, PhD
Background: Parenting interventions have been implemented to improve the compromised developmental potential among 39% of children younger than 5 years living in low-income and middle-income countries. Maternal wellbeing is important for child development, especially in children younger than 3 years who are vulnerable and dependent on their mothers for nutrition and stimulation. We assessed an integrated, community-based parenting intervention that targeted both child development and maternal...
Background Approximately 1.2 million stillbirths occur in the intrapartum period, and a further 717,000 annual neonatal deaths are caused by intrapartum events, most of which occur in resource poor settings. We aim to test the ‘double-hit’ hypothesis that maternal infection in the perinatal period predisposes to neurodevelopmental sequelae from an intrapartum asphyxia insult, increasing the likelihood of an early neonatal death compared with asphyxia alone. This is an observational study of singleton newborn infants with signs of intrapartum asphyxia that uses data from three previously conducted cluster randomized controlled trials taking place in rural Bangladesh and India. Methods From a population of 81,778 births in 54 community clusters in rural Bangladesh and India, we applied mixed effects logistic regression to data on 3890 singleton infants who had signs of intrapartum asphyxia, of whom 769 (20%) died in the early neonatal period. Poor infant condition at five minutes post-delivery was our proxy measure of intrapartum asphyxia. We had data for two markers of maternal infection: fever up to three days prior to labour, and prolonged rupture of membranes (PROM). Cause-specific verbal autopsy data were used to validate our findings using previously mentioned mixed effect logistic regression methods and the outcome of a neonatal death due to intrapartum asphyxia. Results Signs of maternal infection as indicated by PROM, combined with intrapartum asphyxia, increased the risk of an early neonatal death relative to intrapartum asphyxia alone (adjusted odds ratio (AOR) 1.28, 95% CI 1.03 – 1.59). Results from cause-specific verbal autopsy data verified our findings where there was a significantly increased odds of a early neonatal death due to intrapartum asphyxia in newborns exposed to both PROM and intrapartum asphyxia (AOR: 1.52, 95% CI 1.15 – 2.02). Conclusions Our data support the double-hit hypothesis for signs of maternal infection as indicated by
Batis, Jeffery C
Since peaking in the 1990s, inhalant abuse has steadily decreased over the past two decades. Concurrently, nearly every state has passed legislation aimed at minimizing inhalant abuse. While males have historically been more likely to abuse inhalants than females, there is no longer a sex effect in self-reported rates of inhalant abuse. The objective of the present study is to evaluate the effect of anti-inhalant abuse legislation on self-reported rates of inhalant abuse, in high school age males and females. Beginning in 1993, the CDC's biannual Youth Risk Behavior Surveillance Survey asked respondents if they have ever used inhalants to get high. Data from these surveys were collected, along with the date of passage of anti-inhalant abuse legislation in 46 of 50 states. ANOVAs were conducted to assess the effect of legislation on self-reported inhalant abuse rates. There were no significant main effects or interactions that demonstrated that inhalant abuse rates decreased in males or females following passage of legislation aimed at decreasing inhalant abuse. Conclusion/Importance: To date, 46 of 50 states have passed laws aimed at minimizing inhalant abuse, and while inhalant abuse rates have been decreasing for the past two decades, there is no evidence that this decline is related to enactment of these laws. Further research is needed to determine the cause of the decrease in inhalant abuse. The laws may benefit from amendments to include options for treatment.
Bókay, János; Kiss, Erika; Simon, Erika; Szőnyi, László
Elevated maternal phenylalanine levels during pregnancy are teratogenic, and may result in embryo-foetopathy, which could lead to stillbirth, significant psychomotor handicaps and birth defects. This foetal damage is known as maternal phenylketonuria. Women of childbearing age with all forms of phenylketonuria, including mild variants such as hyperphenylalaninaemia, should receive detailed counselling regarding their risks for adverse foetal effects, optimally before contemplating pregnancy. The most assured way to prevent maternal phenylketonuria is to maintain the maternal phenylalanine levels within the optimal range already before conception and throughout the whole pregnancy. Authors review the comprehensive programme for prevention of maternal phenylketonuria at the Metabolic Center of Budapest, they survey the practical approach of the continuous maternal metabolic control and delineate the outcome of pregnancies of mothers with phenylketonuria from the introduction of newborn screening until most recently.
Martinek, Radek; Kelnar, Michal; Koudelka, Petr; Vanus, Jan; Bilik, Petr; Janku, Petr; Nazeran, Homer; Zidek, Jan
This paper describes the design, construction, and testing of a multi-channel fetal electrocardiogram (fECG) signal generator based on LabVIEW. Special attention is paid to the fetal heart development in relation to the fetus' anatomy, physiology, and pathology. The non-invasive signal generator enables many parameters to be set, including fetal heart rate (FHR), maternal heart rate (MHR), gestational age (GA), fECG interferences (biological and technical artifacts), as well as other fECG signal characteristics. Furthermore, based on the change in the FHR and in the T wave-to-QRS complex ratio (T/QRS), the generator enables manifestations of hypoxic states (hypoxemia, hypoxia, and asphyxia) to be monitored while complying with clinical recommendations for classifications in cardiotocography (CTG) and fECG ST segment analysis (STAN). The generator can also produce synthetic signals with defined properties for 6 input leads (4 abdominal and 2 thoracic). Such signals are well suited to the testing of new and existing methods of fECG processing and are effective in suppressing maternal ECG while non-invasively monitoring abdominal fECG. They may also contribute to the development of a new diagnostic method, which may be referred to as non-invasive trans-abdominal CTG + STAN. The functional prototype is based on virtual instrumentation using the LabVIEW developmental environment and its associated data acquisition measurement cards (DAQmx). The generator also makes it possible to create synthetic signals and measure actual fetal and maternal ECGs by means of bioelectrodes.
Reuben, Julia D.; Shaw, Daniel S.; Brennan, Lauretta M.; Dishion, Thomas J.; Wilson, Melvin N.
Objective This study focused on whether a brief family-based intervention for toddlers, the Family Check-Up (FCU), designed to address parent management skills and prevent early conduct problems, would have collateral effects on maternal depressive symptoms and subsequent child emotional problems. Method Parents with toddlers were recruited from the Women, Infants, and Children Nutritional Supplement Program based on the presence of socioeconomic, family, and child risk (N= 731). Families were randomly assigned to the FCU intervention or control group with yearly assessments beginning at child age 2. Maternal depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale at child ages 2 and 3. Child internalizing problems were collected from primary caregivers, alternative caregivers, and teachers using the Child Behavior Checklist at ages 7.5 and 8.5. Results Structural equation models revealed that mothers in families randomly assigned to the FCU showed lower levels of depressive symptoms at child age 3, which in turn were related to lower levels of child depressed/withdrawal symptoms as reported by primary caregivers, alternative caregivers, and teacher at ages 7.5–8.5. Conclusions Findings suggest that a brief, preventive intervention improving maternal depressive symptoms can have enduring effects on child emotional problems that are generalizable across contexts. As there is a growing emphasis for the use of evidence-based and cost-efficient interventions that can be delivered in multiple delivery settings serving low-income families and their children, clinicians and researchers welcome evidence that interventions can promote change in multiple problem areas. The FCU appears to hold such promise. PMID:26302250
Bero Lisa A
Full Text Available Abstract Background We sought to identify factors that affect the passage of public health legislation by examining the use of arguments, particularly arguments presenting research evidence, in legislative debates regarding workplace smoking restrictions. Methods We conducted a case-study based content analysis of legislative materials used in the development of six state workplace smoking laws, including written and spoken testimony and the text of proposed and passed bills and amendments. We coded testimony given before legislators for arguments used, and identified the institutional affiliations of presenters and their position on the legislation. We compared patterns in the arguments made in testimony to the relative strength of each state's final legislation. Results Greater discussion of scientific evidence within testimony given was associated with the passage of workplace smoking legislation that provided greater protection for public health, regardless of whether supporters outnumbered opponents or vice versa. Conclusion Our findings suggest that an emphasis on scientific discourse, relative to other arguments made in legislative testimony, might help produce political outcomes that favor public health.
Canevari, Giulia; Re Depaolini, Stefania; Cucchi, Ulisse; Bertrand, Jay A; Casale, Elena; Perrera, Claudia; Forte, Barbara; Carpinelli, Patrizia; Felder, Eduard R
Maternal embryonic leucine zipper kinase (MELK) is upregulated in several types of tumor, including breast, prostate, and brain tumors. Its expression is generally associated with cell survival, cell proliferation, and resistance to apoptosis. Therefore, the potential of MELK inhibitors as therapeutic agents is recently attracting considerable interest. Here we report the first structures of MELK in complex with AMP-PNP and with nanomolar inhibitors. Our studies shed light on the role of the MELK UBA domain, provide a characterization of the kinase active site, and identify key residues for achieving high potency, laying the groundwork for structure-based drug design efforts.
Soraya da Rocha BRITTO
Full Text Available ABSTRACT Objective: This study examined food product advertisements directed to children and aired on closed television channels in Brazil, according to the types of foods and beverages advertised and the advertising content. Methods: A descriptive study was conducted on the adequacy of food commercials directed to children and aired by six pay-television broadcasters according to two parameters: "The Food Guide for the Brazilian Population, 2014", and the National Council on Children's and Adolescents' Rights Resolution nº 163 of 2014 about food advertising. The advertisements were recorded in July 2015, at different times and days of the week. Results: One hundred and sixty-two hours were recorded, registering 3,468 commercials: 1,850 were related to internal programming and 1,618 advertised toys (22.15%, food and beverages (5.61%, applications for electronic devices (5.58%, and entertainment/events (5.56%. The Fisher exact test showed fewer number of food commercials compared to other types of commercials (p<0.001. The main food items advertised by all television stations were ultraprocessed foods and no advertisements of fresh food were observed (p<0.001. Most of the food commercials (64.30% used children's language and characters; 43.00% used songs in children's voices, and 21.40% linked gift distribution to food. Conclusion: The number of food commercials observed was lower than in previous national studies. However, the advertisements did not follow current legislation, indicating the abuse of marketing communication to children. More effective public policies and the respect and enforcement of legislation on child advertising could protect children from high consumption of ultraprocessed foods.
Waldenström, Ulla; Ekéus, Cecilia
Obstetric anal sphincter injury (OASI) is a rare but serious outcome of vaginal birth. Based on concerns about the increasing number of women who commence childbearing later than previous generation, this study aimed at investigating age-related risk of OASI in women of different parity. A population-based register study including 959,559 live singleton vaginal births recorded in the Swedish Medical Birth Register 1999 to 2011. In each parity group risks of OASI at age 25-29 years, 30-34 years, and ≥35 years compared with age birth, education, region of birth, smoking, Body Mass Index, infant birthweight and fetal presentation; and in parous women, history of OASI and cesarean section. Additional analyses also adjusted for mediating factors, such as epidural analgesia, episiotomy, and instrumental delivery, and maternal age-related morbidity. Rates of OASI were 6.6%, 2.3% and 0.9% in first, second and third births respectively. Age-related risk increased from 25-29 years in first births (Adjusted OR 1.66; 95% CI 1.59-1.72) and second births (Adjusted OR 1.78; 95% CI 1.58-2.01), and from 30-34 years in third births (Adjusted OR 1.60; 95% CI 1.00-2.56). In all parity groups the risk was doubled at age ≥ 35 years, compared with the respective reference group of women under 25 years. Adding mediating factors and maternal age-related morbidity only marginally reduced these risk estimates. Maternal age is an independent risk factor for OASI in first, second and third births. Although age-related risks by parity are relatively similar, more nulliparous than parous women will be exposed to OASI due to the higher baseline rate.
Sørensen, Holger J; Nielsen, Philip R; Pedersen, Carsten B
Recent findings suggest that maternal iron deficiency may increase the risk of schizophrenia-spectrum disorder in offspring. We initiated this study to determine whether maternal prepartum anemia influences offspring risk of schizophrenia. We conducted a population-based study with individual...... a 1.60-fold (95% confidence interval = 1.16-2.15) increased risk of schizophrenia. Although the underlying mechanisms are unknown and independent replication is needed, our findings suggest that maternal iron deficiency increases offspring risk of schizophrenia....... record linkage of the Danish Civil Registration System, the Danish Psychiatric Central Register, and the Danish National Hospital Register. In a cohort of 1 115 752 Danish singleton births from 1978 to 1998, cohort members were considered as having a maternal history of anemia if the mother had received...
Becher, Michael; Christiansen, Flemming Juul
Chief executives in many parliamentary democracies have the power to dissolve the legislature. Despite a well-developed literature on the endogenous timing of parliamentary elections, political scientists know remarkably little about the strategic use of dissolution power to influence policymaking....... To address this gap, we propose and empirically evaluate a theoretical model of legislative bargaining in the shadow of executive dissolution power. The model implies that the chief executive's public support and legislative strength, as well as the time until the next constitutionally mandated election...
This paper reviews Slovenian national legislation in the field of third party liability for nuclear damage, applicability of the international nuclear liability treaties in Slovenia legal system and outlines some main provisions of national legislation. It is worth mentioning that legal instruments covering third party liability and compulsory insurance of such liability exist in Slovenia for almost 20 years and that our nuclear facilities are covered by relevant international treaties and conventions in this field, among them also by the Vienna Convention on Civil Liability for Nuclear Damage (from 1977) and the Joint Protocol Relating to the Application of the Vienna Convention and the Paris Convention (from 1994). (author)
Legislative Districts, This Layer was drawn by the U.S. District Court based on Census 2000 TIGER/Line files to delineate voter districts for the U.S. Congress., Published in 2005, 1:100000 (1in=8333ft) scale, Atlanta Regional Commission.
NSGIC Regional | GIS Inventory — Legislative Districts dataset current as of 2005. This Layer was drawn by the U.S. District Court based on Census 2000 TIGER/Line files to delineate voter districts...
... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Legislation. 1508.17 Section 1508.17 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY TERMINOLOGY AND INDEX § 1508.17 Legislation. Legislation includes a bill or legislative proposal to Congress developed by or with the significant...
Vargas P, Elkin; Gonzalez S, Carmen Lucia
The document analyses the Colombian mining legislation, Act 685 of 2001, based on the reasons expressed by the government and the miners for its conceit and approval. The document tries to determine the developments achieved by this new Mining Code considering international mining competitiveness and its adaptation to the constitutional rules about environment, indigenous communities, decentralization and sustainable development. The analysis formulates general and specific hypothesis about the proposed objectives of the reform, which are confronted with the arguments and critical evaluations of the results. Most hypothesis are not verified, thus demonstrating that the Colombian mining legislation is far from being the necessary instrument to promote mining activities, making it competitive according to international standards and adapted to the principles of sustainable development, healthy environment, community participation, ethnic minorities and regional autonomy
MacKinnon, Karen; Marcellus, Lenora; Rivers, Julie; Gordon, Carol; Ryan, Maureen; Butcher, Diane
The overall aim of this systematic review is to identify the appropriateness and meaningfulness of maternal-child simulation-based learning for undergraduate or pre-registration nursing students in educational settings to inform curriculum decision-making.1. What are the experiences of nursing or health professional students participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings?2. What are the experiences of educators participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings?3. What teaching and learning practices in maternal-child simulation-based learning are considered appropriate and meaningful by students and educators? Maternal-child care is one of the pillars of primary health care. Health promotion and illness/ injury prevention begin in the preconception period and continue through pregnancy, birth, the postpartum period and the childrearing years. Thus, lifelong wellness is promoted across the continuum of perinatal and pediatric care which influences family health and early child development. Registered nurses (RNs) are expected to have the knowledge and skills needed to provide evidence-based nursing with childbearing and child-rearing families to promote health and address health inequities in many settings, including inner city, rural, northern, indigenous and global communities. The Canadian Maternity Experiences survey and the Report by the Advisor on Healthy Children and Youth provide information on current shortages of perinatal and child health care providers and stress the importance of the role of nurses as providers of rural and remote care. From a global health perspective, continued concern with both perinatal and child health morbidities and mortalities highlight the importance of maintaining and strengthening the presence of maternal and child health learning opportunities within undergraduate nursing curriculum.Despite this
Contemporary reporting of maternal mortality is focused on single, mutually exclusive causes of death among a minority of maternal decedents (pregnancy-related deaths), reflecting initial events leading to death. Although obstetric patients are susceptible to the lethal effects of downstream, more proximate contributors to death and to conditions not caused or precipitated by pregnancy, the burden of both categories and related patients' attributes is invisible to clinicians and healthcare policy makers with the current reporting system. Thus, the population-level demographics, clinical characteristics, and resource utilization associated with pregnancy-associated deaths in the United States have not been adequately characterized. We used the Texas Inpatient Public Use Data File to perform a population-based cohort study of the patterns of demographics, chronic comorbidity, occurrence of early maternal demise, potential contributors to maternal death, and resource utilization among maternal decedents in the state during 2001 - 2010. There were 557 maternal decedents during study period. Chronic comorbidity was reported in 45.2%. Most women (74.1%) were admitted to an ICU. Hemorrhage (27.8%), sepsis (23.5%), and cardiovascular conditions (22.6%) were the most commonly reported potential contributing conditions to maternal death, varying across categories of pregnancy-associated hospitalizations. More than one condition was reported in 39% of decedents. One in three women died during their first day of hospitalization, with no significant change over the past decade. The mean hospital length of stay was 7.9 days and total hospital charges were $250,000 or higher in 65 (11.7%) women. The findings of the high burden of chronic illness, patterns of occurrence of a broad array of potential contributing conditions to pregnancy-associated death, and the resource-intensive needs of a large contemporary population-based cohort of maternal decedents may better inform
Jessica E Miller
Full Text Available OBJECTIVE: In a large population-based cohort in Denmark to examine if maternal use of antibiotics during pregnancy, as a marker of infection, increases the risk of febrile seizures in childhood in a large population-based cohort in Denmark. METHODS: All live-born singletons born in Denmark between January 1, 1996 and September 25, 2004 and who were alive on the 90(th day of life were identified from the Danish National Birth Registry. Diagnoses of febrile seizures were obtained from the Danish National Hospital Register and maternal use of antibiotics was obtained from the National Register of Medicinal Product Statistics. Hazard ratios (HR and 95% confidence intervals (95% CI were estimated by Cox proportional hazard regression models. RESULTS: We followed 551,518 singletons for up to 5 years and identified a total of 21,779 children with a diagnosis of febrile seizures. Slightly increased hazard ratios were observed among most exposure groups when compared to the unexposed group, ex. HR 1.08 95% CI: 1.05-1.11 for use of any systemic antibiotic during pregnancy. CONCLUSION: We found weak associations between the use of pharmacologically different antibiotics during pregnancy and febrile seizures in early childhood which may indicate that some infections, or causes or effects of infections, during pregnancy could affect the fetal brain and induce susceptibility to febrile seizures.
Leite, Mimmi; Albieri, Vanna; Kjaer, Susanne K; Jensen, Allan
To examine the association between maternal smoking during pregnancy and risk for congenital malformations. Population-based prospective cohort study. Denmark. A total of 838 265 singleton liveborn babies delivered in Denmark between 1997 and 2010 and registered in the Danish Medical Birth Register containing detailed information on smoking during pregnancy and congenital malformations. Associations [odds ratios (OR) with 95% CI] between maternal smoking and risk for various groups of congenital malformations, investigated using the generalized estimating equation for binary outcomes, with adjustment for potential confounders. Groups of congenital malformations. Ever smoking during pregnancy did not increase the overall risk for congenital malformations, but increased risks were observed for multiple malformations (i.e. when two or more malformations are diagnosed in a child) (odds ratio 1.06, 95% confidence interval 1.01-1.10) and various main groups of congenital malformations including the cardiovascular system (odds ratio 1.13, 95% confidence interval 1.07-1.19), the respiratory system (odds ratio 1.25, 95% confidence interval 1.11-1.41), the digestive system (odds ratio 1.15, 95% confidence interval 1.07-1.24) and oral clefts (odds ratio 1.29, 95% confidence interval 1.14-1.46), as well as for some specific congenital malformations including cardiac septal defects, malformations of the pulmonary and tricuspid valves, malformations of the great arteries, pyloric stenosis and clubfoot. Infants of women who quit smoking during the first two trimesters had no increased risk for most groups of congenital malformations. Maternal smoking increases the risk for a number of congenital malformations. Future smoking cessation programs should focus on this adverse health aspect in order to encourage more women to quit smoking before or in early pregnancy. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.
Full Text Available Objective. To evaluate confidence, knowledge, and competence after a simulation-based curriculum on maternal cardiac arrest in an Obstetrics & Gynecologic (OBGYN residency program. Methods. Four simulations with structured debriefing focusing on high yield causes and management of maternal cardiac arrest were executed. Pre- and post-individual knowledge tests (KT and confidence surveys (CS were collected along with group scores of critical performance steps evaluated by content experts for the first and final simulations. Results. Significant differences were noted in individual KT scores (pre: 58.9±8.9 versus post: 72.8±6.1, p=0.01 and CS total scores (pre: 22.2±6.4 versus post: 29.9±3.4, p=0.007. Significant differences were noted in airway management, p=0.008; appropriate cycles of drug/shock-CPR, p=0.008; left uterine displacement, p=0.008; and identifying causes of cardiac arrest, p=0.008. Nonsignificant differences were noted for administration of appropriate drugs/doses, p=0.074; chest compressions, p=0.074; bag-mask ventilation before intubation, p=0.074; and return of spontaneous circulation identification, p=0.074. Groups remained noncompetent in team leader tasks and considering therapeutic hypothermia. Conclusion. This study demonstrated improved OBGYN resident knowledge, confidence, and competence in the management of third trimester maternal cardiac arrest. Several skills, however, will likely require more longitudinal curricular exposure and training to develop and maintain proficiency.
Paula, Carlos Eduardo Artiaga; Silva, Ana Paula da; Bittar, Cléria Maria Lôbo
Minorities are in an inferior position in society and therefore vulnerable in many aspects. This study analyzes legislative vulnerability and aims to categorize as "weak" or "strong" the protection conferred by law to the following minorities: elderly, disabled, LGBT, Indians, women, children/ adolescents and black people. In order to do so, it was developed a documental research in 30 federal laws in which legal provisions were searched to protect minorities. Next, the articles were organized in the following categories: civil, criminal, administrative, labor and procedural, to be analyzed afterwards. Legal protection was considered "strong" when there were legal provisions that observed the five categories and "weak" when it did not meet this criterion. It was noted that six groups have "strong" legislative protection, which elides the assertion that minorities are outside the law. The exception is the LGBT group, whose legislative protection is weak. In addition, consecrating rights through laws strengthens the institutional channels for minorities to demand their rights. Finally, it was observed that the legislative protection granted tominorities is not homogeneous but rather discriminatory, and there is an interference by the majority group in the rights regulation of vulnerable groups.
Higher Education in the States, 1971
Because of the radical variance in residency requirements from state to state and sometimes from institution to institution, and because of several court cases involving this issue, the Education Commission of the States appointed a Committee to develop (1) a statement of principles for consideration in drafting legislation in connection with…
Borcherdt, Roger D.; Brown, Robert B.; Page, Robert A.; Wentworth, Carl M.; Hendley, James W.
When a powerful earthquake strikes an urban region, damage concentrates not only near the quake's source. Damage can also occur many miles from the source in areas of soft ground. In recent years, scientists have developed ways to identify and map these areas of high seismic hazard. This advance has spurred pioneering legislation to reduce earthquake losses in areas of greatest hazard.
In this brief article, John Wertman describes the evolution of the Every Student Succeeds Act (ESSA) of 2015, the role the American Association of Geographers (AAG) played over the last decade in getting it passed, and the impact the Act has on funding for K-12 geography education. The legislation, while not perfect, includes promising new…
Franco, G; Mora, Erika
Ethical behaviour consists ofindividual choices inspired by knowledge and professional experience derived from the universally acknowledged ethical principles of beneficience/nonmaleficience, autonomy and justice. However, in spite of the unanimous consent on their universal importance, such principles do not usually have the strength of a law. The recently introduced Italian law on the protection of workers' health represents a novelty because it gives the Ethics Code of the International Commission on Occupational Health legal strength. This paper aims at examining article 25 of legislative decree 81/2008 by comparing the points of the Ethics Code and the Deontology Code of the Italian medical profession. The relationships between the 12 points of paragraph 1 of article 25, the 26 points ofthe Code ofEthics and the 75 articles of the Deontology Code are described with regard to the occupational health physician's duties (i) of collaboration with other occupational health professionals, (ii) of organization and execution of health surveillance, (iii) of recording, securing, transmitting of medical files on workers' health and (iv) of employee and employer information on the importance and meaning of health surveillance.
Puhakka, Laura; Renko, Marjo; Helminen, Merja; Peltola, Ville; Heiskanen-Kosma, Tarja; Lappalainen, Maija; Surcel, Heljä-Marja; Lönnqvist, Tuula; Saxen, Harri
Both primary and non-primary maternal cytomegalovirus (CMV) infection during pregnancy can lead to vertical transmission. We evaluated the proportion of maternal primary/non-primary infections among 26 babies with symptomatic congenital CMV infection born in Finland from 2000 to 2012. We executed a database search on hospital records from all five university hospitals in Finland to identify infants with congenital CMV infection. The preserved maternal serum samples drawn at the end of the first trimester were analysed for CMV antibodies. Maternal infection was classified to be non-primary, if there was high avidity CMV immunoglobulin G (IgG) in the early pregnancy samples. Infection was considered primary in the case of either low avidity IgG (primary infection in the first trimester or near conception) or absent CMV IgG at the end of the first trimester (primary infection in the second or third trimester). The majority of the symptomatic congenital CMV infections (54%) were due to maternal non-primary infection, 27% due to maternal primary infection in the first trimester or near conception, and 19% during the second or third trimester. Long-term sequelae occurred in 59% of patients: in 6/7 after primary infection in the first trimester, in 0/5 after primary infection in the second or third trimester, and in 9/14 after non-primary infection. In this register-based cohort, non-primary infections caused the majority of symptomatic congenital CMV infections, and resulted in significant morbidity.
Fore, C.S.; Heiskell, M.M.
The transportation of radioactive materials, as well as hazardous materials in general, has been an issue of ever-increasing concern and an object of numerous regulations and legislative actions worldwide. The Transportation Technology Center of the US Department of Energy's Sandia Laboratories in Albuquerque, New Mexico, is currently involved in developing a national program to assure the safe shipment of radioactive materials. At Oak Ridge National Laboratory (ORNL), Oak Ridge, Tennessee, this overall effort is being supported in a specialized manner. As part of the Logistics Modeling program at ORNL, the Ecological Sciences Information Center has developed comprehensive data bases containing legislative and regulatory actions relevant to the transportation of hazardous materials. The data bases are separated according to status level of the legislation. The Current Legislation Data Base includes all new legislative actions introduced during the present year (1980) or those bills carried over from the previous year's sessions. The second data file, Historical Legislation Data Base, consists of all legislative actions since 1976 that have passed and become public laws, as well as those actions that were unsuccessful and were classified as denied by law. Currently the data bases include state-, local-, and federal, level legislation, with emphasis on the transportation of radioactive materials. Because of their relevance to the transportation issues, actions involving related subject areas such as, disposal and storage of radioactive wastes, moratoriums on power plant construction, and remedial actions studies, special agencies to regulate shipment of radioactive materials, and requirements of advanced notification, permits and escorts are also included in the data bases
Full Text Available The link between socioeconomics and conservation and the role of legislation in conservation work was discussed in the group with participants from nine European countries. Interest and knowledge among the general public, stakeholders and managers is the key to successful conservation of native crayfish species. Exploitation and conservation do not necessarily exclude each other. A controlled fishery, where it can be sustained, may be an essential tool for conservation by increasing the general awareness and involving more people in the task of protecting the native crayfish species. This strategy is mainly possible for the noble crayfish in the northern part of its distribution, where strong traditions connected to crayfish also exist. A balance between utilisation and overexploitation has to be found and local guidelines for sustainable exploitation produced. Media, the Internet and educational material aimed at schools and stakeholders are excellent ways of reaching a wide audience with information. Universal objectives, rules and regulations at the European level are desirable and the noble crayfish and the stone crayfish should be included in Annex II of the Habitat Directive. Based on this framework detailed regulations are best worked out at the national level, considering the specific crayfish situation in the country. Information about the legislation, the purpose of the legislation and the consequences when not obeying it should be distributed. Stricter regulation of the trade with live alien crayfish is vital because of the associated risk of introducing new diseases and species.
Guzmán-Bárcenas, José; Hernández, José Alfredo; Arias-Martínez, Joel; Baptista-González, Héctor; Ceballos-Reyes, Guillermo; Irles, Claudine
Leptin and insulin levels are key factors regulating fetal and neonatal energy homeostasis, development and growth. Both biomarkers are used as predictors of weight gain and obesity during infancy. There are currently no prediction algorithms for cord blood (UCB) hormone levels using Artificial Neural Networks (ANN) that have been directly trained with anthropometric maternal and neonatal data, from neonates exposed to distinct metabolic environments during pregnancy (obese with or without gestational diabetes mellitus or lean women). The aims were: 1) to develop ANN models that simulate leptin and insulin concentrations in UCB based on maternal and neonatal data (ANN perinatal model) or from only maternal data during early gestation (ANN prenatal model); 2) To evaluate the biological relevance of each parameter (maternal and neonatal anthropometric variables). We collected maternal and neonatal anthropometric data (n = 49) in normoglycemic healthy lean, obese or obese with gestational diabetes mellitus women, as well as determined UCB leptin and insulin concentrations by ELISA. The ANN perinatal model consisted of an input layer of 12 variables (maternal and neonatal anthropometric and biochemical data from early gestation and at term) while the ANN prenatal model used only 6 variables (maternal anthropometric from early gestation) in the input layer. For both networks, the output layer contained 1 variable to UCB leptin or to UCB insulin concentration. The best architectures for the ANN perinatal models estimating leptin and insulin were 12-5-1 while for the ANN prenatal models, 6-5-1 and 6-4-1 were found for leptin and insulin, respectively. ANN models presented an excellent agreement between experimental and simulated values. Interestingly, the use of only prenatal maternal anthropometric data was sufficient to estimate UCB leptin and insulin values. Maternal BMI, weight and age as well as neonatal birth were the most influential parameters for leptin while
Williams-Crowe, S M; Aultman, T V
A new era of health care reform places increasing pressure on public health leaders and agencies to participate in the public policy arena. Public health professionals have long been comfortable in providing the scientific knowledge base required in policy development. What has been more recent in its evolution, however, is recognition that they must also play an active role in leading and shaping the debate over policy. A profile of effective State legislative policy "entrepreneurs" and their strategies has been developed to assist health agencies in developing such a leadership position. Based on the experiences of State legislative liaison officers, specific strategies for dealing with State legislatures have been identified and are organized into five key areas--agency organization, staff skills, communications, negotiation, and active ongoing involvement. A public health agency must be organized effectively to participate in the legislative policy process. Typically, effective agencies centralize responsibility for policy activities and promote broad and coordinated participation throughout the organization. Playing a key role in the agency's political interventions, the legislative liaison office should be staffed with persons possessing excellent interpersonal skills and a high degree of technical competence. Of central importance to effective legislative policy entrepreneurship is the ability to communicate the agency's position clearly. This includes setting forward a focused policy agenda, documenting policy issues in a meaningful manner, and reaching legislators with the proper information. Once a matter is on the legislative agenda, the agency must be prepared to negotiate and build broad support for the measure. Finally, public health agencies must be active policy players. To take advantage of new opportunities for action, the public health (policy) leader must monitor the political environment continually.By working to anticipate and formulate
Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group.
Alkema, Leontine; Chou, Doris; Hogan, Daniel; Zhang, Sanqian; Moller, Ann-Beth; Gemmill, Alison; Fat, Doris Ma; Boerma, Ties; Temmerman, Marleen; Mathers, Colin; Say, Lale
Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030. We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources. We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%. Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country
Full Text Available Background. Maternal obesity and excessive gestational weight gain (GWG are on the rise with negative impact on pregnancy and birth outcomes. Research into managing GWG using accessible technology is limited. The maternal obesity management using mobile technology (MOMTech study aimed at evaluating the feasibility of text messaging based complex intervention designed to support obese women (BMI ≥ 30 with healthier lifestyles and limit GWG. Methods. Participants received two daily text messages, supported by four appointments with healthy lifestyle midwife, diet and activity goal setting, and self-monitoring diaries. The comparison group were obese mothers who declined to participate but consented for their routinely collected data to be used for comparison. Postnatal interviews and focus groups with participants and the comparison group explored the intervention’s acceptability and suggested improvements. Results. Fourteen women completed the study which did not allow statistical analyses. However, participants had lower mean GWG than the comparison group (6.65 kg versus 9.74 kg and few (28% versus 50% exceeded the Institute of Medicine’s upper limit of 9 kg GWG for obese women. Conclusions. MOMTech was feasible within clinical setting and acceptable intervention to support women to limit GWG. Before further trials, slight modifications are planned to recruitment, text messages, and the logistics of consultation visits.
Liu, Baohong; Tang, Xiaoyan; Qiu, Feng; Tao, Chunmei; Gao, Junhui; Ma, Mengmeng; Zhong, Tingyan; Cai, JianPing; Li, Yixue; Ding, Guohui
Background. With the development of massively parallel sequencing (MPS), noninvasive prenatal diagnosis using maternal cell-free DNA is fast becoming the preferred method of fetal chromosomal abnormality detection, due to its inherent high accuracy and low risk. Typically, MPS data is parsed to calculate a risk score, which is used to predict whether a fetal chromosome is normal or not. Although there are several highly sensitive and specific MPS data-parsing algorithms, there are currently no tools that implement these methods. Results. We developed an R package, detection of autosomal abnormalities for fetus (DASAF), that implements the three most popular trisomy detection methods-the standard Z-score (STDZ) method, the GC correction Z-score (GCCZ) method, and the internal reference Z-score (IRZ) method-together with one subchromosome abnormality identification method (SCAZ). Conclusions. With the cost of DNA sequencing declining and with advances in personalized medicine, the demand for noninvasive prenatal testing will undoubtedly increase, which will in turn trigger an increase in the tools available for subsequent analysis. DASAF is a user-friendly tool, implemented in R, that supports identification of whole-chromosome as well as subchromosome abnormalities, based on maternal cell-free DNA sequencing data after genome mapping.
Elisabeth S. Lindholm
Full Text Available Objective. To assess whether antenatal health care consumption is associated with maternal body mass index (BMI. Design. A register based observational study. Methods. The Swedish Medical Birth Register, the Maternal Health Care Register, and the Inpatient Register were used to determine antenatal health care consumption according to BMI categories for primiparous women with singleton pregnancies, from 2006 to 2008, n=71,638. Pairwise comparisons among BMI groups are obtained post hoc by Tukey HSD test. Result. Obese women were more often admitted for in-patient care (p<0.001, had longer antenatal hospital stays (p<0.001, and were more often sick-listed by an obstetrician (p<0.001 during their pregnancy, compared to women with normal weight women. Preeclampsia was more than four times as common, hypertension five times as common, and gestational diabetes 11 times as common when comparing in-patient care, obese to normal weight women (p<0.001 for all comparisons. Underweight mothers had longer stay in hospitals (p<0.05 and hydronephrosis and hyperemesis gravidarum were more than twice as common (both p<0.001. Conclusion. Obese and underweight mothers consumed significantly more health care resources and obese women were significantly more often sick-listed during their pregnancy when compared to pregnant women of normal weight.
Full Text Available The purpose of this case study is to first examine the implications of accountability legislation on the financial and performance reporting of a public sector agency in the Canadian province of Newfoundland and Labrador and secondly, to compare the level of accountability with Stewart’s (1984 ladder of accountability. This paper is based on the first phase of a two-phase study. The first phase focuses on the initial impacts of accountability legislation on agencies and the challenges created by the legislation’s ‘one size fits all’ approach. The second phase of this study will examine the impact of the legislation on stakeholders after it has been in operation for five years. The second phase will include interviews with stakeholders to ascertain the level of satisfaction with the new legislation. The first phase of the study is significant since it highlights how governments could consider stakeholder needs when drafting such legislation. This research contributes to the body of literature on stakeholder accountability since there is a paucity of research focused specifically on the impact of accountability legislation on public sector agencies. An important contribution of this paper is the introduction of a framework for legislated accountability reporting. The main theoretical frameworks used to analyse the findings are Stewart’s (1984 ladder of accountability in conjunction with Friedman and Miles (2006 ladder of stakeholder management and engagement.
Full Text Available To examine the association between maternal depression and anxiety disorders (MDAD and child development assessed during the kindergarten year.Administrative data from several health and social databases in Manitoba, Canada, were used to study 18,331 mother-child pairs. MDAD over the period from one year prior to the child's birth to the kindergarten year was defined using physician diagnoses and filled prescriptions. Child development was assessed during the kindergarten year using the Early Development Instrument (EDI which measures vulnerability across five domains of development. Structural equation modeling was used to examine associations between timing, recurrence and severity of MDAD and child outcomes. Health at Birth (preterm, low birth weight, neonatal intensive care stay and long birth hospitalization, Family Context (teen mother, lone parent, socio-economic status (SES, child age and child sex were covariates.MDAD had a modest negative association with child EDI scores across all models tested, particularly for social, emotional and physical development. Prenatal MDAD had a stronger negative association with outcomes than other time periods; however, recurrent MDAD had a stronger negative association with outcomes than any specific time period or MDAD severity. The influence of MDAD was mediated by Family Context, which had a strong, negative association with outcomes, particularly language and cognitive development.The number of time periods a child was exposed to MDAD in early childhood was more negatively associated with five areas of child development than timing or severity. Prenatal exposure may be more sensitive to MDAD than other time periods. The familial context (teen mother, lone parenthood and low SES had a stronger influence on child outcomes than MDAD. Findings can be used to inform interventions which address maternal mental health from the prenatal period onward, and to support disadvantaged families to encourage
Pakrashi, Sunandan; Tan, Cheng; Wang, Wen-Xiong
In the present study, we tested whether bioaccumulation in specific tissues of Daphnia magna could explain silver nanoparticle (AgNP) toxicity. Daphnids were exposed to different concentrations of well-suspended AgNPs and AgNO 3 . The accumulations of Ag in the whole body, gut, and nongut tissues, as well as the mortality of daphnids, were recorded over a period of 7 d. Regression analysis showed a higher degree of positive correlation between the concentration of Ag in the nongut tissues than gut tissues and the mortality of daphnids. The results strongly suggested that the toxicity of AgNPs could be better explained in terms of bioaccumulation of AgNPs in the nongut tissues. We further tested the maternal transfer of AgNPs in daphnids into the next generation using radioactive tracers, which were able to detect as low as 1.0 to 3.2% of total accumulated Ag transferred to the neonates. The AgNPs significantly affected the reproduction process during the first 2 broods after exposure, whereas AgNO 3 only had significant effects on the first brood. It is possible that AgNPs have longer adverse effects than AgNO 3 on the reproduction of Daphnia. The present study identified the sensitive site of AgNP toxic action in daphnids and documented the extent of maternal transfer and the significant influence of AgNPs on the reproduction of daphnids. Environ Toxicol Chem 2017;36:3359-3366. © 2017 SETAC. © 2017 SETAC.
Las relaciones trilaterales entre la legislación sobre la violencia de género, la pornografía y el cine español / Trilateral Relations: Gender-Based Violence Legislation, Pornography and Spanish Cinema
Full Text Available En teoría, España tiene las leyes más progresistas de Europa en cuanto a la violencia de género. Dicha legislación reconoce a los medios de comunicación como parte del problema y de la posible solución, adoptando una perspectiva que, curiosamente en una cultura que nunca ha aplicado de una manera seria y sistemática la teoría feminista a los productos audiovisuales, se basa en los mismos fundamentos que las teorías feministas internacionales que abogan por la censura de ciertas imágenes misóginas y / o pornográficas. En este artículo, compagino un análisis de estas sinergias entre el cine español y la legislación vigente con una exploración de lo que en el caso español podría aportar a debates y prácticas en el ámbito internacional.Palabras clave: violencia de género, legislación audiovisual, censura, feminismo, pornografía, sociología española, masculinidades, Luis Tosar, María Valverde, Rae Langton.AbstractIn theory, Spain has the most progressive laws on domestic violence in Europe. This legislation recognises the media as being part of the problem and of the possible solution. In a development that it is somewhat counter-intuitive for a culture that has never taken the application of feminist theory to audiovisual analysis particularly seriously, the legislation is predicated on the same logic as the work of some international feminist theorists who call for the censoring of specific misogynist and / or pornographic images. In this article, I will analyse the synergies between Spanish cinema and the current legislation, with an exploration of what the Spanish case could contribute to debates and practices in the international arena.Keywords: gender-based violence, audiovisual legislation, censorship, feminism, pornography, Spanish sociology, masculinities, Luis Tosar, María Valverde, Rae Langton.
Full Text Available Objective. To evaluate the effectiveness of a community-based intervention project aimed at reducing maternal and infant mortality in a poor urban district in the city of Natal, in the Northeast of Brazil. Methods. The intervention, called the ProNatal project, introduced a program of integrated community health care to a geographically defined population. The interventions included the establishment of antenatal clinics at the district's health centers, the opening of the maternity facilities at the polyclinic for low-risk deliveries, the introduction of a family planning clinic and a breast-feeding clinic, support from pediatricians for under-5 (well-baby clinics, children's outpatient services and children's emergency care, and the introduction of health agents recruited from the local community. Representative surveys of the population were taken at the project's inception (July 1995 and then 30 months later (December 1997, using a general health questionnaire adapted to the local conditions. Mortality data were collected from local registration systems as well as from an autopsy survey of perinatal and infant deaths. Results. During 1995 there were 4 maternal deaths from 1 195 pregnancies (maternal mortality of 335/100 000; three of the deaths were related to hypertension and one to uterine perforation after an illegal abortion. During 1998 (post-intervention, there were no maternal deaths in pregnancy or childbirth. In 1993 no deliveries took place at the polyclinic, but in 1998 there were 946 deliveries at the clinic without any serious complications. The method of delivery, the incidence of prematurity, and the incidence of low birthweight did not change significantly over the study period. In the post-intervention survey, 75% of women reported receiving contraceptive advice from a doctor in the preceding year, compared to 50% in the first sample. A mortality survey carried out in 1993-1995 estimated the infant mortality rate to be 60
In Malawi the maternal mortality ratio is extremely high. Since almost all maternal deaths are avoidable, maternal mortality is also an issue of human rights. This paper examines the root causes of high maternal mortality in Malawi and applies a human rights-based approach to the reduction of maternal mortality.
Cain, Louis P.; Kaiser, Brooks
Tsurikov, N.; Koperski, J.
Processing of minerals often increases concentrations of naturally occurring radioactive materials (NORM) in mineral concentrates, products and waste streams. This so-called TENORM (Technologically Enhanced Naturally Occurring Radioactive Materials) phenomenon can result in usually very small increases of radiation exposures to workers and the public. However, proposed international radiation protection standards are likely to bring the TENORM issue into the realm of regulatory concern. Verbatim adoption by the national legislation's of the radiation protection standards like those proposed in the IAEA's 1996 Basic Safety Standards (BSS) would present enormous practical problems. Many industries and industrial practices would, for the first time, become subjected to the provisions of radiation protection legislation. Consequently, registration, licensing, occupational and environmental monitoring, statutory reporting, appointment of appropriately qualified staff, new approaches to the management of minerals and waste labeled as 'radioactive', etc. would be required. This would be mirrored by corresponding demands on the regulatory authorities, needing to provide an increased radiation protection regulatory control. In response to new Australian and other national radiation protection legislation that have incorporated the BSS criteria, this paper illustrates their impact on a number of industries that historically have not been considered as dealing with radioactive materials. The paper also proposes a number of initiatives that could be considered. Nationally, those initiatives should aim at adopting radiation protection legislation that is commensurate with the nature of the minerals industry operations, national circumstances, conditions and interests without compromising rational radiation protection practices. Otherwise, non-judicious application of the BSS would result in major diversions of resources from well recognized occupational health and safety issues
Legislators from the world's largest carbon dioxide (CO2) emitting countries met on 14-15 February in Washington, D.C., to discuss the future of the global climate and strategies to mitigate temperature increases resulting from global warming. The world faces a ``double challenge-how to reduce damaging carbon emissions while still meeting the energy demand that the world's poor need to escape poverty,'' said World Bank President Paul Wolfowitz during a keynote talk.
Byrne, Jean; Hauck, Yvonne; Fisher, Colleen; Bayes, Sara; Schutze, Robert
This pilot study tested the feasibility and effectiveness of using Mindfulness-Based Childbirth Education (MBCE), a novel integration of mindfulness meditation and skills-based childbirth education, for mental health promotion with pregnant women. The MBCE protocol aimed to reduce fear of birth, anxiety, and stress and improve maternal self-efficacy. This pilot study also aimed to determine the acceptability and feasibility of the MBCE protocol. A single-arm pilot study of the MBCE intervention using a repeated-measures design was used to analyze data before and after the MBCE intervention to determine change trends with key outcome variables: mindfulness; depression, anxiety, and stress; childbirth self-efficacy; and fear of childbirth. Pregnant women (18-28 weeks' gestation) and their support companions attended weekly MBCE group sessions over 8 weeks in an Australian community setting. Of the 18 women who began and completed the intervention, missing data allowed for complete data from 12 participants to be analyzed. Statistically significant improvements and large effect sizes were observed for childbirth self-efficacy and fear of childbirth. Improvements in depression, mindfulness, and birth outcome expectations were underpowered. At postnatal follow-up significant improvements were found in anxiety, whereas improvements in mindfulness, stress, and fear of birth were significant at a less conservative alpha level. This pilot study demonstrated that a blended mindfulness and skills-based childbirth education intervention was acceptable to women and was associated with improvements in women's sense of control and confidence in giving birth. Previous findings that low self-efficacy and high childbirth fear are linked to greater labor pain, stress reactivity, and trauma suggest the observed improvements in these variables have important implications for improving maternal mental health and associated child health outcomes. Ways in which these outcomes can be
The US Department of Energy is carrying out a national program to assure the safe shipment of radioactive materials. As part of this overall effort, the Hazardous Materials Information Center of Oak Ridge National Laboratory has developed the comprehensive Legislative and Regulatory Information System, which contains information on federal-, state-, and local-level legislative and regulatory actions pertaining primarily to the shipment of radioactive materials. Specific subject areas chosen to highlight particular transportation restrictions include: (1) identification of state agency responsible for regulating transportation, (2) type of escorts required, (3) areas requiring prior notification, (4) areas requiring permits or licenses, and (5) areas totally banning transportation of all radioactive materials. Other legislative information being categorized and of immediate relevance to the transportation issues is covered under the areas of disposal, storage, and management of radioactive materials; establishment of additional regulations; emergency response regulations; moratoriums on power plant construction and siting; radiation safety and control studies; and remedial action studies. The collected information is abstracted, indexed, and input into one of the two data bases developed under this information system - Current Legislation Data Base and Historical Legislation Data Base. An appendix is included which provides a summary of the state and local laws affecting the transportation of radioactive materials throughout the United States. The Legislative and Regulatory Information System is supported by the Transportation Technology Center located at Sandia National Laboratories, Albuquerque, New Mexico
The US Department of Energy is carrying out a national program to assure the safe shipment of radioactive materials. As part of this overall effort, the Hazardous Materials Information Center of Oak Ridge National Laboratory has developed the comprehensive Legislative and Regulatory Information System, which contains information on federal-, state-, and local-level legislative and regulatory actions pertaining primarily to the shipment of radioactive materials. Specific subject areas chosen to highlight particular transportation restrictions include: (1) identification of state agency responsible for regulating transportation, (2) type of escorts required, (3) areas requiring prior notification, (4) areas requiring permits or licenses, and (5) areas totally banning transportation of all radioactive materials. Other legislative information being categorized and of immediate relevance to the transportation issues is covered under the areas of disposal, storage, and management of radioactive materials; establishment of additional regulations; emergency response regulations; moratoriums on power plant construction and siting; radiation safety and control studies; and remedial action studies. The collected information is abstracted, indexed, and input into one of the two data bases developed under this information system - Current Legislation Data Base and Historical Legislation Data Base. An appendix is included which provides a summary of the state and local laws affecting the transportation of radioactive materials throughout the United States. The Legislative and Regulatory Information System is supported by the Transportation Technology Center located at Sandia National Laboratories, Albuquerque, New Mexico.
Full Text Available Abstract Background Recent reports have shown that air pollution may increase the risk of adverse birth outcomes. We have evaluated the relationship between ambient air pollution and the occurrence of low birth weight and preterm delivery using routinely collected data in Lithuania. Methods This epidemiological study comprised all singleton newborns (N = 3,988, born to women in 1998, who resided in the City of Kaunas. Birth data and information on maternal characteristics were obtained from the Lithuanian National Birth Register. To estimate residential exposure levels, we used measurements of ambient nitrogen dioxide (NO2 and formaldehyde, which were collected at 12 monitoring posts. Multivariate logistic regression was used to estimate the effect that each pollutant would have on low birth weight (LBW and premature birth while controlling for potential confounders. Results Adjusted odds ratios (OR for LBW increased with increasing formaldehyde exposure (OR2nd tertile = 1.86, 95% CI 1.10–3.16; OR3rd tertile = 1.84, 95% CI 1.12–3.03. Adjusted ORs of preterm birth for the medium and high NO2 tertile exposures were OR = 1.14 (95% CI 0.77–1.68 and OR = 1.68 (95% CI 1.15–2.46, respectively. The risk of preterm birth increased by 25% (adjusted OR = 1.25, 95% CI 1.07–1.46 per 10 μg/m3 increase in NO2 concentrations. An analysis by trimester showed that pregnancy outcomes were associated with first-trimester exposure to air pollutants. However, there were no significant relationships in other pregnancy periods between preterm birth and exposure to formaldehyde or between LBW and NO2 exposure. Conclusion Our findings suggest that in the City of Kaunas there might be a relationship between maternal exposure to ambient formaldehyde and the risk of LBW, as well as between NO2 exposure and the risk of preterm birth.
Chaksuwat, Pakorn; Sirichotiyakul, Supatra; Luewan, Suchaya; Tongsong, Theera
To evaluate the agreement of risk categorization for Down syndrome screening between ultrasound scan-based gestational age (GA) and last menstrual period-based gestational age in both first and second trimesters by maternal serum markers. Data comprising 4,055 and 4,016 cases of first and second trimester screening were used. The maternal serum markers were analyzed using the ultrasound-based GA and menstrual age. The subjects whose menstrual age and ultrasound-based GA fell in different trimesters were excluded because the risk could not be calculated due to the different serum markers used in each trimester. The agreement of risk categorization for fetal Down syndrome was evaluated. The agreement of Down syndrome screening in the first and the second trimesters were 92.7% and 89%, respectively. The study found a good agreement of risk categorization by Kappa index, which was 0.615 for the overall screening. The menstrual age had a slight decrease in the detection rate and a lower false-positive rate. Menstrual age is acceptable in cases of accurate last menstrual period. However, in places where ultrasonography is not readily available, gestational age estimation by menstrual age along with clinical examination that corresponds to the gestational age can be reliable.
Full Text Available Intimate partner violence (IPV is the most prevalent form of gender-based violence worldwide. IPV either before or during pregnancy has been documented as a risk factor for the health of the mother and her unborn child. The aim of this study was to examine the relationship between maternal experience of IPV and low birth weight (LBW.A hospital-based survey was conducted among women in the postnatal wards of a large public hospital at Rajshahi, Bangladesh. Data on socio-economic characteristics, reproductive health characteristics, intimate partner violence, and antenatal, delivery and newborn care were collected from 400 women between July 2015 and April 2016.Results of this study indicated that 43% of women reported experiencing any physical IPV in their lifetime, 35.5% of them experienced sexual IPV, and 32.5% experienced both physical and sexual IPV. Approximately one in every three (29.2% infants was born with LBW. Physical IPV was associated with an increased risk of having a child with low birth weight (adjusted odds ratio [AOR]: 3.01, 95% CI: 2.35-5.81. The risk of infants born with LBW increased with women's lifetime experience of sexual IPV (AOR: 1.98; 95% CI: 1.23-4.15 and both physical and sexual IPV (AOR: 4.05; 95% CI: 2.79-7.33.Maternal lifetime experience of IPV is positively associated with LBW children. Preventing women from the experience of IPV may help improve neonatal and child mortality in Bangladesh.
Shilpi, Tanjida; Sattar, Humayun; Miah, Md Ruhul Amin
The present study was conducted over a period of one year to find the right time for measles vaccination when maternal antibody titer in infants was decayed rendering them susceptible to wild virus infection. Blood samples were collected from the cord of new born (147), 2-5 months (47) and 5 to 7.5 months (24) of age. The mean measles IgG antibody titer detected in cord blood at birth (0 months) was 348.8 mlU/mL which steeply decreased to 155.6 mlU/mL by the age of 2-3 months. After that the fall in antibody becomes relatively slower and decreased to 101.6 mIU/mL by the age of 3-5 months and 38.8 mlU/mL by the age of 5-6 months and to 19.2 mIU/mL between the age of 6 to 7.5 months. The fall in antibody level with the advance of age was statistically significant (p < 0.001 ). Majority of the subjects (97.6%) exhibited protective level of antibody at birth. But only a little above one-quarter (25.5%) of them persisted the protective level between the age of 2-5 months and none had protective level from 5 months onwards.
Starkey, D; Hill, K
The purpose of this guide is to allow individual state legislators to gain a better understanding of municipal solid waste (MSW) management issues in general, and examine the applicability of these concerns to their state. This guide incorporates a discussion of MSW management issues and a comprehensive overview of the components of an integrated solid waste management system. Major MSW topics discussed include current management issues affecting states, federal activities, and state laws and local activities. Solid waste characteristics and management approaches are also detailed.
Citi, Manuele; Justesen, Mogens Kamp
of regulatory reform in the EU. The rise in the number of legislative proposal, in turn, is affected by the extent of gridlock between the EU’s legislative bodies. These findings show that the Commission steps up its legislative activity when the institutional opportunity space allows for greater policy change.......This paper studies how institutional constraints affect legislative activism, and how legislative activism affects policy change, analyzing the case of the European Union’s legislative process. Our argument revolves around the key role of the Commission in advancing policy change, and emphasizes...... that the Commission can successfully push for increased policy change by increasing its legislative activity when the institutional opportunity space widens. Using a novel panel dataset covering eight policy sectors from 1984--‐2012, we find that the number of legislative proposals significantly affects the extent...
Citi, Manuele; Justesen, Mogens Kamp
This article presents a study of how institutional constraints affect legislative activism and how legislative activism in turn affects policy change through an analysis of the European Union's legislative process. The argument revolves around the key role of the European Commission in advancing...... policy change, and emphasises that the Commission can successfully push for increased policy change by increasing its legislative activity when the institutional opportunity space widens. Using a novel panel dataset covering eight policy sectors from the period 1984–2012, the article shows...... that the number of legislative proposals significantly affects the extent of regulatory reform in the EU. The rise in the number of legislative proposals, in turn, is affected by the extent of gridlock between the EU's legislative bodies. These findings show that the Commission steps up its legislative activity...
Full Text Available Abstract Background In sub-Saharan Africa, maternal and perinatal mortality and morbidity are major problems. Service availability and quality of care in health facilities are heterogeneous and most often inadequate. In resource-poor settings, the facility-based maternal death review or audit is one of the most promising strategies to improve health service performance. We aim to explore and describe health workers' perceptions of facility-based maternal death reviews and to identify barriers to and facilitators of the implementation of this approach in pilot health facilities of Senegal. Methods This study was conducted in five reference hospitals in Senegal with different characteristics. Data were collected from focus group discussions, participant observations of audit meetings, audit documents and interviews with the staff of the maternity unit. Data were analysed by means of both quantitative and qualitative approaches. Results Health professionals and service administrators were receptive and adhered relatively well to the process and the results of the audits, although some considered the situation destabilizing or even threatening. The main barriers to the implementation of maternal deaths reviews were: (1 bad quality of information in medical files; (2 non-participation of the head of department in the audit meetings; (3 lack of feedback to the staff who did not attend the audit meetings. The main facilitators were: (1 high level of professional qualifications or experience of the data collector; (2 involvement of the head of the maternity unit, acting as a moderator during the audit meetings; (3 participation of managers in the audit session to plan appropriate and realistic actions to prevent other maternal deaths. Conclusion The identification of the barriers to and the facilitators of the implementation of maternal death reviews is an essential step for the future adaptation of this method in countries with few resources. We
An outline is given of the national legislation in 39 countries in the field of food irradiation. Where available the following information is given for each country: form of legislation, object of legislation including information on the irradiation treatment, the import and export trade of irradiated food, the package labelling and the authorization and control of the irradiation procedures
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false State legislation. 13.3... ADMINISTRATION, FIDUCIARY ACTIVITIES § 13.3 State legislation. Field facility Directors are authorized to... regarding any proposed legislation relating to fiduciary matters will be taken without the approval of the...
... 46 Shipping 2 2010-10-01 2010-10-01 false Special legislation. 67.132 Section 67.132 Shipping... legislation. (a) Vessels not otherwise entitled to be operated in the coastwise trade or in the fisheries may obtain these privileges as a result of special legislation by the Congress of the United States. (b) In...
... 29 Labor 1 2010-07-01 2010-07-01 true Legislation. 11.14 Section 11.14 Labor Office of the... Administrative Procedures § 11.14 Legislation. Notwithstanding any provisions of this part, environmental assessments or impact statements prepared in connection with requests for new legislation or modification of...
... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Assent legislation. 80.3 Section 80.3... WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS § 80.3 Assent legislation. A State may participate in the benefits of the Act(s) only after it has passed legislation which assents to the provisions...
Legal framework policy of Japan in the field of education has been analyzed. The problem of influence of legislative materials on the development of education in Japan, its legislative support has been considered. It has been defined that directive materials affect the development of education system in Japan. Legislation policy of the country is…
... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Legislative history. 276.5 Section 276.5 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF... Legislative history. Discussion of this legislation is contained in the reports by the Senate Committee on...
Hargreave, Marie; Jensen, Allan; Nielsen, Thor Schütt Svane
Large population-based studies are needed to examine the effect of maternal use of fertility drugs on the risk of cancer in children, while taking into account the effect of the underlying infertility. A cohort of 123,322 children born in Denmark between 1964 and 2006 to 68,255 women who had been...... evaluated for infertility was established. We used a case-cohort design and calculated hazard ratios (HRs) for cancer in childhood (0-19 years) and in young adulthood (20-29 years) associated with maternal use of six groups of fertility drugs (clomiphene, gonadotropins [i.e., human menopausal gonadotropins...... and follicle-stimulating hormone], gonadotropin-releasing hormone analogs, human chorionic gonadotropins, progesterone and other fertility drugs). We found no statistically significant association between maternal use of fertility drugs and risk for overall cancer in childhood or young adulthood. However...
Sørensen, Holger J; Nielsen, Philip R; Pedersen, Carsten B
a diagnosis of anemia at any time during the pregnancy. Cohort members were followed from their 10th birthday until onset of schizophrenia, death, or December 31, 2008, whichever came first. Adjusted for relevant confounders, cohort members whose mothers had received a diagnosis of anemia during pregnancy had......Recent findings suggest that maternal iron deficiency may increase the risk of schizophrenia-spectrum disorder in offspring. We initiated this study to determine whether maternal prepartum anemia influences offspring risk of schizophrenia. We conducted a population-based study with individual...... a 1.60-fold (95% confidence interval = 1.16-2.15) increased risk of schizophrenia. Although the underlying mechanisms are unknown and independent replication is needed, our findings suggest that maternal iron deficiency increases offspring risk of schizophrenia....
Lysell, Henrik; Dahlin, Marie; Viktorin, Alexander; Ljungberg, Elsa; D'Onofrio, Brian M; Dickman, Paul; Runeson, Bo
Recent research suggests that having a newborn child is associated with substantially reduced risk for maternal suicide. We studied postpartum suicides in a national cohort of mothers and the role of mental disorder, self-harm and delivery related factors. We used a nested case-control design with data from Swedish registries. The cohort consisted of all women given birth in Sweden 1974-2009. Mothers who died by suicide during follow-up were considered cases (n = 1,786) and risk of suicide was estimated with proximity to delivery as the explanatory variable. In a second step, association between suicide during the first year following delivery (n = 145) and mental disorder, self-harm and delivery related variables risk factors were analyzed. The first postpartum year was associated with a lower risk of suicide, compared to later (RR 0.80, 95%CI 0.66-0.96), which was unaltered after adjustment for socio-economic status and history of self-harm (aRR 0.82, 95%CI 0.68-0.99). Compared to living mothers, suicide victims of the postpartum year more often had affective disorders (aRR 133.94, 95%CI 45.93-390.61), psychotic disorders (aRR 83.69, 95%CI 36.99-189.31) and history of self-harm (aRR 47.56, 95%CI 18.24-124.02). The aRR of stillbirth was 2.66 (95%CI 0.63-11.30). We found only a weak negative association between childbirth during the preceding year and suicide, when using mothers as controls. A severe mental disorder after delivery and a history of self-harm was strongly associated with increased risk of suicide in the postpartum year and may inform the clinical assessment postpartum.
Full Text Available There is a substantial amount of evidence from experimental studies to indicate that a variety of individual skills are impaired at blood alcohol concentrations (BACs well below 0.05%. Epidemiological studies indicate that the risk of a crash increases sharply for drivers with BACs below 0.05%. The correlation between drunk driving and the risk of traffic accidents has been established on the individual as well as the aggregate level. The BAC level legally permitted is a public policy decision by legislators, while scientists can present experimental and epidemiological evidence indicating the BAC level at which psychomotor skills deteriorate and accident probabilities increase. There is considerable epidemiological evidence to support the fact that the risk of alcohol impaired drivers being involved in traffic crashes rises with increasing BAC's. By contrast, the evidence on the BAC at which a driver should be regarded as committing an offence has been the subject of much debate and various legislative decisions. Historically, per se laws specify BAC levels which are a compromise figure intended to reflect both the point at which a driver becomes significantly more likely to be involved in an accident than a comparative driver with a zero BAC and that which is politically acceptable, but falls within the BAC region of increased accident liability. Therefore, the per se legislation in most countries has not kept pace with scientific progress. This study suggests that if saving lives on the road is an important issue, then, passing laws that incorporate scientific and epidemiological studies, is necessary.
AbstRACt. Aim: To determine annual trends of maternal mortality ratio in a tertiary hospital offering free maternity services. settings and Design: This retrospective descriptive study was conducted at the Mother and Child Hospital Akure, Ondo. State, a busy purpose‑built tertiary care facility premised on evidence‑based ...
Full Text Available Early detection and interventions for metabolic syndrome (MetS are the most cost-effective methods for preventing many chronic diseases. There have been discordant findings in various countries due to different genetics and lifestyles. The goal of this study was to investigate the association of MetS with parental diseases, a Chinese-style diet, and rural-urban regional differences with a large-scale epidemiological survey in Taiwan. Data were obtained from the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH, a cross-sectional population-based study with multistage stratified random sampling conducted by the Taiwan Bureau of Health Promotion in 2002. Public health nurses visited homes to conduct the survey, including blood drawing and an interview. Multiple logistic regression analysis was used for exploring the factors associated with MetS. A total of 6591 people completed data for analysis. Our results revealed that older age, male sex, and maternal diabetes or hypertension, were significantly associated with MetS. Eating poultry with skin and fat and eating a bean-free diet may be associated with a higher risk of MetS. People who exercised regularly and the residents of the Taipei metropolitan area had a lower prevalence of MetS. As a result, people with maternal diabetes or hypertension should pay attention to their cardiovascular health and prevention of MetS. We suggest that eating skinless and low-fat poultry, eating more beans, and exercising regularly, may decrease the risk of MetS. We should make an effort to advocate for health promotion, including lifestyle modification, especially among the high-risk population and among residents in rural areas with limited medical resources.
Juárez, Sol P; Small, Rhonda; Hjern, Anders; Schytt, Erica
To investigate the association between maternal country of birth and father's origin and unplanned and planned caesarean birth in Sweden. Population-based register study including all singleton births in Sweden between 1999 and 2012 (n = 1 311 885). Multinomial regression was conducted to estimate odds ratios (OR) for unplanned and planned caesarean with 95% confidence intervals for migrant compared with Swedish-born women. Analyses were stratified by parity. Women from Ethiopia, India, South Korea, Chile, Thailand, Iran, and Finland had statistically significantly higher odds of experiencing unplanned (primiparous OR 1.10-2.19; multiparous OR 1.13-2.02) and planned caesarean (primiparous OR 1.18-2.25; multiparous OR 1.13-2.46). Only women from Syria, the former Yugoslavia and Germany had consistently lower risk than Swedish-born mothers (unplanned: primiparous OR 0.76-0.86; multiparous OR 0.74-0.86. Planned; primiparous OR 0.75-0.82; multiparous OR 0.60-0.94). Women from Iraq and Turkey had higher odds of an unplanned caesarean but lower odds of a planned one (among multiparous). In most cases, these results remained after adjustment for available social characteristics, maternal health factors, and pregnancy complications. Both parents being foreign-born increased the odds of unplanned and planned caesarean in primiparous and multiparous women. Unplanned and planned caesarean birth varied by women's country of birth, with both higher and lower rates compared with Swedish-born women, and the father's origin was also of importance. These variations were not explained by a wide range of social, health, or pregnancy factors. © 2017 John Wiley & Sons Ltd.
This section treats of the following activities sorted by country: 1 - Belarus: International cooperation, Organisation and structure, Licensing and regulatory infrastructure, Nuclear safety and radiological protection; 2 - France: Nuclear safety and radiological protection, Radioactive waste management, Environmental protection, Liability and compensation, International co-operation; 3 - Hungary: General legislation, Radioactive waste management, Nuclear security; 4 - Ireland: Nuclear safety and radiological protection (including emergency planning); 5 - Lithuania: Licensing and regulatory infrastructure; 6 - Moldova: Nuclear safety and radiological protection; 7 - Portugal: Radioactive waste management, Nuclear safety and radiological protection; 8 - Slovak Republic: Radioactive waste management, Liability and compensation; 9 - Spain: Radioactive waste management; 10 - Ukraine: Radioactive waste management; 11 - United Kingdom: Organisation and structure
Harmon, Nikolaj Arpe; Fisman, Raymond; Kamenica, Emir
Abstract We exploit seating rules in the European Parliament to estimate causal peer effects in legislative voting. We find that sitting next to each other reduces by 13 percent the likelihood that two Members of the European Parliament (MEPs) from the same party differ in their vote. Using...... variation in seating across the two venues of the Parliament (Brussels and Strasbourg), we show that this effect reflects persistent peer influence: a pair of MEPs who have sat together in the past are less likely to disagree on a vote even if they do not sit together during that particular vote....
Du, Li; Qin, Min; Zhang, Lei; Xu, Houqin; Zhu, Liping
Although Shanghai has good maternal health indicators, it also has a large in-migrating population, which has made control of maternal mortality a major challenge. This study analyzed maternal mortality and causes of death in pregnant women in Shanghai in the ten years from 2000 to 2009, comparing resident and migrant women. All live births were registered and every maternal death audited. The number of live births rose from 84,898 in 2000 to 187,335 in 2009. The number of migrants increased 4.6 times, while the proportion of live births to migrant women increased from 27% to 55%. There were 262 maternal deaths, 55 in Shanghai residents and 207 in migrant women (78.9% of the total). Most deaths in migrant women were due to illegal delivery. Three policy changes focusing on maternal health greatly reduced deaths: low-cost delivery services were established for migrant women in maternity hospitals, five obstetric emergency care and referral centres were created in general hospitals, and training for health professionals and health education for women were instituted. Maternal mortality in Shanghai decreased steadily from 2000 to 2009, reaching 10 per 100,000 live births in 2009. Among Shanghai permanent residents the ratio was below ten in most of those years, while among migrant women it declined sharply from 58 to 12 per 100,000 live births. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.
Kim, Sunghee; Shin, Gisoo
Since previous studies on simulation-based education have been focused on fundamental nursing skills for nursing students in South Korea, there is little research available that focuses on clinical nurses in simulation-based training. Further, there is a paucity of research literature related to the integration of the nursing process into simulation training particularly in the emergency nursing care of high-risk maternal and neonatal patients. The purpose of this study was to identify the effects of nursing process-based simulation on knowledge, attitudes, and skills for maternal and child emergency nursing care in clinical nurses in South Korea. Data were collected from 49 nurses, 25 in the experimental group and 24 in the control group, from August 13 to 14, 2013. This study was an equivalent control group pre- and post-test experimental design to compare the differences in knowledge, attitudes, and skills for maternal and child emergency nursing care between the experimental group and the control group. The experimental group was trained by the nursing process-based simulation training program, while the control group received traditional methods of training for maternal and child emergency nursing care. The experimental group was more likely to improve knowledge, attitudes, and skills required for clinical judgment about maternal and child emergency nursing care than the control group. Among five stages of nursing process in simulation, the experimental group was more likely to improve clinical skills required for nursing diagnosis and nursing evaluation than the control group. These results will provide valuable information on developing nursing process-based simulation training to improve clinical competency in nurses. Further research should be conducted to verify the effectiveness of nursing process-based simulation with more diverse nurse groups on more diverse subjects in the future. Copyright © 2015 Elsevier Ltd. All rights reserved.
McKinnon, Britt; Auger, Nathalie; Kaufman, Jay S
Smoke-free legislation may have positive effects on birth outcomes. Given that smoking and secondhand smoke during pregnancy vary with socioeconomic position, legislation may have greater effects in some socioeconomic groups. For this study, we evaluated the impact of a 2006 ban on smoking in public places in the Canadian province of Quebec on preterm birth, small-for-gestational-age birth and birth weight, and on educational differences in these birth outcomes. We analysed data on singleton births in Quebec between 2003 and 2010. Logistic regression was used to model the association of smoke-free legislation with preterm birth (legislation. Interaction terms were included to assess differential effects by level of maternal education. Smoke-free legislation was associated with average reductions of 3.1 preterm births (95% CI 0.1 to 6.0), 2.3 very preterm births (95% CI 0.9 to 3.7), 5.9 small-for-gestational-age births (95% CI 2.6 to 9.3) and 1.0 low birthweight infants (95% CI 0.4 to 1.6) per 1000 live births, as well as a 17.1 g increase in mean birth weight (95% CI 10.7 to 23.6). Legislation was associated with improved birth outcomes in all categories of maternal education. Smoke-free legislation in Quebec was associated with reductions in preterm and small-for-gestational-age births, and an increase in birth weight. There was no compelling evidence that legislation impacted educational gradients in birth outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Tieu, Joanna; McPhee, Andrew J; Crowther, Caroline A; Middleton, Philippa; Shepherd, Emily
Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mothers and their infants in the short and long term. There is strong evidence to support treatment for GDM. However, there is uncertainty as to whether or not screening all pregnant women for GDM will improve maternal and infant health and if so, the most appropriate setting for screening. This review updates a Cochrane Review, first published in 2010, and subsequently updated in 2014. To assess the effects of screening for gestational diabetes mellitus based on different risk profiles and settings on maternal and infant outcomes. We searched Cochrane Pregnancy and Childbirth's Trials Register (31 January 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (14 June 2017), and reference lists of retrieved studies. We included randomised and quasi-randomised trials evaluating the effects of different protocols, guidelines or programmes for screening for GDM based on different risk profiles and settings, compared with the absence of screening, or compared with other protocols, guidelines or programmes for screening. We planned to include trials published as abstracts only and cluster-randomised trials, but we did not identify any. Cross-over trials are not eligible for inclusion in this review. Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included trials. We resolved disagreements through discussion or through consulting a third reviewer. We included two trials that randomised 4523 women and their infants. Both trials were conducted in Ireland. One trial (which quasi-randomised 3742 women, and analysed 3152 women) compared universal screening versus risk factor-based screening, and one trial (which randomised 781 women, and analysed 690 women) compared primary care screening versus
Full Text Available According to business climate and competitiveness indicators published by international organisations, Croatia is a country with a rigid labour market and a high level of the legal protection of employees. Given that an Act on Amendments to the Labour Act (OG 73/13 entered into force in Croatia in June 2013, this paper examines changes in employment protection legislation in Croatia and Central and Eastern European (CEE countries, as well as in Croatia's main trading partners during the period between 2008 and 2013. A cross-country comparison shows a strong downward trend in legal employment protection in most CEE countries during the observed period, primarily as concerns individual dismissal in the cases of regular employment contracts, while in the case of temporary employment the protection strengthened slightly. On the other hand, despite the adoption of amendments to the Labour Act (LA, Croatian labour legislation governing employment protection for regular employment contracts remains relatively inflexible compared to that in other countries.
This section treats of the following National legislative and regulatory activities: 1 - Australia: General legislation - Bill to amend the Australian Radiation Protection and Nuclear Safety Act 1998; 2 - France: General legislation - Law No. 2015-992 of 17 August 2015 on the energy transition for green growth; ASN Report on the state of nuclear safety and radiation protection in France in 2014; 3 - Germany: Radioactive waste management - First Ordinance to amend the 2005 Gorleben Development Freeze Ordinance (2015); 4 - Greece: Radioactive waste management - Joint Ministerial Decision establishing the national policy on the management of spent fuel and radioactive waste; 5 - Lithuania: Nuclear safety and radiological protection - Revised requirements for modifications, Plan for enhancement of nuclear safety, New requirements for the commissioning of nuclear power plants, Revised requirements regulating the provision of information on abnormal events; Radioactive waste management - Revised requirements for acceptance criteria for near surface repository; Nuclear security - Revised requirements for physical protection; 6 - Romania: Licensing and regulatory infrastructure - Government Decision No. 600/2014 for approval of National Nuclear Safety and Security; International co-operation - Government Decision No. 525/2014 for approval of the Co-operation Agreement on the radioactive waste management between the French National Radioactive Waste Management Agency (ANDRA) and Nuclear Agency and Radioactive Waste (ANDR) Strategy; Memorandum of Understanding for Co-operation and Exchange of Information in Nuclear Regulatory Matters between the National Commission for Nuclear Activities Control (CNCAN) of Romania and the President of National Atomic Energy Agency (PAA) of Poland; Government Decision No. 540/2015 for approval of the Agreement between the Government of Romania and the Government of the People's Republic of China regarding co-operation in the peaceful
This section treats of the following National legislative and regulatory activities: 1 - Algeria, Nuclear safety and radiological protection, Executive Decree No. 17-126 of 27 March 2017; 2 - Belgium, Liability and compensation, Law of 7 December 2016 modifying the law of 22 July 1985 on third party liability in the field of nuclear energy; 3 - Canada, Liability and compensation, Ratification by Canada of the Convention on Supplementary Compensation for Nuclear Damage; 4 - France, Radioactive waste management: Decree No. 2017-231 of 23 February 2017 implementing Article L. 542-1-2 of the French Environmental Code (Code de l'environnement) and setting out the provisions of the National Radioactive Material and Waste Management Plan; and Order of 23 February 2017 implementing Decree No. 2017-231 of 23 February 2017 implementing Article L. 542-1-2 of the French Environmental Code setting out the provisions of the National Radioactive Material and Waste Management Plan; Liability and compensation: Order of 10 November 2016 amending the Appendix to the Order of 19 August 2016, setting the list of reduced liability amount sites pursuant to Decree No. 2016-333 of 21 March 2016 implementing Article L. 597-28 of the Environmental Code and relating to third party liability in the nuclear energy field; International co-operation: Decree No. 2016-1225 of 16 September 2016 making public the Protocol to the Co-operation Agreement between the Government of the French Republic and the Government of the Hashemite Kingdom of Jordan for the Development of the Pacific Uses of Nuclear Energy, signed in Paris on 27 August 2008; 5 - Germany, Transport of radioactive materials: New Versions of Ordinances on the Transport of Dangerous Goods (2017); Radioactive Waste Management: Act on the Reorganisation of the Responsibility of Nuclear Waste Disposal (2017); 6 - Lithuania, Nuclear security: Cyber security; Nuclear installations: Free release criteria of buildings and site of nuclear
Barsumian, L.; Vandevender, S.G.
This report is an account of the energy legislation and associated issues considered during the 1979 session of the 34th New Mexico Legislature. The session's major issue was the federal study of a proposed nuclear Waste Isolation Pilot Plant (WIPP) in New Mexico. A large proportion of time and effort was spent on resolving the state's formal position toward the federal project. However, other energy concerns were also significant even though they were neither as controversial nor as visible as the primary issue. The two most important laws enacted were the Radioactive Waste Consultation Act and the Radioactive Waste Transportation Act. The Legislature considered 47 other energy-related bills, of which 17 were enacted
Barsumian, L.; Vandevender, S.G.
This report is an account of the energy legislation and associated issues considered during the 1979 session of the 34th New Mexico Legislature. The session's major issue was the federal study of a proposed nuclear Waste Isolation Pilot Plant (WIPP) in New Mexico. A large proportion of time and effort was spent on resolving the state's formal position toward the federal project. However, other energy concerns were also significant even though they were neither as controversial nor as visible as the primary issue. The two most important laws enacted were the Radioactive Waste Consultation Act and the Radioactive Waste Transportation Act. The Legislature considered 47 other energy-related bills, of which 17 were enacted.
Government decides to grant licensees for oil exploration the operators have to develop specific EIAs for all major activities. The activities shall be based on BEP (Best Environmental Practice) and BAT (Best Environmental Technology) principles, and operators shall conduct supplementary environmental...
Reed, J.B.; Cummins, J.
This is the seventh report prepared by the National Conference of State Legislatures (NCSL) on developments in radioactive materials transportation. It updates information contained in the April 1993 report on Legislative Developments in Radioactive Materials Transportation and describes activities for the period April 1, 1993--August 31, 1993. NCSL currently is updating an on-line data base that contains abstracts of federal, state and local laws and regulations relating to the transportation of radioactive materials. The data base will be operated by NCSL under a cooperative agreement with the Department of Energy's (DOE) Office of Civilian Radioactive Waste Management. Limited availability of on-line capability is anticipated by the end of 1993. Users approved by DOE and NCSL will have access to the data base. A copy of any legislation listed in this report can be obtained by contacting the people listed below. This report contains the current status of legislation introduced in the 1993 state legislative sessions, not previously reviewed in past reports. Bills that address nuclear materials transportation and the broader area of hazardous materials transportation are grouped by state according to their status--enacted, pending or failed. In addition, bills that deal with emergency preparedness are described. (General nuclear waste legislation with no transportation element is no longer tracked.) Also included are Federal Register notices pertinent to radioactive waste and hazardous materials transportation
Mohammed Abdalla A
Full Text Available Abstract Background The maternal mortality ratio in Sudan was estimated at 750/100,000 live births. Sudan was one of eleven countries that are responsible for 65% of global maternal deaths according to a recent World Health Organization (WHO estimate. Maternal mortality in Kassala State was high in national demographic surveys. This study was conducted to investigate the causes and contributing factors of maternal deaths and to identify any discrepancies in rates and causes between different areas. Methods A reproductive age mortality survey (RAMOS was conducted to study maternal mortality in Kassala State. Deaths of women of reproductive age (WRA in four purposively selected areas were identified by interviewing key informants in each village followed by verbal autopsy. Results Over a three-year period, 168 maternal deaths were identified among 26,066 WRA. Verbal autopsies were conducted in 148 (88.1% of these cases. Of these, 64 (43.2% were due to pregnancy and childbirth complications. Maternal mortality rates and ratios were 80.6 per 100,000 WRA and 713.6 per 100,000 live births (LB, respectively. There was a wide discrepancy between urban and rural maternal mortality ratios (369 and 872100,000 LB, respectively. Direct obstetric causes were responsible for 58.4% of deaths. Severe anemia (20.3% and acute febrile illness (9.4% were the major indirect causes of maternal death whereas obstetric hemorrhage (15.6%, obstructed labor (14.1% and puerperal sepsis (10.9% were the major obstetric causes. Of the contributing factors, we found delay of referral in 73.4% of cases in spite of a high problem recognition rate (75%. 67.2% of deaths occurred at home, indicating under utilization of health facilities, and transportation problems were found in 54.7% of deaths. There was a high illiteracy rate among the deceased and their husbands (62.5% and 48.4%, respectively. Conclusions Maternal mortality rates and ratios were found to be high, with a wide
Herstad, Lina; Klungsøyr, Kari; Skjærven, Rolv; Tanbo, Tom; Forsén, Lisa; Åbyholm, Thomas; Vangen, Siri
Maternal age at delivery and cesarean section rates are increasing. In older women, the decision on delivery mode may be influenced by a reported increased risk of surgical interventions during labor and complications with increasing maternal age. We examined the association between maternal age and adverse outcomes in low-risk primiparous women, and the risk of adverse outcomes by delivery modes, both planned and performed (elective and emergency cesarean section, operative vaginal delivery, and unassisted vaginal delivery) in women aged ≥ 35 years. A population-based registry study was conducted using data from the Medical Birth Registry of Norway and Statistics Norway including 169,583 low-risk primiparas with singleton, cephalic labors at ≥ 37 weeks during 1999 - 2009. Outcomes studied were obstetric blood loss, maternal transfer to intensive care units, 5-min Apgar score, and neonatal complications. We adjusted for potential confounders using relative risk models and multinomial logistic regression. Most adverse outcomes increased with increasing maternal age. However, the increase in absolute risks was low, except for moderate obstetric blood loss and transfer to the neonatal intensive care unit (NICU). Operative deliveries increased with increasing maternal age and in women aged ≥ 35 years, the risk of maternal complications in operative delivery increased. Neonatal adverse outcomes increased mainly in emergency operative deliveries. Moderate blood loss was three times more likely in elective and emergency cesarean section than in unassisted vaginal delivery, and twice as likely in operative vaginal delivery. Low Apgar score and neonatal complications occurred two to three times more often in emergency operative deliveries than in unassisted vaginal delivery. However, comparing outcomes after elective cesarean section and planned vaginal delivery, only moderate blood loss (higher in elective cesarean section), neonatal transfer to
Cheng, Ching-Yu; Liou, Shwu-Ru; Tsai, Hsiu-Min; Chang, Chia-Hao
The Team-Based Learning (TBL) method has been used as a teaching strategy in many disciplines. It is instructor-led, learner-centered learning with functions similar to those of problem-based learning, but it is more cost-effective. However, little is known about the application of TBL to nursing education. The objectives of the study are to employ the TBL approach in a Maternal-Child Nursing course and to evaluate its effects on learning outcomes. We present one-group pretest-posttest research design with the intervention of the TBL teaching strategy. The study was conducted in one of the nursing universities in Taiwan. One-hundred-four students in 2011 and 103 students in 2012 in an RN-to-BSN program who enrolled in the Maternal-Child Nursing course participated in this study. These students had graduated from a five-year nursing diploma program before enrolling in the RN-BSN program. Data were collected before and after the implementation of the TBL, which included active learning, in-class activities, and application exercises. The Class Engagement Survey (CES), Value of Teams (VTs), Self-Directed Learning Instrument (SDLI), and exam scores were used to measure students' learning outcomes. TBL significantly influenced the students' learning outcomes. Students who expressed that TBL increased their learning interests had a higher score on VT; and students who had high achievement from the current TBL course had higher scores on the CES, VT, and SDLI. The means of the group test scores and the final examination score were significantly higher than the individual scores from the in-class tests in both 2011, 2012, and the combination of 2011 and 2012. The TBL design requires out-of-class preparation before all classes, which requires active and self-directed learning. TBL provides opportunities to foster learner-to-learner interactions, which lead to more active engagement and teamwork among learners. It also promotes the students' class engagement and teamwork
Newman, Angela B; Kjervik, Diane K
Health care legislation can be difficult to understand and apply in critical situations where patients may not be physically capable of autonomous control of confidential health information. Nurses are often the first to encounter confidential information about patients. To explore critical care nurses' knowledge of federal and North Carolina state legislation regarding confidentiality. This descriptive, qualitative study included 12 critical care nurses who were asked to describe their knowledge of federal confidentiality legislation and specific knowledge of North Carolina's confidentiality legislation. Critical care nurses were knowledgeable about federal confidentiality laws but demonstrated a need for further education about state-specific legislation. Nurses' application of confidentiality legislation demonstrates their knowledge of confidentiality legislation. To continue the trusting relationship that nurses have traditionally held with patients and patients' families, it is imperative for nurses to remain current about confidentiality legislation. Through education both before and after licensure, correct application of legislation can be achieved. Further research can aid in exploring the intersection between health care legislation and ethics. ©2016 American Association of Critical-Care Nurses.
This chapter of Nuclear Law Bulletin gathers some documents about national legislative and regulatory activities: - Belgium: Amendment of the Act on classification and security clearances, certifications and security notifications; Czech Republic: Resolution of the government of the Czech Republic on the time schedule of preparatory works for enlarging the nuclear power plant Temelin; Finland: Temporary Amendment to the Nuclear Liability Act; Ireland: Merchant Shipping Act; Romania: Emergency Ordinance on the identification, designation and protection of critical infrastructures; Emergency Ordinance on the control regime of dual-use items; Amendment to the Act on the safe conduct of nuclear activities; Nuclear safety norms on design and construction of nuclear power plants and nuclear safety norms on siting of nuclear power plants; United Kingdom: Establishment of the Office for Nuclear Regulation; United States: Waste Confidence Decision and Rule Update; Response to recent events in Japan
I. V. Puz
Full Text Available This article deals with the problems of modern motherhood and studies the phenomenon of deviant maternal behavior. Based on the literature, present study analyzes such forms of violation of maternal behavior as mother's refusal from a baby; mother's cruel treatment of a baby; frequent abortions; maternity in the early reproductive age; conscious maternity postponement for a later reproductive age. Also the factors that contribute to various manifestations of deviant motherhood are described.
Jennings, Larissa; Omoni, Adetayo; Akerele, Akunle; Ibrahim, Yisa; Ekanem, Ekpenyong
Mobile communication technologies may reduce maternal health disparities related to cost, distance, and infrastructure. However, the ability of mHealth initiatives to accelerate maternal health goals requires in part that women with the greatest health needs have access to mobile phones. This study examined if women with limited mobile phone access have differential odds of maternal knowledge and health service utilization as compared to female mobile phone users who are currently eligible to participate in maternal mHealth programs. Using household survey data from Nigeria, multivariable logistic regressions were used to examine the odds of maternal knowledge and service utilization by mobile phone strata. Findings showed that in settings with unequal access to mobile phones, mHealth interventions may not reach women who have the poorest maternal knowledge and care-seeking as these women often lacked mobile connectivity. As compared to mobile users, women without mobile phone access had significantly lower odds of antenatal care utilization (OR=0.48, 95%CI: 0.36-0.64), skilled delivery (OR=0.56, 95%CI: 0.45-0.70), and modern contraceptive use (OR=0.50, 95%CI: 0.33-0.76) after adjusting for demographic characteristics. They also had significantly lower knowledge of maternal danger signs (OR=0.69, 95%CI: 0.53-0.90) and knowledge of antenatal (OR=0.46, 95%CI: 0.36-0.59) and skilled delivery care benefits (OR=0.62, 95%CI: 0.47-0.82). No differences were observed by mobile phone strata in uptake of emergency obstetric care, postnatal services, or breastfeeding. As maternal mHealth strategies are increasingly utilized, more efforts are needed to improve women's access to mobile phones and minimize potential health inequities brought on by health systems and technological barriers in access to care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Olusanya, B O; Alakija, O P; Inem, V A
Scaling-up of skilled attendants and facility-based services is necessary for improving maternal and child care in developing countries but their effectiveness is crucially influenced by the uptake of such services. This study set out to establish the pattern and uptake of maternity services and associated factors against the backdrop of rapid urbanization in Nigeria. A cross-sectional study of socio-demographic and obstetric characteristics of mothers attending the Bacille Calmette-Guérin (BCG) immunization clinics in inner-city Lagos was conducted from July 2005 to December 2007, and their association with non-hospital delivery and use of unskilled attendants was determined by multiple logistic regression analyses. Of the 6465 participants, over half (51.4%) delivered outside hospital facilities and 81.8% of this group had no skilled attendants at delivery. Non-hospital delivery or the presence of unskilled attendants at delivery was associated with teenage mothers, Muslim religion, low or middle social class and use of herbal drugs in pregnancy. Additionally, non-hospital delivery was associated with ethnicity (Yoruba tribe), lack of tertiary education or full-time employment, accommodation with shared sanitation facilities and multiparity. The results suggest that availability of and access/proximity to hospital facilities or skilled attendants is no guarantee of uptake of maternity services. Efforts aimed at improving maternal and child health in developing countries should take cognisance of the socio-demographic and cultural underpinnings of maternal health-seeking behaviour of urban mothers beyond the provision of facility-based services or strengthening of the existing health care systems.
Martinek, Radek; Kahankova, Radana; Nazeran, Homer; Konecny, Jaromir; Jezewski, Janusz; Janku, Petr; Bilik, Petr; Zidek, Jan; Nedoma, Jan; Fajkus, Marcel
This paper is focused on the design, implementation and verification of a novel method for the optimization of the control parameters (such as step size μ and filter order N ) of LMS and RLS adaptive filters used for noninvasive fetal monitoring. The optimization algorithm is driven by considering the ECG electrode positions on the maternal body surface in improving the performance of these adaptive filters. The main criterion for optimal parameter selection was the Signal-to-Noise Ratio (SNR). We conducted experiments using signals supplied by the latest version of our LabVIEW-Based Multi-Channel Non-Invasive Abdominal Maternal-Fetal Electrocardiogram Signal Generator, which provides the flexibility and capability of modeling the principal distribution of maternal/fetal ECGs in the human body. Our novel algorithm enabled us to find the optimal settings of the adaptive filters based on maternal surface ECG electrode placements. The experimental results further confirmed the theoretical assumption that the optimal settings of these adaptive filters are dependent on the ECG electrode positions on the maternal body, and therefore, we were able to achieve far better results than without the use of optimization. These improvements in turn could lead to a more accurate detection of fetal hypoxia. Consequently, our approach could offer the potential to be used in clinical practice to establish recommendations for standard electrode placement and find the optimal adaptive filter settings for extracting high quality fetal ECG signals for further processing. Ultimately, diagnostic-grade fetal ECG signals would ensure the reliable detection of fetal hypoxia.
Archer, Natalie P.; Perez-Andreu, Virginia; Scheurer, Michael E.; Rabin, Karen R.; Peckham-Gregory, Erin C.; Plon, Sharon E.; Zabriskie, Ryan C.; De Alarcon, Pedro A.; Fernandez, Karen S.; Najera, Cesar R.; Yang, Jun J.; Antillon-Klussmann, Federico; Lupo, Philip J.
Background Children of Hispanic ancestry have a higher incidence of acute lymphoblastic leukemia (ALL) than other ethnic groups, but the genetic basis for racial disparities remain incompletely understood. Genome-wide association studies (GWAS) of childhood ALL to date have focused on inherited genetic effects; however, maternal genetic effects (the role of maternal genotype on offspring phenotype development) may also play a role in ALL susceptibility. Methods We conducted a family-based exome-wide association study (EXWAS) of maternal genetic effects among Hispanics with childhood B-cell ALL (B-ALL) using the Illumina Human Exome BeadChip. We used a discovery cohort of 312 Guatemalan and Hispanic American families and an independent replication cohort of 152 Hispanic American families. Results Three maternal SNPs approached our threshold for significance, after correction for multiple testing (P<1.0×10−6): MTL5 rs12365708 (RR=2.62, 95% CI=1.61-4.27, P=1.8×10−5); ALKBH1 rs6494 (RR=3.77, 95% CI=1.84-7.74, P=3.7×10−5); NEUROG3 rs4536103 (RR=1.75, 95% CI=1.30-2.37, P=1.2×10−4). While effect sizes were similar, these SNPs were not nominally significant in our replication cohort. In a meta-analysis comprised of the discovery cohort and the replication cohort, these SNPs were still not statistically significant after correction for multiple comparisons (rs12365708: pooled RR=2.27, 95% CI=1.48-3.50, P=1.99×10−4; rs6494: pooled RR=2.31, 95% CI=1.38-3.85, P=0.001; rs4536103: pooled RR=1.67, 95% CI=1.29-2.16, P=9.23×10−5). Conclusions In the first family-based EXWAS to investigate maternal genotype effects associated with childhood ALL, our results did not implicate a strong role of maternal genotype on disease risk among Hispanics; however, we identified three maternal SNPs that may play a modest role in susceptibility. PMID:27529658
Hartwig, Sophie A; Robinson, Lara R; Comeau, Dawn L; Claussen, Angelika H; Perou, Ruth
This article presents the findings of a qualitative study of maternal perceptions of parenting following participation in Legacy for Children TM (Legacy), an evidence-based parenting program for low-income mothers of young children and infants. To further examine previous findings and better understand participant experiences, we analyzed semistructured focus-group discussions with predominantly Hispanic and Black, non-Hispanic Legacy mothers at two sites (n = 166) using thematic analysis and grounded theory techniques. The qualitative study presented here investigated how mothers view their parenting following participation in Legacy, allowing participants to describe their experience with the program in their own words, thus capturing an "insider" perspective. Mothers at both sites communicated knowledge and use of positive parenting practices targeted by the goals of Legacy; some site-specific differences emerged related to these parenting practices. These findings align with the interpretation of quantitative results from the randomized controlled trials and further demonstrate the significance of the Legacy program in promoting positive parenting for mothers living in poverty. This study emphasizes the importance of understanding real-world context regarding program efficacy and the benefit of using qualitative research to understand participant experiences. © 2017 Michigan Association for Infant Mental Health.
Alem, Meseret; Enawgaw, Bamlaku
Background. Anaemia is a global public health problem which has an eminence impact on pregnant mother. The aim of this study was to assess the prevalence and predictors of maternal anemia. Method. A cross-sectional study was conducted from March 1 to April 30, 2012, on 302 pregnant women who attended antenatal care at Gondar University Hospital. Interview-based questionnaire, clinical history, and laboratory tests were used to obtain data. Bivariate and multivariate logistic regression was used to identify predictors. Result. The prevalence of anemia was 16.6%. Majority were mild type (64%) and morphologically normocytic normochromic (76%) anemia. Anemia was high at third trimester (18.9%). Low family income (AOR [95% CI] = 3.1 [1.19, 8.33]), large family size (AOR [95% CI] = 4.14 [4.13, 10.52]), hookworm infection (AOR [95% CI] = 2.72 [1.04, 7.25]), and HIV infection (AOR [95% CI] = 5.75 [2.40, 13.69]) were independent predictors of anemia. Conclusion. The prevalence of anemia was high; mild type and normocytic normochromic anemia was dominant. Low income, large family size, hookworm infection, and HIV infection were associated with anemia. Hence, efforts should be made for early diagnosis and management of HIV and hookworm infection with special emphasis on those having low income and large family size. PMID:24669317
Koski, Sari M; Laitinen-Parkkonen, Pirjo; Airaksinen, Marja
The study aim was to explore the progress of legislation relating to herbal medicinal products in the European Union and compare it with the corresponding progress of the legislation in Finland in 1965-2007. The study was carried out using content analysis. Data were searched from publicly available European Union directives and national acts. All definitions and safety-related requirements for herbal medicinal products were identified. The transposition of safety-related requirements into the national legislation was studied. Medicinal products from plant origins have been part of the European Union legislation since 1965. Most plant-based products have not initially been regarded as medicinal products but rather as some kind of medicine-like products. The official definition of herbal medicinal products was introduced in Directive 2004/24/EC and implemented into the Finnish legislation with the terminology to recognise herbal medicinal products as part of medicinal products. The current safety-related requirements of medicinal products concern analogously herbal medicinal products. Herbal medicinal products have had different definitions in pharmaceutical legislation over the study period in the European Union and Finland. The current definition places herbal medicinal products more clearly under the medicinal products' legislation. Safety-related requirements are now practically identical for all medicinal products. Transposition of the European Union legislation into the national legislation in Finland is apparent. Copyright © 2013 John Wiley & Sons, Ltd.
The project will also look at the impact of results-based financing on health providers' motivation and teamwork, local leadership, community management committees of health facilities, access to and use of health ... L'importance des services de garde d'enfants pour améliorer les possibilités économiques des femmes.
Full Text Available Phenylketonuria is a hereditary metabolic disorder inherited in an autosomal recessive pattern. Elevated phenylalanine levels in a pregnant woman with phenylketonuria result in phenylalanine embryopathy. Failure to follow special diets during gestation results in neonatal dysplasia. More favorable outcomes are observed when phenylalanine levels remain within normal ranges prior to conception, or at least when they reach normal levels by the 4th-10th weeks of gestation. We report the case of a newborn with maternal phenylketonuria.
These columns treat of the legislative and regulatory activities of different OECD countries: Australia (environment protection and biodiversity conservation act and regulations, 1999-2000); Bulgaria (basic standards for radiation protection, 2000); France (decree on the standard tax charged on polluting activities due from operators of installations classified for environmental protection purposes, 2000; amendment of the orders on the transport of dangerous goods by road and by rail, 2000); Georgia (law on nuclear and radiation safety, 1998); Germany (amendments to nuclear legislation implementing EURATOM directives, 2000; amendment to the nuclear third party liability provisions of the atomic energy act, 2001; amendment to the foreign trade ordinance, 2000; ordinance on the treatment of foodstuffs with radiation, 2000; general administrative regulations on radioactivity limits in food and feeds); Ireland (European communities regulations on foodstuffs treated with ionizing radiations, 2000); Japan (law for nuclear sitting area development, 2000; Republic of Korea (amendments to the act on compensation for nuclear damage, 2001); Latvia (act on radiation safety and nuclear safety, 2000); Lithuania (resolution approving the decommissioning program for Unit 1, Ignalina NPP, 2001); Luxembourg (grand-ducal regulations on the protection of the public against the risks resulting from ionizing radiation, 2000; grand-ducal regulations relating to foods and food ingredients treated with ionizing radiation, 2000); Mexico (norm regarding selection, qualification and training requirements for staff of a NPP, 2000; norm regarding solid residue as radioactive waste, 2000); Mongolia (law on nuclear weapons free status and its implementing resolution, 2000); Netherlands (amendment to the nuclear energy act, 2000); Norway (act on radiation and use of radiation, 2000); Pakistan (nuclear authority ordinance, 2001); Poland (atomic energy act, 2000); Spain (royal decree on activities
This section treats of the following National legislative and regulatory activities: 1 - Argentina: Organisation and structure; 2 - France: Radioactive waste management (Act No. 2016-1015 of 25 July 2016 specifying the procedures for creating a reversible deep geological repository for long-lived medium and high-level radioactive waste), Liability and compensation (Decree No. 2016-333 of 21 March 2016 implementing Article L. 597-28 of the French Environmental Code and relating to third party liability in the field of nuclear energy; Ministerial Order of 19 August 2016 listing the sites benefiting from a reduced amount of liability pursuant to decree No. 2016-333 of 21 March 2016 implementing Article L. 597-28 of the French Environmental Code and relating to third party liability in the field of nuclear energy), Nuclear facilities (Decree No. 2016-846 of 28 June 2016 related to the modification, final shutdown and decommissioning of basic nuclear installations, and to subcontracting); 3 - Germany: Nuclear trade - including non-proliferation (Amendments to the Foreign Trade Act and the Foreign Trade Ordinance (2015)), Radioactive waste management (Act on the Organisational Restructuring in the Field of Radioactive Waste Management (2016); Final report of the Commission to Review the Financing for the Phase-out of Nuclear Energy; Draft Bill of an Act on the Reorganisation of the Responsibility of Nuclear Waste Disposal (2016)); 4 - Lithuania: Nuclear safety and radiological protection (including nuclear emergency planning), Nuclear security (Physical security of sources of ionising radiation), Radioactive waste management, Licensing and regulatory infrastructure (Enforcement measures); 5 - Luxembourg: Radioactive waste management (Agreement between the Grand Duchy of Luxembourg and the Kingdom of Belgium on the Management and Final Disposal of the Radioactive Waste of the Grand Duchy of Luxembourg on the Territory of the Kingdom of Belgium, signed on 4 July 2016); 6
Manzi, Fatuma; Daviaud, Emmanuelle; Schellenberg, Joanna; Lawn, Joy E; John, Theopista; Msemo, Georgina; Owen, Helen; Barger, Diana; Hanson, Claudia; Borghi, Josephine
Despite health systems improvements in Tanzania, gaps in the continuum of care for maternal, newborn and child health persist. Recent improvements have largely benefited those over one month of age, leading to a greater proportion of under-five mortality in newborns. Community health workers providing home-based counselling have been championed as uniquely qualified to reach the poorest. We provide financial and economic costs of a volunteer home-based counselling programme in southern Tanzania. Financial costs of the programme were extracted from project accounts. Ministry of Health and Social Welfare costs associated with programme implementation were collected based on staff and project monthly activity plans. Household costs associated with facility-based delivery were also estimated based on exit interviews with post-natal women. Time spent on the programme by implementers was assessed by interviews conducted with volunteers and health staff. The programme involved substantial design and set-up costs. The main drivers of set-up costs were activities related to volunteer training. Total annualized costs (design, set-up and implementation) amounted to nearly US$300 000 for financial costs and just over US$400 000 for economic costs. Volunteers (n = 842) spent just under 14 hours per month on programme-related activities. When volunteer time was valued under economic costs, this input amounted to just under half of the costs of implementation. The economic consequences of increased service use to households were estimated at US$36 985. The intervention cost per mother-newborn pair visited was between US$12.60 and US$19.50, and the incremental cost per additional facility-based delivery ranged from US$85.50 to US$137.20 for financial and economic costs (with household costs). Three scale-up scenarios were considered, with the financial cost per home visit respectively varying from $1.44 to $3.21 across scenarios. Cost-effectiveness compares well with supply
Kubo, Ai; Deardorff, Julianna; Laurent, Cecile A; Ferrara, Assiamira; Greenspan, Louise C; Quesenberry, Charles P; Kushi, Lawrence H
Early puberty is associated with adverse health outcomes. We investigated whether in utero exposure to maternal obesity is associated with daughters' pubertal timing using 15,267 racially/ethnically diverse Kaiser Permanente Northern California members age 6-11 years with pediatrician-assessed Tanner staging (2003-2017). We extracted maternal body mass index (BMI) during pregnancy from the electronic health record. Using a proportional hazards model with interval censoring we examined the associations between maternal obesity and girl's pubertal timing, and effect modification by race/ethnicity and mediation by pre-pubertal BMI. Maternal obesity (BMI ≥30 kg/m2) or overweight (BMI 25-29.9 kg/m2) was associated with earlier breast onset in girls [hazard ratio (HR) = 1.39, 95% confidence interval (CI): 1.30, 1.49; HR = 1.21, 95% CI: 1.13, 1.29, respectively], adjusting for girls' race/ethnicity, maternal age, education, parity and smoking during pregnancy. There was interaction by race/ethnicity for associations between maternal obesity and girls' pubic hair onset: associations were strongest among Asian and white girls [HR = 1.53, 95% CI: 1.24, 1.90; HR = 1.34, 95% CI: 1.18, 1.52, respectively] and absent for African-American girls. Adjustment for girls' pre-pubertal BMI only slightly attenuated associations. Our results suggest the importance of maternal metabolic factors during pregnancy on girls' pubertal timing and potential differences in the associations by race/ethnicity.
Thornton, Matthew D; Cicero, Mark X; McCabe, Megan E; Chen, Lei
Automated external defibrillators (AEDs) have demonstrated increased survival in out-of-hospital cardiac arrest, and their prevalence continues to rise. In 2009, Connecticut passed a legislation requiring all schools to have an AED, barring financial barriers. The objectives of this study were (1) to determine if this legislation was associated with an increase in Connecticut high school AEDs and (2) to detect disparities in the availability of AEDs based on school type, student demographics, and school size. A single researcher conducted a scripted telephone survey of all 54 public and 13 private high schools in New Haven County, Connecticut. A response rate of 100% was achieved. Forty-nine percent of high schools had an AED before the legislation, compared with 88% after (P schools had a higher percentage of AEDs than public schools (69% vs 44%; P = 0.1). Postlegislation, the difference is less (92% vs 87%; P = 0.4). Small schools (schools (40% vs 100%; P Schools with a higher percentage of students with disabilities are also less likely to have an AED (P = 0.005), even when controlling for school size (P = 0.03). State legislation requiring schools to have an AED, if financially feasible, was associated with a significant increase in AED presence among New Haven County high schools. Small high schools and those with a higher percentage of students with disabilities remain less likely to have an AED despite legislation.
Jessica M E van den Oever
Full Text Available OBJECTIVES: RASSF1A has been described to be differentially methylated between fetal and maternal DNA and can therefore be used as a universal sex-independent marker to confirm the presence of fetal sequences in maternal plasma. However, this requires highly sensitive methods. We have previously shown that Pyrophosphorolysis-activated Polymerization (PAP is a highly sensitive technique that can be used in noninvasive prenatal diagnosis. In this study, we have used PAP in combination with bisulfite conversion to develop a new universal methylation-based assay for the detection of fetal methylated RASSF1A sequences in maternal plasma. METHODS: Bisulfite sequencing was performed on maternal genomic (gDNA and fetal gDNA from chorionic villi to determine differentially methylated regions in the RASSF1A gene using bisulfite specific PCR primers. Methylation specific primers for PAP were designed for the detection of fetal methylated RASSF1A sequences after bisulfite conversion and validated. RESULTS: Serial dilutions of fetal gDNA in a background of maternal gDNA show a relative percentage of ~3% can be detected using this assay. Furthermore, fetal methylated RASSF1A sequences were detected both retrospectively as well as prospectively in all maternal plasma samples tested (n = 71. No methylated RASSF1A specific bands were observed in corresponding maternal gDNA. Specificity was further determined by testing anonymized plasma from non-pregnant females (n = 24 and males (n = 21. Also, no methylated RASSF1A sequences were detected here, showing this assay is very specific for methylated fetal DNA. Combining all samples and controls, we obtain an overall sensitivity and specificity of 100% (95% CI 98.4%-100%. CONCLUSIONS: Our data demonstrate that using a combination of bisulfite conversion and PAP fetal methylated RASSF1A sequences can be detected with extreme sensitivity in a universal and sex-independent manner. Therefore, this assay could be of great
SIBLEY P. J.
Full Text Available Underpinning the conservation management of Austropotamobius pallipes in the UK is the process of monitoring and reporting crayfish distribution. Should the current trend in the decline of A. pallipes continue, the species could be virtually extinct in mainland Britain within 30 years (SIBLEY, 2003. Conversely, if the increase in the distribution of non-indigenous crayfish species (NICS continues at its current rate, the distribution (by 10 km squares of these species could double within 15 years. These forward projections are based on a number of possibly unreliable assumptions; they illustrate however the magnitude of the challenge facing those concerned with the conservation of A. pallipes in the UK at this time. Recent work in crayfish conservation management in the UK has yielded guidance in several areas including monitoring, habitat enhancement and a re-introduction protocol for A. pallipes (KEMP and HILEY, 2003. Similarly, scientific research continues to inform our understanding of the movement and behaviour of NICS and explores new methods for the potential management of these species. In addition, the protection afforded to A. pallipes by current legislation is key to the long-term survival prospects of the species, albeit with a probable fragmented distribution, across the British Isles and continental Europe. Legal provisions in the UK derive in part from European instructions (e.g. EC Habitats and Species Directive and also from national legislation (e.g. Salmon and Freshwater Fisheries Act (1975 and the Wildlife and Countryside Act (1981. Also, a raft of “quasi-legislation” exists which requires responsible organisations in the UK to implement the white-clawed crayfish biodiversity action plan (BAP. Altogether these provisions constitute a considerable volume of legal protection for crayfish and provide the legal framework on which UK management policy and practice are based.
Full Text Available The article analyses problems facing electronic legislation development (especially legislation processes of publishing acts in EU and EFTA member countries.All European countries were publishing acts officially on paper until the end of year 2000. The way of publishing acts officially was the same in all Europe countries, except that some counties had one “official journal” in which legal acts and other official documents and legal notices were published, and other countries had separate legal gazettes for acts publishing and an official gazette for publishing other official documents and legal notices.At the beginning of 2001 Norway started to publish acts officially in digital form, and only 12-20 times a year paper editions to present the statutes and regulations enacted since the publication of the previous issue are published. In 2002 Estonia decided to finish the publishing of paper editions, and started to publish acts only electronically. Till 2011 more than 10 European countries started to publish acts officially in digital format.Author discusses the advantages, principles, and legitimate expectation of electronic legislation. For future electronic legislation information systems developments the following principles should be a guide: broad/universal and equal access to legislation, reliability of the means of publicity, integrity of information, easy access to the requisite information. The advantages of digital act forms, and internet based publications are instantaneous outreach to the public, free of charge, information easily accessible and retrievable, voluminous technical acts easier to handle, no printing costs, more environmentally-friendly, more and more people use ICT to seek information, no time constraints to the availability of data, legal certainty will be granted.The author thinks that before creating future digital legislation information systems, some procedures shall be done. If we want to have pan
Full Text Available The article analyses problems facing electronic legislation development (especially legislation processes of publishing acts in EU and EFTA member countries. All European countries were publishing acts officially on paper until the end of year 2000. The way of publishing acts officially was the same in all Europe countries, except that some counties had one “official journal” in which legal acts and other official documents and legal notices were published, and other countries had separate legal gazettes for acts publishing and an official gazette for publishing other official documents and legal notices. At the beginning of 2001 Norway started to publish acts officially in digital form, and only 12-20 times a year paper editions to present the statutes and regulations enacted since the publication of the previous issue are published. In 2002 Estonia decided to finish the publishing of paper editions, and started to publish acts only electronically. Till 2011 more than 10 European countries started to publish acts officially in digital format. Author discusses the advantages, principles, and legitimate expectation of electronic legislation. For future electronic legislation information systems developments the following principles should be a guide: broad/universal and equal access to legislation, reliability of the means of publicity, integrity of information, easy access to the requisite information. The advantages of digital act forms, and internet based publications are instantaneous outreach to the public, free of charge, information easily accessible and retrievable, voluminous technical acts easier to handle, no printing costs, more environmentally-friendly, more and more people use ICT to seek information, no time constraints to the availability of data, legal certainty will be granted. The author thinks that before creating future digital legislation information systems, some procedures shall be done. If we want to have pan
Nigatu, Dabere; Gebremariam, Abebe; Abera, Muluemebet; Setegn, Tesfaye; Deribe, Kebede
Women's autonomy in health-care decision is a prerequisite for improvements in maternal and child health. Little is known about women's autonomy and its influencing factors on maternal and child health care in Ethiopia. Therefore, this study was conducted to assess women's autonomy and identify associated factors in Southeast Ethiopia. A community based cross-sectional study was conducted from March 19th until March 28th, 2011. A total of 706 women were selected using stratified sampling technique from rural and urban kebeles. The quantitative data were collected by interviewer administered questionnaire and analyzed using SPSS for window version 16.0. Descriptive statistics, bivariate and multiple logistic regression analyses were carried out to identify factors associated with women's autonomy for health care utilization. Out of 706 women less than half (41.4%) had higher autonomy regarding their own and their children's health. In the multiple logistic regression model monthly household income >1000 ETB [adjusted odds ratio(AOR):3.32(95% C.I: 1.62-6.78)], having employed husband [AOR: 3.75 (95% C.I:1.24-11.32)], being in a nuclear family structure [AOR: 0.53(95% C.I: 0.33-0.87)], being in monogamous marriage [AOR: 3.18(95% C.I: 1.35-7.50)], being knowledgeable and having favorable attitude toward maternal and child health care services were independently associated with an increased odds of women's autonomy. Socio-demographic and maternal factors (knowledge and attitude) were found to influence women's autonomy. Interventions targeting women's autonomy with regards to maternal and child health care should focus on addressing increasing awareness and priority should be given to women with a lower socioeconomic status.
Puig Cardozo, Diva E.
The laws on radiological protection have special characteristics. They can exist laws that regulate dangerous activities that will be also applicable, if it corresponds to the activities that involve radioactive materials. But a law of radiological protection should exist. It foresees the existence of an appropriate regulatory body and specialized institutions, definitions, infractions and sanctions then the respective regulations will be elaborated for the different applications. The objective is to contribute to the development of the nuclear energy in the country and to provide the regulatory basis that assures a reasonable security for radioactive installations. The essential objectives of these laws are: 1. to establish the legislative framework for the development and employment of nuclear energy, without risks, according with treaties and conventions that the countries have approved. 2. To fix the fundamental principles and the conditions of their setting in practice allowing to a specific regulation determining application procedures. 3. To create a structure of regulation of enough authority to be able to control and to watch over in an effective way the authorized activities 4. To guarantee an appropriate financial protection against the derived damages of accidents or nuclear incidents. (author)
Full Text Available The need for punishment of juveniles occurred from the time when there was no clear line separating them from the adult criminal population. At the same time, the evolution of the juvenile punishment is not in itself involve substantial changes to their criminal status. On the contrary, the status of minors in society did not show serious differences regarding the status of young adults, as well as the adult elderly. On the other hand, on the ground of their punishment is recorded deviations that go in the direction of application of mild corporal punishment. Closing the minor was performed in a physically separate parts of the general penal institutions with the use of a lower degree of restrictions while serving juvenile prison. Due to the different treatment of minors during the evolution of their criminal status leads to their different treatment in comparative law. That is why we are witnessing the existence of numerous differences in the juvenile punishment in some countries in the world. On the European continent there is a wide range of different legal solutions when it comes to punishing juveniles. There are considerable differences in the procedure pronouncing juvenile prison and in particular penal treatment of juveniles in penitentiary institutions. For these reasons, the author has decided to show the basic statutory provisions in the part that relates to the issue of punishment of minors in the legislation of individual countries.
Full Text Available In Europe, as in the rest of industrialized countries, reforms of the labour market have generally concerned employment protection legislation (EPL. One of the main missions of this legislation is to insure security for workers, particularly in case of redundancy. The object of this article is to compare the strictness and the degree of rigidity of EPL in two different economies, namely, Canada and France. This choice is justified by the fact that the labour market policies in both countries do not have the same orientation and are based on different ideological references.
Zhang, Ling; Xue, Chengbing; Wang, Youjie; Zhang, Liuyi; Liang, Yuan
Despite the benefits of maternal health services, these services are often underutilized, especially in the developing countries. The aim of the present study is to provide insight regarding factors affecting maternal health services use from the family perspective. We use data from the fourth National Health Services Survey in Jiangsu province of Eastern China to investigate the effect of family characteristics on the use of maternal health services. Family characteristics included whether or not living with parents, age of husband, husband's education, and husband's work status as well as family economic status. Demographic variables, social and environmental factors, and previous reproductive history were taken as potential confounders. Multiple logistic regression models were used to examine the independent effects of the family characteristic variables on maternal health service utilization. The data indicate that the percentages of prenatal care, postnatal visits and hospital delivery were 85.44, 65.12 and 99.59 % respectively. Living with parents was associated with less use of prenatal care and husband's age, education and employment status had no effect on the use of prenatal care after adjusting for potential confounding variables. Our findings suggest that maternal health education (especially the role of prenatal care) needs to be extended beyond the expectant mothers themselves to their parents and husbands. The difference of health care delivery as a result of traditional family culture may highlight the differences in factors influencing the use of postnatal visits and those influencing the use of prenatal care; which may be worthy of further study.
1 Need and necessity for the legislation of Chinese space activities --Complying with UN treaties and principles on outer space --Adapting to the requirements of market economy --Promoting the further development of Chinese space activities --Developing international space cooperation 2 Research method for legislation of Chinese space activities The research method is ROCCIPI. This method was introduced into China with the project "Legislation Supports Economy Reform" supported by the UN Office of Development Planning - By analyzing the correlations among the seven factors: Rule, Opportunity, Capacity, Communication, Interest, Process and Ideology, the optimal legal measures can be found . Such analysis and research works on the master law of Chinese space activities have been made in the paper. 3 Research of international treaties &principles on outer space, and of national space laws of other countries. Studies have been made in this paper on many aspects of international outer space laws, such as framework, development stage, current characteristics, new problems will be faced with in new century, and development tendency in the future, etc. Based on the investigation and study of national space laws of other countries, analyses and researches on national space law have been made in the paper from some aspects, such as legislative purpose, legislative aim, legislative form, legislative content and etc, and some enlightenments, which can be used for reference in the legislation of Chinese Space Laws, are found. 4 Framework of Chinese Space Laws The jurisdiction of Chinese Space Laws lies in three areas: space technology - space applications and space science. Chinese Space Laws are divided into 3 levels: Master law, Administration Regulations of the State Council of the P.R.C, Rules of governmental sectors. 5 Conclusions and Suggestions --The legislation of Chinese Space Activities should be strengthened --More attentions should be paid to the research work in
Ekirapa-Kiracho, Elizabeth; Barger, Diana; Mayora, Chripus; Waiswa, Peter; Lawn, Joy E; Kalungi, James; Namazzi, Gertrude; Kerber, Kate; Owen, Helen; Daviaud, Emmanuelle
The Uganda Newborn Study (UNEST) was a two-arm cluster Randomized Control Trial to study the effect of pregnancy and postnatal home visits by local community health workers called 'Village Health Teams' (VHT) coupled with health systems strengthening. To inform programme planning and decision making, additional economic and financial costs of community and facility components were estimated from the perspective of the provider using the Excel-based Cost of Integrating Newborn Care Tool. Additional costs excluded costs already paid by the government for the routine health system and covered design, set-up, and 1-year implementation phases. Improved efficiency was modelled by reducing the number of VHT per village from two to one and varying the number of home visits/mother, the programme's financial cost at scale was projected (population of 100 000). 92% of expectant mothers (n = 1584) in the intervention area were attended by VHTs who performed an average of three home visits per mother. The annualized additional financial cost of the programme was $83 360 of which 4% ($3266) was for design, 24% ($20 026) for set-up and 72% ($60 068) for implementation. 56% ($47 030) went towards health facility strengthening, whereas 44% ($36 330) was spent at the community level. The average cost/mother for the community programme, excluding one-off design costs, amounted to $22.70 and the average cost per home visit was $7.50. The additional cost of the preventive home visit programme staffed by volunteer VHTs represents $1.04 per capita, 1.8% of Uganda's public health expenditure per capita ($59.00). If VHTs were to spend an average of 6 h a week on the programme, costs per mother would drop to $13.00 and cost per home visit to $3.20, in a population of 100 000 at 95% coverage. Additional resources are needed to rollout the government's VHT strategy nationally, maintaining high quality and linkages to quality facility-based care. © The Author 2017. Published by Oxford
Najmi, N.; Sikandar, R.; Zuberi, N.F.
Objectives: To determine the prevalence of Group B Streptococcus genital tract infection in pregnant women and to determine the risk factors for its colonisation. Methods: The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi and Sobhraj Hospital, Karachi, from May to August 2007. Pregnant women at 35-37 weeks gestation attending antenatal clinic at these hospitals constituted the study population. Based on stratified sampling, 405 patients were recruited. High vaginal swabs of these patients were taken in order to calculate the prevalence of infection at each hospital. Logistic regression was used to evaluate the risk factor association. SPSS 11.5 was used for statistical analysis. Results: The overall prevalence of colonisation was 17% (n=69) (95% CI: 13.4-20.7). Of the 155(38.27%) women at the Aga Khan Hospital, 35(22.6%) were positive, while among the 250 (61.72%) women at Sobhraj Hospital, the prevalence was 13.6% (n=34). The colonisation was found to be significantly associated inversely with the body mass index of the patient (OR 0.91; 95% CI: 0.08-1.0). Conclusion: Group B Streptococcus screening should be an integral part of antenatal care and should be offered to all pregnant women. (author)
The first national nutrition survey of Thailand in 1960 revealed that malnutrition among children and women in this rice-exporting country was highly prevalent. Malnutrition received national-level attention in the 1970s, when a national multisectoral nutrition plan was included in the Fourth National Economic and Social Development Plan (NESDP) (1977-81), followed by effective implementation through Thailand's primary healthcare system and poverty alleviation plan in the 1982-87 NESDP. Nutrition was embedded into primary healthcare, and a community-based nutrition program was successfully implemented through community participation via manpower mobilization and capacity-building, financing, and organization. Growth-monitoring, promotion of infant and young child feeding, and joint financing (government and community) of a nutrition fund were implemented. The poverty alleviation plan made it possible to streamline resource allocations at the national level down to priority poverty areas, which also facilitated microlevel planning. Effective, integrated actions were undertaken using the basic minimum needs approach, wherein community people identified problems and participated in actions with inputs from government personnel. This effective process took about 5 years to put in place. In response, child undernutrition declined significantly. Severe malnutrition was practically eradicated, and it remains resilient despite social and economic challenges, such as the Asian economic crisis in 1977. Currently, stunting and subclinical micronutrient deficiencies remain, while overweight and obesity among children are rising rapidly. A different paradigm and strategy will be essential to address the nation's current nutrition challenges.
Huang, Yan; Luo, Bi-ru
To detect the diet behavior and influencing factors of related behavior at different stages among pregnant women. Based on the Theory of Reasoned Action (TRA), literature review, expert evaluation and preliminary investigation, we designed and finalized three questionnaires. Diet behaviors among women in early term, medium term and late term were investigated by using the questionnaires. 624 early term, 619 medium term and 738 late term valid questionnaires were returned. Participants ranged from 18 to 45 years of age. 74% pregnancy body mass index (BMI) was within the normal range. More than 43% care taking was provided by the mother, followed by the husband. The participants had a good eating behavior on the whole. At 3 stages, carbohydrate intake, protein intake and fat intake were no significant difference when compared with that of recommended value (P> 0. 05). The pregnant women intaked insufficient cereal, beans, dairy and aquatic products, while fruit and nuts were more than needed (Preasonable combination of a variety of food. Subjective norms influenced their behavior attitude and behavioral intention. The mother had the strongest influence on the pregnant woman's diet attitude and behavioral intention among all those had direct contact with the pregnant woman.
Ang, K C; Leow, J W H; Yeap, W K; Hood, S; Mahani, M C; Md-Zain, B M
Malaysia remains as a crossroad of different cultures and peoples, and it has long been recognized that studying its population history can provide crucial insight into the prehistory of Southeast Asia as a whole. The earliest inhabitants were the Orang Asli in Peninsular Malaysia and the indigenous groups in Sabah and Sarawak. Although they were the earliest migrants in this region, these tribes are divided geographically by the South China Sea. We analyzed DNA sequences of 18 Orang Asli using mitochondrial DNA extracted from blood samples, each representing one sub-tribe, and from five Sarawakian Iban. Mitochondrial DNA was extracted from hair samples in order to examine relationships with the main ethnic groups in Malaysia. The D-loop region and cytochrome b genes were used as the candidate loci. Phylogenetic relationships were investigated using maximum parsimony and neighbor joining algorithms, and each tree was subjected to bootstrap analysis with 1000 replicates. Analyses of the HVS I region showed that the Iban are not a distinct group from the Orang Asli; they form a sub-clade within the Orang Asli. Based on the cytochrome b gene, the Iban clustered with the Orang Asli in the same clade. We found evidence for considerable gene flow between Orang Asli and Iban. We concluded that the Orang Asli, Iban and the main ethnic groups of Malaysia are probably derived from a common ancestor. This is in agreement with a single-route migration theory, but it does not dismiss a two-route migration theory.
Meulen, van der B.M.J.
A variety of systems are presented in the perspective of the development of food legislation to give an impression of the features found in food law and the reasons they have taken certain forms. Legislation on food is not only widely distributed in time but also in space. The assurance of safe food
... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Legislation. 26.4 Section 26.4 Public Lands: Interior Office of the Secretary of the Interior GRANTS TO STATES FOR ESTABLISHING YOUTH CONSERVATION CORPS PROGRAMS § 26.4 Legislation. State programs must meet all of the requirements of section 4...
McBride, Shirley R.
This article reviews the historical context in which Canadian legislation and policy for children with special needs has evolved. The potential for the rights of students with special needs in light of the Canadian Charter of Rights and Freedoms is outlined. The role of the Federal and Provincial governments in legislation and policy vis-à-vis…
Problems and principles of domestic sanitary legislation, concerning population radiation protection, are considered. The legislation envisages preventive measures, directed to contamination preventation of the main environmental objects, it regulates their content in the objects, their human intake and ionizing radiation doses, which might affect population. Existing domestic hygienic guides and safety standards for personnel and population are enumerated and characterized
... on the environment, that subunit shall prepare a legislative environmental impact statement in... ENVIRONMENTAL POLICY ACT Implementing Procedures § 61.7 Legislative proposals. (a) Each subunit of the... to Congress which may have an effect on the environment shall, in the early stages of development of...
Iversen, Ditte S; Kesmodel, Ulrik S; Ovesen, Per G
We aimed to investigate the change in prevalence of overweight and obesity in pregnant Danish women from 2004 to 2012, and investigate whether increasing parity was associated with a change in body mass index (BMI) prevalence. We obtained a population-based cohort from the Danish Medical Birth Registry consisting of all Danish women giving birth in 2004-2012 (n = 572 321). This registry contains information on 99.8% of all births in Denmark. We calculated the overall change in prepregnancy BMI status among pregnant women in Denmark, and a multiple linear regression model with adjustment for several potential confounders was used to examine the change in prepregnancy BMI with increasing parity. In 2004, the prevalence of prepregnancy overweight and obesity (BMI ≥ 25) and obesity alone (BMI ≥ 30) was 31.9 and 11%, respectively. In 2012, the prevalence had reached 34.2 and 12.8%. The mean BMI increased for every additional parity from 23.80 (95% CI 23.77-23.82) in parity group 1 to 26.70 (26.52-26.90) in parity group 5+. A multiple linear regression adjusted for potential confounders showed that women on average gained 0.62 (0.58-0.65) BMI units after every additional birth. This study showed a 7.2% increase in overweight and obesity (BMI ≥ 25) and a 16.4% increase in obesity alone (BMI ≥ 30) for pregnant women in Denmark from 2004 to 2012. In addition, an increase in interpregnancy BMI was seen at every additional delivery, suggesting that obesity is an increasing challenge in obstetrics. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.
Bolajoko O Olusanya
Full Text Available Objective: To identify the socio-demographic antecedents and pregnancy-related history of infants with abnormal head sizes in a developing country. Materials and Methods: An observational study of mother-infant pairs attending routine immunization clinics in an inner-city community in Lagos, Nigeria. Age and gender-specific head circumference was determined with the current Child Growth Standards of the World Health Organization (WHO. Factors independently associated with any abnormal head size (z-score 2SD, based on the adjusted odds ratio (OR and 95% confidence interval (CI, were explored with multiple logistic regression analyses. Results: Of the 5731 mothers studied, 730 (12.7% had an offspring with an abnormal head size. In the final regression model, teenage mothers (OR:1.86; CI:1.26 - 2.75, mothers with primary or no education (OR:1.65; P = 0.007, multiple pregnancies (OR:3.88; CI:2.53 - 5.95, and delivery in either private hospitals (OR:1.54; CI:1.22 - 1.95 or residential homes (OR:1.50; CI:1.05 - 2.14, compared to government hospitals, were significantly more likely to have offsprings with abnormal head sizes. Conclusions: Community-oriented public health education, targeting prospective mothers with multiple pregnancies, teenage girls, and women with little or no formal education on the potential risk of delivery outside public hospitals, may curtail the burden of abnormal head size of their offspring and reduce the pressure on the already overstretched rehabilitation services in resource-poor countries.
Watson, Chanel L; O'Connor, Tom
The role of nurses as patient advocates is one which is well recognised, supported and the subject of a broad body of literature. One of the key impediments to the role of the nurse as patient advocate is the lack of support and legislative frameworks. Within a broad range of activities constituting advocacy, whistleblowing is currently the subject of much discussion in the light of the Mid Staffordshire inquiry in the United Kingdom (UK) and other instances of patient mistreatment. As a result steps to amend existing whistleblowing legislation where it exists or introduce it where it does not are underway. This paper traces the development of legislation for advocacy. The authors argue that while any legislation supporting advocacy is welcome, legislation on its own will not encourage or enable nurses to whistleblow.
Full Text Available BACKGROUND: An association between maternal pre-pregnancy BMI and childhood intelligence quotient (IQ has repeatedly been found but it is unknown if this association is causal or due to confounding caused by genetic or social factors. METHODS: We used a cohort of 1,783 mothers and their 5-year-old children sampled from the Danish National Birth Cohort. The children participated between 2003 and 2008 in a neuropsychological assessment of cognitive ability including IQ tests taken by both the mother and the child. Linear regression analyses were used to estimate the associations between parental BMI and child IQ adjusted for a comprehensive set of potential confounders. Child IQ was assessed with the Wechsler Primary and Preschool Scales of Intelligence--Revised (WPPSI-R. RESULTS: The crude association between maternal BMI and child IQ showed that BMI was adversely associated with child IQ with a reduction in IQ of -0.40 point for each one unit increase in BMI. This association was attenuated after adjustment for social factors and maternal IQ to a value of -0.27 (-0.50 to -0.03. After mutual adjustment for the father's BMI and all other factors except maternal IQ, the association between paternal BMI and child IQ yielded a regression coefficient of -0.26 (-0.59 to 0.07, which was comparable to that seen for maternal BMI (-0.20 (-0.44 to 0.04. CONCLUSION: Although maternal pre-pregnancy BMI was inversely associated with the IQ of her child, the similar association with paternal BMI suggests that it is not a specific pregnancy related adiposity effect.
Bliddal, Mette; Olsen, Jørn; Støvring, Henrik; Eriksen, Hanne-Lise F; Kesmodel, Ulrik S; Sørensen, Thorkild I A; Nøhr, Ellen A
An association between maternal pre-pregnancy BMI and childhood intelligence quotient (IQ) has repeatedly been found but it is unknown if this association is causal or due to confounding caused by genetic or social factors. We used a cohort of 1,783 mothers and their 5-year-old children sampled from the Danish National Birth Cohort. The children participated between 2003 and 2008 in a neuropsychological assessment of cognitive ability including IQ tests taken by both the mother and the child. Linear regression analyses were used to estimate the associations between parental BMI and child IQ adjusted for a comprehensive set of potential confounders. Child IQ was assessed with the Wechsler Primary and Preschool Scales of Intelligence--Revised (WPPSI-R). The crude association between maternal BMI and child IQ showed that BMI was adversely associated with child IQ with a reduction in IQ of -0.40 point for each one unit increase in BMI. This association was attenuated after adjustment for social factors and maternal IQ to a value of -0.27 (-0.50 to -0.03). After mutual adjustment for the father's BMI and all other factors except maternal IQ, the association between paternal BMI and child IQ yielded a regression coefficient of -0.26 (-0.59 to 0.07), which was comparable to that seen for maternal BMI (-0.20 (-0.44 to 0.04)). Although maternal pre-pregnancy BMI was inversely associated with the IQ of her child, the similar association with paternal BMI suggests that it is not a specific pregnancy related adiposity effect.
Vaughn, Brian E.; Coppola, Gabrielle; Verissimo, Manuela; Monteiro, Ligia; Santos, Antonio Jose; Posada, German; Carbonell, Olga A.; Plata, Sandra J.; Waters, Harriet S.; Bost, Kelly K.; McBride, Brent; Shin, Nana; Korth, Bryan
The secure-base phenomenon is central to the Bowlby/Ainsworth theory of attachment and is also central to the assessment of attachment across the lifespan. The present study tested whether mothers' knowledge about the secure-base phenomenon, as assessed using a recently designed wordlist prompt measure for eliciting attachment-relevant stories,…
This section compiles the presentations of the following texts sorted by country. Armenia - Licensing and regulatory infrastructure: New design safety requirements adopted, New seismic hazard assessment guidelines adopted; France - Licensing and regulatory infrastructure: Decree No. 2012-1248 of 9 November 2012 authorising the ITER Organisation to create the 'ITER' basic nuclear installation in Saint-Paul-lez-Durance (Bouches-du-Rhone); - Nuclear security: Law No. 2012-1473 of 28 December 2012 authorizing the approval of the Amendment to the Convention on the Physical Protection of Nuclear Material; - Nuclear safety and radiological protection: Complementary safety assessments. Follow-up of the stress tests carried out on French nuclear power plants. Action Plan of the French Nuclear Safety Authority (ASN) - December 2012; - International cooperation: Decree No. 2012-1178 of 22 October 2012 publishing the Cooperation Agreement between the government of the French Republic and the government of the Republic of Tunisia for the development of peaceful uses of nuclear energy, signed in Tunis on 23 April 2009; Decree No. 2012-1180 of 22 October 2012 publishing the Cooperation Agreement between the government of the French Republic and the government of Mongolia in the field of nuclear energy (with annex), signed in Ulaanbaatar on 14 October 2010; Germany - General legislation: Bill to amend the Atomic Energy Act to expedite the retrieval of radioactive waste from and to decommission the Asse II Mine (2013); Act to amend the Act on Environmental Legal Remedies and other environmental provisions (2013); - Radiation protection: General administrative rules on Section 47 of the Radiation Protection Ordinance (2012); - Nuclear Safety: Safety requirements for nuclear power plants (2012); - Transport of radioactive material: International Transport of Dangerous Goods by Road (2010, 2012); - Regulations on nuclear trade (including non-proliferation): Export List (2013); Greece
The International Commission on Radiological Protection (ICRP) and The Council of the European Union have recommended the Member States to take action against radon in homes and at workplaces. Within the EU project European Research into Radon in Construction Concerted Action, ERRICCA, the Topic Group on Legal and Building Code Impact was designated to study the current radon legislation and give advice regarding future enactment of laws and recommendations. On behalf of the Group, a questionnaire on radon legislation was sent out to nearly all European states and a selection of non-European states. Questions were asked regarding reference levels for dwellings, workplaces and drinking water, and about regulations or recommendations for building materials and city planning. All 15 EU Member States, 17 non-EU European countries and 10 non-European countries responded to the questionnaire. Their answers are considered current as of the end of 1998. Most European States and many non-European countries have recommended reference levels for dwellings and workplaces, and some have guidelines for measures against radon incorporated in their building codes and guidelines for construction techniques. However, only a few countries have enforced reference levels or regulations for planning and construction. The reference levels for indoor radon concentration in existing and new dwellings or workplaces are within the range 150-1000 Bq/m 3 . Sweden is the only country (Out of 15 EU member states) which has enforced limits for existing dwellings. Sweden and the UK have both enforced levels for new dwellings. 7 non-European countries (Out of 17 responding countries) have enforced levels for existing dwellings and 9 have them for new dwellings. At the end of 1998, only Finland, Sweden, the Czech Republic, Romania, Russia and the Slovak Republic had limits for radon in water, although 8 countries were planning to introduce such limits. The present limits are within the range for 50
Neyssen, Peter J.G.
Food irradiation legislation is very different in most member-states of the EU. For many years there was the desire by many interested groups to harmonise this legislation. As the member-states had a different view on irradiated foods, often based on their existing regulation, it took many years and revised drafts to come to a harmonised regulation acceptable to the majority. The background on the development of this EU-legislation and the final draft is discussed. Some information is also given on the possible influence of WTO (SPS- and TBT-agreements) and Codex Alimentarius on this EU-legislation. (author)
Reed, J.B.; Cummins, J.
This is the sixth report prepared by the National Conference of State Legislatures (NCSL) on developments in radioactive materials transportation. It updates information contained in the November 1992 Legislative and Legal Developments in Radioactive Materials Transportation report and describes activities for the period November 1, 1992--March 31, 1993. NCSL is working to bring on-line a data base that contains abstracts of state laws and regulations relating to the transportation of radioactive materials. The data base will be operated by NCSL under a cooperative agreement with the Department of Energy's (DOE) Office of Civilian Radioactive Waste Management. Limited availability of on-line capability is anticipated by the end of July 1993. Users approved by DOE and NCSL will have access to the data base. Hard copy of any legislation listed in this report can be obtained by contacting the people listed below. This report contains summaries of legislation introduced in the 1993 state legislative sessions. Bills that address nuclear materials transportation and the broader area of hazardous materials transportation are grouped by state according to their status--enacted, pending or failed. In addition, bills that deal with emergency preparedness and general nuclear waste issues are described. Also included are Federal Register notices pertinent to radioactive waste and hazardous materials transportation. A recent court decision is also summarized
Worthley, J.A.; Reed, J.B.; Cummins, J.
This is the eighth report prepared by the National Conference of State Legislatures (NCSL) on developments in radioactive materials transportation. It updates information contained in the September 1993 report on Legislative Developments in Radioactive Materials Transportation and describes activities for the period September 1, 1993--June 30, 1994. NCSL currently is updating an on-line data base that contains abstracts of federal, state and local laws and regulations relating to the transportation of radioactive materials. The data base will be operated by NCSL under a cooperative agreement with the Department of Energy's (DOE) Office of Civilian Radioactive Waste Management. Availability of on-line capability is anticipated by the end of August 1994. Users approved by DOE and NCSL will have access to the data base. This report contains the current status of legislation introduced in the 1993 and 1994 state legislative sessions, not previously reviewed in past reports. Bills that address nuclear materials transportation and the broader area of hazardous materials transportation are grouped by state according to their status--enacted, pending or failed. In addition, bills that deal with emergency preparedness are described. (General nuclear waste legislation with no transportation element is no longer tracked.) Also included are Federal Register notices and changes in federal regulations pertinent to radioactive waste and hazardous materials transportation
Baker, Michael; Milligan, Kevin
We study the impact of maternal care on early child development using an expansion in Canadian maternity leave entitlements. Following the leave expansion, mothers who took leave spent 48-58 percent more time not working in their children's first year of life. This extra maternal care primarily crowded out home-based care by unlicensed…
Boatin, Adeline Adwoa; Adu-Bonsaffoh, Kwame; Wylie, Blair Johnson; Obed, Samuel A
Objective To describe facility-based decision-making for women with one prior cesarean delivery (CD) in a resource-limited setting and to characterize maternal and perinatal outcomes in these groups. Methods One year retrospective study of women with one prior CD delivering at Korle-Bu Teaching Hospital (KBTH), Ghana. Women were categorized into three groups based on initial plan of management on admission [trial of labor after cesarean (TOLAC), emergency repeat CD (EMCD) or non-emergent repeat CD (RCD)]. Characteristics and outcomes across these groups were then compared. Results During the study period, 1247 women with one prior CD delivered at KBTH, of which 377 (30.2%) were triaged to RCD, 439 (35.2%) to EMCD and 431 (34.6%) to TOLAC. Twelve uterine ruptures and no maternal deaths occurred. Perinatal mortality was 4.2% (n = 52). Compared to the RCD group, the TOLAC group had a lower risk for maternal adverse events (aOR 0.3, 95% CI 0.1-1.0; p = 0.04) and non-significant higher risk of perinatal adverse events (aOR 1.6, 95% CI 0.7-3.3; p = 0.25). Compared to women triaged to RCD, the EMCD group had a non-significant increase in risk of maternal adverse events (aOR 1.6, 95% CI 0.8-3.5; p = 0.2) and a significantly higher rate of perinatal adverse events (aOR 2.4, 95% CI 1.2-4.9; p = 0.01). Conclusions for Practice Women triaged to EMCD at admission are different when compared to women allowed a TOLAC or offered a non-emergent RCD. These women bear increased rates of adverse outcomes and should be considered as a separate group for analysis in future studies conducted in similar settings.
Full Text Available BACKGROUND: Maternal overweight and obesity increase risks of pregnancy and delivery complications and neonatal mortality, but the mechanisms are unclear. The objective of the study was to investigate associations between maternal body mass index (BMI in early pregnancy and severe asphyxia-related outcomes in infants delivered at term (≥37 weeks. METHODS AND FINDINGS: A nation-wide Swedish cohort study based on data from the Medical Birth Register included all live singleton term births in Sweden between 1992 and 2010. Logistic regression analyses were used to obtain odds ratios (ORs with 95% CIs for Apgar scores between 0 and 3 at 5 and 10 minutes, meconium aspiration syndrome, and neonatal seizures, adjusted for maternal height, maternal age, parity, mother's smoking habits, education, country of birth, and year of infant birth. Among 1,764,403 term births, 86% had data on early pregnancy BMI and Apgar scores. There were 1,380 infants who had Apgar score 0-3 at 5 minutes (absolute risk = 0.8 per 1,000 and 894 had Apgar score 0-3 at 10 minutes (absolute risk = 0.5 per 1,000. Compared with infants of mothers with normal BMI (18.5-24.9, the adjusted ORs (95% CI for Apgar scores 0-3 at 10 minutes were as follows: BMI 25-29.9: 1.32 (1.10-1.58; BMI 30-34.9: 1.57 (1.20-2.07; BMI 35-39.9: 1.80 (1.15-2.82; and BMI ≥40: 3.41 (1.91-6.09. The ORs for Apgar scores 0-3 at 5 minutes, meconium aspiration, and neonatal seizures increased similarly with maternal BMI. A study limitation was lack of data on effects of obstetric interventions and neonatal resuscitation efforts. CONCLUSION: Risks of severe asphyxia-related outcomes in term infants increase with maternal overweight and obesity. Given the high prevalence of the exposure and the severity of the outcomes studied, the results are of potential public health relevance and should be confirmed in other populations. Prevention of overweight and obesity in women of reproductive age is important
Hendriks, J.; Zwart, J.J.; Briet, E.; Brand, A.; van Roosmalen, J.
Background It is beyond doubt that blood transfusion services have added to the decline in maternal mortality in high-resource countries. To quantify the clinical benefit of red blood cell (RBC) transfusion in obstetric care, we performed a hypothetical experimental study using data from a
Yatsenko, Svetlana A; Peters, David G; Saller, Devereux N; Chu, Tianjiao; Clemens, Michelle; Rajkovic, Aleksandar
Noninvasive prenatal screening (NIPS) by next-generation sequencing of cell-free DNA (cfDNA) in maternal plasma is used to screen for common aneuploidies such as trisomy 21 in high risk pregnancies. NIPS can identify fetal genomic microdeletions; however, sensitivity and specificity have not been systematically evaluated. Commercial companies have begun to offer expanded panels including screening for common microdeletion syndromes such as 22q11.2 deletion (DiGeorge syndrome) without reporting the genomic coordinates or whether the deletion is maternal or fetal. Here we describe a phenotypically normal mother and fetus who tested positive for atypical 22q deletion via maternal plasma cfDNA testing. We performed cfDNA sequencing on saved maternal plasma obtained at 11 weeks of gestation from a phenotypically normal woman with a singleton pregnancy whose earlier screening at a commercial laboratory was reported to be positive for a 22q11.2 microdeletion. Fluorescence in situ hybridization and chromosomal microarray diagnostic genetic tests were done postnatally. NIPS detected a 22q microdeletion that, upon diagnostic workup, did not include the DiGeorge critical region. Diagnostic prenatal or postnatal testing with chromosomal microarray and appropriate parental studies to determine precise genomic coordinates and inheritance should follow a positive microdeletion NIPS result.
Juarez, Deborah Taira; Seto, Jason; Guimaraes, Alexander; Masterson, James; Davis, James; Seto, Todd B
To examine perspectives on e-cigarette use and regulations in Hawaii through key informant interviews with state legislators. E-cigarette use is rapidly increasing, with sales in 2013 topping $1 billion in the United States, but e-cigarettes are still a largely unregulated industry. Although e-cigarettes are thought by most to be a healthier alternative to traditional cigarettes, long-term health effects are not yet known. Semistructured key informant interviews were conducted with Hawaii state legislators (n = 15). We found a lack of consensus among legislators, which suggests that substantial legislative action is unlikely in the upcoming session. However, most legislators believe that some type of incremental legislation will pass, such as enactment of a small tax, limitations on advertising to protect adolescents, or regulations concerning where people can use e-cigarettes. Legislators eagerly await further research to clarify the overall benefits and harms of e-cigarettes at both the individual and population levels.
Sipe, Theresa Ann; Finnie, Ramona K.C.; Knopf, John A.; Qu, Shuli; Reynolds, Jeffrey A.; Thota, Anilkrishna B.; Hahn, Robert A.; Goetzel, Ron Z.; Hennessy, Kevin D.; McKnight-Eily, Lela R.; Chapman, Daniel P.; Anderson, Clinton W.; Azrin, Susan; Abraido-Lanza, Ana F.; Gelenberg, Alan J.; Vernon-Smiley, Mary E.; Nease, Donald E.
Context Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e., decrease financial burden) and to increase access to, and use of, mental health services. This systematic review was conducted to determine the effectiveness of mental health benefits legislation, including executive orders, in improving mental health. Evidence acquisition Methods developed for the Guide to Community Preventive Services were used to identify, evaluate, and analyze available evidence. The evidence included studies published or reported from 1965 to March 2011 with at least one of the following outcomes: access to care, financial protection, appropriate utilization, quality of care, diagnosis of mental illness, morbidity and mortality, and quality of life. Analyses were conducted in 2012. Evidence synthesis Thirty eligible studies were identified in 37 papers. Implementation of mental health benefits legislation was associated with financial protection (decreased out-of-pocket costs) and appropriate utilization of services. Among studies examining the impact of legislation strength, most found larger positive effects for comprehensive parity legislation or policies than for less-comprehensive ones. Few studies assessed other mental health outcomes. Conclusions Evidence indicates that mental health benefits legislation, particularly comprehensive parity legislation, is effective in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. Evidence is limited for other mental health outcomes. PMID:25998926
Brian K Lee
Full Text Available BACKGROUND: Although screening for maternal red blood cell antibodies during pregnancy is a standard procedure, the prevalence and clinical consequences of non-anti-D immunization are poorly understood. The objective was to create a national database of maternal antibody screening results that can be linked with population health registers to create a research resource for investigating these issues. STUDY DESIGN AND METHODS: Each birth in the Swedish Medical Birth Register was uniquely identified and linked to the text stored in routine maternal antibody screening records in the time window from 9 months prior to 2 weeks after the delivery date. These text records were subjected to a computerized search for specific antibodies using regular expressions. To illustrate the research potential of the resulting database, selected antibody prevalence rates are presented as tables and figures, and the complete data (from more than 60 specific antibodies presented as online moving graphical displays. RESULTS: More than one million (1,191,761 births with valid screening information from 1982-2002 constitute the study population. Computerized coverage of screening increased steadily over time and varied by region as electronic records were adopted. To ensure data quality, we restricted analysis to birth records in areas and years with a sustained coverage of at least 80%, representing 920,903 births from 572,626 mothers in 17 of the 24 counties in Sweden. During the study period, non-anti-D and anti-D antibodies occurred in 76.8/10,000 and 14.1/10,000 pregnancies respectively, with marked differences between specific antibodies over time. CONCLUSION: This work demonstrates the feasibility of creating a nationally representative research database from the routine maternal antibody screening records from an extended calendar period. By linkage with population registers of maternal and child health, such data are a valuable resource for addressing important
Slovenia as a member of the first group of candidates countries which started the accession negotiations with the European Union. The extensive work started in 1998 to align the domestic legislation with the legislation of the European Union. The activities related to the accession of Slovenia to EU in the area of nuclear legislation are carried out in different national working groups. The main part of activities is in working groups: energy and environment, but there are some topics, which are covered in other groups, like control of dual-use materials in the group of External Relations, research in reactor physics, nuclear engineering and fusion in the group Science and Technology
Vinceti, Marco; Malagoli, Carlotta; Malavolti, Marcella; Cherubini, Andrea; Maffeis, Giuseppe; Rodolfi, Rossella; Heck, Julia E.; Astolfi, Gianni; Calzolari, Elisa; Nicolini, Fausto
A few studies have suggested an association between maternal exposure to ambient air pollution from vehicular traffic and risk of congenital anomalies in the offspring, but epidemiologic evidence is neither strong nor entirely consistent. In a population-based case-control study in a Northern Italy community encompassing 228 cases of birth defects and 228 referent newborns, we investigated if maternal exposure to PM10 and benzene from vehicular traffic during early pregnancy, as estimated through a dispersion model, was associated with excess teratogenic risk. In conditional logistic regression analysis, and with adjustment for the other pollutant, we found that higher exposure to PM10 but not benzene was associated with increased risk of birth defects overall. Anomaly categories showing the strongest dose-response relation with PM10 exposure were musculoskeletal and chromosomal abnormalities but not cardiovascular defects, with Down syndrome being among the specific abnormalities showing the strongest association, though risk estimates particularly for the less frequent defects were statistically very unstable. Further adjustment in the regression model for potential confounders did not considerably alter the results. All the associations were stronger for average levels of PM10 than for their maximal level. Findings of this study give some support for an excess teratogenic risk following maternal exposure during pregnancy to PM10, but not benzene. Such association appears to be limited to some birth defect categories. PMID:26410719
... 10 Energy 2 2010-01-01 2010-01-01 false Proposals for legislation. 51.88 Section 51.88 Energy...) Legislative Environmental Impact Statements-Proposals for Legislation § 51.88 Proposals for legislation. The... proposals for legislation. final environmental impact statements—general requirements ...
Janssen Patti A
Full Text Available Abstract Background Interpersonal violence is responsible for more ill-health and premature death in women under the age of 45 than other preventable health conditions, but findings concerning the effects of violence during pregnancy on both maternal and foetal health have been inconsistent. Methods A retrospective population-based cohort study was undertaken using linked data from the Hospital Morbidity Data Collection and the Western Australian Midwives' Notification System from 2002 to 2008. The aim was to determine the association between exposure to interpersonal violence during pregnancy and adverse maternal and foetal health outcomes at the population level. Results A total of 468 pregnant women were hospitalised for an incident of interpersonal violence during the study period, and 3,744 randomly selected pregnant women were included as the comparison group. The majority of violent events were perpetrated by the pregnant women's partner or spouse. Pregnant Indigenous women were over-represented accounting for 67% of all hospitalisations due to violence and their risk of experiencing adverse maternal outcomes was significantly increased compared to non-Indigenous women (adjusted odds ratio 1.53, 95% CI 1.21 to 1.95, p = 0.01. Pregnant women hospitalised for an incident of interpersonal violence sustained almost double the risk for adverse maternal complications than the non-exposed group (95% CI 1.34 to 2.18, p Conclusions The risk of adverse health outcomes for both the mother and the baby increases if a pregnant woman is hospitalised for an incident of interpersonal violence during pregnancy.
US Census Bureau, Department of Commerce — The 2015 TIGER Geodatabases are extracts of selected nation based and state based geographic and cartographic information from the U.S. Census Bureau's Master...
Gaps identified to militate against maternal mortality reduction efforts include discontinuity and disconnect in government policies and programmes; legislation and other services emanating from change in government or between the executive and legislature within the same government; poor leadership of the health sector ...
These columns summarize the recent changes made in the nuclear legislation and regulation of OECD countries: Argentina: Reorganization of the National Atomic Energy Commission (2001); Canada: Order aiming to increase security at major nuclear installations (2001); France: Establishment of the French Agency for Environmental Health Safety and the Institute for the Protection of Nuclear Safety (2001). Amendment of the Decree on the Holding Company of the Atomic Energy Commission (2001). Decree on the Special Commission for Major Nuclear Installations Classified as Secret (2001).Ordinance on the Implementation of EU Directives in the Field of Protection against Ionising Radiation (2001). Decree on Information of the Public (2001). Decree governing the Safety and Radiation Protection of Nuclear Installations and Activities used for Defence Purposes (2001). Order on Postal Deliveries of Radioactive Materials (2001). Order on the Carriage of Dangerous Goods by Road ('ADR Order') (2001). Order on the Transport of Dangerous Goods by Rail ('RID Order') (2001). Germany: Agreement on the phase-out of nuclear energy (2001). Ordinance implementing Euratom Directives on Radiation Protection (2001). Greece: Radiation Protection Regulations (2001). Italy: Amendment of the Decree implementing the Euratom basic radiation protection standards (2001) Implementation of the European Directive on the Quality of Water Intended for Human Consumption (2001). JAPAN: Revision of the Nuclear Disaster Prevention Guidelines (2000). Republic of Korea: Amendments to the Act on Compensation for Nuclear Damage (2001). Lithuania: Regulations for the Classification of Legal Acts Regulating Nuclear Safety (2001); Hygiene Standard 'Radiation Safety in Nuclear Power Plants' (2001). Guidelines governing the Procedure on Radiological Monitoring and Limitation of Releases of Radionuclides into the Environment from Nuclear Facilities (2001). Law on the Decommissioning Fund for the Ignalina Nuclear Power
Parkin, P C; Degroot, J; Macpherson, A; Fuselli, P; Macarthur, C
The objective of this study was to survey Canadian parents on their attitudes and beliefs about bicycle helmet legislation and to compare responses from parents living in provinces with and without legislation. A national survey of 1002 parents of children aged under 18 years was conducted. Chi-square tests were used to compare responses from the surveyed parents in the different jurisdictions. Responses from parents living in provinces with legislation (n = 640) and without legislation (n = 362) were as follows: concern for injury (63% vs. 68%, nonsignificant [NS]); believe helmets are effective (98% vs. 98%, NS); child always wears a helmet (74% vs. 69%, NS); support legislation for children (95% vs. 83%, p legislation for all ages (85% vs. 75%, p legislation decreases the amount of time their child bicycles (5% vs. 8%, NS). Parents are highly supportive of bicycle helmet legislation in Canada. They believe that bicycle helmets are effective and that legislation does not decrease the amount of time a child spends bicycling. There was also a high level of support for legislation across all ages, and for police enforcement.
U.S. Department of Health & Human Services — 1995-2015. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation – Advertising. The STATE...
U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. LegislationâPreemption. The STATE...
U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation â Smokefree Campuses. The...
U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. LegislationâPreemption. The STATE...
U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. LegislationâLicensure. The STATE...
Recent alterations in the radiation protection laws of the Nordic countries are presented. The report amends the previous SS-report 87-37 with the title Radiation Protection and Atomic Energy Legislation in the Nordic Countries. (au)
U.S. Department of Health & Human Services — 1995-2016. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. LegislationâYouth Access. The STATE...
U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. LegislationâYouth Access. The STATE...
U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation â Fire-Safety. The STATE...
U.S. Department of Health & Human Services — 1995-2018. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation – Fire-Safety. The STATE...
U.S. Department of Health & Human Services — 1995-2016. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation â Smokefree Campuses. The...
U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation-Tax. The STATE System...
U.S. Department of Health & Human Services — 1995-2018. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation-Tax. The STATE System...
Barger, Diana; Pooley, Bertha; Dupuy, Julien Roger; Cardenas, Norma Amparo; Wall, Steve; Owen, Helen; Daviaud, Emmanuelle
To address inequitable access to health services of indigenous communities in the Bolivian highlands, the Bolivian Ministry of Health, with the support of Save the Children-Saving Newborn Lives, conducted operational research to identify, implement and test a package of maternal and newborn interventions using locally recruited, volunteer Community Health Workers (vCHW) between 2008 and 2010. The additional annual economic and financial costs of the intervention were estimated from the perspective of the Bolivian Ministry of Health in two municipalities. The cost of intervention-stimulated increases in facility attendance was estimated with national surveillance data using a pre-post comparison, adjusted for secular trends in facility attendance. Three scale-up scenarios were modelled by varying the levels of coverage and the number (per mother and child pair) and frequency of home visits. Average cost per mother and average cost per home visit are presented in constant 2015 US$. Eighteen per cent of expectant mothers in the catchment area were visited at least once. The annualized additional financial cost of the community-based intervention across both municipalities was $43 449 of which 3% ($1324) was intervention design, 20% ($8474) set-up and 77% ($33 651) implementation. Drivers of additional costs were additional paid staff (68%), 81% of which was for management and support by local implementing partner and 19% of which was for vCHW supervision. The annual financial cost per vCHW was $595. Modelled scale-up scenarios highlight potential efficiency gains. Recognizing local imperatives to reduce inequalities by targeting underserved populations, the observed low coverage by vCHWs resulted in a high cost per mother and child pair ($296). This evaluation raises important questions about this model's ability to achieve its ultimate goals of reducing neonatal mortality and inequalities through behaviour change and increased care seeking and has served to
Korevaar, Tim I M; Muetzel, Ryan; Medici, Marco; Chaker, Layal; Jaddoe, Vincent W V; de Rijke, Yolanda B; Steegers, Eric A P; Visser, Theo J; White, Tonya; Tiemeier, Henning; Peeters, Robin P
Thyroid hormone is involved in the regulation of early brain development. Since the fetal thyroid gland is not fully functional until week 18-20 of pregnancy, neuronal migration and other crucial early stages of intrauterine brain development largely depend on the supply of maternal thyroid hormone. Current clinical practice mostly focuses on preventing the negative consequences of low thyroid hormone concentrations, but data from animal studies have shown that both low and high concentrations of thyroid hormone have negative effects on offspring brain development. We aimed to investigate the association of maternal thyroid function with child intelligence quotient (IQ) and brain morphology. In this population-based prospective cohort study, embedded within the Generation R Study (Rotterdam, Netherlands), we investigated the association of maternal thyroid function with child IQ (assessed by non-verbal intelligence tests) and brain morphology (assessed on brain MRI scans). Eligible women were those living in the study area at their delivery date, which had to be between April 1, 2002, and Jan 1, 2006. For this study, women with available serum samples who presented in early pregnancy (IQ (assessed at a median of 6·0 years of age [95% range 5·6-7·9 years]) or brain MRI scans (done at a median of 8·0 years of age [6·2-10·0]) were obtained. Analyses were adjusted for potential confounders including concentrations of human chorionic gonadotropin and child thyroid-stimulating hormone and free thyroxine. Data for child IQ were available for 3839 mother-child pairs, and MRI scans were available from 646 children. Maternal free thyroxine concentrations showed an inverted U-shaped association with child IQ (p=0·0044), child grey matter volume (p=0·0062), and cortex volume (p=0·0011). For both low and high maternal free thyroxine concentrations, this association corresponded to a 1·4-3·8 points reduction in mean child IQ. Maternal thyroid-stimulating hormone was
1 Abstract This Master's thesis entitled Legislation on treating animals in human care compares Czech and Australian legislation in selected aspects of three categories of animals in human care - farm animals, companion animals and animals used for scientific and other research purposes. The thesis is composed of 5 main chapters. The first chapter describes sources of law regarding treating animals in human care from the perspectives of international law, European Union law, federal Czech law...
Singla, Daisy R; Kumbakumba, Elias; Aboud, Frances E
Parenting interventions have been implemented to improve the compromised developmental potential among 39% of children younger than 5 years living in low-income and middle-income countries. Maternal wellbeing is important for child development, especially in children younger than 3 years who are vulnerable and dependent on their mothers for nutrition and stimulation. We assessed an integrated, community-based parenting intervention that targeted both child development and maternal wellbeing in rural Uganda. In this community-based, cluster randomised trial, we assessed the effectiveness of a manualised, parenting intervention in Lira, Uganda. We selected and randomly assigned 12 parishes (1:1) to either parenting intervention or control (inclusion on a waitlist with a brief message on nutrition) groups using a computer-generated list of random numbers. Within each parish, we selected two to three eligible communities that had a parish office or a primary school in which a preschool could be established, more than 75 households with children younger than 6 years, and at least 15 socially disadvantaged families (ie, maternal education of primary school level or lower) with at least one child younger than 36 months. Participants within communities were mother-child dyads, where the child was 12-36 months of age at enrollment, and the mother had low maternal education. In the parenting intervention group, participants attended 12 fortnightly peer-led group sessions focusing on child care and maternal wellbeing. The primary outcomes were cognitive and receptive language development, as measured with the Bayley Scales of Infant Development, 3rd edn. Secondary outcomes included self-reported maternal depressive symptoms, using the Center for Epidemiologic Studies Depression Scale, and child growth. Theoretically-relevant parenting practices, including the Home Observation for Measurement of the Environment inventory, and mother-care variables, such as perceived spousal
García-Merino, Isabel Ma; Consuegra, Irene; Jiménez, José Luís; Muñoz-Fernández, Ma Ángeles
Spain has enacted specific legislation concerning biobanks. This legislation regulates how biobanks should be set up, how they should operate, and the requirements they need to comply with. The main objective of this legislation is to keep a good balance between scientific progress and respect for the rights and freedom of individuals participating in research. Therefore, this legislation lays down a series of basic principles, for instance, the principle to inform donors accurately i) on the deposit of samples in terms of the objectives and implications of their donation and on the need to obtain written consents; ii) on the obligation to establish consistent procedures to guarantee the confidentiality of personal data associated with and obtained from biological samples; iii) on the concept of free sample donation either by donors or by biobanks; iv) on the need for consistent procedures to deposit samples and data in biobanks; and v) for acts of donation and data for research projects to be performed correctly. Although this Spanish legislation fulfills its objectives, it has some drawbacks; mainly it overprotects research participants. This issue should be analyzed in future revisions of the legislation.
Breda, Joao; Robertson, Aileen
This publication has three parts: •a summary of the results of a systematic review of the most recent evidence on maternal nutrition, the prevention of obesity and noncommunicable diseases; •a review of existing recommendations for nutrition, physical activity and weight gain during pregnancy...... in European countries; and •lists of possible opportunities for action in European countries. The overview and exploration of the national recommendations for nutrition, physical activity and weight gain during pregnancy are based on the results of a survey in which 51 of the 53 Member States in the WHO....... These are opportunities to promote nutrition and health throughout the life-course, ensure optimal diet-related fetal development and reduce the impact of morbidity and risk factors for noncommunicable diseases by improving maternal nutrition....
Byars, Sean G; Boomsma, Jacobus J
Effects of maternal and paternal age on offspring autism and schizophrenia risks have been studied for over three decades, but inconsistent risks have often been found, precluding well-informed speculation on why these age-related risks might exist. To help clarify this situation we analysed a massive single population sample from Denmark including the full spectrum of autistic and schizophrenic disorders (eliminating between-study confounding), used up to 30 follow-up years, controlled for over 20 potentially confounding factors and interpret the ultimate causation of the observed risk patterns using generally accepted principles of parent-offspring conflict and life-history theory. We evaluated the effects of paternal age, maternal age and parental age difference on offspring mental disorders and found consistently similar risk patterns for related disorders and markedly different patterns between autistic and schizophrenic disorders. Older fathers and mothers both conferred increased risk for autistic but not schizophrenic disorders, but autism risk was reduced in younger parents and offspring of younger mothers had increased risk for many schizophrenic disorders. Risk for most disorders also increased when parents were more dissimilarly aged. Monotonically increasing autism risk is consistent with mutation accumulation as fathers' age, but this explanation is invalid for schizophrenic disorders, which were not related to paternal age and were negatively correlated with maternal age. We propose that the observed maternally induced risk patterns ultimately reflect a shifting ancestral life-history trade-off between current and future reproduction, mediated by an initially high but subsequently decreasing tendency to constrain foetal provisioning as women proceed from first to final pregnancy. © The Author(s) 2016. Published by Oxford University Press on behalf of the Foundation for Evolution, Medicine, and Public Health.
Zhou, Nan; Buehler, Cheryl
This study used data from the NICHD Study of Early Child Care and Youth Development (N = 1,019) to examine family, employment, and individual antecedents of maternal work-family enrichment from infancy through middle childhood. Work-family conflict and important confounding factors were controlled. From the family domain, higher income-to-needs ratio and social support were associated with higher work-family enrichment. From the employment domain, greater job rewards, benefits of employment for children, and work commitment were associated with higher work-family enrichment. From the individual domain, higher maternal education and extroversion were associated with higher work-family enrichment. No family, employment, and individual characteristics were associated with work-family conflict across time except for partner intimacy. In general, the results supported antecedents of work-family enrichment that supply needed resources. The present study contributed to the literature by identifying antecedents of maternal work-family enrichment across early child developmental stages, which goes beyond examinations of particular life stages and a work-family conflict perspective. Implications for theory and practice are discussed. PMID:26641483
Full Text Available Abstract Background Maternal age is a known risk factor for stillbirth and delayed childbearing is a societal norm in developed country settings. The timing and reasons for age being a risk factor are less clear. This study aimed to document the gestational specific risk of maternal age throughout pregnancy and whether the underlying causes of stillbirth differ for older women. Methods Using linkage of state maternity and perinatal death data collections the authors assessed risk factors for antepartum stillbirth in New South Wales Australia for births between 2002 – 2006 (n = 327,690 using a Cox proportional hazards model. Gestational age specific risk was calculated for different maternal age groups. Deaths were classified according to the Perinatal Mortality Classifications of the Perinatal Society of Australia and New Zealand. Results Maternal age was a significant independent risk factor for antepartum stillbirth (35 – 39 years HR 1.4 95% CI 1.12 – 1.75; ≥ 40 years HR 2.41 95% CI 1.8 – 3.23. Other significant risk factors were smoking HR 1.82 (95% CI 1.56 –2.12 nulliparity HR 1.23 (95% CI 1.08 – 1.40, pre-existing hypertension HR 2.77 (95% CI 1.94 – 3.97 and pre-existing diabetes HR 2.65 (95% CI 1.63 – 4.32. For women aged 40 or over the risk of antepartum stillbirth beyond 40 weeks was 1 in 455 ongoing pregnancies compared with 1 in 1177 ongoing pregnancies for those under 40. This risk was increased in nulliparous women to 1 in 247 ongoing pregnancies. Unexplained stillbirths were the most common classification for all women, stillbirths classified as perinatal infection were more common in the women aged 40 or above. Conclusions Women aged 35 or older in a first pregnancy should be counselled regarding stillbirth risk at the end of pregnancy to assist with informed decision making regarding delivery. For women aged 40 or older in their first pregnancy it would be reasonable to offer induction of labour by 40 weeks
Perez-Blasco, Josefa; Viguer, Paz; Rodrigo, Maria F
Several pilot studies have provided evidence that mindfulness-based intervention is beneficial during pregnancy, yet its effects in mothers during the early parenting period are unknown. The purpose of the present pilot study was to examine the effectiveness of a mindfulness-based intervention in breast-feeding mothers. We developed and tested an 8-week mindfulness-based intervention aimed at improving maternal self-efficacy, mindfulness, self-compassion, satisfaction with life, and subjective happiness, and at reducing psychological distress. A randomized controlled, between-groups design was used with treatment and control groups (n = 26) and pretest and posttest measures. ANCOVA results indicated that, compared to the control group, mothers in the treatment group scored significantly higher on maternal self-efficacy, some dimensions of mindfulness (observing, acting with awareness, non-judging, and non-reactivity), and self-compassion (self-kindness, mindfulness, over-identification, and total self-compassion). In addition, mothers who received the treatment exhibited significantly less anxiety, stress, and psychological distress. The results supported previous research findings about the benefits of mindfulness-based intervention in women from the perinatal and postpartum periods through the early parenting period. Additional research is needed to validate our findings in non-breast-feeding mothers and to examine the intervention's indirect benefits in terms of family relationships and child development.
Full Text Available Information privacy has received much public and research interest in recent years. Globally this has arisen from public anxiety following the September 11 attacks and within Australia a progressive tightening of privacy legislation in particular the privacy amendment (private sector Act of 2000 which became operative in 2001. This paper presents the results of a study into attitudes towards information privacy. Based on an instrument developed and validated by Smith et al (1996a this study sets out to measure individual concerns regarding organisational use of information along four dimensions: collection, errors, unauthorised secondary use, and improper access. The survey was completed by 67 undergraduate and postgraduate students enrolled in an e-commerce security subject at the University of Queensland. Comparisons are drawn between the results of this study and an identical one carried out at the University of North Alabama. Whilst it is too early to draw conclusions about the impact of these attitudes on the success of e-commerce in general, the results should be of interest to those within universities seeking to expand the use of networking technologies for handling sensitive information such as enrolment and fee processing (Vanscoy & Oakleaf 2003
In the Senate bill on waste disposal the definition for high-level waste was based on the source of the waste. High-level waste was defined as the liquids and solids resulting from reprocessing. The other terms defined in that bill that are crucial for any legislation dealing with high-level waste are storage and disposal. In the Senate bill, the definition of storage specifically mentioned transuranic (TRU) waste, but it did not include TRU waste in the definition of disposal. In the four House versions of the nuclear waste bill, the definition of high-level waste are addressed more carefully. This paper discusses the following four House committee's versions particularly pointing out how TRU waste is defined and handled: (1) Science Committee bill; (2) Interior Committee bill; (3) Commerce Committee bill; and (4) Armed Service Committee bill. The final language concerning TRU waste will depend on the next series of conference between these Committees. After resolving any differences, conferences will be held between the House and Senate. Here a concensus bill will be developed and it will go to the Rules Committee and then to the floor
Koperski, J. G.
Australia is a federation of nine jurisdictions, each with independent radiation protection legislation. The existing legislative non-uniformity across the jurisdictions has constituted an impediment for operators who must comply with differing legislative requirements in different jurisdictions. To address this issue, a National Competition Policy Review of Radiation Protection Legislation took place in 2000/2001. It has produced 19 Recommendations, which addressed objectives of the legislation, the need to regulate, alternative regulatory approaches, national uniformity, licensing and registration, strict and prescriptive standards, advertising and promotional activities, compliance costs and cost recovery issues. The Review has recommended that jurisdictions should retain the regulatory approach to achieve radiation protection objectives rather than leave them to be decided by market forces. But the approach should be performance-based, i.e. outcome-focused rather than prescriptive. An Implementation Plan of the Recommendations has been created which, by the end of 2004, will produce the National Directory for Radiation Protection. The Directory, which will become a consolidated repository of radiation protection standards, guidelines, codes of practice and administrative principles will provide a uniform national framework for radiation protection legislation in Australia. It will provide guidance for the jurisdictions redrawing their legislations. Because of its central role in shaping future legislation, the Directory will contain only those provisions, which have passed a formal process (process for issue resolution) concluded by an approval by the Australian Health Ministers Conference. Such process will also expedite the uniform adoption nationwide of legislative trends emerging from international radiation protection recommendations and standards. This Australian model might be a viable example for other multi-jurisdictional countries to consider
Thrall, James H
Unintended consequences of health care legislation threaten the financial and social well-being of the United States. Examples of major legislation resulting in unintended and unforeseen consequences include the Social Security Amendments Acts of 1989 and 1993 (the Stark laws), the Balanced Budget Act of 1997, and the Social Security Amendments Act of 1965 (Medicare and Medicaid). Each of these has had unintended financial and social outcomes. Spending for Medicare and Medicaid now equals an unsustainable 23% of the federal budget. Major reasons for unintended consequences include failure to appreciate the complexity of the issues, the open-ended nature of medical advances with attendant increases in costs, the inducement of change in behaviors in response to legislation, and the moral hazard of people spending other people's money. Actions that should be considered to avoid unintended consequences include more involvement of health professionals in the design of legislation, the inclusion of triggers to target review of legislatively defined programs, and the setting of time limits for sun-setting legislation. The ACR has played an important advocacy role and should continue to offer input to legislators, federal policymakers, and other stakeholders. Many opportunities exist to address the current financial situation by reducing the amount of unnecessary care delivered. Both major US political parties need to find the political will to compromise to chart the way forward. Some level of sacrifice is likely to be necessary from patients and providers and other stakeholders. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Rafael Silveira e Silva
Full Text Available Even though they possess several power resources, Brazilian Presidents also elaborate their legislative proposals based upon bills already being processed in Congress through a phenomenon called Appropriation of the legislative agenda. In this paper I examine the conditions under which this phenomenon occurs by means of a typology and a qualitative comparative analysis (QCA. I conclude that Appropriation provides the President with the expansion of the formal support base by controlling the agenda of allied and opposition parties as well as obtaining the "paternity" of several policies already in motion in Congress, thus enabling a public association of the President's actions and his or her party with the possibility of social benefits. Be it in the pursuit of promising agendas or for the maintenance of their own dominance, Appropriation shows that Brazilian Presidents must go beyond coalition presidentialism.
van Voorst, Stijn; Mastenbroek, Ellen
Whereas the European Commission officially intends to periodically evaluate all major European Union legislation in force, in practice it only evaluates a minority of major regulations and directives. This article tries to explain the variation in the initiation of such ex-post legislative evaluations by the Commission with the help of two theoretical motives: an enforcement motive and a strategic motive. Based on two novel datasets and binary logistic regression analysis, the results show that the type and complexity of the legislation, the presence of an evaluation clause and the evaluation capacity of the responsible Directorates-General enhance the chances of evaluation. These findings indicate that ex-post legislative evaluations are at least partly driven by the Commission's need to enforce legislation.
Jardim, Maria Aparecida Chaves [UNESP; Jard, Sidney
This paper addresses the creation of pension funds for federal civil servants in Brazil, analyzing the existing legislation and regulation on this issue. To this end, it takes off based on the genesis of the Brazilian private pension plans, logging the emergence of private funds as well as the existence of various laws and constitutional amendments prior to Law 12.618/2012, which provided for the pension funds system for Brazilian federal public servants. It also identifies proponents and opp...
Lai, C W; Chan, W K
To understand legislation combating counterfeit drugs in Hong Kong. This study consisted of two parts. In part I, counterfeit drugs–related ordinances and court cases were reviewed. In part II, indepth interviews of the stakeholders were described. Hong Kong. All Hong Kong ordinances were screened manually to identify those combating counterfeit drugs. Court cases were searched for each of the identified cases. Then, the relevant judgement justifications were analysed to identify sentencing issues. Indepth interviews with the stakeholders were conducted to understand their perceptions about such legislation. Trade Marks Ordinance, Patents Ordinance, Trade Descriptions Ordinance, and Pharmacy and Poisons Ordinance were current legislative items combating counterfeit drugs. Sentencing criteria depended on: intention to deceive, quantity of seized drugs, presence of expected therapeutic effect or toxic ingredients, previous criminal records, cooperativeness with Customs officers, honest confessions, pleas of guilty, types of drugs, and precautionary measures to prevent sale of counterfeit drugs. Stakeholders’ perceptions were explored with respect to legislation regarding the scale and significance of the counterfeit drug problem, penalties and deterrents, drug-specific legislation and authority, and inspections and enforcement. To plug the loopholes, a specific law with heavy penalties should be adopted. This could be supplemented by non-legal measures like education of judges, lawyers, and the public; publishing the names of offending pharmacies; and emphasising the role of pharmacists to the public.
Travers, Jasmine; Smaldone, Arlene; Cohn, Elizabeth Gross
A health-care workforce representative of our nation's diversity is a health and research priority. Although racial and ethnic minorities represent 37% of Americans, they comprise only 16% of the nursing workforce. The purpose of this study was to examine the effect of state legislation on minority recruitment to nursing. Using data from the National Conference of State Legislatures, American Association of Colleges of Nursing, and U.S. census, we compared minority enrollment in baccalaureate nursing programs of states (Texas, Virginia, Michigan, California, Florida, Connecticut, and Arkansas) before and 3 years after enacting legislation with geographically adjacent states without legislation. Data were analyzed using descriptive and chi-square statistics. Following legislation, Arkansas (13.8%-24.5%), California (3.3%-5.4%), and Michigan (8.0%-10.0%) significantly increased enrollment of Blacks, and Florida (11.8%-15.4%) and Texas (11.2%-13.9%) significantly increased enrollment of Hispanic baccalaureate nursing students. States that tied legislation to funding, encouragement, and reimbursement had larger enrollment gains and greater minority representation. © The Author(s) 2015.
The present report contains certain information concerning the current situation dealing with provision of nuclear and radiation safety during the performance of all types of activity associated with nuclear installations, facilities of radioactive waste management and utilization of ionizing radiation sources in 1999. We try to make a concise analysis o legal bases of ensuring safety and to present general information concerning the Nuclear Insurance Pool of Ukraine. (author)
Cvjetković Cvjetana M.
Full Text Available In this paper the author considers CFC legislation in the Member States of the European Union, and points to the official attitude of the institutions of the European Union toward CFC legislation. Special attention in this paper is focused on Judgment of the Court of Justice of the European Union in the case Cadbury Schweppes. The aim of the paper is to analyze CFC legislation in the Member States in order to determine its basic characteristics, as well as to determine its compatibility with freedoms guaranteed by the primary law of the European Union, i.e. with Judgment of the Court of Justice of the European Union in the Cadbury Schweppes case.
PALIU – POPA LUCIA
Full Text Available In the context of the debate analysis from the last decades on the relationship between accounting and taxation, independence or dependence of the accounting rules from the tax ones and taking into consideration that the independence of the two leads to permanent and even significant differences between the accounting and tax profit, I found that certain terms are regulated differently in accounting legislation in our country compared to fiscal one or the legislation in the economic field. Taken from this perspective the main objective of this scientific approach is the identification of accounting and tax legislative nonconformities and the proposal of the ways to solve them so as to eliminate, where possible, differentiated professional interpretations.
PALIU – POPA LUCIA
Full Text Available In the context of the debate analysis from the last decades on the relationship between accounting and taxation, independence or dependence of the accounting rules from the tax ones and taking into consideration that the independence of the two leads to permanent and even significant differences between the accounting and tax profit, I found that certain terms are regulated differently in accounting legislation in our country compared to fiscal one or the legislation in the economic field. Taken from this perspective the main objective of this scientific approach is the identification of accounting and tax legislative nonconformities and the proposal of the ways to solve them so as to eliminate, where possible, differentiated professional interpretations.
Stocco, Ester; Dario, Claudia; Piazzi, Gioia; Fiori Nastro, Paolo
The different models of mental illness which have followed one another in Italian psychiatry have been linked to the history of psychiatric legislation and its various attempts at reform. The first law of the newly United State which unified legislations and former procedures, whose prevalent psychiatric theories were those that referred to degeneration, was the law 36/1904 that set up the asylums. Accordingly psychiatric praxis was focused on social protection and custody, given that the mentally ill was seen as incurable; Fascism added the inmate's obligation to be enrolled in the judicial register. Afterwards numerous attempts to reform the psychiatric legislation were made that eventually gave rise to law 431/1968 which paved the way to territorial psychiatry. Law 180/1978 changed the organization of Italian psychiatry abolishing asylums and the concept of dangerousness, including psychiatry in the National Health Service but adopting an idea of mental illness as simply social unease.
Full Text Available Abstract Background Studies conducted in Western countries have shown that bone loss associated with pregnancy and breast-feeding is recovered after weaning. However, it is not clear whether recovery takes place after repeated pregnancies followed by prolonged periods of breast-feeding; especially in developing countries where nutritional intake is comparatively low. This study was designed to examine the effects of multiparity and prolonged breast-feeding on maternal bone mineral density (BMD in a community-based sample of 210 Sri Lankan women, aged between 46 and 98 years. Methods BMD of the lumbar spine (L2–L4 and femoral neck were measured by dual-energy X-ray absorptiometry. Reproductive history was recorded by using a questionnaire. Women were, first, divided into groups according to parity (nulliparous, 1–2, 3–4, and 5 or more children, and BMDs in different groups were compared, initially unadjusted and then adjusted for age. Same subjects were subdivided, again, according to the total duration of breast-feeding (0, 1–48, 49–96, and 97 months or more and similar analysis was carried out. Results Women who had 5 or more children and women who had breast-fed for 97 months or more were older than the other women (p Conclusion From this population-based study conducted in a developing country, we infer that history of multiparity or prolonged breast-feeding has no detrimental effects on maternal BMD in post-menopausal age.
Csáky-Szunyogh, Melinda; Vereczkey, Attila; Gerencsér, Balázs; Czeizel, Andrew E
To establish possible aetiological factors contributing to congenital heart defects (CHD) overall and separately for different types of CHD, as causes are unknown for the vast majority of patients. To estimate a possible association with maternal diseases and related drug treatments as exposures in the mothers of cases with right-sided obstructive defects of the heart (RSODH). A large population-based Hungarian Case-Control Surveillance of Congenital Abnormalities data set. Newborn infants with four types of RSODH based on autopsy or surgical records. Comparison of 200 live-born cases with RSODH including 72 (36.0%) with pulmonary valve stenosis, 13 (6.5%) with tricuspid atresia/stenosis, 7 (3.5%) with Ebstein's anomaly and 108 (54.0%) with pulmonary atresia, with 304 matched controls and 38 151 population controls without any defects. Risk of any RSODH and risk of each type of RSODH. High blood pressure, particularly chronic hypertension with nifedipine treatment, was associated with a risk for RSODH (OR 7.03, 95% CI 3.13 to 13.84). High doses of folic acid reduced the birth prevalence of pulmonary atresia (OR 0.29, 95% CI 0.16 to 0.53). The multifactorial threshold model provides the best explanation for the origins of RSODH. Genetic predisposition may be triggered by maternal hypertension with nifedipine treatment, while the risk for pulmonary atresia is reduced by high doses of folic acid in early pregnancy.
Nongrum, Rida; Thomas, Elsy; Lionel, Jessie; Jacob, Kuruthukulangara S
This study attempted to follow up a cohort of women who presented to a tertiary hospital to investigate the effect of domestic violence on maternal and neonatal outcomes. Women, between 26-34 weeks of gestation, attending the obstetrics outpatient department, were recruited and followed up until delivery. They were assessed at recruitment and after delivery using the Edinburgh Postnatal Depression Scale, the Abuse Assessment Screen, and a pro forma to assess socio-demographic and clinical characteristics. Bivariate and multivariate statistics were employed to assess statistical significance. One hundred and fifty women were recruited, 132 delivered in the hospital and were followed up. Domestic violence was associated with antenatal and postnatal depression, spouse's insistence of a boy baby, medical complications during pregnancy, preterm delivery, and lower birth-weight. Domestic violence has a significant impact on maternal and neonatal outcomes. Screening for domestic violence and interventions should be part of all antenatal programs. India should also employ public health approaches to change its patriarchal culture.
Ueda, Michiko; Kondo, Naoki; Takada, Misato; Hashimoto, Hideki
This study examined how maternal work-related factors, including the availability of paid maternal leave, affect childhood vaccination status. Relatively little is known about the association between the employment status of mothers and the vaccination status of their children. We examined data from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE), an ongoing epidemiologic household panel study in Japan. We used surveys taken in 2010-2011 in this study. We found that mothers who returned to work after giving birth were much less likely to follow recommended vaccine schedules for their children compared with mothers who stayed at home and those who had left the workforce by the time of childbirth. However, taking parental leave significantly reduced the risk of not being up-to-date with the vaccination schedule at 36 months of age. We also found that children whose mother was younger and less educated, and those from an economically deprived family were at a high risk of not being up-to-date with the vaccination status at 36 months of age. Because vaccination is free and widely available in Japan, our findings indicate that provision of free vaccinations is not sufficient to achieve high vaccination rates. Copyright © 2014 Elsevier Inc. All rights reserved.
Silwal Ram C
Full Text Available Abstract Background The challenge of delivering multiple, complex messages to promote maternal and newborn health in the terai region of Nepal was addressed through training Female Community Health Volunteers (FCHVs to counsel pregnant women and their families using a flipchart and a pictorial booklet that was distributed to clients. The booklet consists of illustrated messages presented on postcard-sized laminated cards that are joined by a ring. Pregnant women were encouraged to discuss booklet content with their families. Methods We examined use of the booklet and factors affecting adoption of practices through semi-structured interviews with district and community-level government health personnel, staff from the Nepal Family Health Program, FCHVs, recently delivered women and their husbands and mothers-in-law. Results The booklet is shared among household members, promotes discussion, and is referred to when questions arise or during emergencies. Booklet cards on danger signs and nutritious foods are particularly well-received. Cards on family planning and certain aspects of birth preparedness generate less interest. Husbands and mothers-in-law control decision-making for maternal and newborn care-seeking and related household-level behaviors. Conclusions Interpersonal peer communication through trusted community-level volunteers is an acceptable primary strategy in Nepal for promotion of household-level behaviors. The content and number of messages should be simplified or streamlined before being scaled-up to minimize intervention complexity and redundant communication.
Agopian, A J; Langlois, Peter H; Cai, Yi; Canfield, Mark A; Lupo, Philip J
Previous literature has suggested a link between maternal exposure to atrazine (the most commonly used herbicide in the US) and risk for gastroschisis (a birth defect that involves incomplete closure of the abdominal wall). Our objective was to evaluate the relationship between maternal atrazine exposure and gastroschisis risk by maternal age. We analyzed data for 1,161 cases with isolated gastroschisis and 8,390 controls delivered in Texas from 1999 through 2008. We estimated atrazine exposure based on maternal county of residence and data from the United States Geological Survey. Logistic regression was conducted among all subjects, and separately among offspring of women <25 and ≥25 years. Risk for gastroschisis in offspring was significantly increased for women ≥25 years with high levels of residential atrazine exposure compared to low (adjusted odds ratio: 1.97, 95 % confidence interval 1.19-3.26). This association was not observed among women <25 years. Our results provide additional insight into the suspected relationship of gastroschisis with atrazine. This relationship appears to be different in older versus younger mothers, providing further evidence that the etiology of gastroschisis may vary based on maternal age.
Faber, Timor; Been, Jasper V; Reiss, Irwin K; Mackenbach, Johan P; Sheikh, Aziz
In this paper, we aim to present an overview of the scientific literature on the link between smoke-free legislation and early-life health outcomes. Exposure to second-hand smoke is responsible for an estimated 166 ,000 child deaths each year worldwide. To protect people from tobacco smoke, the World Health Organization recommends the implementation of comprehensive smoke-free legislation that prohibits smoking in all public indoor spaces, including workplaces, bars and restaurants. The implementation of such legislation has been found to reduce tobacco smoke exposure, encourage people to quit smoking and improve adult health outcomes. There is an increasing body of evidence that shows that children also experience health benefits after implementation of smoke-free legislation. In addition to protecting children from tobacco smoke in public, the link between smoke-free legislation and improved child health is likely to be mediated via a decline in smoking during pregnancy and reduced exposure in the home environment. Recent studies have found that the implementation of smoke-free legislation is associated with a substantial decrease in the number of perinatal deaths, preterm births and hospital attendance for respiratory tract infections and asthma in children, although such benefits are not found in each study. With over 80% of the world's population currently unprotected by comprehensive smoke-free laws, protecting (unborn) children from the adverse impact of tobacco smoking and SHS exposure holds great potential to benefit public health and should therefore be a key priority for policymakers and health workers alike.
Douglas Lee points out that the question of nuclear waste will not go away. Nuclear waste is with us and consumers should support legislation to deal with the problem once and for all. The spent fuel is growing, and twenty-nine nuclear plants will face onsite storage problems in this decade. If these plants shut down, consumers will face higher electric generating costs if a switch to a more expensive fuel is necssary, or if the utilities are forced to purchase power of the grid. The cost of waste disposal under this proposed legislation will amount to about 75 cents per month for those electric customers serviced by nuclear plants
Antoni, W.; Haeusler, C.; Hermann, H.P.; Meyer-Woebse, G.; Schmidt, K.
The authors survey substantial developments of legislation in the electricity economy in 1980. They deal with prominent, legal subjects of a political nature and discuss questions posed by the interpretation and application of laws with regard to supply concepts, to the 4th amendment to the anti-trust law, to legislation relating to the anti-trust law, to recommendations by the Investigation Committee, to rate approvals, general terms and conditions governing supplies, to atomic energy law, to the environmental protection law, to the law relating to the conservation of nature and preservation of rural amenities, to the law relating to roads and to developments of tax laws. (HSCH) [de
Rygg, Malin; Rømen, Dagfinn; Sterri, Brynhild Runa
This paper gives an overview of the Norwegian legislation on Universal Design of information and communication technology (ICT) and how the Norwegian Authority for Universal Design of ICT works to enforce and achieve the goals behind the legislation. The Authority uses indicators to check websites for compliance with the regulations. This paper describes the rationale and intended use for the indicators and how they are used for both supervision and benchmarks as well as a way of gathering data to give an overview of the current state of Universal Design of websites in Norway.
Hassan, Ahmed; Jokar, Tahereh Orouji; Rhee, Peter; Ibraheem, Kareem; Kulvatunyou, Narong; Anderson, Kathryn Tinsley; Gries, Lynn; Roward, Zachary Thomas; Joseph, Bellal
The aim of our study was to assess the impact of helmet legislations on the incidence and the mortality rate of motorcycle collision (MCC)-related traumatic brain injury (TBI) in young adult trauma patients. A 1-year (2011) retrospective analysis was performed of all patients under 21 years old with trauma-related hospitalization using the Nationwide Inpatient Sample database (representing 20% of all in-patient admissions). Patients with MCC were identified using E-codes. States were classified into three groups based on helmet legislations: universal age helmet legislation, legislation, and legislation. Outcome measures were the rates of TBI and mortality. Linear regression analysis was used to assess outcomes among the states. A total of 1,165,150 patients with trauma-related hospitalizations across 29 states were reviewed of which, 587 patients with MCC were included. Ten states had universal age legislation; 13 states had age legislation, and 6 states had age legislation. There was a lower incidence in the rate of TBI (P = 0.03) in states with universal helmet legislations compared with states with age-restricted helmet legislation. Universal helmet legislations lowered the rate of MCC-related TBI injures by a factor of 2.15 (β coefficient: 2.15; 95% confidence interval: 0.91-10.18; P = 0.04). States with age-restricted helmet legislations have a higher rate of traumatic brain injury and mortality compared with states with universal helmet legislations. Establishing universal helmet legislations across the states may provide a potential preventive strategy against traumatic brain injury.
This presentation will provide a current congressional status of legislation related to low-level waste and DOE cleanup. Key legislation discussed will include S. 755 for Privatization of the Uranium Enrichment Corporation and the markup of H.R. 1020, the Nuclear Waste Legislation. In addition, the session will include a discussion of legislation related to the approval of the Texas compact.
Full Text Available Progress towards the Millennium Development Goal No. 5 was measured by an indicator that excluded women who died due to pregnancy and childbirth after 42 days from the date of delivery. These women suffered from what are defined as late deaths and sequelae-related deaths (O96 and O97 respectively, according to the International Classification of Diseases, 10th revision. Such deaths end up not being part of the numerator in the calculation of the Maternal Mortality Ratio (MMR, the indicator that governments and international agencies use for reporting. The issue is not trivial since these deaths account for a sizeable fraction of all maternal deaths in the world and show an upward trend over time in many countries. The aim of this study was to analyze empirical data on maternal deaths that occurred between 2010 and 2013 in Mexico, linking databases of the Deliberate Search and Reclassification of Maternal Deaths (BIRMM and the Birth Information Subsystem (SINAC of the Ministry of Health. Data were analyzed by negative binomial regression, survival analysis and multiple cause analysis. While the reported MMR decreased by 5% per year between 2010 and 2013, the MMR due to late and sequelae-related deaths doubled from 3.5 to 7 per 100,000 live-births in 2013 (p <0.01. A survival analysis of all maternal deaths revealed nothing particular around the 42 day threshold, other than the exclusion of 18% of women who died due to childbirth in 2013. The multiple cause analysis showed a strong association between the excluded deaths and obstetric causes. It is suggested to review the construction of the MMR to make it a more inclusive and dignified measurement of maternal mortality by including all deaths due to pregnancy and childbirth into the Maternal Death definition.
Processing of minerals results in increased concentrations of the naturally occurring radioactive materials (NORM) in mineral products and/or process wastes, relative to those in the source materials. Due to the current legislative trends this technologically enhanced naturally occurring radioactive material (TENORM) phenomenon may bring mineral processing practices, including disposal of NORM-elevated wastes, into the realm of regulatory concern for practically all mineral-processing operations in Australia. The 1999 Australian Radiation Protection and Nuclear Safety (ARPANS) legislation has been based on the 1996 International Basic Safety Standards (BSS) recommended by the International Atomic Energy Agency (IAEA). As such, it contains very restrictive exemption criteria from the provisions of the legislation. ARPANS legislation is only binding upon Commonwealth entities. They, incidentally, do not include minerals industry operations. This legislation has been incompatible with the nature of the minerals industry. However, the current legislative developments have been aimed at imposing this legislation onto States and Territories. If this happens, and the current ARPANS legislative exemption criteria are not rationalised, major radiation safety-related operational and administrative impacts on the Australian minerals industry will occur. They will result in a marked burden to the national economy for yet to be clearly identified health and safety benefits. It is thus recommended that, without compromising rational radiation protection principles and practices, legislation commensurate with the nature of the minerals industry operations, national and state circumstances, conditions and interests be adopted in Australia. Such legislation would follow the spirit of the IAEA 1996 recommendations. Copyright (2001) Australasian Radiation Protection Society Inc
Dumont, Alexandre; Fournier, Pierre; Abrahamowicz, Michal; Traoré, Mamadou; Haddad, Slim; Fraser, William D
Maternal mortality is higher in west Africa than in most industrialised countries, so the development and validation of effective interventions is essential. We did a trial to assess the effect of a multifaceted intervention to promote maternity death reviews and onsite training in emergency obstetric care in referral hospitals with high maternal mortality rates in Senegal and Mali. We did a pragmatic cluster-randomised controlled trial, with hospitals as the units of randomisation and patients as the unit of analysis. 46 public first-level and second-level referral hospitals with more than 800 deliveries a year were enrolled, stratified by country and hospital type, and randomly assigned to either the intervention group (n=23) or the control group with no external intervention (n=23). All women who delivered in each of the participating facilities during the baseline and post-intervention periods were included. The intervention, implemented over a period of 2 years at the hospital level, consisted of an initial interactive workshop and quarterly educational clinically-oriented and evidence-based outreach visits focused on maternal death reviews and best practices implementation. The primary outcome was reduction of risk of hospital-based mortality. Analysis was by intention-to-treat and relied on the generalised estimating equations extension of the logistic regression model to account for clustering of women within hospitals. This study is registered with ClinicalTrials.gov, number ISRCTN46950658. 191,167 patients who delivered in the participating hospitals were analysed (95,931 in the intervention groups and 95,236 in the control groups). Overall, mortality reduction in intervention hospitals was significantly higher than in control hospitals (odds ratio [OR] 0·85, 95% CI 0·73-0·98, p=0·0299), but this effect was limited to capital and district hospitals, which mainly acted as first-level referral hospitals in this trial. There was no effect in second
This book deals with legislation on university technology transfer in 2012, which includes invention promotion act, legislation on technology transfer and promotion of industrialization, legislation on industrial education and industrial cooperation, and special legislation on venture business. It lists the legislation related research and development by government department : fundamental law of scientific technique, law on evaluation and management of domestic research development business, national science and technology council and the patent office.
Hartwig, Tanja Schlaikjær; Sørensen, Steen; Jørgensen, Finn Stener
OBJECTIVES: Most currently used age-related risks of T21, T18 and T13 are based on estimates of the live-birth prevalence, and describe an exponential increase of risk by increased maternal age. We investigated the first trimester prevalence of T21, T18 and T13 in a large population of Danish women....... METHODS: From the Danish Cytogenetic Central Registry we got the information of all pre- and postnatally diagnosed fetuses with T21, T18 or T13 between 2005 and 2014 in Denmark. Information on the total number of births and maternal age at birth were gathered from StatBank Denmark. RESULTS: The total...... number of included women was 605 853. The total number of T21 cases was 1564, T18 cases was 401 and T13 cases was 157. The overall first trimester prevalence per 10 000 pregnancies was 25.8 for T21, 6.6 for T18 and 2.6 for T13. Boltzmann sigmoidal model (Y = Bottom + (top-bottom / (1 - exp (V50 - X...
Anna S. Tretyak
Full Text Available The paper presents a brief historical overview of the evolution of maternal and child health care in Russia. A system of Public Health Service in the Central Black Earth Region governments (territorial subdivisions of Russia, 1708-1929 is taken as an example. A retrospective of the review is limited to the last third of the XIX century. The paper discusses historical aspects of the problem, which are mainly concentrated in the first quarter of the XX century. Organizational aspects of the medical staff training, problems with the obstetric aid organization are also considered. Characteristics of the governments in their activity to fight with infant mortality are stated in the paper.
Full Text Available The article deals with safety of European road tunnels in accordance with actual European legislation. Standards and recommendations of European Commission, PIARC and other professional bodies of the European Union define minimal technological requirements for equipment and operation of the tunnels in scope of Trans-European Road Network.
This article looks at the incorporation of empirical research into legislation from a juridical law perspective. Juridical law is characterized by four elements: autonomous and artificial reasoning; making statements to authorize factual actions; mobilizing helpers of the proponent and de-mobilizing
Background: The Choice on Termination of Pregnancy (CTOP) Act legalised abortion on request in South Africa until up to 12 weeks of gestation and thereafter under specified conditions. Within the context of liberal legislation, accurate information is a necessary (although not sufficient) requirement for women to exercise ...
Thomsen, Jakob Hartvig; Hassager, Christian; Bro-Jeppesen, John
INTRODUCTION: Informed consent in incapacitated adults is permitted in the form of proxy consent by both the patients' closest relative (next of kin, NOK) and general practitioner (GP). In research in acute situations not involving pharmaceuticals, Danish legislation allows for randomisation...
Holland, John; Pell, Gabrielle
The study researched parent's experiences of The Children and Families Act 2014 in Hull and the East Riding of Yorkshire. A sample of parents using KIDS Services in the area were surveyed by questionnaire, both before and after the legislation came into force. Nearly half of the parents were aware of a change in Special Educational Needs and…
This paper argues that military rule does not provide the appropriate environment for the growth and development of legislative libraries. Cooperation and not competition is stated as the driving philosophy for library networks and cooperation. Resource sharing is the premise for participation in library network. Network ...
the Consortium for Refugees and Migrants in South. Africa and convener of ... risk for developing a variety of mental health problems including ..... organisation has expressed an interest in support- ing South Africa by providing experts for related training.57. Regardless of whether hate crime legislation is adopted in South ...
A review is presented of Federal and State radiation control legislation for calendar year 1974, in Federal-State, subject, and status order. A brief description of each bill introduced in 1974 is included, plus existing laws or statutes governing radiation control. (auth)
Veillard, Jérémy; Tipper, Brenda; Klazinga, Niek
While the Excellent Care for All Act, 2010 (ECFA Act) provides a comprehensive approach to stimulating quality improvement in healthcare, there are other examples of legislations articulating strategies aimed at the same goal but proposing different approaches. This paper reviews quality of care
A general picture of toxicological approach and practical aspects of cosmetic safety is described in this thesis. Such considerations are the basis for introducing negative and positive lists of cosmetic ingredients into cosmetic legislation. The first Dutch Cosmetic Act of 1968 already has several
van der Elst, C.F.
In 2014 the European Union reformed the regulatory framework of statutory audits in Directive 2014/56/EC and Regulation (EU) Nr. 537/2014. Part of the new legislation addresses the composition and responsibilities of the audit committee of public-interest entities. This contribution studies the
One specific area of industrial relations training is considered--that of meeting the implications of change as a result of the current theme of joint involvement in proposed industrial relations legislation. This will demand new approaches for industry in England. (Author/BP)
The Nobel Foundation‟s citation on Soyinka in 1986 as a writer “who in a wide cultural perspective and with poetic overtones, fashions the drama of existence” marks the zenith of recognition accorded his humanistic legislative mission. Implied here is a profound cultural intelligence which authenticates his ...
that peace, order and good governance shall be promoted both at the Federal and State levels. Keywords: Executive appointments, Legislative approval, National Assembly, Constitutional duty. 1. Introduction. The National Assembly is the highest law making and representative body in Nigeria. It is the. Constitutional ...
Hooyenga, P.A.; Witkamp, R.F.; Groen, K.P.
Marketing of herbal products in the European Union (EU) has been regulated under national legislation for years, leading to differences in legal status of these herbal products. In one member state, a product may be regulated as a food supplement, while in the other member state the same product is
Regan, Sandra; Orchard, Carole; Khalili, Hossein; Brunton, Laura; Leslie, Kate
Changes to Ontario's health professions regulatory system were initiated through various legislative amendments. These amendments introduced a legislative obligation for health regulatory colleges to support interprofessional collaboration (IPC), collaborate where they share controlled acts, and incorporate IPC into their quality assurance programs. The purpose of this policy analysis was to identify activities, strategies, and collaborations taking place within health professions regulatory colleges pertaining to legislative changes related to IPC. A qualitative content analysis of (1) college documents pertaining to IPC (n = 355) and (2) interviews with representatives from 14 colleges. Three themes were identified: ideal versus reality; barriers to the ideal; and legislating IPC. Commitment to the ideal of IPC was evident in college documents and interviews. Colleges expressed concern about the lack of clarity regarding the intent of legislation. In addition, barriers stemming from long-standing issues in practice including scope of practice protection, conflicting legislation, and lack of knowledge about the roles of other health professionals impede IPC. Government legislation and health professional regulation have important roles in supporting IPC; however, broader collaboration may be required to achieve policy objectives.
Full Text Available Abstract Background Undetected and untreated developmental problems can have a significant economic and social impact on society. Intervention to ameliorate potential developmental problems requires early identification of children at risk of future learning and behaviour difficulties. The objective of this study was to estimate the prevalence of risk for developmental problems among preschool children born to medically low risk women and identify factors that influence outcomes. Methods Mothers who had participated in a prenatal trial were followed up three years post partum to answer a telephone questionnaire. Questions were related to child health and development, child care, medical care, mother's lifestyle, well-being, and parenting style. The main outcome measure was risk for developmental problems using the Parents' Evaluation of Developmental Status (PEDS. Results Of 791 children, 11% were screened by the PEDS to be at high risk for developmental problems at age three. Of these, 43% had previously been referred for assessment. Children most likely to have been referred were those born preterm. Risk factors for delay included: male gender, history of ear infections, a low income environment, and a mother with poor emotional health and a history of abuse. A child with these risk factors was predicted to have a 53% chance of screening at high risk for developmental problems. This predicted probability was reduced to 19% if the child had a mother with good emotional health and no history of abuse. Conclusion Over 10% of children were identified as high risk for developmental problems by the screening, and more than half of those had not received a specialist referral. Risk factors for problems included prenatal and perinatal maternal and child factors. Assessment of maternal health and effective screening of child development may increase detection of children at high risk who would benefit from early intervention. Trial registration Current
Nation's Schools, 1972
In precedent-setting decrees, courts and federal and State authorities have branded compulsory maternity leaves either unconstitutional or illegal. School administrators are urged to prod boards of education to adopt more lenient maternity leave policies -- now. (Author)
Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long-term mortality impact.
Perry, Henry B; Rassekh, Bahie M; Gupta, Sundeep; Freeman, Paul A
There is limited evidence about the long-term effectiveness of integrated community-based primary health care (CBPHC) in improving maternal, neonatal and child health. However, the interventions implemented and the approaches used by projects with such evidence can provide guidance for ending preventable child and maternal deaths by the year 2030. A database of 700 assessments of the effectiveness of CBPHC in improving maternal, neonatal and child health has been assembled, as described elsewhere in this series. A search was undertaken of these assessments of research studies, field project and programs (hereafter referred to as projects) with more than a single intervention that had evidence of mortality impact for a period of at least 10 years. Four projects qualified for this analysis: the Matlab Maternal Child Health and Family Planning (MCH-FP) P in Bangladesh; the Hôpital Albert Schweitzer in Deschapelles, Haiti; the Comprehensive Rural Health Project (CRHP) in Jamkhed, India; and the Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, India. These four projects have all been operating for more than 30 years, and they all have demonstrated reductions in infant mortality, 1- to 4-year mortality, or under-5 mortality for at least 10 years. They share a number of characteristics. Among the most notable of these are: they provide comprehensive maternal, child health and family planning services, they have strong community-based programs that utilize community health workers who maintain regular contact with all households, they have develop strong collaborations with the communities they serve, and they all have strong referral capabilities and provide first-level hospital care. The shared features of these projects provide guidance for how health systems around the world might improve their effectiveness in improving maternal, neonatal and child health. Strengthening these features will contribute to achieving the goal of
Jaime Edwin Martínez Ventura
Full Text Available With the expansion of organized crime in Central America, the countries in this continental sub-region have enacted a great deal of internal legislation, and have ratified international treaties at the universal, regional and Central American level, particularly after the United Nations Convention against Transnational Organized Crime took effect in 2000.This abundance of laws is very positive, and is an expression of these Central American States’ intent to fulfill their supranational obligations and provide security for their inhabitants. However, it is also negative in that it has led to dispersion, dislocation, discrepancies and inaccuracies regarding the prevailing legal regulations, because national laws have been developed with different concepts, structures, approaches, scope and definitions.Despite these conditions that are adverse to legal harmonization, Central America can move forward with matching its legislation against organized crime. Actually, there already exists an extensive common legal framework in this area, expressed in the fact that most international treaties on Organized Crime have come into force at the universal, regional and subregional levels, ratified by all or most countriesPolitical will is the common denominator that should mediate all efforts of harmonization and alignment of legislation in Central America; it is essential for proposing steps that are based on a common strategy or program.DOI: http://dx.doi.org/10.5377/rpsp.v1i2.1359
World of Work, 1998
Discusses the need for maternity benefits for working women. Suggests that although most countries provide paid maternity leave by law, there is a gap between that law and practice. Includes a chart depicting maternity protection (length of leave, cash benefits, who pays) around the world. (JOW)
Goudar, Shivaprasad S; Stolka, Kristen B; Koso-Thomas, Marion; Honnungar, Narayan V; Mastiholi, Shivanand C; Ramadurg, Umesh Y; Dhaded, Sangappa M; Pasha, Omrana; Patel, Archana; Esamai, Fabian; Chomba, Elwyn; Garces, Ana; Althabe, Fernando; Carlo, Waldemar A; Goldenberg, Robert L; Hibberd, Patricia L; Liechty, Edward A; Krebs, Nancy F; Hambidge, Michael K; Moore, Janet L; Wallace, Dennis D; Derman, Richard J; Bhalachandra, Kodkany S; Bose, Carl L
To describe quantitative data quality monitoring and performance metrics adopted by the Global Network's (GN) Maternal Newborn Health Registry (MNHR), a maternal and perinatal population-based registry (MPPBR) based in low and middle income countries (LMICs). Ongoing prospective, population-based data on all pregnancy outcomes within defined geographical locations participating in the GN have been collected since 2008. Data quality metrics were defined and are implemented at the cluster, site and the central level to ensure data quality. Quantitative performance metrics are described for data collected between 2010 and 2013. Delivery outcome rates over 95% illustrate that all sites are successful in following patients from pregnancy through delivery. Examples of specific performance metric reports illustrate how both the metrics and reporting process are used to identify cluster-level and site-level quality issues and illustrate how those metrics track over time. Other summary reports (e.g. the increasing proportion of measured birth weight compared to estimated and missing birth weight) illustrate how a site has improved quality over time. High quality MPPBRs such as the MNHR provide key information on pregnancy outcomes to local and international health officials where civil registration systems are lacking. The MNHR has measures in place to monitor data collection procedures and improve the quality of data collected. Sites have increasingly achieved acceptable values of performance metrics over time, indicating improvements in data quality, but the quality control program must continue to evolve to optimize the use of the MNHR to assess the impact of community interventions in research protocols in pregnancy and perinatal health. NCT01073475.
Context: Maternal mortality statistics in Nigeria derive mainly from urban based hospital data. In rural areas of the country where available medical facilities and trained medical personnel are inadequate, the incidence, and major causes of maternal death may differ. Aims and Objectives: To provide information on maternal ...
Gwozdz, Wencke; Sousa-Poza, Alfonso; Reisch, Lucia
The substantial increase in female employment rates in Europe over the past two decades has often been linked in political and public rhetoric to negative effects on child development, including obesity. We analyse this association between maternal employment and childhood obesity using rich...... objective reports of various anthropometric and other measures of fatness from the IDEFICS study of children aged 2-9 in 16 regions of eight European countries. Based on such data as accelerometer measures and information from nutritional diaries, we also investigate the effects of maternal employment...... on obesity's main drivers: calorie intake and physical activity. Our analysis provides little evidence for any association between maternal employment and childhood obesity, diet or physical activity....
Gwozdz, Wencke; Sousa-Poza, Alfonso; Reisch, Lucia
The substantial increase in female employment rates in Europe over the past two decades has often been linked in political and public rhetoric to negative effects on child development, including obesity. We analyse this association between maternal employment and childhood obesity using rich...... objective reports of various anthropometric and other measures of fatness from the IDEFICS study of children aged 2-9 in 16 regions of eight European countries. Based on such data as accelerometer measures and information from nutritional diaries, we also investigate the effects of maternal employment...... on obesity's main drivers: calorie intake and physical activity. Our analysis provides little evidence for any association between maternal employment and childhood obesity, diet or physical activity....
Full Text Available Legislation that governs the health and safety of communities near major-hazard installations in South Africa is largely based on existing legislation that had been developed in the United Kingdom and other European Union countries. The latter was developed as a consequence of several major human-induced technological disasters in Europe. The history of the evolution of health-and-safety legislation for the protection of vulnerable communities in European Union (EU countries, France, Malaysia and the USA is explored through a literature survey. A concise comparison is drawn between EU countries, the USA and South Africa to obtain an exploratory view of whether current South-African legislation represents an optimum model for the protection of the health-and-safety of workers and communities near major-hazard installations. The authors come to the conclusion that South-African legislation needs revision as was done in the UK in 2011. Specific areas in the legislation that need revision are an overlap between occupational health and safety and environmental legislation, appropriate land-use planning for the protection of communities near major-hazard installations, the inclusion of vulnerability studies and the refinement of appropriate decision-making instruments such as risk assessment. This article is the first in a series that forms part of a broader study aimed at the development of an optimised model for the regulatory management of human-induced health and safety risks associated with hazardous installations in South Africa.
Parker, G; Lipscombe, P
While maternal overprotection appears associated with several neurotic and psychotic disorders, little is known about determinants of such a parental characteristic. Several hypotheses have been tested in a large nonclinical sample. Maternal and cultural factors seemed of greater relevance than characteristics in the child. Overprotective mothers gave evidence of marked maternal preoccupations before having children, of showing a capacity to be overprotective after the active stage of mothering, and of having personality characteristics of high anxiety, obsessionality and a need to control. Maternal overprotection appears associated with low, rather than with high maternal care. This has important primary prevention and treatment implications.
Murphy, Cliona M
OBJECTIVE: To assess the prevalence and causes of severe maternal morbidity in Dublin over a two year period from 2004 to 2005. STUDY DESIGN: A prospective cohort study from January 2004 to December 2005 was undertaken in the three large maternity hospitals in Dublin, which serve a population of 1.5 million people. All are tertiary referral centres for obstetrics and neonatology and have an annual combined delivery rate of circa 23,000 births. Cases of severe maternal morbidity were identified. A systems based classification was used. The primary cause of maternal morbidity and the number of events experienced per patient was recorded. RESULTS: We identified 158 women who fulfilled the definition for severe maternal morbidity, giving a rate of 3.2 per 1000 maternities. There were two maternal deaths during the time period giving mortality to morbidity ratio of 1:79. The commonest cause of severe morbidity was vascular dysfunction related to obstetric haemorrhage. Eclampsia comprised 15.4% of cases. Intensive care or coronary care admission occurred in 12% of cases. CONCLUSION: The prevalence of severe maternal morbidity in this population is 3.2\\/1000 maternities. Obstetric haemorrhage was the main cause of severe maternal morbidity.
Lamadrid-Figueroa, Hector; Montoya, Alejandra; Fritz, Jimena; Olvera, Marisela; Torres, Luis M; Lozano, Rafael
Progress towards the Millennium Development Goal No. 5 was measured by an indicator that excluded women who died due to pregnancy and childbirth after 42 days from the date of delivery. These women suffered from what are defined as late deaths and sequelae-related deaths (O96 and O97 respectively, according to the International Classification of Diseases, 10th revision). Such deaths end up not being part of the numerator in the calculation of the Maternal Mortality Ratio (MMR), the indicator that governments and international agencies use for reporting. The issue is not trivial since these deaths account for a sizeable fraction of all maternal deaths in the world and show an upward trend over time in many countries. The aim of this study was to analyze empirical data on maternal deaths that occurred between 2010 and 2013 in Mexico, linking databases of the Deliberate Search and Reclassification of Maternal Deaths (BIRMM) and the Birth Information Subsystem (SINAC) of the Ministry of Health. Data were analyzed by negative binomial regression, survival analysis and multiple cause analysis. While the reported MMR decreased by 5% per year between 2010 and 2013, the MMR due to late and sequelae-related deaths doubled from 3.5 to 7 per 100,000 live-births in 2013 (p definition.
Drake, Emily E; Humenick, Sharron S; Amankwaa, Linda; Younger, Janet; Roux, Gayle
To explore maternal responsiveness in the first 2 to 4 months after delivery and to evaluate potential predictors of maternal responsiveness, including infant feeding, maternal characteristics, and demographic factors such as age, socioeconomic status, and educational level. A cross-sectional survey design was used to assess the variables of maternal responsiveness, feeding patterns, and maternal characteristics in a convenience sample of 177 mothers in the first 2 to 4 months after delivery. The 60-item self-report instrument included scales to measure maternal responsiveness, self-esteem, and satisfaction with life as well as infant feeding questions and sociodemographic items. An online data-collection strategy was used, resulting in participants from 41 U.S. states. Multiple regression analysis showed that satisfaction with life, self-esteem, and number of children, but not breastfeeding, explained a significant portion of the variance in self-reported maternal responsiveness scores. In this analysis, sociodemographic variables such as age, education, income, and work status showed little or no relationship to maternal responsiveness scores. This study provides additional information about patterns of maternal behavior in the transition to motherhood and some of the variables that influence that transition. Satisfaction with life was a new predictor of maternal responsiveness. However, with only 15% of the variance explained by the predictors in this study, a large portion of the variance in maternal responsiveness remains unexplained. Further research in this area is needed.
Bashkireva, A S; Shestakov, V P; Svintsov, A A; Raduto, V I; Bogdanov, E A; Chernova, G I; Cherniakina, T S
The systematic review and data analysis of the social services legislative regulation among elderly citizens and disabled persons in Russian Federation was submitted. The structure of the consolidated legislation on social services among citizens of advanced age was defined. The Russian legislative database in all subjects of the Russian Federation was analyzed. Analytical results thus obtained made it possible to designate the subjective rights of elderly citizens in the field of social services, the lists of bases for providing social services, different kinds of these services according to the consolidated legislation in all subjects of the Russian Federation, and various legal organizational forms providing these social services also.
Baeva, Sonia; Archer, Natalie P; Ruggiero, Karen; Hall, Manda; Stagg, Julie; Interis, Evelyn Coronado; Vega, Rachelle; Delgado, Evelyn; Hellerstedt, John; Hankins, Gary; Hollier, Lisa M
A commentary on maternal mortality in Texas is provided in response to a 2016 article in Obstetrics & Gynecology by MacDorman et al. While the Texas Department of State Health Services and the Texas Maternal Mortality and Morbidity Task Force agree that maternal mortality increased sharply from 2010 to 2011, the percentage change or the magnitude of the increase in the maternal mortality rate in Texas differs depending on the statistical methods used to compute and display it. Methodologic challenges in identifying maternal death are also discussed, as well as risk factors and causes of maternal death in Texas. Finally, several state efforts currently underway to address maternal mortality in Texas are described. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Pederson, L. L.; Bull, S. B.; Ashley, M. J.
OBJECTIVE: With regard to the workplace, to examine restrictions on smoking, smoking at work, attitudes toward and reactions to restrictions, and workplace programmes in the context of the legislative environment. DESIGN: Population-based telephone interview survey of adult residents of the jurisdictions of Metropolitan Toronto, Ontario, Canada. SUBJECTS: Workers within the City of Toronto (n = 374) were compared with other workers (n = 536), because their legislative environments with ...
Torgersen, Leila; Ystrom, Eivind; Siega-Riz, Anna Maria; Berg, Cecilie Knoph; Zerwas, Stephanie C; Reichborn-Kjennerud, Ted; Bulik, Cynthia M
Knowledge of infant diet and feeding practices among children of mothers with eating disorders is essential to promote healthy eating in these children. This study compared the dietary patterns of 6-month-old children of mothers with anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified-purging subtype, to the diet of children of mothers with no eating disorders (reference group). The study was based on 53,879 mothers in the Norwegian Mother and Child Cohort Study (MoBa). Latent class analysis (LCA) was used to identify discrete latent classes of infant diet based on the mothers' responses to questions about 16 food items. LCA identified five classes, characterized by primarily homemade vegetarian food (4% of infants), homemade traditional food (8%), commercial cereals (35%), commercial jarred baby food (39%), and a mix of all food groups (11%). The association between latent dietary classes and maternal eating disorders were estimated by multinomial logistic regression. Infants of mothers with bulimia nervosa had a lower probability of being in the homemade traditional food class compared to the commercial jarred baby food class, than the referent (O.R. 0.59; 95% CI 0.36-0.99). Infants of mothers with binge eating disorder had a lower probability of being in the homemade vegetarian class compared to the commercial jarred baby food class (O.R. 0.77; 95% CI 0.60-0.99), but only before adjusting for relevant confounders. Anorexia nervosa and eating disorder not otherwise specified-purging subtype were not statistically significantly associated with any of the dietary classes. These results suggest that maternal eating disorders may to some extent influence the child's diet at 6 months; however, the extent to which these differences influence child health and development remains an area for further inquiry. Copyright © 2014 Elsevier Ltd. All rights reserved.
Chan, Man Yi; Ip, Wan Yim; Choi, Kai Chow
breast feeding has a number of well-documented benefits. Numerous studies have been conducted to investigate an effective approach to increase the breast feeding rate, duration and exclusive breast feeding rate, in which maternal breast feeding self-efficacy was determined as one of the major contributors. Although numerous breast feeding educational programmes have been developed to enhance maternal breastfeeding self-efficacy, results on the effectiveness of these programmes remain inconclusive. this study aims to investigate the effectiveness of a self-efficacy-based breast feeding educational programme (SEBEP) in enhancing breast feeding self-efficacy, breast feeding duration and exclusive breast feeding rates among mothers in Hong Kong. eligible pregnant women were randomized to attend a 2.5-hour breast feeding workshop at 28-38 weeks of gestation and receive 30-60minutes of telephone counselling at two weeks post partum, whereas both intervention and control groups received usual care. At two weeks postpartum, the Breast feeding Self-Efficacy Scale-Short Form (BSES-SF) and a self-developed post partum questionnaire were completed via telephone interviews. The breast feeding duration, pattern of breast feeding and exclusive breast feeding rates were recorded at two weeks, four weeks, eight weeks and six months post partum. results of analyses based on an intention-to-treat (ITT) assumption showed a significant difference (p<0.01) in the change in BSES-SF mean scores between the mothers who received SEBEP and those who did not receive SEBEP at two weeks post partum. The exclusive breast feeding rate was 11.4% for the intervention group and 5.6% for the control group at six months post partum. the findings of this study highlight the feasibility of a major trial to implement breast feeding education targeted at increasing breast feeding self-efficacy and exclusive breast feeding rates in Hong Kong. Copyright © 2016 Elsevier Ltd. All rights reserved.
Tadmor, J.; Schlesinger, T.; Lemesch, C.
Various governmental agencies, including the Ministry of Health, the Ministry of Labor and the Israel AEC are responsible for the control of the use of radioactive materials and medical X-ray machines in Israel. Present legislation deals mainly with the legal aspects of the purchase, transport and possession of radioactive materials and the purchase and operation of medical X-ray machines. No legislation refers explicitly to the protection of the worker from ionizing (and non-ionizing) radiation. A special group of experts appointed by the Minister of Labor recently worked out a comprehensive draft law concerning all legal aspects of occupational radiation protection in Israel. Among the main chapters of the draft are: general radiation protection principles, national radiation protection standards, medical supervision of radiation workers, personal monitoring requirements. The present situation with regard to radiation hazard control in Israel and details of the proposed radiation protection law is discussed. (Author)
Serafini, Mauro; Stanzione, Alessandra; Foddai, Sebastiano
The concept of functional foods was born in Japan in the 1980s. They are foods that were developed specifically to promote health or reduce the risk of disease. Functional foods have not already been defined by the legislation in Europe. Generally, they are considered as those foods which are intended to be consumed as part of the normal diet and which contain biologically active components which offer the potential of enhanced health or reduced risk of disease. Attention concerning this category of foods has grown, new products have appeared in the European market and interest has turned to define the standards and guidelines for the development and promotion of this kind of foods. In the European Union, there is harmonised legislation on health claims, while compounds, ingredients, plants are still regulated only at national level. The question of traditional use and the role of European Food Safety Authority as European Authority for Food Safety will be examined.
Bader, Heather N; Bierer, Linda M; Lehrner, Amy; Makotkine, Iouri; Daskalakis, Nikolaos P; Yehuda, Rachel
Parental traumatization has been associated with increased risk for the expression of psychopathology in offspring, and maternal posttraumatic stress disorder (PTSD) appears to increase the risk for the development of offspring PTSD. In this study, Holocaust-related maternal age of exposure and PTSD were evaluated for their association with offspring ambient cortisol and PTSD-associated symptom expression. Ninety-five Holocaust offspring and Jewish comparison subjects received diagnostic and psychological evaluations, and 24 h urinary cortisol was assayed by RIA. Offspring completed the parental PTSD questionnaire to assess maternal PTSD status. Maternal Holocaust exposure was identified as having occurred in childhood, adolescence, or adulthood and examined in relation to offspring psychobiology. Urinary cortisol levels did not differ for Holocaust offspring and comparison subjects but differed significantly in offspring based on maternal age of exposure and maternal PTSD status. Increased maternal age of exposure and maternal PTSD were each associated with lower urinary cortisol in offspring, but did not exhibit a significant interaction. In addition, offspring PTSD-associated symptom severity increased with maternal age at exposure and PTSD diagnosis. A regression analysis of correlates of offspring cortisol indicated that both maternal age of exposure and maternal PTSD were significant predictors of lower offspring urinary cortisol, whereas childhood adversity and offspring PTSD symptoms were not. Offspring low cortisol and PTSD-associated symptom expression are related to maternal age of exposure, with the greatest effects associated with increased age at exposure. These effects are relatively independent of the negative consequences of being raised by a trauma survivor. These observations highlight the importance of maternal age of exposure in determining a psychobiology in offspring that is consistent with increased risk for stress-related pathology.
Heather N Bader
Full Text Available Background: Parental traumatization has been associated with increased risk for the expression of psychopathology in offspring, and maternal PTSD appears to increase the risk for the development of offspring PTSD. In this study, Holocaust-related maternal age of exposure and PTSD were evaluated for their association with offspring ambient cortisol and PTSD-associated symptom expression. Method: 95 Holocaust offspring and Jewish comparison subjects received diagnostic and psychological evaluations, and 24 hour urinary cortisol was assayed by RIA. Offspring completed the Parental PTSD Questionnaire to assess maternal PTSD status. Maternal Holocaust exposure was identified as having occurred in childhood, adolescence or adulthood and examined in relation to offspring psychobiology. Results: Urinary cortisol levels did not differ for Holocaust offspring and comparison subjects but differed significantly in offspring based on maternal age of exposure and maternal PTSD status. Increased maternal age of exposure and maternal PTSD were each associated with lower urinary cortisol in offspring, but did not exhibit a significant interaction. In addition, offspring PTSD-associated symptom severity increased with maternal age at exposure and PTSD diagnosis. A regression analysis of correlates of offspring cortisol indicated that both maternal age of exposure and maternal PTSD were significant predictors of lower offspring urinary cortisol, whereas childhood adversity and offspring PTSD symptoms were not. Conclusions: Offspring low cortisol and PTSD-associated symptom expression are related to maternal age of exposure, with the greatest effects associated with increased age at exposure. These effects are relatively independent of the negative consequences of being raised by a trauma survivor. These observations highlight the importance of maternal age of exposure in determining a psychobiology in offspring that is consistent with increased risk for stress
Bader, Heather N.; Bierer, Linda M.; Lehrner, Amy; Makotkine, Iouri; Daskalakis, Nikolaos P.; Yehuda, Rachel
Background: Parental traumatization has been associated with increased risk for the expression of psychopathology in offspring, and maternal posttraumatic stress disorder (PTSD) appears to increase the risk for the development of offspring PTSD. In this study, Holocaust-related maternal age of exposure and PTSD were evaluated for their association with offspring ambient cortisol and PTSD-associated symptom expression. Method: Ninety-five Holocaust offspring and Jewish comparison subjects received diagnostic and psychological evaluations, and 24 h urinary cortisol was assayed by RIA. Offspring completed the parental PTSD questionnaire to assess maternal PTSD status. Maternal Holocaust exposure was identified as having occurred in childhood, adolescence, or adulthood and examined in relation to offspring psychobiology. Results: Urinary cortisol levels did not differ for Holocaust offspring and comparison subjects but differed significantly in offspring based on maternal age of exposure and maternal PTSD status. Increased maternal age of exposure and maternal PTSD were each associated with lower urinary cortisol in offspring, but did not exhibit a significant interaction. In addition, offspring PTSD-associated symptom severity increased with maternal age at exposure and PTSD diagnosis. A regression analysis of correlates of offspring cortisol indicated that both maternal age of exposure and maternal PTSD were significant predictors of lower offspring urinary cortisol, whereas childhood adversity and offspring PTSD symptoms were not. Conclusion: Offspring low cortisol and PTSD-associated symptom expression are related to maternal age of exposure, with the greatest effects associated with increased age at exposure. These effects are relatively independent of the negative consequences of being raised by a trauma survivor. These observations highlight the importance of maternal age of exposure in determining a psychobiology in offspring that is consistent with increased
Nitavska, Natalija; Zigmunde, Daiga
With the adoption and the ratification of the European Landscape Convention a legally justified need for a clear landscape policy was grounded in the European countries. It includes the elaboration of the new and the improvement of the existing legislative documents on landscape planning, protection and management. The aim of the particular study is to analyse the existing legislative documents in Latvia influencing landscape planning on different scales / and the implementation of the European Landscape Convention. The study emphasizes the complex structure of the Latvian legislative framework affected by the distribution of the normative documents under the various ministries. Therefore, the main problem is unclear responsibility levels and organizational system for solving the issues regarding landscape planning, protection and management. Thus the various discussions between the involved disciplines and responsible institutions are arising. Two groups of the legislative documents influencing the implementation of the landscape policy in Latvia are detected within the study. The first group is strategic documents determining main landscape planning principles and directions at European, national, regional and professional or sectoral level. The second group is operational documents providing a set of actions for the landscape planning, protection and management at the local or the municipality level. The study concludes that operational documents developed by the municipalities are in high importance because of their direct influence on the landscape planning in Latvia. This often leads to the different landscape planning requirements included in the normative documents of the neighbouring municipalities, although the spatial and ecological borders of the visual landscape do not fit with the formal borders of the municipalities. Thus, it is essential to develop the common principles and actions that would be incumbent on all municipalities to provide the
Rowhani-Rahbar, Ali; Mills, Brianna; Young, Bessie; Rivara, Frederick P.
Objectives. We investigated whether stricter state-level firearm legislation was associated with lower hospital discharge rates for nonfatal firearm injuries. Methods. We estimated discharge rates for hospitalized and emergency department–treated nonfatal firearm injuries in 18 states in 2010 and used negative binomial regression to determine whether strength of state firearm legislation was independently associated with total nonfatal firearm injury discharge rates. Results. We identified 26 744 discharges for nonfatal firearm injuries. The overall age-adjusted discharge rate was 19.0 per 100 000 person-years (state range = 3.3–36.6), including 7.9 and 11.1 discharges per 100 000 for hospitalized and emergency department–treated injuries, respectively. In models adjusting for differences in state sociodemographic characteristics and economic conditions, states in the strictest tertile of legislative strength had lower discharge rates for total (incidence rate ratio [IRR] = 0.60; 95% confidence interval [CI] = 0.44, 0.82), assault-related (IRR = 0.58; 95% CI = 0.34, 0.99), self-inflicted (IRR = 0.18; 95% CI = 0.14, 0.24), and unintentional (IRR = 0.53; 95% CI = 0.34, 0.84) nonfatal firearm injuries. Conclusions. There is significant variation in state-level hospital discharge rates for nonfatal firearm injuries, and stricter state firearm legislation is associated with lower discharge rates for such injuries. PMID:26066935
French legislation on food irradiation subjects marketing of such foodstuffs to a prior licence granted by an interministerial order on the type of goodstuff concerned. The basic text on the licensing procedure is the Decree of 8 May 1970 whose purpose is to ensure the health and safety of the consumer by laying down instructions for the operations, surveillance and labelling, which must set out clearly the type of treatment. (NEA) [fr
The cause for the urgent need of nuclear safety legislation and supervision in China is firstly described, and then a brief introduction to the basic principle and guideline of nuclear safety is presented. Finally the elaboration on the establishment of nuclear safety regulatory system, the enactment of a series of regulations and safety guides, and the implementation of licencing, nuclear safety supervision and research for ensuring the safety of nuclear energy, since the founding of the National Nuclear Safety Administration, are introduced
Ngo, Fawn; Jaishankar, K; Agustina, Jose R.
'Sexting, the portmanteau of Sex and Texting, has become a hot topic of debate between the legislators, researchers, educators, parents and teens' (Jaishankar, 2009, para 1). In spite of the considerable and growing body of literature on sexting, there are significant gaps in the current research. A review of research to date also reveals a dearth of cross-national and cross-cultural research on the topic of sexting. Notably, legal and ethical issues abound with the current method for punishi...
The political situation and the state of legislation after World War II make it difficult to pinpoint a precise date of origin of German nuclear legislation. The restrictions imposed by the Allied High Commission (AHC) without any exception put a ban on the production of uranium and thorium metal as well as the construction of nuclear reactors. These restrictions were lifted expressly when the German Atomic Energy Act (AtG) entered into force on January 1, 1960, i.e. much later than the formal step of gaining sovereignty, which was marked by the protocol of May 5, 1955 terminating the Occupation Statute. In October 1955, the German federal government established the then Federal Ministry for Atomic Matters also in an attempt to reconnect to developments in nuclear fission in other parts of the Western world. To supersede the AHC law, the German federal government in December 1956 publicized a draft Atomic Energy Act. It is safe, therefore, to consider that year the starting point of German atomic legislation. This step was followed by deliberations preparatory to the adoption of the Atomic Energy Act. In 1957, however, adoption failed because no two-thirds majority was reached to amend the Basic Law, i.e. the Constitution. As a consequence, some federal states saw the need to adopt state legislation to regulate this area. On December 3, 1959, a new draft Atomic Energy Act was adopted by the German federal parliament after the second and third readings - coupled with an amendment to the Basic Law on that same day - with the votes of the opposition and with one abstention. (orig.)
van Amsterdam, Jan; Nutt, David; van den Brink, Wim
New psychoactive drugs (NPDs, new psychoactive substances) enter the market all the time. However, it takes several months to ban these NPDs and immediate action is generally not possible. Several European countries and drug enforcement officers insist on a faster procedure to ban NPDs. Introduction of generic legislation, in which clusters of psychotropic drugs are banned in advance, has been mentioned as a possible solution. Here we discuss the pros and cons of such an approach. First, generic legislation could unintentionally increase the expenditures of enforcement, black market practices, administrative burden and health risks for users. Second, it may have a negative impact on research and the development of new treatments. Third, due to the complexity of generic legislation, problems in the enforcement are anticipated due to lack of knowledge about the chemical nomenclature. Finally, various legal options are already available to ban the use, sale and trade of NPDs. We therefore conclude that the currently used scientific benefit-risk evaluation should be continued to limit the adverse health effects of NPDs. Only in emergency cases, where fatal incidents (may) occur, should this approach be overruled.
TIMOFTE Claudia Simona
Full Text Available This paper underlines the current legislation and compliance issues leather waste in different waste groups according to relevant legislation and shows that, although seemingly harmless waste of skin sometimes contain dangerous compounds. As presented risks to human health were some restricted substances in leather. Since 2001 Romania had preoccupation in national legislation on waste management, but some categories, such as leather waste are not framed to this category. Also, another goal is implementing the EU management/storage strategy of industrial waste. Unfortunately, Romania imports huge quantities of used clothing and shoes. Transport, storage and use of them are poor, and many of these are subsequently stored waste by the fact that it is even sometimes improperly discarded. The paper also shows the statistics on waste management in the Bihor County by activity of national economy and by activity of industry at level of CANE REV.2 Section. Analyzing the postings on Internet regarding the sale and purchase of leather wastes in Romania, it was found that there are the following 'categories' of wastes: leather goods, leather from coats, leather from footwear industry, suede, leather, leather resulting from the production of upholstery. It was found that most car buyers use waste leather upholstery. It is recommended that production companies to highlight more transparent their inventory textile and leather waste on types for those interested (including online can access/capitalize them.
Wang, Sufang; Ge, Xing; Zhu, Beibei; Xuan, Yujie; Huang, Kun; Rutayisire, Erigene; Mao, Leijing; Huang, Sanhuan; Yan, Shuangqin; Tao, Fangbiao
Supplementation with folic acid (FA) was proven to prevent neural tube defects (NTDs) and was recommended worldwide before and during early pregnancy. However, much less is known regarding the role of FA after the 12th gestational week (GW). This study aimed to investigate the related effects of continued FA supplementation after the first trimester of pregnancy on fetal growth. The study subjects came from the Ma'anshan-Anhui Birth Cohort Study (MABC) that recruited 3474 pregnant women from the city of Ma'anshan in Anhui Province in China during the period of May 2013 to September 2014. The information on use of vitamin and mineral supplements was recorded in different periods (the first/second/third trimester of pregnancy). Small-for-gestational-age (SGA) births were live-born infants that were birth weight, and large-for-gestational-age (LGA) births were live-born infants that were ≥90th percentile of birth weight according to nomograms based on gender and gestational age from the latest standards. We used multivariable logistic regression to evaluate the effects of FA supplement consumption in the second/third trimester of pregnancy on the risk of LGA and SGA. In addition, propensity score analysis was also performed to examine the effects. In this prospective birth cohort study conducted in Chinese women who had taken FA in the first trimester of pregnancy, we found that continued FA supplementation with 400 micrograms/day in the second and third trimesters of pregnancy significantly increased the risk of LGA (RR = 1.98 (1.29, 3.04)). This relation was strong or monotonic after adjusting for maternal age, newborn's gender, maternal pre-pregnancy BMI, maternal education level, smoking, alcohol consumption and calcium supplementation. We did not observe that continuing FA supplementation after the first trimester of pregnancy remarkably decreased the risk of SGA. The propensity score analysis showed similar results. To confirm these findings, additional
Human exposition to non ionizing electromagnetic radiations. Legislation and base stations measurements Exposición humana a las radiaciones electromagnéticas no ionizantes. Legislación y medidas de estaciones base
Antonio García Pino
Full Text Available This work deals about measurement procedures of non-ionizing radiations and their recorded levels in practice. The analyzed radiation sources cover the most common broadcasting media such as AM and FM transmissions and the GSM mobile telephony base stations. These sources currently radiate locations with high density of population. Spanish radiation level regulations are briefly described and some possible improvements are pointed out. The measurement results are discussed.Este trabajo trata sobre los procedimientos de medida de las radiaciones no ionizantes y sus niveles registrados en medidas reales. Las fuentes de radiación analizadas cubren los medios de radiodifusión más corrientes, tales como las transmisiones AM y FM y también las estaciones base de telefonía móvil GSM. Estas fuentes habitualmente radian sobre áreas con alta densidad de población. Se describe brevemente el marco legal que regula los niveles de radiación en España y se señalan algunas posibles mejoras. Se valorarán los resultados encontrados en las medidas.
Distribution of maternal age and birth order groups in cases with unclassified multiple congenital abnormalities according to the number of component abnormalities: a national population-based case-control study.
Csermely, Gyula; Czeizel, Andrew E; Veszprémi, Béla
Multiple congenital abnormalities are caused by chromosomal aberrations, mutant major genes and teratogens. A minor proportion of these patients are identified as syndromes but the major part belonging to the group of unclassified multiple CAs (UMCAs). The main objective of this study was to evaluate the maternal age and birth order in pregnant women who had offspring affected with UMCA. The strong association between numerical chromosomal aberrations, e.g., Down syndrome and advanced maternal age is well-known and tested here. The Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980 to 1996, yielded a large population-based national data set with 22,843 malformed newborns or fetuses ("informative cases") included 1349 UMCA cases with their 2407 matched controls. Case-control comparison of maternal age and birth order was made for cases with UMCA, stratified by component numbers and their controls. In addition, 834 cases with Down syndrome were compared to 1432 matched controls. The well-known advanced maternal age with the higher risk for Down syndrome was confirmed. The findings of the study suggest that the young age of mothers associates with the higher risk of UMCA, in addition birth order 4 or more associates with the higher risk for UMCA with 2 and 3 component CAs. This study was the first to analyze the possible maternal and birth order effect for cases with UMCA, and the young age and higher birth order associated with a higher risk for UMCA. © 2014 Wiley Periodicals, Inc.
Vangen, Siri; Bødker, Birgit; Ellingsen, Liv
INTRODUCTION: Despite the seriousness of the event, maternal deaths are substantially underreported. There is often a missed opportunity to learn from such tragedies. The aim of the study was to identify maternal deaths in the five Nordic countries, to classify causes of death based...... on internationally acknowledged criteria, and to identify areas that would benefit from further teaching, training or research to possibly reduce the number of maternal deaths. MATERIAL AND METHODS: We present data for the years 2005-2013. National audit groups collected data by linkage of registers and direct...... reporting from hospitals. Each case was then assessed to determine the cause of death, and level of care provided. Potential improvements to care were evaluated. RESULTS: We registered 168 maternal deaths, 90 direct and 78 indirect cases. The maternal mortality ratio was 7.2/100 000 live births ranging from...
Santos, M R; de Sá, T Q V; da Silva, F E; Dos Santos Junior, M R; Maia, T A; Reis, Z S N
Background Around the world, people receive care at various institutions; therefore, clinical information is recorded either on paper or distributed on different information systems with reduced capabilities for sharing data. One approach to handling the complex nature of the health information systems and making it interoperable is the two-level modeling, and the ISO 13606 standard is an option to support this model. A regionally governed EHR program in Brazil proposed to use the ISO 13606 standard and archetypes. This program includes an EHR repository for consolidating the longitudinal electronic record of patients' health. Objective This article aims to present the results and lessons learned from a proof-of-concept (POC) for integrating the Maternal and Neonatal Healthcare Information System (SISMater) developed by the Federal University of Minas Gerais (UFMG) with the EHR system developed by the Department of Healthcare for the State of Minas Gerais (SES/MG). Methods The design of the architecture and software development were driven by the content to be exchanged between the SISMater system and the EHR system and the usage of XML transformation to translate an ISO 13606 EHR extract and vice versa. This POC did not include tests related to revision objects according to ISO 13606 reference model. Results The software architecture and software components required for this POC were proposed and tested. The EHR system validated the syntax and semantic and persisted the extract in the EHR repository. Complete results can be accessed at https://github.com/pocppsus/repository. Conclusion The approach for using XML transformations could make easier the process for ISO 13606 noncompliant EMR systems to exchange EHR data with the SES/MG EHR system.
Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 1. rationale, methods and database description.
Perry, Henry B; Rassekh, Bahie M; Gupta, Sundeep; Wilhelm, Jess; Freeman, Paul A
Community-based primary health care (CBPHC) is an approach used by health programs to extend preventive and curative health services beyond health facilities into communities and even down to households. Evidence of the effectiveness of CBPHC in improving maternal, neonatal and child health (MNCH) has been summarized by others, but our review gives particular attention to not only the effectiveness of specific interventions but also their delivery strategies at the community level along with their equity effects. This is the first article in a series that summarizes and analyzes the assessments of programs, projects, and research studies (referred to collectively as projects) that used CBPHC to improve MNCH in low- and middle-income countries. The review addresses the following questions: (1) What kinds of projects were implemented? (2) What were the outcomes of these projects? (3) What kinds of implementation strategies were used? (4) What are the implications of these findings? 12 166 reports were identified through a search of articles in the National Library of Medicine database (PubMed). In addition, reports in the gray literature (available online but not published in a peer-reviewed journal) were also reviewed. Reports that describe the implementation of one or more community-based interventions or an integrated project in which an assessment of the effectiveness of the project was carried out qualified for inclusion in the review. Outcome measures that qualified for inclusion in the review were population-based indicators that defined some aspect of health status: changes in population coverage of evidence-based interventions or changes in serious morbidity, in nutritional status, or in mortality. 700 assessments qualified for inclusion in the review. Two independent reviewers completed a data extraction form for each assessment. A third reviewer compared the two data extraction forms and resolved any differences. The maternal interventions assessed
Baquet, Claudia R; Mishra, Shiraz I; Weinberg, Armin D
This report describes state policy and legislation related to clinical trials participation and Maryland's model to enhance clinical trial availability and participation. Descriptive review of state policy and legislation related to coverage for clinical trials costs based on data from the National Cancer Institute (NCI) State Cancer Legislative Database, the American Cancer Society, and NCI; additionally, discussion of Maryland's comprehensive multilevel clinical trial model comprising policy initiatives, community engagement, research, education, and infrastructure support. Twenty-four states have mandated clinical trial coverage through specific legislation or agreements since 1994. Covered benefits varied among the states. Besides cost and insurance barriers, there is a need to address important patient, physician and researcher, and structural barriers to clinical trial participation. Maryland provides a comprehensive model to address the multi-faceted clinical trial participation determinants as it tracks state and federal policy, documents trial barriers, and conducts community education.
Francisco Ricardo Lins Vieira de Melo
Full Text Available This study aims to make a critical analysis of legislation regulating the inclusion of disabled students in higher education in Brazil and Portugal. Based on a documentary study, conducted between September and November 2015, the legal standards in recent decades have been analyzed. The results point out different stages of construction of the inclusion policy in the researched countries. It is emphasized that there is a significant variety of norms in the Brazilian context to ensure that these students have equal opportunities, and a scarcity of regulations in Portugal. The legislation has been referred to as an important factor for the development of inclusive education; however it is noteworthy that the existence of legislation does not necessarily imply it is actually complied. Besides legislation, removing barriers for the full participation and learning of disabled students involves awareness, investment in resources, public policy makers and managers’ scientific knowledge to ensure a quality education throughout life for all people.
Saunders, Margaret; Palmer, Maria; Preece, Alan; Millard, Roger
Organ residence times were calculated for diagnostic intakes of 99m Tc pertechnetate, 2,3-dimercaptosuccinic acid (DMSA), diethylene triamine penta-acetic acid (DTPA), hydroxymethylene diphosphonate (HDP), macroaggregated albumin (MAA) and mercapto-acetyltriglycine (MAG 3 ) during the 1st and 3rd stages of pregnancy and used with the MIRDOSE3 pregnant female phantoms for generation of dose estimates. At stage 3 individual foetal organ doses were estimated via a surrogate phantom based on that for the new-born but with mean dose/cumulated activity (S) values scaled for compatibility with foetal whole body S. Stage 1 or 3 whole foetus doses ranged from 5.2 to 0.77 μGy MBq -1 respectively, analogous to current ICRP estimates for these agents using similar in vivo biodistribution model databases. Most stage 3 maternal and foetal organ doses were similar within a factor of 3, being higher in the foetus than the mother with pertechnetate, DTPA and MAG 3 , and lower with DMSA, HDP and MAA. Doses were more uniformly distributed among foetal organs than in the mother. Placental transfer was greatest with pertechnetate, where dose to the stage 3 foetal thyroid was 60-140 μGy MBq -1 . With each agent there was more placental transfer in stage 3 than in stage 1, but doses to stage 1 whole foetus were always higher, with the contribution from the mother dominant. For DMSA, HDP and MAG 3 the maternal contribution to total foetal body dose exceeded 93% for both stages. (orig.)
It is likely that the complex law concerning alcohol and drugs in the workplace is one of the reasons for unwillingness to resolve the problem of intake of such psychoactive substances by employees. 'Iherefore, the author made an attempt to depict Polish legislation in this field based on the review of legal acts and regulations, as well as on their extensive judiciary interpretation. Such an information can be used by employers in developing their workplace policy of diminishing the intake of psychoactive substances by employees. This information can also be helpful for the bodies supporting workplaces in solving problems derived from alcohol and drugs consumption, such as occupational medicine specialists and local governments.
With the U.S. Senate currently considering national energy legislation, Senators John McCain (R-Arizona) and Joseph Lieberman (D-Connecticut) plan to offer a modified version of their bipartisan, proposed Climate Stewardship Act of 2003 (S. 139) as an amendment. The amendment would establish a market driven system of greenhouse gas tradeable allowances to reduce emission. It would also provide for a program of scientific research on abrupt climate change in order to identify and understand past instances of abrupt change; and would establish a national greenhouse gas data base.
Vermeiden, Tienke; Braat, Floris; Medhin, Girmay; Gaym, Asheber; van den Akker, Thomas; Stekelenburg, Jelle
BACKGROUND: Although Ethiopia is scaling up Maternity Waiting Homes (MWHs) to reduce maternal and perinatal mortality, women's use of MWHs varies markedly between facilities. To maximize MWH utilization, it is essential that policymakers are aware of supportive and inhibitory factors. This study had
A number of trends indicate that mandatory seat belt use legislation is to be expected within the near future. The constitutionality of such self-protective legislation has been the subject of recent speculation. Constitutional challenges may be expe...
Yefremov, D V; Jyliyaeva, E P
The article demonstrates the impact of globalization on development of public health legislation at the international level and in particular countries. The legislation is considered as a tool to decrease the globalization health risks for population
This article discusses the importance of developing legislative frameworks for the development of an m - economy in Africa......This article discusses the importance of developing legislative frameworks for the development of an m - economy in Africa...
The legislator can determine the extent of control of administrative courts by reduction of substantive conditions. The author has the opinion that the judicial control cannot be stricter than the legislative control. For the range of the control of administrative courts is decisive, to what extent the legislator is forced to proper legislative settlements. In this context the author discusses the Kalkar-decision of the Federal Constitutional Court of 1978. (CW) [de
Seth C McKee
Full Text Available The marked increase in restrictive voter identification (ID laws since the 2010 elections reveals the extreme partisan polarization in those state legislatures advancing this reform. Unlike previous studies that examine state-level factors expected to influence passage of restrictive voter ID bills, this study is the first to investigate the question using the state legislator as the unit of analysis. Multivariate analysis of the voting behavior of state legislators shows which kinds of district-level factors increase or decrease their likelihood of supporting stricter voter ID laws. Given the differentiable coalitions favoring Democratic and Republican candidates, certain partisan-aligned district demographics influence state lawmaker support for restrictive voter ID legislation. Race in particular is a major cleavage conditioning support for restrictive voter ID laws. Unlike the mixed findings generated by macro-level studies, this article provides convincing evidence that the size of the black district population negatively influences the likelihood that a Democratic legislator votes in favor of a restrictive voter ID bill, but positively affects the probability that a Republican lawmaker votes yes. The findings in this study illuminate the contextual factors that influence legislator voting on this salient election reform.
Liu, Jue; Zhang, Shikun; Liu, Min; Wang, Qiaomei; Shen, Haiping; Zhang, Yiping
Preterm birth is the leading cause of child death in children younger than 5 years. Large cohort studies in developed countries have shown that maternal hepatitis B virus infection is associated with preterm birth, but there is little reliable evidence from China and other developing countries, where hepatitis B virus prevalence is intermediate or high. Hence, we designed this study to investigate the association between pre-pregnancy hepatitis B virus infection and risk of preterm and early preterm birth. Between Jan 1, 2010, and Dec 31, 2012, we did a population-based cohort study using data from 489 965 rural women aged 21-49 years who had singleton livebirths from 220 counties of China who participated in the National Free Preconception Health Examination Project. Participants were divided into three groups according to their pre-pregnancy status of hepatitis B virus infection: women uninfected with hepatitis B virus (control group), women who were HBsAg positive and HBeAg negative (exposure group 1), and women who were both HBsAg and HBeAg positive (exposure group 2). The primary outcome was preterm birth (gestation at less than 37 weeks). We used log-binomial regression to estimate adjusted risk ratios (aRR) of preterm birth for women with pre-pregnancy hepatitis B virus infection, and risk of early preterm birth (gestation less than 34 weeks). 489 965 women met inclusion criteria and were included in this study; of these, 20 827 (4·3%) were infected with hepatitis B virus. Compared with women who were not infected with hepatitis B virus, women who were HBsAg positive and HBeAg negative had a 26% higher risk of preterm birth (aRR 1·26, 95% CI 1·18-1·34) and women who were both HBsAg and HBeAg positive had a 20% higher risk of preterm birth (aRR 1·20, 1·08-1·32). Compared with women who were not infected with hepatitis B virus, women who were HBsAg positive and HBeAg negative manifested an 18% higher risk of early preterm birth (gestation less
Fotso, Jean Christophe; Higgins-Steele, Ariel; Mohanty, Satyanarayan
In response to persistently poor levels of maternal, newborn and child health (MNCH) in rural India, the National Rural Health Mission (NRHM) was launched to support the provision of accessible, affordable and quality health care in deprived and underserved communities. The Accredited Social Health Activists (ASHAs), local women, are trained as health promoters to generate demand for, and facilitate access to MNCH care in their communities. While they are also expected to provide husbands of expectant women with information on MNCH care and family planning, their reach to the husbands is limited. The aim of this study is to describe the influence of a male engagement project on the utilization and community-based delivery of MNCH care in a rural district of the country. We used qualitative data from the evaluation of a project which recruited and trained male Community Health Workers (CHWs) known as Male Health Activists (MHAs) to complement the work of ASHAs and target outreach to men. This paper uses data from in-depth interviews (IDIs) with ASHAs (n=11), Anganwadi Workers (AWWs) (n=4) and Auxiliary Nurse Midwives (ANMs) (n=2); with women who had delivered at home, community health center or district hospital in the few months preceding the date of the interview (n=11); and with husbands of these women (n=7). Participants' responses are broadly organized around the facilitation of ASHAs' work by MHAs, and male engagement activities undertaken by MHAs. More specifically, the narratives reflected gender-based divisions of work and space in three core areas of delivery and use of MNCH services: escorting women to health centers for facility-based deliveries; mobilizing women and children to attend Village Health and Nutrition Days and Immunization Days; and raising awareness among men on MNCH and family planning. This study sheds light on male engagement as a strategy to improve the delivery, access and uptake of maternal, newborn and child health in the context of
... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Proposals for legislation. 1506.8 Section 1506.8 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY OTHER REQUIREMENTS OF NEPA § 1506.8 Proposals for legislation. (a) The NEPA process for proposals for legislation (§ 1508.17...
... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Influencing legislation or... DEPARTMENT OF THE TREASURY EMPLOYEE RULES OF CONDUCT Rules of Conduct § 0.212 Influencing legislation or... Congress to favor or oppose any legislation. This prohibition does not apply to the official handling...
Canada has implemented legislation covering all firearms since 1977 and presents a model to examine incremental firearms control. The effect of legislation on homicide by firearm and the subcategory, spousal homicide, is controversial and has not been well studied to date. Legislative effects on homicide and spousal homicide were analyzed using…
... 29 Labor 3 2010-07-01 2010-07-01 false General legislative history. 783.28 Section 783.28 Labor... TO EMPLOYEES EMPLOYED AS SEAMEN Legislative History and Judicial Construction of the Exemptions § 783.28 General legislative history. As originally enacted in 1938, section 13(a)(3) of the Fair Labor...
... 29 Labor 3 2010-07-01 2010-07-01 false General legislative history. 784.102 Section 784.102 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL... Aquatic Products Legislative History of Exemptions § 784.102 General legislative history. (a) As orginally...
Key legislative framework presented in this paper is within the areas of media and access to information, individual rights and freedoms, as well as legislation pertaining to the conduct of elections. In some cases, colonial legislation that politicians claimed to have repealed was reincarnated, as the post-colonial dispensation ...
Ravi, Harini; McNeill, Gabriel; Goel, Shruti; Meltzer, Steven D; Hunkapiller, Nathan; Ryan, Allison; Levy, Brynn; Demko, Zachary P
Non-invasive prenatal testing (NIPT) for aneuploidy using cell-free DNA in maternal plasma has been widely adopted. Recently, NIPT coverage has expanded to detect subchromosomal abnormalities including the 22q11.2 deletion. Validation of a SNP-based NIPT for detection of 22q11.2 deletions demonstrating a high sensitivity (97.8%) and specificity (99.75%) has been reported. We sought to further demonstrate the performance of a revised version of the test in a larger set of pregnancy plasma samples. Blood samples from pregnant women (10 with 22q11.2-deletion‒affected fetuses and 390 negative controls) were successfully analyzed using a revised SNP-based NIPT for the 22q11.2 deletion. The sensitivity and specificity of the assay were measured. Sensitivity of the assay was 90% (9/10), and specificity of the assay was 99.74% (389/390), with a corresponding false positive-rate of 0.26%. The data presented in this study add to the growing body of evidence demonstrating the ability of the SNP-based NIPT to detect 22q11.2 deletions with high sensitivity and specificity.
Frith, Amy L; Naved, Ruchira T; Ekström, Eva-Charlotte; Rasmussen, Kathleen M
Background: Good maternal-infant interaction is essential for optimal infant growth, health, and development. Although micronutrient malnutrition has been associated with poorer interaction, the effects of maternal micronutrient supplementation on interaction are unknown. Objectives: We examined differences in maternal-infant feeding interaction between 3 maternal pre- and postpartum micronutrient supplementation groups that differed in iron dose and inclusion of multiple micronutrients and determined whether any differences observed were mediated by maternal distress. Design: A cohort of 180 pregnant women was selected from 3300 women in the randomized controlled trial Maternal Infant Nutritional Interventions Matlab, which was conducted in Matlab, Bangladesh. At 8 wk of gestation, women were randomly assigned to 1 of 3 groups to receive a daily supplement of micronutrients (14 wk gestation to 12 wk postpartum): 60 or 30 mg Fe each with 400 μg folic acid or multiple micronutrients (MuMS; 30 mg Fe, 400 μg folic acid, and other micronutrients). A maternal-infant feeding interaction was observed in the home when infants were 3.4–4.0 mo of age, and maternal distress was assessed. Results: Compared with 30 mg Fe, 60 mg Fe decreased the quality of maternal-infant feeding interaction by ≈10%. Compared with 30 mg Fe, MuMS did not improve interaction but reduced maternal early postpartum distress. Distress did not mediate the effects of micronutrient supplementation on interaction. Conclusion: For pregnant and postpartum women, micronutrient supplementation should be based on both nutritional variables (eg, iron status) and functional outcomes (eg, maternal-infant interaction and maternal distress). PMID:19439457
Nabsiah Abdul Wahid
Full Text Available The latest attempt by the Malaysian government to restructure its water sector has managed to promulgate two important acts, the Suruhanjaya Perkhidmatan Air Negara (SPAN Act (Act 654 and the Water Services Industry Act (WSIA/Act 655; these also complicate the governing of water services and water resources in the country as they affect the sovereignty of a state’s land and water issues. In Malaysia’s federated system of governance, water resources are placed fully within the purview of each State’s government, as stated in the Waters Act 1920 (Revised 1989, while water services are straddled across the purview of both the State and Federal government (Water Supply Enactment 1955. Any reforms will remain problematic unless further analysis is carried out on the available legislation that directly impacts said reform, particularly the Waters Act and Water Supply Enactment. For example, when the Waters Act stipulates “the entire property in and control of all rivers in any State is vested solely in the Ruler of that State”, it is clear that the Federal Government has no authority whatsoever over water resources of any states. The Water Supply Enactment 1955 (adopted by several States further empowers the state’s water supply authorities to supply water to domestic and commercial consumers. Other legislation that has been enacted to govern land and water issues in the country include the Geological Act 1974 on groundwater abstraction and the Environmental Quality Act 1974 (incorporating all amendments up to 1st January 2006 on some aspects of the environmental impact of groundwater abstraction. While these legislations seemed to provide adequate coverage on the governance of groundwater abstraction; treatment, distribution and wastewater management, which form the water supply value chain in the country, are not covered. Similarly, the Sewerage Services Act 1993 covers only wastewater governance issues rather than the whole value chain
Clara Unoalegie Bola Agbara
Full Text Available In every human interaction, interlocutors strive to maintain appropriate decorum and politeness in order to avoid undue feeling of not being ‘nice’ or being insensitive to co-participant’s self-esteem or image. This culture of being ‘nice’ is expressed not only through verbal codes, but also through non-verbal cues such as pitch, tone, voice modulation, facial expression and other forms of body language. Nigeria legislative House reflects the uniqueness of Nigeria as a multicultural nation with about two hundred and fifty ethnic groups. Each tribe has a unique way of expressing ‘nice’ (politeness. This paper examines how Nigerian legislators from different ethnic groups acknowledge the self-esteem of other legislators during senate debates. The study used Scollon and Scollon’s politeness principle which states that in every interaction there is a continuous ‘face’ (self-image negotiation and this ‘face’ which is made up of two aspects - involvement and independent- must be balanced during interactions because ‘face’ is a paradoxical concept. The interest of this study is to identify and to explain how politicians, who though are in opposition, acknowledge the self-esteem of others. Six hansards were sampled from 2009 to 2010, one bill from each quarter of the year. It was discovered that speakers almost always punctuate their contributions to debate with different types of politeness indicators as a means of acknowledging both the involvement and dependent face wants of participants. The politeness indicators often used by senators include address forms which are used not only as vocative (to the presiding senator but also as designative (for reference to a third person mentioned in the speech, first person plural pronouns, rhetorical (speech politeness markers and ritualized utterances.
Muggli, Monique E; Lockhart, Nikki J; Ebbert, Jon O; Jiménez-Ruiz, Carlos A; Riesco Miranda, Juan Antonio; Hurt, Richard D
While Spain's national tobacco control legislation prohibits smoking in many indoor public places, the law provides for an exception to the prohibition of smoking by allowing separate seating sections and ventilation options in certain public places such as bars and restaurants, hotels and airports. Accordingly, Spain's law is not aligned with Article 8 Guidelines of the World Health Organization's Framework Convention on Tobacco Control, which requires parties to ensure universal protection against secondhand smoke exposure in all enclosed public places, workplaces and on all means of public transport. Spain's law is currently being promoted by the tobacco companies in other countries as a model for smoke-free legislation. In order to prevent weakening of smoke-free laws in other countries through industry-supported exceptions, we investigated the tactics used by the tobacco companies before the implementation of the new law and assessed the consequences of these actions in the hospitality sector. Internal tobacco industry documents made public through US litigation settlements dating back to the 1980s were searched in 2008-9. Documents show that tobacco companies sought to protect hospitality venues from smoking restrictions by promoting separate seating for smokers and ineffective ventilation technologies, supporting an unenforceable voluntary agreement between the Madrid local government and the hospitality industry, influencing ventilation standards setting and manipulating Spanish media. The Spanish National Assembly should adopt comprehensive smoke-free legislation that does not accommodate the interests of the tobacco industry. In doing so, Spain's smoke-free public places law would be better aligned with the Framework Convention on Tobacco Control.
Mayer, V W; Flamm, W G
A brief account is given of the history of the legislative acts that give responsibility to the U.S. Food and Drug Administration (FDA) for ensuring the safety of foods, drugs, and cosmetics. Within the present legislative framework the FDA has the authority to impose regulations which are designed to ensure the safety of all foods, drugs, and cosmetics. The existing legislative authority is adequate for this purpose; however, the difficulty lies instead with technology and the inadequacy of scientific perspective in the emerging area of mutagenicity testing. Earlier efforts in development of mutagenicity screening systems culminated only a few years ago in the proposal to use the host-mediated assay, somatic cell cytogenetics, and dominant lethal tests collectively. Subsequent research efforts indicated that there were serious practical and scientific deficiencies in using this approach. More recently a new proposal, the tier system, has been suggested as an alternative measure. The proposed tier system at FDA consists of three testing levels of increasing complexity. The first tier is an initial screening effort using techniques having maximum sensitivity that are also useful for large-scale, rapid testing. The second tier is designed to identify and confirm that the presumptive mutagens detected in the first tier are truly mutagenic for higher organisms, most especially, for mammals. The third tier would be devoted to explicit genetic tests in mammals designed to ascertain the imposed risk to man by the introduction of a mutagen in our environment. The FDA is currently involved in a number of research activities in the area of mutagenicity safety screening which will explore the adequacies and possible deficiencies of the tier system approach. These efforts are described for our in-house activities, our contract activities, and our cooperative and collaborative activities with other government agencies and institutions.
Azad, Meghan B; Becker, Allan B; Kozyrskyj, Anita L
Perinatal programming is an emerging theory for the fetal origins of chronic disease. Maternal asthma and environmental tobacco smoke (ETS) are two of the best-known triggers for the perinatal programming of asthma, while the potential role of maternal diabetes has not been widely studied. To determine if maternal diabetes is associated with child asthma, and if so, whether it modifies the effects of ETS exposure and maternal asthma. We studied 3,574 Canadian children, aged 7-8 years, enrolled in a population-based birth cohort. Standardized questionnaires were completed by the children's parents, and data were analyzed by multivariable logistic regression. Asthma was reported in 442 children (12.4%). Compared to those without asthma, asthmatic children were more likely to have mothers (P = 0.003), but not fathers (P = 0.89), with diabetes. Among children without maternal history of diabetes, the likelihood of child asthma was 1.4-fold higher in those exposed to ETS (adjusted odds ratio, 1.40; 95% confidence interval, 1.13-1.73), and 3.6-fold higher in those with maternal asthma (3.59; 2.71-4.76). Among children born to diabetic mothers, these risks were amplified to 5.7-fold (5.68; 1.18-27.37) and 11.3-fold (11.30; 2.26-56.38), respectively. In the absence of maternal asthma or ETS, maternal diabetes was not associated with child asthma (0.65, 0.16-2.56). Our findings suggest that maternal diabetes may contribute to the perinatal programming of child asthma by amplifying the detrimental effects of ETS exposure and maternal asthma. Copyright © 2012 Wiley Periodicals, Inc.
This document is a compilation of nuclear regulatory legislation and other relevant material through the 102d Congress, 2d Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include: The Atomic Energy Act of 1954, as amended; Energy Reorganization Act of 1974, as amended, Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statutes and treaties on export licensing, nuclear non-proliferation, and environmental protection
Belluco, Simone; Halloran, Afton Marina Szasz; Ricci, Antonia
Growing global food demand has generated a greater interest in the consumption of new and diversified protein sources. Novel foodstuffs represent a challenge for food law as they need proper safety assessments before obtaining market permission. The case of edible insects and European law is a good...... framework for a novel food in a regulatory context. Once admitted, edible insects require proper rules to assure consumers and stakeholders of their benefits and safety. This overview highlights the need to develop clearer legislation to govern the future production and consumption of new food in Europe...
García-Vigil, José Luis
It had been established that labor damage are: laboral injuries, professional diseases and others diseases related with laboral conditions. All of them are referred to as diseases or damages suffered as a consequence of a laboral relations. It is implicated that the damage occurs in the place or during a laboral scheduled time with a causal direct relation. There is a trend in the Spanish laboral legislation, which is controversial in laboral medicine, because it includes a Law for the Prevention of Laboral Risks that consider also to the chronic diseases as a cause no traumatic of a laboral risk to conditioned a damage during the laboral journey.
This document is a compilation of nuclear regulatory legislation and other relevant material through the 102d Congress, 2d Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include The Atomic Energy Act of 1954, as amended; Energy Reorganization Act of 1974, as amended, Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statutes and treaties on export licensing, nuclear non-proliferation, and environmental protection
This document is a compilation of nuclear regulatory legislation and other relevant material through the 101st Congress, 2nd Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include The Atomic Energy Act of 1954, as amended: Energy Reorganization Act of 1974, as amended; Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statues and treaties on export licensing, nuclear non-proliferation, and environmental protection
Daniela C. A. Pigosso
Full Text Available Environmental legislation is increasingly changing its focus from manufacturing-oriented to product-oriented instruments. Compliance with product-related environmental legislation is achieved by the incorporation of environmental requirements into the early phases of the product development process (PDP. Nevertheless, the deployment of product-related environmental legislation into product requirements is still a challenge. This study followed an inductive approach to propose a guideline to support the identification, analysis and deployment of product requirements based on product-related environmental legislation. The guideline is composed of nine steps, clustered into three groups according to their main objective: (A identification of environmental product-related legislation; (B identification of legislative topics to be considered for the deployment of requirements; and (C creation and validation of product requirements. The product requirements deployed are to be considered during the PDP. The guideline was evaluated in an expert consultation in a large manufacturing company, suggesting that it can be used to support the systematization and deployment of product-related environmental requirements.
Background Newly established high-technology areas such as eHealth require regulations regarding the interoperability of health information infrastructures and data protection. It is argued that government capacities as well as the extent to which public and private organizations participate in policy-making determine the level of eHealth legislation. Both explanatory factors are influenced by international organizations that provide knowledge transfer and encourage private actor participation. Methods Data analysis is based on the Global Observatory for eHealth - ATLAS eHealth country profiles which summarizes eHealth policies in 114 countries. Data analysis was carried out using two-component hurdle models with a truncated Poisson model for positive counts and a hurdle component model with a binomial distribution for zero or greater counts. Results The analysis reveals that the participation of private organizations such as donors has negative effects on the level of eHealth legislation. The impact of public-private partnerships (PPPs) depends on the degree of government capacities already available and on democratic regimes. Democracies are more responsive to these new regulatory demands than autocracies. Democracies find it easier to transfer knowledge out of PPPs than autocracies. Government capacities increase the knowledge transfer effect of PPPs, thus leading to more eHealth legislation. Conclusions All international regimes – the WHO, the EU, and the OECD – promote PPPs in order to ensure the construction of a national eHealth infrastructure. This paper shows that the development of government capacities in the eHealth domain has to be given a higher priority than the establishment of PPPs, since the existence of some (initial) capacities is the sine qua non of further capacity building. PMID:24410989
Lemstra, Mark; Olszynski, W P
Although there have been numerous strategies to prevent motor vehicle collisions and their subsequent injuries, few have been effective in preventing motor vehicle injury claims. In this paper, we examine the role of legislation and compensation system in altering injury claim incidence. The population base for our natural experiment was all Saskatchewan, Manitoba, British Columbia and Quebec residents who submitted personal injury claims to their respective motor vehicle insurance provider from 1990 to 1999. The provinces of Saskatchewan and Manitoba switched from Tort to pure No-Fault insurance on January 1, 1995 and on March 1, 1994 respectively. British Columbia maintained tort insurance and Quebec maintained pure no-fault insurance throughout the entire 10-year period. The conversion from tort insurance to pure no-fault motor vehicle insurance resulted in a five-year 31% (RR = 0.69; 95% CI 0.68-0.70) reduction in total injury claims per 100,000 residents in Saskatchewan and a five-year 43% (RR = 0.57; 95% CI 0.56-0.58) reduction in Manitoba. At the same time, the province of British Columbia retained tort insurance and had a five-year 5% reduction (RR = 0.95; 95% CI 0.94-0.99). Quebec, which retained pure no-fault throughout the entire 10-year period, had less than one third of the injury claims per 100,000 residents than the tort province of British Columbia. The conversion from tort to pure no-fault legislation has a large influence in reducing motor vehicle injury claim incidence in Canada. Legislative system and injury compensation scheme have an observable impact on injury claim incidence and can therefore have significant impact on the health care system.
This study presents the current state of legislation and regulations governing the peaceful uses of nuclear energy in the central and eastern European countries (CEEC) and the New Independent States (NIS). It also contains information on the national bodies responsible for the regulation and control of nuclear energy. The nuclear energy sector has not escaped from the changes that have affected the political, economic and social climates over the past fifteen years. Under the former socialist regime, activities in this field came within the sole remit of the State administration. In the legal area, it had not been deemed necessary in most of these countries to enact laws guaranteeing democratic control of electronuclear programmes and establishing a clear distinction between activities promoting this source of energy and regulatory control, while ensuring that safety imperatives take priority over all other considerations. With the arrival of new political forces came the will to remedy this situation promptly by creating new regulatory structures and drafting legislative texts based on those used in western countries. This evolution was all the more necessary given that, at the same time, the new policy of accountability had revealed safety defects in numerous nuclear installations in these countries, thus rendering international assistance indispensable. From the legal point of view, the outcome of these years of effort is remarkably positive: almost all countries of Eastern Europe pursuing electronuclear programmes have established institutions capable of exercising efficient control over nuclear power plants and other installations. Accession to the international conventions which form the backbone of nuclear law has become widespread. Modern legislation is henceforth in place in almost all of these states. (author)
Houle, Brian; Clark, Samuel J; Kahn, Kathleen; Tollman, Stephen; Yamin, Alicia
Maternal mortality, the HIV/AIDS pandemic, and child survival are closely linked. This study contributes evidence on the impact of maternal death on children's risk of dying in an HIV-endemic population in rural South Africa. We used data for children younger than 10 years from the Agincourt health and socio-demographic surveillance system (1992 - 2013). We used discrete time event history analysis to estimate children's risk of dying when they experienced a maternal death compared to children whose mother survived (N=3,740,992 child months). We also examined variation in risk due to cause of maternal death. We defined mother's survival status as early maternal death (during pregnancy, childbirth, or within 42 days of most recent childbirth or identified cause of death), late maternal death (within 43-365 days of most recent childbirth), any other death, and mothers who survived. Children who experienced an early maternal death were at 15 times the risk of dying (RRR 15.2; 95% CI 8.3-27.9) compared to children whose mother survived. Children under 1 month whose mother died an early (p=0.002) maternal death were at increased risk of dying compared to older children. Children whose mothers died of an HIV/AIDS or TB-related early maternal death were at 29 times the risk of dying compared to children with surviving mothers (RRR 29.2; 95% CI 11.7-73.1). The risk of these children dying was significantly higher than those children whose mother died of a HIV/AIDS or TB-related non-maternal death (p=0.017). This study contributes further evidence on the impact of a mother's death on child survival in a poor, rural setting with high HIV prevalence. The intersecting epidemics of maternal mortality and HIV/AIDS - especially in sub-Saharan Africa - have profound implications for maternal and child health and well-being. Such evidence can help guide public and primary health care practice and interventions.
Bringing Russian legislation into compliance with international norms and standards is necessary after its accession to the World Trade Organization. Harmonization of food legislation and of sanitary and phytosanitary measures are among the problems that had to be solved first. Many Russian food and trade regulations had been changed or are still in the process of being reformed, largely owing to a policy of integration pursued by the Customs Union of Russia, Belarus and Kazakhstan. However, as a member of the Eurasian Economic Community, Russia is also engaged not only in harmonization throughout the Customs Union but also Kirgizstan and Tajikistan, and Armenia, Moldova and Ukraine as observer countries. Russia also continues to coordinate policy reforms closely with the European Union, its primary trade partner, ultimately bringing Russian food and sanitary norms closer to international standards (e.g. Codex). Today, all participants in the Russian food production chain, processing and sale of foods have to deal with growing numbers of security standards. Many organizations are certified under several schemes, which leads to unnecessary costs. Harmonization of standards has helped promote solutions in the domestic market as well as import-export of foods and raw materials for production. Priorities have included food safety for human health, consumer protection, removal of hazardous and/or adulterated products and increased competition within the domestic food market as well as mutual recognition of certification in bilateral and multilateral (inter)national agreements. © 2013 Society of Chemical Industry.
Application of Neural Networks for classification of Patau, Edwards, Down, Turner and Klinefelter Syndrome based on first trimester maternal serum screening data, ultrasonographic findings and patient demographics.
Catic, Aida; Gurbeta, Lejla; Kurtovic-Kozaric, Amina; Mehmedbasic, Senad; Badnjevic, Almir
feedback was 98.8%. The results presented in this paper prove that an expert diagnostic system based on neural networks can be efficiently used for classification of five aneuploidy syndromes, covered with this study, based on first trimester maternal serum screening data, ultrasonographic findings and patient demographics. Developed Expert System proved to be simple, robust, and powerful in properly classifying prenatal aneuploidy syndromes.
Uzondu, Charles A; Doctor, Henry V; Findley, Sally E; Afenyadu, Godwin Y; Ager, Alastair
Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services. Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008-2010 (before introduction of the pilot) with data from 2011-2013 (during and after the pilot) to gauge sustainability of the model. Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years. Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas. © Uzondu et al. This is an open-access article distributed under
The impact of human rights interventions on health outcomes is complex, multiple, and difficult to ascertain in the conventional sense of cause and effect. Existing approaches based on probable (experimental and statistical) conclusions from evidence are limited in their ability to capture the impact of rights-based transformations in health. This paper argues that a focus on plausible conclusions from evidence enables policy makers and researchers to take into account the effects of a co-occurrence of multiple factors connected with human rights, including the significant role of "context" and power. Drawing on a subject-near and interpretive (in other words, with regard to meaning) perspective that focuses on the lived experiences of human rights-based interventions, the paper suggests that policy makers and researchers are best served by evidence arrived at through plausible, observational modes of ascertaining impact. Through an examination of what human rights-based interventions mean, based on the experience of their operationalization on the ground in culturally specific maternal and reproductive health care contexts, this paper contributes to an emerging scholarship that seeks to pluralize the concept of evidence and to address the methodological challenges posed by heterogeneous forms of evidence in the context of human rights as applied to health. Copyright © 2015 Unnithan. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.
Maternal beliefs about infant teething. 1. 2. 3. OG Uti , KO Savage ... Nigeria. 3Department of Community Health, College of Medicine, University of Lagos, Lagos. Nigeria. KEY WORDS: Infant teething. Maternal beliefs. Lagos. Nigeria now accurately .... the questions into the appropriate language or Pidgin. English. Analysis.
Friedman, Alexander M
This article reviews evidence and recommendations for maternal early warning systems designed to reduce severe maternal morbidity and mortality. The clinical rationale for these systems is discussed as is research literature on early warning systems from other fields. Copyright © 2015 Elsevier Inc. All rights reserved.
Maternal death reviews provide evidence of where the main problems in overcoming maternal mortality and morbidity may lie, produce an analysis of what can be done in practical terms and highlight the key areas requiring recommendations for health sector and community action as well as policy directions (8). In Ethiopia ...
In January 2007, we issued our Call for Action in which we joined together to call for prompt enactment of national legislation in the United States to slow, stop and reverse the growth of greenhouse gas (GHG) emissions over the shortest time reas...
Full Text Available Maternal mortality is an important indicator which reflects the health status of a community. It can be calculated by maternal mortality ratio (MMR, maternal mortality rate (MMRate, and adult life time risk of maternal death. MMR estimates are based on varieties of methods that include household surveys, sisterhood methods, reproductive-age mortality studies (RAMOS, verbal autopsies and censuses. Main causes of maternal mortality are hemorrhage, infection, unsafe abortion, hypertensive disorder of pregnancy and obstructed labour. Factors of maternal mortality have been conceptualized by three delays model. Estimates of maternal mortality ratio (MMR trend between 1990 and 2010 (over 20 years period suggest a global reduction (47%, with a greater reduction in developing countries (47% including Bangladesh than in developed countries (39%. However, to meet the challenge of Fifth Millennium Development Goal (MDG5 i.e. to ensure 75% reduction of MMR by the year 2015, the annual rate of MMR decline and increase of skilled attendant at birth need to be still faster. Ibrahim Med. Coll. J. 2012; 6(2: 64-69
Shin, Hyunjeong; Park, Young-Joo; Ryu, Hosihn; Seomun, Gyeong-Ae
The aim of this paper is to report a concept analysis of maternal sensitivity. Maternal sensitivity is a broad concept encompassing a variety of interrelated affective and behavioural caregiving attributes. It is used interchangeably with the terms maternal responsiveness or maternal competency, with no consistency of use. There is a need to clarify the concept of maternal sensitivity for research and practice. A search was performed on the CINAHL and Ovid MEDLINE databases using 'maternal sensitivity', 'maternal responsiveness' and 'sensitive mothering' as key words. The searches yielded 54 records for the years 1981-2007. Rodgers' method of evolutionary concept analysis was used to analyse the material. Four critical attributes of maternal sensitivity were identified: (a) dynamic process involving maternal abilities; (b) reciprocal give-and-take with the infant; (c) contingency on the infant's behaviour and (d) quality of maternal behaviours. Maternal identity and infant's needs and cues are antecedents for these attributes. The consequences are infant's comfort, mother-infant attachment and infant development. In addition, three positive affecting factors (social support, maternal-foetal attachment and high self-esteem) and three negative affecting factors (maternal depression, maternal stress and maternal anxiety) were identified. A clear understanding of the concept of maternal sensitivity could be useful for developing ways to enhance maternal sensitivity and to maximize the developmental potential of infants. Knowledge of the attributes of maternal sensitivity identified in this concept analysis may be helpful for constructing measuring items or dimensions.
Preston, Hanna; Jaye, Chrystal; Miller, Dawn L
The number of general practitioners (GPs) providing maternity care in New Zealand has declined dramatically since legislative changes of the 1990s. The Ministry of Health wants GPs to provide maternity care again. To investigate New Zealand general practice registrars' perspectives on GPs' role in maternity care; specifically, whether maternity services should be provided by GPs, registrars' preparedness to provide such services, and training opportunities available or required to achieve this. An anonymous online questionnaire was distributed to all registrars enrolled in The Royal New Zealand College of General Practitioners' (RNZCGP's) General Practice Education Programme (GPEP) in 2012, via their online learning platform OWL. 165 of the 643 general practice registrars responded (25.7% response rate). Most (95%) believe that GPs interested and trained in maternity care should consider providing antenatal, postnatal or shared care with midwives, and 95% believe women should be able to access maternity care from their general practice. When practising as a GP, 90% would consider providing antenatal and postnatal care, 47.3% shared care, and 4.3% full pregnancy care. Professional factors including training and adequate funding were most important when considering providing maternity care as a GP. Ninety-five percent of general practice registrars who responded to our survey believe that GPs should provide some maternity services, and about 90% would consider providing maternity care in their future practice. Addressing professional issues of training, support and funding are essential if more GPs are to participate in maternity care in New Zealand.
Objectives: Although maternal employment rates have increased in the last decade in the UK, there is very little research investigating the linkages between maternal nonstandard work schedules (i.e., work schedules outside of the Monday through Friday, 9–5 schedule) and breastfeeding initiation and duration, especially given the wide literature citing the health advantages of breastfeeding for mothers and children. Methods This paper uses a population-based, UK cohort study, the Millennium Co...
The issue of maternal obesity has become a major public health problem. Internationally, the diagnosis of obesity is based on body mass index (BMI) that is, weight in kg\\/height in m2. While epidemiological associations have been shown between different BMI categories and adverse clinical outcomes, there is also a growing realisation that BMI has significant limitations. In this review, we assess current methods to measure body fat and, in particular, their application in pregnant women.
Full Text Available The subject. The article is devoted to the analysis of ongoing systematic reform of Chinese anticorruption legislation and practice of its enforcement.The purpose of the article is to formulate ways of improvement Chinese anti-corruption legislation.The methods of legislation analysis and synthesis of legislative gaps and contradictions are used.The results, scope of application. Nowadays, China is moving from the struggle against corruption by political means to the struggle by legal means. In attempt to construct a system of anti-corruption legislation, China is actively forming a dualistic normative system and a mechanism for the interaction between party norms and state legislation. A multilevel vertical-integrated system of anti-corruption legislation with "The anti-corruption law" as a core was created; the Party is stressing the priority status of preventive legislation and the auxiliary role of legislation on control over power. This system should became the basis for building Chinese anti-corruption legislation. The author formulated a system of principles of Chinese anti-corruption legislation, including the principles of efficiency, consistency, economy and gradualism. The importance of the anti-corruption legislative program, the task formulated in 2015, is underlined. The list of the main anti-corruption legislative acts has been determined, including legislation in the aspects "do not dare to take [bribes]", "cannot take [bribes]" and "do not want to take [bribes]". The problem of improving the legislation in the "do not dare to take" aspect have been specially considered, including improvement of criminal legislation, adoption of the law on accountability and responsibility of public servants, as well as the adoption of an anti-corruption law. The main alternatives and problems of improving legislation in the context of "not being able to take" are considered, such as adoption of laws on declaration of property of public servants
Bich, Nguyen Ngoc; Cook, Margaret; Johnstone, Kelly; Capra, Mike; Lan, Vu Thi Hoang
In 2013, legislation in Vietnam regulated smoking in public areas. Included was a ban on indoor smoking at universities. Since awareness and attitude are moderators of the effectiveness of smokefree policy, ou aim was to assess changes in students' knowledge and attitude tosecond hand smoke (SHS) and awareness and support of smoke-free legislation at four Vietnamese universities, one year after legislative changes. A two-phase cross sectional study of undergraduate students using self-administered questionnaires (based on the Global Adult Tobacco Survey and the Thrasher survey) was conducted at the introduction of the legislation and one year thereafter. One-year post legislation there were significant increases in knowledge of smoke-free legislation and awareness of universities as smoke-free environments. There was a significant increase in knowledge of harmful effects of SHS on diseases such as examples in the heart and lung, including lung cancer, and miscarriage. Students expressed strong support of smoke-free environments in universities, hospitals, schools, workplaces, public transport, libraries, cinemas and theatres; support was also increased post legislation. Changes were seen in attitude to SHS, and rights of non-smokers and smokers. Positive changes have occurred in knowledge and attitude toward smoke-free environments and SHS in universities since enactment of Vietnamese tobacco control legislation.
Full Text Available Introduction: Primary maternity care services are globally provided according to various organisational models. Two models are common in Finland: a maternity health clinic and an integrated maternity and child health clinic. The aim of this study was to clarify whether there is a relation between the organisational model of the maternity health clinics and the utilisation of maternity care services, and certain maternal and perinatal health outcomes. Methods: A comparative, register-based cross-sectional design was used. The data of women (N = 2741 who had given birth in the Turku University Hospital area between 1 January 2009 and 31 December 2009 were collected from the Finnish Medical Birth Register. Comparisons were made between the women who were clients of the maternity health clinics and integrated maternity and child health clinics. Results: There were no clinically significant differences between the clients of maternity health clinics and integrated maternity and child health clinics regarding the utilisation of maternity care services or the explored health outcomes. Conclusions: The organisational model of the maternity health clinic does not impact the utilisation of maternity care services or maternal and perinatal health outcomes. Primary maternity care could be provided effectively when integrated with child health services.
Tuominen, Miia; Kaljonen, Anne; Ahonen, Pia; Mäkinen, Juha; Rautava, Päivi
Primary maternity care services are globally provided according to various organisational models. Two models are common in Finland: a maternity health clinic and an integrated maternity and child health clinic. The aim of this study was to clarify whether there is a relation between the organisational model of the maternity health clinics and the utilisation of maternity care services, and certain maternal and perinatal health outcomes. A comparative, register-based cross-sectional design was used. The data of women (N = 2741) who had given birth in the Turku University Hospital area between 1 January 2009 and 31 December 2009 were collected from the Finnish Medical Birth Register. Comparisons were made between the women who were clients of the maternity health clinics and integrated maternity and child health clinics. There were no clinically significant differences between the clients of maternity health clinics and integrated maternity and child health clinics regarding the utilisation of maternity care services or the explored health outcomes. The organisational model of the maternity health clinic does not impact the utilisation of maternity care services or maternal and perinatal health outcomes. Primary maternity care could be provided effectively when integrated with child health services.
AJRH Managing Editor
translated from Hausa to English language. Using a pre-determined coding framework, coding and thematic analyses were carried out on the qualitative data collected from the baseline. LGA. Community. Estimated. Community. Population. Community maternal support systems established. Community savings. Emergency.
Broekmans, André W; Mol, Peter G M
Recent European legislation has provided new tools to enhance the overseeing of medicinal products in the postmarketing phase. Package leaflets of newly approved medicines contain a black inverted triangle as a signal for enhanced monitoring. The leaflets also have clear instructions on how to report possible adverse drug reactions. Databases of drug reactions are accessible by the public. The most important change is the establishment of the Pharmacovigilance Risk Assessment Committee (PRAC) within the European Medicines Agency (EMA). This Committee will review safety signals of medicinal products arising in the member states of the European Union. The Committee could recommend adaptation of the package leaflet, or suspension or revocation of the marketing authorisation. The PRAC is also involved in the assessment of risk management plans for medicinal products and post-authorisation efficacy and safety studies.
The main objective of the European Union (EU) is to reduce certain contaminants in foodstuffs to acceptable levels. The occurrence of aflatoxin B1 in food was considered to be one of the most important issues of global food security to protect the health of humans and animals, over 100 nations have established maximum tolerable levels for aflatoxin in food. Although EU legislation covers many aspects of food safety was not legally establish an integrated framework that could effectively combat and cover all sectors of the food chain. Monitoring and reporting levels of aflatoxins after controls are essential actions that assist to identify potential risks to human health. The review process for aflatoxin regulations is a complex activity involving many factors and stakeholders.
Hernandez S, Gildardo; Montes de Correa, Consuelo
The most relevant legislative acts promulgated by the Colombian government for controlling atmospheric pollution are reviewed in chronological order. Special emphasis is paid to decree 948 of 1995 modified according to decree 2107 of 1995, e. The general dispositions about norms of air quality, emission levels, contaminant emissions, noise and offensive odors (chapter II), as well as, prohibitions and restrictions to emissions and noise from stationary and mobile sources (chapters III-V) furthermore, the resolutions issued so far by the ministry of the environment for regulating decree 948/95 in those aspects related to the prevention and control of atmospheric pollution are describes. Finally, the main philosophies for regulating air pollutants around the world are explained: the emissions norms, air quality norms, the emission taxes philosophy and the cost-benefit norms
Full Text Available Usually is talking about offender rights and rarely about victim's rights. This study aims to analyse victim's rights especially in Romanian legislation from all points of view. Having involuntary fallen victim to crime, the person is often unaware of what information is available. It is therefore important that the onus is not put on the victim to request a certain piece of information. Victims of crimes need to have their important role in the criminal proceedings and he or she has to know about the extension of them rights. Not least, the study is focus on the right of the victim to receive information, not to be made responsible for the practicalities surrounding its delivery.
Thomsen, Jakob Hartvig; Hassager, Christian; Bro-Jeppesen, John
INTRODUCTION: Informed consent in incapacitated adults is permitted in the form of proxy consent by both the patients' closest relative (next of kin, NOK) and general practitioner (GP). In research in acute situations not involving pharmaceuticals, Danish legislation allows for randomisation...... and subsequent proxy consent, as soon as possible. The aim of this study was to describe the delay associated with obtaining consent and to assess whether consent from NOK or GP/Danish Health and Medicines Authority is obtained with delays beyond the intervention. METHODS: In a prospective study, 171 comatose...... days (IQR: 6-23, max. 527 days). CONCLUSION: NOK fully accepted participation in a clinical trial after OHCA with short delays in consent. Consent from GPs was associated with long delays beyond the intervention, which make GPs less appropriate for proxy consent of incapacitated adults in acute...
van den Broek Nynke
Full Text Available Abstract Background Maternal death reviews is a tool widely recommended to improve the quality of obstetric care and reduce maternal mortality. Our aim was to explore the challenges encountered in the process of facility-based maternal death review in Malawi, and to suggest sustainable and logically sound solutions to these challenges. Methods SWOT (strengths, weaknesses, opportunities and threats analysis of the process of maternal death review during a workshop in Malawi. Results Strengths: Availability of data from case notes, support from hospital management, and having maternal death review forms. Weaknesses: fear of blame, lack of knowledge and skills to properly conduct death reviews, inadequate resources and missing documentation. Opportunities: technical assistance from expatriates, support from the Ministry of Health, national protocols and high maternal mortality which serves as motivation factor. Threats: Cultural practices, potential lawsuit, demotivation due to the high maternal mortality and poor planning at the district level. Solutions: proper documentation, conducting maternal death review in a blame-free manner, good leadership, motivation of staff, using guidelines, proper stock inventory and community involvement. Conclusion Challenges encountered during facility-based maternal death review are provider-related, administrative, client related and community related. Countries with similar socioeconomic profiles to Malawi will have similar 'pull-and-push' factors on the process of facility-based maternal death reviews, and therefore we will expect these countries to have similar potential solutions.
Adrian J Lowe
Full Text Available BACKGROUND: It has been proposed that maternal obesity during pregnancy may increase the risk that the child develops allergic disease and asthma, although the mechanisms underpinning this relationship are currently unclear. We sought to assess if this association may be due to confounding by genetic or environmental risk factors that are common to maternal obesity and childhood asthma, using a sibling pair analysis. METHODS: The study population comprised a Swedish national cohort of term children born between 1992 and 2008 to native Swedish parents. Maternal body mass index (BMI was measured at 8-10 weeks gestation. Unconditional logistic regression models were used to determine if maternal obesity was associated with increased risk of inhaled corticosteroid (ICS in 431,718 first-born children, while adjusting for potential confounders. An age-matched discordant sib-pair analysis was performed, taking into account shared genetic and environmental risk factors. RESULTS: Maternal over-weight and obesity were associated with increased risk that the child would require ICS (for BMI≥35 kg/m(2, aOR = 1.30, 95%CI = 1.10-1.52 compared with normal weight mothers in children aged 6-12 years. Similar effects were seen in younger children, but in children aged 13-16 years, maternal obesity (BMI≥30 was related to increased risk of ICS use in girls (aOR = 1.28, 95%CI = 1.07-1.53 but not boys (OR = 1.05, 95%CI = 0.87-1.26. The sib-pair analysis, which included 2,034 sib-pairs older than six years who were discordant for both ICS use and maternal BMI category, failed to find any evidence that increasing maternal weight was related to increased risk of ICS use. CONCLUSION: Maternal obesity is associated with increased risk of childhood ICS use up to approximately 12 years of age, but only in girls after this age. These effects could not be confirmed in a sib pair analysis, suggesting either limited statistical power, or the effects
Cho, Hyunsan; Hallfors, Denise Dion; Iritani, Bonita J.; Hartman, Shane
This study examines prevention practices and perceptions in U.S. schools since passage of federal No Child Left Behind (NCLB) legislation, using survey data from state education agencies (SEA) and a population-based sample of school districts. Only one third of U.S. public school districts rely on evidence-based prevention curriculum in middle…
Maternity waiting homes were introduced in Eritrea in 2007 as a strategy to mitigate against the attendant high maternal mortality rates in hard to reach regions. Objective: To assess pregnancy outcomes verified through maternal mortality and perinatal mortality rates since the introduction of maternity waiting homes in some ...
The effects of maternal haemoglobin as an indicator of maternal nutritional status on, maternal measles antibodies of mother-infant pairs at birth. *Baba UA1 .... SD = Standard deviation, CI = Confidence interval, GA = Gestational age, MA = Maternal age, BW = Birth .... In order to eliminate measles in children in our setting,.
Full Text Available Abstract Background International organs such as, the African Union and the South African Government view maternal health as a dominant health prerogative. Even though most countries are making progress, maternal mortality in South Africa (SA significantly increased between 1990 and 2015, and prevented the country from achieving Millennium Development Goal 5. Elucidating the space-time patterns and risk factors of maternal mortality in a rural South African population could help target limited resources and policy guidelines to high-risk areas for the greatest impact, as more generalized interventions are costly and often less effective. Methods Population-based mortality data from 2000 to 2014 for women aged 15–49 years from the Africa Centre Demographic Information System located in the Umkhanyakude district of KwaZulu-Natal Province, South Africa were analysed. Our outcome was classified into two definitions: Maternal mortality; the death of a woman while pregnant or within 42 days of cessation of pregnancy, regardless of the duration and site of the pregnancy, from any cause related to or exacerbated by the pregnancy or its management but not from unexpected or incidental causes; and ‘Mother death’; death of a mother whilst child is less than 5 years of age. Both the Kulldorff and Tango spatial scan statistics for regular and irregular shaped cluster detection respectively were used to identify clusters of maternal mortality events in both space and time. Results The overall maternal mortality ratio was 650 per 100,000 live births, and 1204 mothers died while their child was less than or equal to 5 years of age, of a mortality rate of 370 per 100,000 children. Maternal mortality declined over the study period from approximately 600 per 100,000 live births in 2000 to 400 per 100,000 live births in 2014. There was no strong evidence of spatial clustering for maternal mortality in this rural population. However, the study identified a
Full Text Available To investigate the associations of maternal social networks and perceptions of trust with the prevalence of suspected autism spectrum disorders in 18-month-old offspring in Japan.Questionnaires included measurements of maternal social networks (number of relatives or friends they could call upon for assistance, maternal perceptions of trust, mutual assistance (i.e. individual measures of "cognitive social capital", and social participation (i.e. individual measures of "structural social capital" as well as the Modified Checklist for Autism in Toddlers to detect suspected autism spectrum disorder (ASD. These tools were mailed to all families with 18-month-old toddlers in Chiba, a city near Tokyo (N = 6061; response rate: 64%. The association between social capital or social network indicators and suspected ASD were analyzed, adjusted for covariates by logistic regression analysis.Low maternal social trust was found to be significantly positively associated with suspected ASD in toddlers compared with high maternal social trust (adjusted odds ratio [OR]: 1.82, 95% confidence interval [CI]: 1.38 to 2.40; mutual aid was also significantly positively related (low vs. high: OR, 2.08, 95% CI: 1.59 to 2.73 [corrected]. However, maternal community participation showed U-shape association with suspected ASD of offspring. Maternal social network showed consistent inverse associations with suspected ASD of offspring, regardless of the type of social connection (e.g., relatives, neighbors, or friends living outside of their neighborhood.Mothers' cognitive social capital and social networks, but not structural social capital, might be associated with suspected ASD in offspring.
Legislative Process for National Atomic Energy Laws (NAELs) aim at establishing a legal base for the peaceful uses of nuclear energy. Various approaches (partial and comprehensive) to draft the NAELs are studied. The paper also studies some national nuclear energy laws through a comparative legal analysis and the important developments that have taken place in the legislative process for NAELs. There are lessons learned from the legislative process for NAELs. First, each state must develop its own legislative framework based on its own situation. Second, although the NAELs have common features, they vary considerably due to national legal traditions, social, economic circumstances and cultural values. Third, the NAELs have also evolved in time. Fourth, the technical standards, rules and guidelines should not be part of legislation issued by the Parliament because they would also facilitate quick adaption to new technical developments. Fifth, interface between legal and technical issues, requiring legal and technical experts to interact with each other. Sixth, continuing assessment that may lead to amendments to the law over time
DʼAlton, Mary E; Main, Elliott K; Menard, M Kathryn; Levy, Barbara S
Recognition of the need to reduce maternal mortality and morbidity in the United States has led to the creation of the National Partnership for Maternal Safety. This collaborative, broad-based initiative will begin with three priority bundles for the most common preventable causes of maternal death and severe morbidity: obstetric hemorrhage, severe hypertension in pregnancy, and peripartum venous thromboembolism. In addition, three unit-improvement bundles for obstetric services were identified: a structured approach for the recognition of early warning signs and symptoms, structured internal case reviews to identify systems improvement opportunities, and support tools for patients, families, and staff that experience an adverse outcome. This article details the formation of the National Partnership for Maternal Safety and introduces the initial priorities.
Maternal and foetal outcomes among 4118 women with HIV infection treated with lopinavir/ritonavir during pregnancy: analysis of population-based surveillance data from the national study of HIV in pregnancy and childhood in the United Kingdom and Ireland.
Tookey, Pat A; Thorne, Claire; van Wyk, Jean; Norton, Michael
The National Study of HIV in Pregnancy and Childhood (NSHPC) conducts comprehensive population-based surveillance of pregnancies in women with HIV infection in the United Kingdom/Ireland. Use of antepartum antiretroviral therapy (ART) for prevention of mother-to-child transmission (MTCT) and to treat maternal infection, if required, is standard practise in this population; lopinavir/ritonavir (LPV/r) is commonly used. The study objective was to examine the use of LPV/r among pregnant women with HIV infection to describe maternal and foetal outcomes. The NSHPC study collected maternal, perinatal and paediatric data through confidential and voluntary obstetric and paediatric reporting schemes. Pregnancies reported to the NSHPC by June 2013, due to deliver 2003-2012 and with LPV/r exposure were included in this analysis, using pregnancy as the unit of observation. Four thousand eight hundred sixty-four LPV/r-exposed pregnancies resulting in 4702 deliveries in 4118 women were identified. Maternal region of birth was primarily sub-Saharan Africa (77 %) or United Kingdom/Ireland (14 %). Median maternal age at conception was 30 years. LPV/r was initiated preconception in 980 (20 %) and postconception in 3884 (80 %) pregnancies; median duration of antepartum LPV/r exposure was 270 and 107 days, respectively. Viral load close to delivery was caesarean section (elective, 6 %; emergency, 38 %). Among singleton live births, 13 % were infection in the United Kingdom and Ireland who received LPV/r-containing ART regimens demonstrate that these regimens have a good safety profile and are effective for viral suppression during pregnancy, with associated low rates of MTCT.
Building analytic capacity, facilitating partnerships, and promoting data use in state health agencies: a distance-based workforce development initiative applied to maternal and child health epidemiology.
Rankin, Kristin M; Kroelinger, Charlan D; Rosenberg, Deborah; Barfield, Wanda D
The purpose of this article is to summarize the methodology, partnerships, and products developed as a result of a distance-based workforce development initiative to improve analytic capacity among maternal and child health (MCH) epidemiologists in state health agencies. This effort was initiated by the Centers for Disease Control's MCH Epidemiology Program and faculty at the University of Illinois at Chicago to encourage and support the use of surveillance data by MCH epidemiologists and program staff in state agencies. Beginning in 2005, distance-based training in advanced analytic skills was provided to MCH epidemiologists. To support participants, this model of workforce development included: lectures about the practical application of innovative epidemiologic methods, development of multidisciplinary teams within and across agencies, and systematic, tailored technical assistance The goal of this initiative evolved to emphasize the direct application of advanced methods to the development of state data products using complex sample surveys, resulting in the articles published in this supplement to MCHJ. Innovative methods were applied by participating MCH epidemiologists, including regional analyses across geographies and datasets, multilevel analyses of state policies, and new indicator development. Support was provided for developing cross-state and regional partnerships and for developing and publishing the results of analytic projects. This collaboration was successful in building analytic capacity, facilitating partnerships and promoting surveillance data use to address state MCH priorities, and may have broader application beyond MCH epidemiology. In an era of decreasing resources, such partnership efforts between state and federal agencies and academia are essential for promoting effective data use.