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Sample records for perinatal services reducing

  1. Action plan to reduce perinatal mortality.

    Science.gov (United States)

    Bhakoo, O N; Kumar, R

    1990-01-01

    The government of India has set a goal of reducing perinatal mortality from its current rate of 48/1000 to 30-35/1000 by the year 2000. Perinatal deaths result from maternal malnutrition, inadequate prenatal care, complications of delivery, and infections in the postpartum period. Since reductions in perinatal mortality require attention to social, economic, and behavioral factors, as well as improvements in the health care delivery system, a comprehensive strategy is required. Social measures, such as raising the age at marriage to 18 years for females, improving the nutritional status of adolescent girls, reducing the strenuousness of work during pregnancy, improving female literacy, raising women's status in the society and thus in the family, and poverty alleviation programs, would all help eliminate the extent of complications of pregnancy. Measures required to enhance infant survival include improved prenatal care, prenatal tetanus toxoid immunization, use of sterile disposable cord care kits, the provision of mucus extractors and resuscitation materials to birth attendants, the creation of neonatal care units in health facilities, and more efficient referral of high-risk newborns and mothers. Since 90% of births in rural India take place at home priority must be given to training traditional birth attendants in the identification of high risk factors during pregnancy, delivery, and the newborn period.

  2. Perinatal mental health service provision in Switzerland and in the UK.

    Science.gov (United States)

    Amiel Castro, Rita T; Schroeder, Katrin; Pinard, Claudia; Blöchlinger, Patricia; Künzli, Hansjörg; Riecher-Rössler, Anita; Kammerer, Martin

    2015-01-01

    The epidemiology of maternal perinatal-psychiatric disorders as well as their effect on the baby is well recognised. Increasingly well researched specialised treatment methods can reduce maternal morbidity, positively affect mother-baby bonding and empower women's confidence as a mother. Here, we aimed to compare guidelines and the structure of perinatal-psychiatric service delivery in the United Kingdom and in Switzerland from the government's perspective. Swiss cantons provided information regarding guidelines and structure of service delivery in 2000. A subsequent survey using the same questionnaire was carried out in 2007. In the UK, similar information was accessed through published reports from 2000-2012. Guidelines for perinatal psychiatry exist in the UK, whereas in Switzerland in 2000 none of the 26 cantons had guidelines, and in 2007 only one canton did. Joint mother-baby admissions on general psychiatric wards were offered by 92% of the Swiss cantons. In the UK, pregnant women and joint mother-baby admissions are only advised onto specialised perinatal-psychiatric units. In Switzerland, in 2007, three specialised units (max. 24 beds) were in place corresponding to 1 unit per 2.5 million people, while in the UK there were 22 mother-baby units (168 beds) in 2012 (1 unit per 2.8 million). In the UK, less than 50% of trusts provided specialised perinatal-psychiatric health care. The main difference between the UK and Switzerland was the absence of guidelines, regular assessment and plans for future development of perinatal psychiatry in Switzerland. There are still geographical differences in the provision of perinatal-psychiatric services in the UK.

  3. Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh

    Directory of Open Access Journals (Sweden)

    Rahman Anisur

    2011-12-01

    Full Text Available Abstract Background Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. Methods This study took advantage of an ongoing health and demographic surveillance system (HDSS and a new Maternal, Neonatal and Child Health (MNCH Project initiated in 2007 in Matlab, Bangladesh in half (intervention area of the HDSS area. In the other half, women received usual care through the government health system (comparison area. The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006 and after (2008-2009 implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Results Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78. The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018. Conclusion The continuum

  4. Impacts of online and group perinatal education: a mixed methods study protocol for the optimization of perinatal health services.

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    Roch, Geneviève; Borgès Da Silva, Roxane; de Montigny, Francine; Witteman, Holly O; Pierce, Tamarha; Semenic, Sonia; Poissant, Julie; Parent, André-Anne; White, Deena; Chaillet, Nils; Dubois, Carl-Ardy; Ouimet, Mathieu; Lapointe, Geneviève; Turcotte, Stéphane; Prud'homme, Alexandre; Painchaud Guérard, Geneviève; Gagnon, Marie-Pierre

    2018-05-29

    Prenatal education is a core component of perinatal care and services provided by health institutions. Whereas group prenatal education is the most common educational model, some health institutions have opted to implement online prenatal education to address accessibility issues as well as the evolving needs of future parents. Various studies have shown that prenatal education can be effective in acquisition of knowledge on labour and delivery, reducing psychological distress and maximising father's involvement. However, these results may depend on educational material, organization, format and content. Furthermore, the effectiveness of online prenatal education compared to group prenatal education remains unclear in the literature. This project aims to evaluate the impacts of group prenatal education and online prenatal education on health determinants and users' health status, as well as on networks of perinatal educational services maintained with community-based partners. This multipronged mixed methods study uses a collaborative research approach to integrate and mobilize knowledge throughout the process. It consists of: 1) a prospective cohort study with quantitative data collection and qualitative interviews with future and new parents; and 2) a multiple case study integrating documentary sources and interviews with stakeholders involved in the implementation of perinatal information service networks and collaborations with community partners. Perinatal health indicators and determinants will be compared between prenatal education groups (group prenatal education and online prenatal education) and standard care without these prenatal education services (control group). This study will provide knowledge about the impact of online prenatal education as a new technological service delivery model compared to traditional group prenatal education. Indicators related to the complementarity of these interventions and those available in community settings will

  5. Perinatal staff perceptions of safety and quality in their service.

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    Sinni, Suzanne V; Wallace, Euan M; Cross, Wendy M

    2014-11-28

    Ensuring safe and appropriate service delivery is central to a high quality maternity service. With this in mind, over recent years much attention has been given to the development of evidence-based clinical guidelines, staff education and risk reporting systems. Less attention has been given to assessing staff perceptions of a service's safety and quality and what factors may influence that. In this study we set out to assess staff perceptions of safety and quality of a maternity service and to explore potential influences on service safety. The study was undertaken within a new low risk metropolitan maternity service in Victoria, Australia with a staffing profile comprising midwives (including students), neonatal nurses, specialist obstetricians, junior medical staff and clerical staff. In depth open-ended interviews using a semi-structured questionnaire were conducted with 23 staff involved in the delivery of perinatal care, including doctors, midwives, nurses, nursing and midwifery students, and clerical staff. Data were analyzed using naturalistic interpretive inquiry to identify emergent themes. Staff unanimously reported that there were robust systems and processes in place to maintain safety and quality. Three major themes were apparent: (1) clinical governance, (2) dominance of midwives, (3) inter-professional relationships. Overall, there was a strong sense that, at least in this midwifery-led service, midwives had the greatest opportunity to be an influence, both positively and negatively, on the safe delivery of perinatal care. The importance of understanding team dynamics, particularly mutual respect, trust and staff cohesion, were identified as key issues for potential future service improvement. Senior staff, particularly midwives and neonatal nurses, play central roles in shaping team behaviors and attitudes that may affect the safety and quality of service delivery. We suggest that strategies targeting senior staff to enhance their performance in

  6. Midwives' perceptions and experiences of engaging fathers in perinatal services.

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    Rominov, Holly; Giallo, Rebecca; Pilkington, Pamela D; Whelan, Thomas A

    2017-08-01

    The active engagement of fathers in maternity care is associated with long-term benefits for the father, their partner, and their child. Midwives are ideally placed to engage fathers, but few studies have explored midwives' experiences of working with men. Therefore, the aim of this study was to describe midwives' perceptions and experiences of engaging fathers in perinatal services. A multi-method approach was utilised. Registered midwives (N=106) providing perinatal services to families in Australia participated in an online survey. Of these, 13 also participated in semi-structured telephone interviews. Descriptive analyses summarised the online survey data. The interview data were coded using semantic thematic analysis. Survey results indicated that midwives unanimously agreed that engaging fathers is part of their role and acknowledged the importance of receiving education to develop knowledge and skills about fathers. Analysis of the telephone interviews led to the identification of a range of strategies, facilitators and barriers to engaging fathers in midwifery services. Some of these were related to characteristics of midwives, factors related specifically to fathers, and several external factors relating to organisational policies. Findings from this study could inform maternity health care policies, as well the development of resources, education and ongoing professional training for midwives to promote father-inclusive practice. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  7. Perinatal services and outcomes in Quang Ninh province, Vietnam.

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    Nga, Nguyen T; Målqvist, Mats; Eriksson, Leif; Hoa, Dinh P; Johansson, Annika; Wallin, Lars; Persson, Lars-Åke; Ewald, Uwe

    2010-10-01

    We report baseline results of a community-based randomized trial for improved neonatal survival in Quang Ninh province, Vietnam (NeoKIP; ISRCTN44599712). The NeoKIP trial seeks to evaluate a method of knowledge implementation called facilitation through group meetings at local health centres with health staff and community key persons. Facilitation is a participatory enabling approach that, if successful, is well suited for scaling up within health systems. The aim of this baseline report is to describe perinatal services provided and neonatal outcomes. Survey of all health facility registers of service utilization, maternal deaths, stillbirths and neonatal deaths during 2005 in the province. Systematic group interviews of village health workers from all communes. A Geographic Information System database was also established. Three quarters of pregnant women had ≥3 visits to antenatal care. Two hundred and five health facilities, including 18 hospitals, provided delivery care, ranging from 1 to 3258 deliveries/year. Totally there were 17 519 births and 284 neonatal deaths in the province. Neonatal mortality rate was 16/1000 live births, ranging from 10 to 44/1000 in the different districts, with highest rates in the mountainous parts of the province. Only 8% had home deliveries without skilled attendance, but those deliveries resulted in one-fifth of the neonatal deaths. A relatively good coverage of perinatal care was found in a Vietnamese province, but neonatal mortality varied markedly with geography and level of care. A remaining small proportion of home deliveries generated a substantial part of mortality. © 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Paediatrica.

  8. The service needs of mothers with schizophrenia: a qualitative study of perinatal psychiatric and antenatal workers

    OpenAIRE

    Wan, Ming Wai; Moulton, Steff; Abel, Kathryn M.

    2008-01-01

    Objective: The study sought to (1) understand the perspectives of perinatal psychiatric and antenatal health service workers on the service and support needs of mothers with schizophrenia; (2) obtain their views on the feasibility and potential effectiveness of a proposed parenting intervention tailored for this group. Method: Twenty-eight perinatal psychiatry and antenatal service workers were interviewed using a semi-structured methodology, and anonymised verbatim transcripts analysed for c...

  9. Mobile phone intervention reduces perinatal mortality in zanzibar

    DEFF Research Database (Denmark)

    Lund, Stine; Rasch, Vibeke; Hemed, Maryam

    2014-01-01

    BACKGROUND: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies......, evidence for its role in health care is sparse. OBJECTIVE: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. METHODS: This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities...... care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth...

  10. Women's Use of Multi sector Mental Health Services in a Community-Based Perinatal Depression Program

    Science.gov (United States)

    Price, Sarah Kye

    2010-01-01

    Low-income and ethnic minority women have been described as at risk for experiencing depression during and around the time of pregnancy, a finding complicated by low levels of mental health service use within this population. This study retrospectively examined data from a community-based perinatal depression project targeting low-income women in…

  11. Strategies to Reduce Perinatal Health Inequalities : The Healthy Pregnancy 4 All study

    NARCIS (Netherlands)

    A.A. Vos (Amber)

    2015-01-01

    markdownabstractAbstract Promotion of healthy pregnancies has gained high priority in the Netherlands because of the relatively unfavorable perinatal outcomes compared to surrounding countries which was confirmed by two consecutive European reports on perinatal health. Additionally, large

  12. Training traditional birth attendants on the WHO Essential Newborn Care reduces perinatal mortality.

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    Garcés, Ana; McClure, Elizabeth M; Hambidge, Michael; Krebs, Nancy F; Mazariegos, Manolo; Wright, Linda L; Moore, Janet; Carlo, Waldemar A

    2012-05-01

    To evaluate the impact of birth attendant training using the World Health Organization Essential Newborn Care (ENC) course among traditional birth attendants, with a particular emphasis on the effect of acquisition of skills on perinatal outcomes. Population-based, prospective, interventional pre-post design study. 11 rural clusters in Chimaltenango, Guatemala. Health care providers. This study analyzed the effect of training and implementation of the ENC health care provider training course between September 2005 and December 2006. The primary outcome measure was the rate of death from all causes in the first seven days after birth in fetuses/infants ≥1500g. Secondary outcome measures were overall rate of stillbirth, rate of perinatal death, which included stillbirths plus neonatal deaths in the first seven days in fetuses/infants ≥1500g. Perinatal mortality decreased from 39.5/1000 pre-ENC to 26.4 post-ENC (RR 0.72; 95%CI 0.54-0.97). This reduction was attributable almost entirely to a decrease in the stillbirth rate of 21.4/1000 pre-Essential Newborn Care to 7.9/1000 post-ENC (RR 0.40; 95%CI 0.25-0.64). Seven-day neonatal mortality did not decrease (18.3/1000 to 18.6/1000; RR 1.05; 95%CI 0.70-1.57). Essential Newborn Care training reduced stillbirths in a population-based controlled study with deliveries conducted almost exclusively by traditional birth attendants. Scale-up of this intervention in other settings might help assess reproducibility and sustainability. © Published [2012]. This article is a U.S. Government work and is in the public domain in the USA. Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  13. The service needs of mothers with schizophrenia: a qualitative study of perinatal psychiatric and antenatal workers.

    Science.gov (United States)

    Wan, Ming Wai; Moulton, Steff; Abel, Kathryn M

    2008-01-01

    The study sought to (1) understand the perspectives of perinatal psychiatric and antenatal health service workers on the service and support needs of mothers with schizophrenia; (2) obtain their views on the feasibility and potential effectiveness of a proposed parenting intervention tailored for this group. Twenty-eight perinatal psychiatry and antenatal service workers were interviewed using a semi-structured methodology, and anonymised verbatim transcripts analysed for content themes. Many respondents felt that women with schizophrenia received insufficient postnatal support. Perceived needs were: support with adjustment/coping; parenting skills and sensitivity training; maintaining mental health; continuity of care and community support; and encouraging bonding. Service integration/continuity and social stigma were recurring themes that impacted on recommendations, such as the need for interdisciplinary communication and mental health education for midwives. The parenting program was generally well received, although many raised concerns regarding patient involvement and specific intervention characteristics. The views of health workers are a valuable complement to the service user perspective. They highlight the needs of this high-risk group in their transition to motherhood, and how they might be met, as well as a need for staff training so that parenting interventions are better understood as positive prevention work.

  14. The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006

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    Rudge Marilza VC

    2011-11-01

    Full Text Available Abstract Background In 2000, the eight Millennium Development Goals (MDGs set targets for reducing child mortality and improving maternal health by 2015. Objective To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections and maternal/perinatal mortality. Methods Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB and perinatal (/1000 births mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage, with p Results Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births. The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of

  15. Process value of care safety: women's willingness to pay for perinatal services.

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    Anezaki, Hisataka; Hashimoto, Hideki

    2017-08-01

    To evaluate the process value of care safety from the patient's view in perinatal services. Cross-sectional survey. Fifty two sites of mandated public neonatal health checkup in 6 urban cities in West Japan. Mothers who attended neonatal health checkups for their babies in 2011 (n = 1316, response rate = 27.4%). Willingness to pay (WTP) for physician-attended care compared with midwife care as the process-related value of care safety. WTP was estimated using conjoint analysis based on the participants' choice over possible alternatives that were randomly assigned from among eight scenarios considering attributes such as professional attendance, amenities, painless delivery, caesarean section rate, travel time and price. The WTP for physician-attended care over midwife care was estimated 1283 USD. Women who had experienced complications in prior deliveries had a 1.5 times larger WTP. We empirically evaluated the process value for safety practice in perinatal care that was larger than a previously reported accounting-based value. Our results indicate that measurement of process value from the patient's view is informative for the evaluation of safety care, and that it is sensitive to individual risk perception for the care process. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care.

  16. Addressing access barriers to services for mothers at risk for perinatal mood disorders: A social work perspective.

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    Keefe, Robert H; Brownstein-Evans, Carol; Rouland Polmanteer, Rebecca S

    2016-01-01

    This article identifies variables at the micro/individual, mezzo/partner/spouse and family, and macro/health care-system levels that inhibit mothers at risk for perinatal mood disorders from accessing health and mental health care services. Specific recommendations are made for conducting thorough biopsychosocial assessments that address the mothers' micro-, mezzo-, and macro-level contexts. Finally, the authors provide suggestions for how to intervene at the various levels to remove access barriers for mothers living with perinatal mood disorders as well as their families.

  17. Perinatal L-arginine and antioxidant supplements reduce adult blood pressure in spontaneously hypertensive rats

    NARCIS (Netherlands)

    Racasan, S; Braam, B; van der Giezen, DM; Goldschmeding, R; Boer, P; Koomans, HA; Joles, JA

    Embryo cross-transplantation and cross-fostering between spontaneously hypertensive rats (SHR) and normotensive rats (WKY) suggest that perinatal environment modulates the genetically determined phenotype. In SHR the balance between NO and reactive oxygen species (ROS) is disturbed. We hypothesized

  18. Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect

    Directory of Open Access Journals (Sweden)

    Wallace Dennis

    2011-08-01

    . NRP training had no demonstrable effect on early neonatal mortality. Conclusion Training DRC birth attendants using the ENC program reduces perinatal mortality. However, a period of utilization and re-enforcement of training may be necessary before a decline in mortality occurs. ENC training has the potential to be a low cost, high impact intervention in developing countries. Trial registration This trial has been registered at http://www.clinicaltrials.gov (identifier NCT00136708.

  19. Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect.

    Science.gov (United States)

    Matendo, Richard; Engmann, Cyril; Ditekemena, John; Gado, Justin; Tshefu, Antoinette; Kinoshita, Rinko; McClure, Elizabeth M; Moore, Janet; Wallace, Dennis; Carlo, Waldemar A; Wright, Linda L; Bose, Carl

    2011-08-04

    neonatal mortality. Training DRC birth attendants using the ENC program reduces perinatal mortality. However, a period of utilization and re-enforcement of training may be necessary before a decline in mortality occurs. ENC training has the potential to be a low cost, high impact intervention in developing countries. This trial has been registered at http://www.clinicaltrials.gov (identifier NCT00136708).

  20. The effectiveness of regionalization of perinatal care services--a systematic review.

    Science.gov (United States)

    Rashidian, A; Omidvari, A H; Vali, Y; Mortaz, S; Yousefi-Nooraie, R; Jafari, M; Bhutta, Z A

    2014-10-01

    Several reports recommend the implementation of perinatal regionalization for improvements in maternal and neonatal outcomes, while research evidence on the effectiveness of perinatal regionalization has been limited. The interventional studies have been assessed for robust evidence on the effectiveness of perinatal regionalization on improving maternal and neonatal health outcomes. Bibliographic databases of Medline, EMbase, EconLit, HMIC have been searched using sensitive search terms for interventional studies that reported important patient or process outcomes. At least two authors assessed eligibility for inclusion and the risk of biases and extracted data from the included studies. As meta-analysis was not possible, a narrative analysis as well as a 'vote-counting' analysis has been conducted for important outcomes. After initial screenings 53 full text papers were retrieved. Eight studies were included in the review from the USA, Canada and France. Studies varied in their designs, and in the specifications of the intervention and setting. Only three interrupted time series studies had a low risk of bias, of which only one study reported significant reductions in neonatal and infant mortality. Studies of higher risk of bias were more likely to report improvements in outcomes. Implementing perinatal regionalization programs is correlated with improvements in perinatal outcomes, but it is not possible to establish a causal link. Despite several high profile policy statements, evidence of effect is weak. It is necessary to assess the effectiveness of perinatal regionalization using robust research designs in a more diverse range of countries.

  1. Mobile phone intervention reduces perinatal mortality in zanzibar: secondary outcomes of a cluster randomized controlled trial.

    Science.gov (United States)

    Lund, Stine; Rasch, Vibeke; Hemed, Maryam; Boas, Ida Marie; Said, Azzah; Said, Khadija; Makundu, Mkoko Hassan; Nielsen, Birgitte Bruun

    2014-03-26

    Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse. We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality. Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74). Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings. Clinical

  2. Perinatal exposure to low doses of tributyltin chloride reduces sperm count and quality in mice.

    Science.gov (United States)

    Si, Jiliang; Li, Peng; Xin, Quanbing; Li, Xuewen; An, Lihong; Li, Jie

    2015-01-01

    Exposure to endocrine disruptors (EDs) during early development might lead to adverse health outcomes later in life. Tributyltin (TBT), a proven ED, is widely used in consumer goods and industrial products. Herein we demonstrate the effects of low doses of tributyltin chloride (TBTCl) on reproduction of male KM mice. Pregnant mice were administered by gavage with 0, 1, 10, or 100 μg TBTCl/kg body weight/day from day 6 of pregnancy through the period of lactation. TBTCl dramatically decreased sperm counts and motility on postnatal days (PNDs) 49 and 152. Meanwhile, a significant increase in sperm abnormality was observed in exposed mice on PND 49, but comparable to that in the control on PND 152. The histopathological analysis of testes of treated animals showed a dose-dependent increase in sloughing of germ cells in seminiferous tubules. Mice treated with 10 μg TBTCl/kg exhibited decreased intratesticular 17β-estradiol (E2) levels on PND 49, and then followed by an obvious recovery on PND 152. While, no significant differences in serum E2, testosterone (T) levels and intratesticular T levels were detectable between control and TBTCl-exposed offspring at the sacrifice. These results suggest that perinatal TBTCl exposure is implicated in causing long lasting alterations in male reproductive system and these changes may persist far into adulthood. © 2013 Wiley Periodicals, Inc.

  3. Perinatal health care services for imprisoned pregnant women and associated outcomes: a systematic review.

    Science.gov (United States)

    Bard, Eleanor; Knight, Marian; Plugge, Emma

    2016-09-29

    Women are an increasing minority of prisoners worldwide, and most are of childbearing age. Prisons offer unique opportunities for improving the pregnancy outcomes of these high-risk women, and no systematic review to date has looked at their care. This systematic review identified studies describing models of perinatal health care for imprisoned women which report maternal and child health and care outcomes. We systematically searched for literature published between 1980 and April 2014. Studies were eligible if they included a group of imprisoned pregnant women, a description of perinatal health care and any maternal or infant health or care outcomes. Two authors independently extracted data. We described relevant outcomes in prisons (including jails) under models of care we termed PRISON, PRISON+ and PRISON++, depending on the care provided. Where outcomes were available on a comparison group of women, we calculated odds ratios with 95 % confidence intervals. Eighteen studies were reported, comprising 2001 imprisoned pregnant women. Fifteen were in the US, two in the UK and one in Germany. Nine contained a comparison group of women comprising 849 pregnant women. Study quality was variable and outcome reporting was inconsistent. There was some evidence that women in prisons receiving enhanced prison care, PRISON+, were less likely to have inadequate prenatal care (15.4 % vs 30.7 %, p prisons receiving usual care (PRISON). Women participating in two PRISON++ interventions, that is, interventions which included not only enhanced care in prisons but also coordination of community care on release, demonstrated reductions in long term recidivism rates (summary OR 0 · 37, 95 % CI 0 · 19-0 · 70) compared to pregnant women in the same prisons who did not participate in the intervention. Enhanced perinatal care can improve both short and long-term outcomes but there is a lack of data. Properly designed programmes with rigorous evaluation are needed to

  4. Perinatal and psychosocial circumstances associated with risk of attempted suicide, non-suicidal self-injury and psychiatric service use. A longitudinal study of young people.

    LENUS (Irish Health Repository)

    Young, Robert

    2011-11-18

    Abstract Background Past studies using large population based datasets link certain perinatal circumstances (birth weight, parity, etc) with mental health outcomes such as suicide, self-harm and psychiatric problems. Problematically, population datasets omit a number of social confounds. The aim of this study is to replicate past research linking perinatal circumstances and mental health (suicidality and use of psychiatric services) and to determine if such associations remain after adjusting for social circumstances. Methods A longitudinal school-based survey of 2157 young people (surveyed at age 11, 13, 15) followed up in early adulthood (age 19). At age 11 parents of participants provided information about perinatal circumstances (birth weight, birth complications, etc.) and psychiatric service use. Participants provided data about their mental health at age 15 (attempted suicide, suicidal thoughts) and at ages 19 (self-harm, psychiatric service use). In addition, data were collected about their social and psychosocial circumstances (gender, deprivation, religion, sexual behaviour, etc.). Results Predictably, social factors were linked to mental health outcomes. For example, those with same sex partners were more likely (OR 4.84) to self-harm than those without a same sex partner. With a single exception, in both unadjusted and adjusted models, perinatal circumstances were not or only marginally associated with mental health outcomes. The exception was the number of birth complications; young people with two or more complications were approximately 2-3 times more likely than those without complications to use psychiatric services. Conclusions While we failed to replicate results found using large population based datasets, some of our results are compatible with prior research findings. Further, evidence from this study supports the influence of perinatal circumstances (birth complications) on later psychiatric problems, or at least higher than expected contact

  5. Validity of a questionnaire measuring the world health organization concept of health system responsiveness with respect to perinatal services in the Dutch obstetric care system.

    Science.gov (United States)

    van der Kooy, Jacoba; Valentine, Nicole B; Birnie, Erwin; Vujkovic, Marijana; de Graaf, Johanna P; Denktaş, Semiha; Steegers, Eric A P; Bonsel, Gouke J

    2014-12-03

    The concept of responsiveness, introduced by the World Health Organization (WHO), addresses non-clinical aspects of health service quality that are relevant regardless of provider, country, health system or health condition. Responsiveness refers to "aspects related to the way individuals are treated and the environment in which they are treated" during health system interactions. This paper assesses the psychometric properties of a newly developed responsiveness questionnaire dedicated to evaluating maternal experiences of perinatal care services, called the Responsiveness in Perinatal and Obstetric Health Care Questionnaire (ReproQ), using the eight-domain WHO concept. The ReproQ was developed between October 2009 and February 2010 by adapting the WHO Responsiveness Questionnaire items to the perinatal care context. The psychometric properties of feasibility, construct validity, and discriminative validity were empirically assessed in a sample of Dutch women two weeks post partum. A total of 171 women consented to participation. Feasibility: the interviews lasted between 20 and 40 minutes and the overall missing rate was 8%. Construct validity: mean Cronbach's alphas for the antenatal, birth and postpartum phase were: 0.73 (range 0.57-0.82), 0.84 (range 0.66-0.92), and 0.87 (range 0.62-0.95) respectively. The item-own scale correlations within all phases were considerably higher than most of the item-other scale correlations. Within the antenatal care, birth care and post partum phases, the eight factors explained 69%, 69%, and 76% of variance respectively. Discriminative validity: overall responsiveness mean sum scores were higher for women whose children were not admitted. This confirmed the hypothesis that dissatisfaction with health outcomes is transferred to their judgement on responsiveness of the perinatal services. The ReproQ interview-based questionnaire demonstrated satisfactory psychometric properties to describe the quality of perinatal care in the

  6. Perinatal exposure to mixtures of endocrine disrupting chemicals reduces female rat follicle reserves and accelerates reproductive aging

    DEFF Research Database (Denmark)

    Johansson, Hanna Katarina Lilith; Jacobsen, Pernille Rosenskjold; Hass, Ulla

    2016-01-01

    Exposure to endocrine disrupting chemicals (EDCs) during development can have negative consequences later in life. In this study we investigated the effect of perinatal exposure to mixtures of human relevant EDCs on the female reproductive system. Rat dams were exposed to a mixture of phthalates,...

  7. Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study.

    Science.gov (United States)

    Khanam, Rasheda; Baqui, Abdullah H; Syed, Mamun Ibne Moin; Harrison, Meagan; Begum, Nazma; Quaiyum, Abdul; Saha, Samir K; Ahmed, Saifuddin

    2018-06-01

    Intrapartum complications increase the risk of perinatal deaths. However, population-based data from developing countries assessing the contribution of intrapartum complications to perinatal deaths is scarce. Using data from a cohort of pregnant women followed between 2011 and 2013 in Bangladesh, this study examined the rate and types of intrapartum complications, the association of intrapartum complications with perinatal mortality, and if facility delivery modified the risk of intrapartum-related perinatal deaths. Trained community health workers (CHWs) made two-monthly home visits to identify pregnant women, visited them twice during pregnancy and 10 times in the first two months postpartum. During prenatal visits, CHWs collected data on women's prior obstetric history, socio-demographic status, and complications during pregnancy. They collected data on intrapartum complications, delivery care, and pregnancy outcome during the first postnatal visit within 7 days of delivery. We examined the association of intrapartum complications and facility delivery with perinatal mortality by estimating odds ratios (OR) and 95% confidence intervals (CI) adjusting for covariates using multivariable logistic regression analysis. The overall facility delivery rate was low (3922/24 271; 16.2%). Any intrapartum complications among pregnant women were 20.9% (5,061/24,271) and perinatal mortality was 64.7 per 1000 birth. Compared to women who delivered at home, the risk of perinatal mortality was 2.4 times higher (OR = 2.40; 95% CI = 2.08-2.76) when delivered in a public health facility and 1.3 times higher (OR = 1.32, 95% CI = 1.06-1.64) when delivered in a private health facility. Compared to women who had no intrapartum complications and delivered at home, women with intrapartum complications who delivered at home had a substantially higher risk of perinatal mortality (OR = 3.45; 95% CI = 3.04-3.91). Compared to women with intrapartum complications who

  8. Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia.

    Science.gov (United States)

    Chambers, Georgina M; Randall, Sean; Mihalopoulos, Cathrine; Reilly, Nicole; Sullivan, Elizabeth A; Highet, Nicole; Morgan, Vera A; Croft, Maxine L; Chatterton, Mary Lou; Austin, Marie-Paule

    2017-12-05

    Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients' costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011-12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5million for women giving birth in 2007, rising to A$29million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the

  9. Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: Longitudinal study

    OpenAIRE

    Beena Javaregowda Parvathy

    2014-01-01

    Background: Use of Highly active anti-retroviral therapy have increased the life expectancy of human immunodeficiency virus (HIV) infected patients and hence it is imperative that all efforts have to be made by Pediatric dentists to provide a better oral health for these children. Aim: The aim of this study was to evaluate the rate of utilization of free dental treatment provided to these perinatally infected HIV positive children who were previously screened as a part of oral health survey. ...

  10. Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: longitudinal study.

    Science.gov (United States)

    Parvathy, Beena Javaregowda

    2014-01-01

    Use of Highly active anti-retroviral therapy have increased the life expectancy of human immunodeficiency virus (HIV) infected patients and hence it is imperative that all efforts have to be made by Pediatric dentists to provide a better oral health for these children. The aim of this study was to evaluate the rate of utilization of free dental treatment provided to these perinatally infected HIV positive children who were previously screened as a part of oral health survey. Purposive sampling was used. Perinatally infected HIV children screened for oral health status. Patients not screened during the oral health survey. Attendance records of 319 perinatally HIV infected children consisting of 178 males and 141 females attending a specialized pediatric outpatient clinic at Indira Gandhi Institute of Child Health were examined to compare treatment compliance rates. The number of patients in the severe category who completed treatment was significantly less compared with mild and advanced categories (P 0.05). The results show that children with HIV have significantly lower compliance. Even though all dental treatment provided to them was free of the cost it still had no impetus to encourage them to go through with the treatment.

  11. Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: Longitudinal study

    Directory of Open Access Journals (Sweden)

    Beena Javaregowda Parvathy

    2014-01-01

    Full Text Available Background: Use of Highly active anti-retroviral therapy have increased the life expectancy of human immunodeficiency virus (HIV infected patients and hence it is imperative that all efforts have to be made by Pediatric dentists to provide a better oral health for these children. Aim: The aim of this study was to evaluate the rate of utilization of free dental treatment provided to these perinatally infected HIV positive children who were previously screened as a part of oral health survey. Design: Purposive sampling was used. Inclusion criteria: Perinatally infected HIV children screened for oral health status. Exclusion criteria: Patients not screened during the oral health survey. Materials and Methods: Attendance records of 319 perinatally HIV infected children consisting of 178 males and 141 females attending a specialized pediatric outpatient clinic at Indira Gandhi Institute of Child Health were examined to compare treatment compliance rates. Results: The number of patients in the severe category who completed treatment was significantly less compared with mild and advanced categories (P 0.05. Conclusion: The results show that children with HIV have significantly lower compliance. Even though all dental treatment provided to them was free of the cost it still had no impetus to encourage them to go through with the treatment.

  12. Clinical Features and Correlates of Outcomes for High-Risk, Marginalized Mothers and Newborn Infants Engaged with a Specialist Perinatal and Family Drug Health Service

    Directory of Open Access Journals (Sweden)

    Lee Taylor

    2012-01-01

    Full Text Available Background. There is a paucity of research in Australia on the characteristics of women in treatment for illicit substance use in pregnancy and the health outcomes of their neonates. Aims. To determine the clinical features and outcomes of high-risk, marginalized women seeking treatment for illicit substance use in pregnancy and their neonates. Methods. 139 women with a history of substance abuse/dependence engaged with a perinatal drug health service in Sydney, Australia. Maternal (demographic, drug use, psychological, physical, obstetric, and antenatal care and neonatal characteristics (delivery, early health outcomes were examined. Results. Compared to national figures, pregnant women attending a specialist perinatal and family drug health service were more likely to report being Australian born, Aboriginal or Torres Strait Islander, younger, unemployed, and multiparous. Opiates were the primary drug of concern (81.3%. Pregnancy complications were common (61.9%. Neonates were more likely to be preterm, have low birth weight, and be admitted to special care nursery. NAS was the most prevalent birth complication (69.8% and almost half required pharmacotherapy. Conclusion. Mother-infant dyads affected by substance use in pregnancy are at significant risk. There is a need to review clinical models of care and examine the longer-term impacts on infant development.

  13. Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand

    Science.gov (United States)

    Bhutta, Zulfiqar A; Darmstadt, Gary L; Haws, Rachel A; Yakoob, Mohammad Yawar; Lawn, Joy E

    2009-01-01

    Background Although a number of antenatal and intrapartum interventions have shown some evidence of impact on stillbirth incidence, much confusion surrounds ideal strategies for delivering these interventions within health systems, particularly in low-/middle-income countries where 98% of the world's stillbirths occur. Improving the uptake of quality antenatal and intrapartum care is critical for evidence-based interventions to generate an impact at the population level. This concluding paper of a series of papers reviewing the evidence for stillbirth interventions examines the evidence for community and health systems approaches to improve uptake and quality of antenatal and intrapartum care, and synthesises programme and policy recommendations for how best to deliver evidence-based interventions at community and facility levels, across the continuum of care, to reduce stillbirths. Methods We systematically searched PubMed and the Cochrane Library for abstracts pertaining to community-based and health-systems strategies to increase uptake and quality of antenatal and intrapartum care services. We also sought abstracts which reported impact on stillbirths or perinatal mortality. Searches used multiple combinations of broad and specific search terms and prioritised rigorous randomised controlled trials and meta-analyses where available. Wherever eligible randomised controlled trials were identified after a Cochrane review had been published, we conducted new meta-analyses based on the original Cochrane criteria. Results In low-resource settings, cost, distance and the time needed to access care are major barriers for effective uptake of antenatal and particularly intrapartum services. A number of innovative strategies to surmount cost, distance, and time barriers to accessing care were identified and evaluated; of these, community financial incentives, loan/insurance schemes, and maternity waiting homes seem promising, but few studies have reported or evaluated the

  14. The Role of Quality Obstetric Care Services on Reducing Maternal ...

    African Journals Online (AJOL)

    The study recommends that, special initiative should be done to bring changes on reducing maternal mortality, such as ensure essential equipments and ... Enforcement in providing quality of obstetric care services in maternal health services especially in rural areas where majority of people in Tanzania reside is not an ...

  15. Reducing waste in administrative services with lean principles

    NARCIS (Netherlands)

    Wijnhoven, Alphonsus B.J.M.; Beckers, David; Amrit, Chintan Amrit

    2016-01-01

    In the last few decades, lean techniques have been developed for removing with waste in manufacturing. More recently, lean is used outside the manufacturing context as well. This article focuses on using lean thinking for reducing waste in administrative services, i.e., business services with

  16. REST-MapReduce: An Integrated Interface but Differentiated Service

    Directory of Open Access Journals (Sweden)

    Jong-Hyuk Park

    2014-01-01

    Full Text Available With the fast deployment of cloud computing, MapReduce architectures are becoming the major technologies for mobile cloud computing. The concept of MapReduce was first introduced as a novel programming model and implementation for a large set of computing devices. In this research, we propose a novel concept of REST-MapReduce, enabling users to use only the REST interface without using the MapReduce architecture. This approach provides a higher level of abstraction by integration of the two types of access interface, REST API and MapReduce. The motivation of this research stems from the slower response time for accessing simple RDBMS on Hadoop than direct access to RDMBS. This is because there is overhead to job scheduling, initiating, starting, tracking, and management during MapReduce-based parallel execution. Therefore, we provide a good performance for REST Open API service and for MapReduce, respectively. This is very useful for constructing REST Open API services on Hadoop hosting services, for example, Amazon AWS (Macdonald, 2005 or IBM Smart Cloud. For evaluating performance of our REST-MapReduce framework, we conducted experiments with Jersey REST web server and Hadoop. Experimental result shows that our approach outperforms conventional approaches.

  17. SODIM: Service Oriented Data Integration based on MapReduce

    Directory of Open Access Journals (Sweden)

    Ghada ElSheikh

    2013-09-01

    Data integration systems can benefit from innovative dynamic infrastructure solutions such as Clouds, with its more agility, lower cost, device independency, location independency, and scalability. This study consolidates the data integration system, Service Orientation, and distributed processing to develop a new data integration system called Service Oriented Data Integration based on MapReduce (SODIM that improves the system performance, especially with large number of data sources, and that can efficiently be hosted on modern dynamic infrastructures as Clouds.

  18. Group antenatal intervention to reduce perinatal stress and depressive symptoms related to intergenerational conflicts: a randomized controlled trial.

    Science.gov (United States)

    Leung, Sharron S K; Lam, T H

    2012-11-01

    Intergenerational conflicts are a major source of stress, which might lead to depression in new mothers. The conflict is heightened when grandparents are involved in childcare. To examine the effectiveness of an interpersonal psychotherapy oriented group intervention to reduce stress and depressive symptoms in new mothers and enhance happiness and self-efficacy in managing intergenerational conflict in childcare. This study is one of the intervention projects of FAMILY: A Jockey Club Initiative for a Harmonious Society, funded by The Hong Kong Jockey Club Charities Trust. Multisite randomized controlled trial with two arms: an intervention group attended an additional 4-week program and a control group who received usual care only. Six Maternal and Child Health Centres in Hong Kong From September 2009 to January 2010, 156 pregnant women who would have grandparents involved in childcare were recruited at their 14-32 weeks' gestation. Participants were randomized to groups using computer generated random sequences by blinded recruitment staff. Primary outcomes were stress and depressive symptoms immediately after the intervention and 6-8 weeks after delivery. Secondary outcomes were happiness and self-efficacy in managing conflict. After screening 2870 pregnant women, 156 eligible participants were randomized. Intention-to-treat analysis showed that the intervention group (n=78) had significantly lower perceived stress (p=0.017; Cohen d=0.38) and greater happiness (p=0.004; Cohen d=0.41) than the control group (n=78) immediately after the intervention. However, the effects were not sustained at postnatal follow-up. Subgroup analysis showed that participants with depressive symptoms (EPDS>12) at baseline reported significantly lower stress, greater happiness (p=0.035 and 0.037, respectively; both Cohen d=0.61), greater self-efficacy in managing conflict (p=0.012; Cohen d=0.76) than the control group after the intervention. Also, after delivery, they had significantly

  19. Antenatal Deworming and Materno-Perinatal Outcomes in Calabar, Nigeria

    Directory of Open Access Journals (Sweden)

    Ubong Bassey Akpan

    2018-05-01

    CONCLUSION: Presumptive deworming during the antenatal period can significantly reduce the incidence of peripartum anaemia. However, more studies may be needed to prove any positive perinatal outcome.

  20. Do services reduce gender inequality in labor markets? The service sector, knnowledge-intensive services and the gender pay gap

    OpenAIRE

    Dueñas, Diego; Iglesias, Carlos; Llorente, Raquel

    2014-01-01

    The expansion of services and the dissemination of information technologies and communication are identified as important factors that can improve employment opportunities for women, reducing labor by gender differences. The objective of the study is to determine the extent to which services and especially those most closely linked with the knowledge and ICTs such as Knowledge Intensive Services (KIS) are changing some of the basics of labor gender differences. To do it: a), we first measure ...

  1. MRI of perinatal brain injury

    Energy Technology Data Exchange (ETDEWEB)

    Rutherford, Mary; Allsop, Joanna [Imperial College, Robert Steiner MR Unit, Perinatal Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Martinez Biarge, Miriam [La Paz University Hospital, Dept of Neonatology, Madrid (Spain); Counsell, Serena [Imperial College, Robert Steiner MR Unit, Neonatal Medicine, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Cowan, Frances [Imperial College, Dept of Paediatrics, Hammersmith Hospital, London (United Kingdom)

    2010-06-15

    MRI is invaluable in assessing the neonatal brain following suspected perinatal injury. Good quality imaging requires adaptations to both the hardware and the sequences used for adults or older children. The perinatal and postnatal details often predict the pattern of lesions sustained and should be available to aid interpretation of the imaging findings. Perinatal lesions, the pattern of which can predict neurodevelopmental outcome, are at their most obvious on conventional imaging between 1 and 2 weeks from birth. Very early imaging during the first week may be useful to make management decisions in ventilated neonates but brain abnormalities may still be subtle using conventional sequences. Diffusion-weighted imaging (DWI) is very useful for the early identification of ischaemic tissue in the neonatal brain but may underestimate the final extent of injury, particularly basal ganglia and thalamic lesions. MR imaging is an excellent predictor of outcome following perinatal brain injury and can therefore be used as a biomarker in interventional trials designed to reduce injury and improve neurodevelopmental outcome. (orig.)

  2. MRI of perinatal brain injury

    International Nuclear Information System (INIS)

    Rutherford, Mary; Allsop, Joanna; Martinez Biarge, Miriam; Counsell, Serena; Cowan, Frances

    2010-01-01

    MRI is invaluable in assessing the neonatal brain following suspected perinatal injury. Good quality imaging requires adaptations to both the hardware and the sequences used for adults or older children. The perinatal and postnatal details often predict the pattern of lesions sustained and should be available to aid interpretation of the imaging findings. Perinatal lesions, the pattern of which can predict neurodevelopmental outcome, are at their most obvious on conventional imaging between 1 and 2 weeks from birth. Very early imaging during the first week may be useful to make management decisions in ventilated neonates but brain abnormalities may still be subtle using conventional sequences. Diffusion-weighted imaging (DWI) is very useful for the early identification of ischaemic tissue in the neonatal brain but may underestimate the final extent of injury, particularly basal ganglia and thalamic lesions. MR imaging is an excellent predictor of outcome following perinatal brain injury and can therefore be used as a biomarker in interventional trials designed to reduce injury and improve neurodevelopmental outcome. (orig.)

  3. Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia

    Science.gov (United States)

    Rodin, Urelija; Filipović-Grčić, Boris; Đelmiš, Josip; Glivetić, Tatjana; Juras, Josip; Mustapić, Željka; Grizelj, Ruža

    2015-01-01

    Context. Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons. Objective. Description of perinatal health care quality assessment key indicators in Croatia. Methods. Retrospective review of reports from all maternities from 2001 to 2014. Results. According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM) was reduced by 31%, fetal mortality (FM) by 32%, and early neonatal mortality (ENM) by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks' (wks) gestational age (GA) was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32–36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22–27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014. Conclusions. The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment. PMID:26693484

  4. Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia

    Directory of Open Access Journals (Sweden)

    Urelija Rodin

    2015-01-01

    Full Text Available Context. Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons. Objective. Description of perinatal health care quality assessment key indicators in Croatia. Methods. Retrospective review of reports from all maternities from 2001 to 2014. Results. According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM was reduced by 31%, fetal mortality (FM by 32%, and early neonatal mortality (ENM by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks’ (wks gestational age (GA was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32–36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22–27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014. Conclusions. The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment.

  5. Eliminating Perinatal HIV Transmission

    Centers for Disease Control (CDC) Podcasts

    In this podcast, CDC’s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students.

  6. Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture

    DEFF Research Database (Denmark)

    Stenqvist, Charlotte; Madsen, Christian Medom; Riis, Troels

    2016-01-01

    INTRODUCTION: Orthogeriatric service has been shown to improve outcomes in patients with hip fracture. The purpose of this study is to evaluate the effect of orthogeriatrics at Bispebjerg University Hospital, Denmark. The primary outcome is mortality inhospital and after 1, 3, and 12 months...... for patients with hip fracture. The secondary outcome is mortality for home dwellers and nursing home inhabitants. MATERIALS AND METHODS: This is a retrospective clinical cohort study with an historic control group including all patients with hip fracture admitted from 2007 to 2011. Patients with hip fracture...... = .009) after orthogeriatrics. However, when adjusting for age, gender, and American Society of Anaesthesiologists (ASA) score in a multivariate analysis, including all patients with hip fracture, we find significantly reduced mortality inhospital (odds ratio [OR] 0.35), after 30 [OR 0.66] and 90 days...

  7. Interest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care.

    Science.gov (United States)

    Cormick, Gabriela; Kim, Natalie A; Rodgers, Ashlei; Gibbons, Luz; Buekens, Pierre M; Belizán, José M; Althabe, Fernando

    2012-08-06

    Mobile health (mHealth) is emerging as a useful tool to improve healthcare access especially in the developing world, where limited access to health services is linked to poor antenatal care, and maternal and perinatal mortality.The objective of this study is to 1) understand pregnant women's access and usage of cell phones and 2) survey the health information needs and interests in a population attending public hospitals and health centers of two cities in Argentina. This information is not available and it is the basis to develop a strategy for improving maternal care via cell phones. Questionnaires were verbally administered to pregnant women who were attending an antenatal care visit in community health centers and public hospitals in Rosario, Santa Fe and Mercedes, Corrientes. Participants were 18 years of age or older and had previously given birth. The data obtained was qualitative and analyzed using SPSS version 18. A total of 147 pregnant women meeting inclusion criteria (Rosario: 63; Mercedes: 84) were approached and verbally consented to participate. The average age was 29.5 years, most lived in urban areas (89%) with a mean travel time of 43.4 minutes required to get to the health center and 57.3 minutes to get the hospital.Ninety-six percent of women (n = 140) responded that they would like to receive text messages and cell phone calls with information regarding prenatal care, although the topics and period of time to receive information varied greatly. Considering the vast majority of the interviewed women had access to and were interested in receiving text messages and calls with educational information regarding pregnancy and infant health, pregnant women in Argentina could benefit from such an mHealth program. The low access to Internet suggests it is not an option for this population; however, this cannot be assumed as representative of the country's situation.To retain active participation, other forms of health communication, such as a 2

  8. Interest of pregnant women in the use of SMS (short message service text messages for the improvement of perinatal and postnatal care

    Directory of Open Access Journals (Sweden)

    Cormick Gabriela

    2012-08-01

    Full Text Available Abstract Background Mobile health (mHealth is emerging as a useful tool to improve healthcare access especially in the developing world, where limited access to health services is linked to poor antenatal care, and maternal and perinatal mortality. The objective of this study is to 1 understand pregnant women’s access and usage of cell phones and 2 survey the health information needs and interests in a population attending public hospitals and health centers of two cities in Argentina. This information is not available and it is the basis to develop a strategy for improving maternal care via cell phones. Methods Questionnaires were verbally administered to pregnant women who were attending an antenatal care visit in community health centers and public hospitals in Rosario, Santa Fe and Mercedes, Corrientes. Participants were 18 years of age or older and had previously given birth. The data obtained was qualitative and analyzed using SPSS version 18. Results A total of 147 pregnant women meeting inclusion criteria (Rosario: 63; Mercedes: 84 were approached and verbally consented to participate. The average age was 29.5 years, most lived in urban areas (89% with a mean travel time of 43.4 minutes required to get to the health center and 57.3 minutes to get the hospital. Ninety-six percent of women (n = 140 responded that they would like to receive text messages and cell phone calls with information regarding prenatal care, although the topics and period of time to receive information varied greatly. Conclusions Considering the vast majority of the interviewed women had access to and were interested in receiving text messages and calls with educational information regarding pregnancy and infant health, pregnant women in Argentina could benefit from such an mHealth program. The low access to Internet suggests it is not an option for this population; however, this cannot be assumed as representative of the country’s situation. To retain

  9. Eliminating Perinatal HIV Transmission

    Centers for Disease Control (CDC) Podcasts

    2012-11-26

    In this podcast, CDC’s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students.  Created: 11/26/2012 by Division of HIV/AIDS Prevention.   Date Released: 11/26/2012.

  10. Maternal and fetal determinants of perinatal transmission of HIV ...

    African Journals Online (AJOL)

    All effort should be geared toward identifying those positive and minimized or modify risks factors through behavior change, prompt initiation of treatment and prophylaxis for those found positive with a view to reduce the incidence of perinatal transmission. Key Words: perinatal transmission, HIV, maternal, fetal determinants, ...

  11. Risk factors and prognostic models for perinatal asphyxia at term

    NARCIS (Netherlands)

    Ensing, S.

    2015-01-01

    This thesis will focus on the risk factors and prognostic models for adverse perinatal outcome at term, with a special focus on perinatal asphyxia and obstetric interventions during labor to reduce adverse pregnancy outcomes. For the majority of the studies in this thesis we were allowed to use data

  12. 76 FR 58517 - Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV...

    Science.gov (United States)

    2011-09-21

    ...-2011-0011] Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus... public comment on the draft Public Health Service Guideline for Reducing Transmission of Human..., Attn: Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV...

  13. Factors related to main preventable perinatal injuries of public hospital in the Brazilian Federal District.

    Directory of Open Access Journals (Sweden)

    Pamella Padilha BRITO

    2015-02-01

    Full Text Available Introduction: The quality of prenatal care, childbirth and newborn are determinants of perinatal morbidity and mortality. The realization of a adequate prenatal care and skilled birth assistance would reduce the incidence of injuries and perinatal deaths that are largely preventable. Method: Descriptive and exploratory study of quantitative and qualitative nature.  Interview and review of medical records of thirty mothers and newborns were made. The results were chart using the SPSS software, version 20.0, for processing and statistical analysis. We performed thematic analysis of interviews, and tabulated according to their frequencies, identifying the differences and similarities between data. Results: The most frequent perinatal injuries were prematurity (74.2%, Respiratory Distress (71%, Underweight (51.6%, Infection or Sepsis (41.9%, Perinatal Asphyxia (19.4%  and Oligohydramnio (19.4%. These injuries were related to several factors such as inadequate prenatal care, with fewer than six prenatal consultations (70% and late onset (50%, and presence of maternal health problems such as: changes in amniotic fluid (50% and preterm labor (50%. The interviewees added other factors such as failures in the care professional (43%, failures in care and service (33%, difficulty of access (19% and breast self-care failures (16.6%. Conclusion: Stood out in this study the occurrence of perinatal injuries in children of mothers with stable socio-demographic profile and in term newborns as also the percentage of deaths (16.1%. The perinatal injuries and deaths could have been avoided with qualified prenatal care, childbirth and newborn care.

  14. Exploring the views and experiences of callers to the PANDA Post and Antenatal Depression Association Australian National Perinatal Depression Helpline: a cross-sectional survey.

    Science.gov (United States)

    Biggs, Laura J; Shafiei, Touran; Forster, Della A; Small, Rhonda; McLachlan, Helen L

    2015-09-07

    Anxiety and depression are common in the perinatal period. Telephone interventions, including telephone peer support and counselling, have been developed to support those experiencing perinatal mental illness. PANDA Post and Antenatal Depression Association provides support to women and men experiencing perinatal mental illness via the Australian National Perinatal Depression Helpline, encompassing both volunteer peer support and professional counselling. This study aimed to explore the experiences of callers to the Helpline. A cross-sectional survey design was used. All new callers from 1(st) May to 30(th) September 2013 were invited to participate. The survey, adapted from a previous survey of PANDA callers, included 23 questions using Likert-type scales, demographic and open-ended questions. Thematic network analysis was undertaken for responses to open-ended questions. 124 responses were received (124/405; 30% response). The majority of callers had called the Helpline regarding themselves (90%), with over one third (33%) of all callers seeking crisis support and help. Ninety-nine per cent of respondents 'agreed' or 'strongly agreed' that staff and/or volunteers understood their concerns, and 97% 'agreed' or 'strongly agreed' that overall PANDA had helped them. Callers described the PANDA service as uniquely tailored to the perinatal period, providing accessible, non-judgemental understanding and support, with a global theme from open-ended comments describing PANDA as 'a safe space to be heard and receive support without judgement'. Recommendations for service changes included increased hours of availability. Callers reported positive experiences of accessing support from the PANDA National Perinatal Depression Helpline. The Helpline was described as an accessible and acceptable telephone support for individuals experiencing perinatal mental illness. Recommendations for changes to the service included an increase in hours of operation to enable greater

  15. The Perinatal Mental Health and Wellness Project: Improving perinatal mental health outcomes by working together across sectors

    OpenAIRE

    Herde, Emily Louise

    2018-01-01

    This paper reports on the Perinatal Mental Health and Wellness Project which aimed to develop and evaluate a collaborative model for mental health promotion, illness prevention and early intervention in the perinatal period. The project took on a place-based action research approach, developing and trialling the model with expectant parents (n=537) engaged with Redcliffe Hospital Maternity Services in the Metro North Hospital and Health Service in Queensland, Australia, from 2015 – 2017.In Au...

  16. Género, salud materna y la paradoja perinatal

    OpenAIRE

    Simone Grilo DINIZ

    2010-01-01

    En los últimos 20 años mejoraron prácticamente todos los indicadores de salud materna en el Brasil, así como hubo un amplio acceso a los servicios de salud. Gender, maternal health and the perinatal paradox1 Gênero, saúde materna e o paradoxo perinatal Género, salud materna y la paradoja perinatal REFLEXÕES SOBRE HUMANIZAÇÃO E A REALIDADE DOS SERVIÇOS REFLECTIONS ON HUMANIZATION AND THE REALITY OF HEALTH SERVICES REFLEXIONES SOBRE LA HUMANIZACIÓN Y LA REALIDAD DE LO...

  17. Reducing Attendance Time in LR-EPONs With Differentiated Services

    KAUST Repository

    Elrasad, Amr

    2015-04-09

    This work presents a novel on-the-fly void filling scheme for Long-Reach EPON called Size Controlled Batch Void Filling (SCBVF). SCBVF aims at reducing the time between consecutive bandwidth grants (attendance time) and hence reducing the average delay for delay-sensitive traffic.

  18. Reduced risks and improved economic operation of ancillary services

    NARCIS (Netherlands)

    Bosch, van den P.P.J.; Jokic, A.; Hermans, R.M.; Frunt, J.; Kling, W.L.; Nobel, Frank; Boonekamp, P.; Boer, de W.W.

    2010-01-01

    Present arrangements and regulation for ancillary services for power balance in power systems cannot cope with future developments in power systems as the participants do not receive proper incentives for required behaviour. This paper analyzes the consequences of current arrangements for system

  19. Building Perinatal Case Manager Capacity Using Quality Improvement

    OpenAIRE

    Fitzgerald, Elaine

    2015-01-01

    Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote a...

  20. Perinatal pathology: practice suggestions for limited-resource settings.

    Science.gov (United States)

    Roberts, Drucilla J

    2013-06-01

    The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.

  1. Identifying perinatal risk factors for infant maltreatment: an ecological approach

    Directory of Open Access Journals (Sweden)

    Hallisey Elaine J

    2006-12-01

    Full Text Available Abstract Background Child maltreatment and its consequences are a persistent problem throughout the world. Public health workers, human services officials, and others are interested in new and efficient ways to determine which geographic areas to target for intervention programs and resources. To improve assessment efforts, selected perinatal factors were examined, both individually and in various combinations, to determine if they are associated with increased risk of infant maltreatment. State of Georgia birth records and abuse and neglect data were analyzed using an area-based, ecological approach with the census tract as a surrogate for the community. Cartographic visualization suggested some correlation exists between risk factors and child maltreatment, so bivariate and multivariate regression were performed. The presence of spatial autocorrelation precluded the use of traditional ordinary least squares regression, therefore a spatial regression model coupled with maximum likelihood estimation was employed. Results Results indicate that all individual factors or their combinations are significantly associated with increased risk of infant maltreatment. The set of perinatal risk factors that best predicts infant maltreatment rates are: mother smoked during pregnancy, families with three or more siblings, maternal age less than 20 years, births to unmarried mothers, Medicaid beneficiaries, and inadequate prenatal care. Conclusion This model enables public health to take a proactive stance, to reasonably predict areas where poor outcomes are likely to occur, and to therefore more efficiently allocate resources. U.S. states that routinely collect the variables the National Center for Health Statistics (NCHS defines for birth certificates can easily identify areas that are at high risk for infant maltreatment. The authors recommend that agencies charged with reducing child maltreatment target communities that demonstrate the perinatal risks

  2. Association between the safe delivery app and quality of care and perinatal survival in Ethiopia

    DEFF Research Database (Denmark)

    Lund, Stine; Boas, Ida Marie; Bedesa, Tariku

    2016-01-01

    the health care workers' knowledge and skills in neonatal resuscitation as long as 12 months after introduction. Perinatal mortality was nonsignificantly reduced after the intervention. The results are highly relevant in low-income countries, where quality of care is challenged by a lack of continuing......Importance: Health apps in low-income countries are emerging tools with the potential to improve quality of health care services, but few apps undergo rigorous scientific evaluation. Objective: To determine the effects of the safe delivery app (SDA) on perinatal survival and on health care workers......' knowledge and skills in neonatal resuscitation. Design, setting, and participants: In a cluster-randomized clinical trial in 5 rural districts of Ethiopia, 73 health care facilities were randomized to the mobile phone intervention or to standard care (control). From September 1, 2013, to February 1, 2015...

  3. Five-year trends in epidemiology and prevention of mother-to-child HIV transmission, St. Petersburg, Russia: results from perinatal HIV surveillance

    Directory of Open Access Journals (Sweden)

    Kissin Dmitry M

    2011-10-01

    Full Text Available Abstract Background The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission. Methods Standard HIV case-reporting and enhanced perinatal HIV surveillance systems were used for prospective assessment of HIV-infected women giving birth in St. Petersburg, Russia, during 2004-2008. Trends in social, perinatal, and clinical factors influencing mother-to-child HIV transmission stratified by history of injection drug use, and rates of perinatal HIV transmission were assessed using two-sided χ2 or Cochran-Armitage tests. Results Among HIV-infected women who gave birth, the proportion of women who self-reported ever using injection drugs (IDUs decreased from 62% in 2004 to 41% in 2008 (P P P P for trend Conclusions Reduced proportion of IDUs and improved clinical services among HIV-infected women giving birth were accompanied by decreased perinatal HIV transmission, which can be further reduced by increasing outreach and HIV testing of women before and during pregnancy.

  4. Inflatable door seals - reduced maintenance and longer service-life

    International Nuclear Information System (INIS)

    Kuran, S.; Wensel, R.; Lazic, M.

    1995-01-01

    Inflatable door seals, designed more than a quarter of a century ago, have given good service in Canadian and overseas CANDU reactors. These thin-walled elastomeric seals have been exposed to many thousands of cycles of inflation and deflation, various types of aging (temperature, radiation and time), ozone degradation, abrasion, pinching, stiction, cracking and installation damage. The fact that they have operated successfully as part of the reactor building containment structure - subjected to the same pressures and temperatures as those for the thick reinforced concrete walls and steel doors highlights the achievement of these thin rubber seals. However, in the last decade, the rubber industry has developed new compounds that are more resistant to radiation, temperature, and time-dependent aging. Components manufactured from such compounds are less prone to hardening, stress cracking and permanent set; thereby saving on replacement costs, inventory and overall maintenance. This paper discusses development and testing of recent material and design changes to inflatable seals, and addresses various practical issues faced by the operations engineers and maintainers using these seals. (author)

  5. Perinatal tuberculosis: a diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Edna Lúcia S. de Souza

    Full Text Available Despite the high prevalence of tuberculosis in adults and children, the congenital and perinatal forms of tuberculosis are rare. In Brazil, there has been only one published case of congenital tuberculosis and two cases of the perinatal form of this disease. We report a case of perinatal tuberculosis presenting with pneumonia. Alcohol-acid-resistant bacilli were found in the gastric lavage. Diagnosis of this disease presentation requires a high index of suspicion.

  6. A systematic review of perinatal depression interventions for adolescent mothers.

    Science.gov (United States)

    Lieberman, Kate; Le, Huynh-Nhu; Perry, Deborah F

    2014-12-01

    Poor, adolescent, racial/ethnic minority women are at great risk for developing perinatal depression. However, little research has been conducted evaluating interventions for this population. We conducted a systematic review of preventive and treatment interventions for perinatal depression tested with adolescents, with a focus on low income, minority populations. Nine research-based articles (including one that reported on two studies) were reviewed systematically, and quality ratings were assigned based on a validated measure assessing randomization, double-blinding, and reporting of participant withdrawals. Two treatment studies were identified, both of which were successful in reducing depression. Eight prevention studies were located, of which four were more efficacious than control conditions in preventing depression. Studies sampled mostly minority, low socioeconomic status adolescents. No consistent characteristics across efficacious interventions could be identified. This review underscores the need for researchers to further investigate and build an evidence base. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  7. Is lowering reducing sugars concentration in French fries an effective measure to reduce acrylamide concentration in food service establishments?

    NARCIS (Netherlands)

    Sanny, M.A.I.; Jinap, S.; Bakker, E.J.; Boekel, van M.A.J.S.; Luning, P.A.

    2012-01-01

    The objective of this study was to obtain insight into the actual effectiveness of lowering reducing sugars concentration in par-fried potato strips on the concentration and variation of acrylamide in French fries prepared in real-life situations in food service establishments. Acrylamide, frying

  8. Application of six sigma DMAIC methodology to reduce service resolution time in a service organization

    Directory of Open Access Journals (Sweden)

    Virender Narula

    2017-11-01

    Full Text Available The popularity of Six Sigma, as a means for improving quality, has grown exponentially in recent years. It is a proven methodology to achieve breakthrough improvement in process performance that generates significant savings to bottom line of an organization. This paper illustrates how Six Sigma methodology may be used to improve service processes. The purpose of this paper is to develop Six Sigma DMAIC methodologies that would help service organizations look into their processes. In addition, it demonstrates the vital linkages between process improvement and process variation. The study identifies critical process parameters and suggests a team structure for Six Sigma project in service operations.

  9. Perinatal risk factors for strabismus

    DEFF Research Database (Denmark)

    Torp-Pedersen, Tobias; Boyd, Heather A; Poulsen, Gry

    2010-01-01

    Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype.......Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype....

  10. An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan.

    Science.gov (United States)

    Jokhio, Abdul Hakeem; Winter, Heather R; Cheng, Kar Keung

    2005-05-19

    There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year. There is limited evidence from clinical trials to guide the development of effective maternity services in developing countries. We performed a cluster-randomized, controlled trial involving seven subdistricts (talukas) of a rural district in Pakistan. In three talukas randomly assigned to the intervention group, traditional birth attendants were trained and issued disposable delivery kits; Lady Health Workers linked traditional birth attendants with established services and documented processes and outcomes; and obstetrical teams provided outreach clinics for antenatal care. Women in the four control talukas received usual care. The primary outcome measures were perinatal and maternal mortality. Of the estimated number of eligible women in the seven talukas, 10,114 (84.3 percent) were recruited in the three intervention talukas, and 9443 (78.7 percent) in the four control talukas. In the intervention group, 9184 women (90.8 percent) received antenatal care by trained traditional birth attendants, 1634 women (16.2 percent) were seen antenatally at least once by the obstetrical teams, and 8172 safe-delivery kits were used. As compared with the control talukas, the intervention talukas had a cluster-adjusted odds ratio for perinatal death of 0.70 (95 percent confidence interval, 0.59 to 0.82) and for maternal mortality of 0.74 (95 percent confidence interval, 0.45 to 1.23). Training traditional birth attendants and integrating them into an improved health care system were achievable and effective in reducing perinatal mortality. This model could result in large improvements in perinatal and maternal health in developing countries. Copyright 2005 Massachusetts Medical Society.

  11. Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania

    Directory of Open Access Journals (Sweden)

    Thomas Angela N

    2009-09-01

    Full Text Available Abstract Background Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR. Methods From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133 with birth weight 1500 g or more at Muhimbili National Hospital (MNH. The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care. The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient. Results The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors. Conclusion There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality.

  12. Excess of methyl donor in the perinatal period reduces postnatal leptin secretion in rat and interacts with the effect of protein content in diet.

    Directory of Open Access Journals (Sweden)

    Fanny Giudicelli

    Full Text Available Methionine, folic acid, betaine and choline interact in the one-carbon metabolism which provides methyl groups for methylation reactions. An optimal intake of these nutrients during pregnancy is required for successful completion of fetal development and evidence is growing that they could be involved in metabolic long-term programming. However, the biological pathways involved in the action of these nutrients are still poorly known. This study investigated the interaction between methyl donors and protein content in maternal diet during the preconceptual, pregnancy and lactation periods and the consequences on the rat offspring in the short and long term. Methyl donor supplementation reduced leptin secretion in offspring, whereas insulin levels were mostly affected by protein restriction. The joint effect of protein restriction and methyl donor excess strongly impaired postnatal growth in both gender and long term weight gain in male offspring only, without affecting food intake. In addition, rats born from protein restricted and methyl donor supplemented dams gained less weight when fed a hypercaloric diet. Methylation of the leptin gene promoter in adipose tissue was increased in methyl donor supplemented groups but not affected by protein restriction only. These results suggest that maternal methyl donor supplementation may influence energy homeostasis in a gender-dependent manner, without affecting food intake. Moreover, we showed that macronutrients and micronutrients in maternal diet interact to influence the programming of the offspring.

  13. Assessing the quality of bereavement care after perinatal death: development and piloting of a questionnaire to assess parents' experiences.

    Science.gov (United States)

    Aiyelaagbe, Esther; Scott, Rebecca E; Holmes, Victoria; Lane, Emma; Heazell, Alexander E P

    2017-10-01

    Understanding parents' experience of care is essential to develop high-quality perinatal bereavement services. This study aimed at developing a questionnaire to identify parents' needs and record their experience of care. The patient experience questionnaire was developed by professionals and parents, and piloted in a tertiary maternity unit. Responses were received from 58 parents. Sensitivity and kindness of staff and time spent with their baby were ranked as 'very important' by 95% of parents. Care in these areas largely met their needs (90%), although 5% of respondents stated that partners could have been more involved. Between 8% and 15% of respondents did not feel that language used at the diagnosis of fetal death was sensitive, clear and unambiguous. Parents did not always receive written information about their care (5%) or post-mortem (13%). Analysis of bereaved parents' responses identified areas for improvement including greater involvement of partners and a need for timely information. Impact statement What is already known on this subject?: Good quality bereavement care after perinatal death reduces the negative emotional, psychological and social effects for parents. Description of parents' experiences is a potential means to improve the quality of perinatal bereavement care. What do the results of this study add?: Parents' needs and experiences of care after perinatal death were recorded using a patient-experience questionnaire designed by a multi-professional team and parents. Staff behaviour, particularly sensitivity and kindness was highly valued by parents. Giving both verbal and written information could be improved. Training is needed for professionals, particularly those who come into contact with bereaved parents less frequently. What are the implications of these findings for clinical practice and/or further research?: Description of parents' priorities and views can be used to identify areas for improvement in perinatal bereavement care

  14. Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model

    OpenAIRE

    Moore, Donna; Drey, Nicholas; Ayers, Susan

    2017-01-01

    BACKGROUND: Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-...

  15. Preconception prophylactic of the urinary tract infection in women of high-risk groups: reserves to reduce perinatal and obstetric complications

    Directory of Open Access Journals (Sweden)

    A. Limanskaya

    2016-06-01

    Full Text Available The aim of the study is to reveal the effectiveness of «Novoks» manufacturing by Organosin companies in preconception treatment of urinary tract infections in women with lupus nephritis and pyelonephritis gestational history. Material and methods. The study involved 30 women with gestational pyelonephritis history and 15 women with lupus nephritis. Inclusion criteria were the presence of at least one of the clinical symptoms (pain in the lumbar region, dysuria, pain in the PST region in conjunction with microbiological criteria: number of leukocytes in the urine over a field of view of 10–15; the number of colony forming units of a microorganism > 104; sensitivity to levofloxacin as a result of urine culture. Inclusion criteria: urinalysis, urine culture with antibiotic susceptibility, clinical and biochemical blood tests, an ultrasound examination of the kidneys. All women received the drug Novaks (Organosin 500 mg once daily for 5–7 days, and the probiotic Probiz Femina 1 capsule 2 times per day till 14 days. Results. After a treatment with Novaks in combination with a probiotic Probiz-Femina (Organosin noted a progressive decrease in the degree of bacteriuria, which was manifested during a urine test research absence of bacteria and decrease the number of white blood cells. Also regressed inflammatory changes in the peripheral blood. During the control urine culture after 10 days of treatment and 1 month later, revealed no growth of pathogenic organisms in the relevant titer. Conclusions. Novoks (levofloxacin is recommended for use in preconception prevention and treatment of infectious diseases of the urinary system in women at high risk. Using microbial interference therapy using modern probiotic Probiz Femina leads to a significant improvement in intestinal microbiocenosis in antibiotic therapy, reduce contamination of the intestines and the vagina, which allows you to take drug treatment Novaks without impairing the quality of life.

  16. Can Appealing to Patient Altruism Reduce Overuse of Health Care Services? An Experimental Survey.

    Science.gov (United States)

    Riggs, Kevin R; Ubel, Peter A; Saloner, Brendan

    2017-07-01

    A challenge to reducing overuse of health services is communicating recommendations against unnecessary health services to patients. The predominant approach has been to highlight the limited benefit and potential harm of such services for that patient, but the prudent use of health resources can also benefit others. Whether appealing to patient altruism can reduce overuse is unknown. To determine whether altruistic appeals reduce hypothetical requests for overused services and affect physician ratings. Experimental survey using hypothetical vignettes describing three overused health services (antibiotics for acute sinusitis, imaging for acute low back pain, and annual exams for healthy adults). U.S. adults recruited from Research Now, an online panel of individuals compensated for performing academic and marketing research surveys. In the control version of the vignettes, the physician's rationale for recommending against the service was the minimal benefit and potential for harm. In the altruism version, the rationale additionally included potential benefit to others by forgoing that service. Differences in requests for overused services and physician ratings between participants randomized to the control and altruism versions of the vignettes. A total of 1001 participants were included in the final analyses. There were no significant differences in requests for overused services for any of the clinical scenarios (P values ranged from 0.183 to 0.547). Physician ratings were lower in the altruism version for the acute sinusitis (6.68 vs. 7.03, P = 0.012) and back pain scenarios (6.14 vs. 6.83, P < 0.001), and marginally lower for the healthy adult scenario (5.27 vs. 5.57, P = 0.084). In this experimental survey, altruistic appeals delivered by physicians did not reduce requests for overused services, and resulted in more negative physician ratings. Further studies are warranted to determine whether alternative methods of appealing to patient altruism

  17. Reduced service of the “IT Service Desk” (Computing Helpdesk) on the after noon of Friday 8 October 2010

    CERN Multimedia

    IT Department

    2010-01-01

    Please note that due to relocation, the “IT Service Desk” will be operating a reduced service on Friday 8th October from 12-30. In particular, the telephone line 78888 will not be available and users will be invited to submit their requests by e-mail (Computing.Helpdesk@cern.ch). E-mail requests will be treated as normal, but some delays are possible. In the event of urgent problems you may call the IT Manager on Duty on 163013. We also take this opportunity to remind you about the “IT Service Status Board” where all computing incidents and scheduled interventions are updated online. Please see: http://cern.ch/it-servicestatus. Normal service will be resumed at 8-30 a.m on Monday 11 October. Thank you in advance for your understanding. The CERN “User Support” Team (IT-UDS-HUS)

  18. Perinatal grief in Latino parents.

    Science.gov (United States)

    Whitaker, Claudia; Kavanaugh, Karen; Klima, Carrie

    2010-01-01

    Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based on research done primarily with non-Latino families. Are these common practices appropriate for this population? Because there is a paucity of research on this topic, this article describes what has been written over the past 30 years on the topic of grief and perinatal loss in Latino culture.

  19. Perinatal postmortem radiography

    International Nuclear Information System (INIS)

    Seppaenen, U.

    1986-01-01

    During 1980-1982 a postmortem radiologic investigation was carried out on 514 perinatally dead infants from 22 hospitals in Finland. Pathologic radiologic findings were seen in 30% of the material. Ninety-nine cases had congenital defects, while the rest showed other skeletal or soft tissue abnormalities. Of those with congenital defects, there were 6 osteochondrodysplasias, 16 chromosomal malformation syndromes, 13 autosomal recessive inherited malformation syndromes and 18 multiple malformation syndromes of unknown aetiology. There were also 18 cases with malformation sequences and 10 single malformations with abnormal radiologic findings. Congenital defects due to disruptions were detected in 12 cases and defects due to deformations in 7. The present article includes a review of the radiologic findings in 514 cases, with special reference to the skeletal findings. (orig./MG)

  20. Is lowering reducing sugars concentration in French fries an effective measure to reduce acrylamide concentration in food service establishments?

    Science.gov (United States)

    Sanny, M; Jinap, S; Bakker, E J; van Boekel, M A J S; Luning, P A

    2012-12-01

    The objective of this study was to obtain insight into the actual effectiveness of lowering reducing sugars concentration in par-fried potato strips on the concentration and variation of acrylamide in French fries prepared in real-life situations in food service establishments. Acrylamide, frying time, frying temperature, and reducing sugars were measured and characteristics of fryers were recorded. Data showed that the use of par-fried potato strips with lower concentrations of reducing sugars than the commonly used potato strips was an effective measure to reduce acrylamide concentrations in French fries prepared under standardised frying conditions. However, there was still large variation in the acrylamide concentrations in French fries, although the variation in reducing sugars concentrations in low and normal types of par-fried potato strips was very small and the frying conditions were similar. Factors that could affect the temperature-time profile of frying oil were discussed, such as setting a lower frying temperature at the end than at the start of frying, product/oil ratio and thawing practice. These need to be controlled in daily practice to reduce variation in acrylamide. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Understanding the Collaborative Planning Process in Homeless Services: Networking, Advocacy, and Local Government Support May Reduce Service Gaps.

    Science.gov (United States)

    Jarpe, Meghan; Mosley, Jennifer E; Smith, Bikki Tran

    2018-06-07

    The Continuum of Care (CoC) process-a nationwide system of regional collaborative planning networks addressing homelessness-is the chief administrative method utilized by the US Department of Housing and Urban Development to prevent and reduce homelessness in the United States. The objective of this study is to provide a benchmark comprehensive picture of the structure and practices of CoC networks, as well as information about which of those factors are associated with lower service gaps, a key goal of the initiative. A national survey of the complete population of CoCs in the United States was conducted in 2014 (n = 312, 75% response rate). This survey is the first to gather information on all available CoC networks. Ordinary least squares (OLS) regression was used to determine the relationship between internal networking, advocacy frequency, government investment, and degree of service gaps for CoCs of different sizes. United States. Lead contacts for CoCs (n = 312) that responded to the 2014 survey. Severity of regional service gaps for people who are homeless. Descriptive statistics show that CoCs vary considerably in regard to size, leadership, membership, and other organizational characteristics. Several independent variables were associated with reduced regional service gaps: networking for small CoCs (β = -.39, P < .05) and local government support for midsized CoCs (β = -.10, P < .05). For large CoCs, local government support was again significantly associated with lower service gaps, but there was also a significant interaction effect between advocacy and networking (β = .04, P < .05). To reduce service gaps and better serve the homeless, CoCs should consider taking steps to improve networking, particularly when advocacy is out of reach, and cultivate local government investment and support.

  2. Association of antenatal care with facility delivery and perinatal survival – a population-based study in Bangladesh

    Directory of Open Access Journals (Sweden)

    Pervin Jesmin

    2012-10-01

    Full Text Available Abstract Background Antenatal Care (ANC during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples. Methods This study was conducted within the Health and Demographic Surveillance System (HDSS of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006 and after (2008–2009 implementation of the MNCH program. Results Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR 1.91; 95% confidence intervals (CI: 1.50, 2.42 among women who received ≤1 ANC compared to women who received ≥3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78 to non-significance (OR 0.81; 95% CI: 0.65, 1.01, when comparing cohorts before

  3. Diabetes and perinatal mortality in twin pregnancies.

    Directory of Open Access Journals (Sweden)

    Zhong-Cheng Luo

    Full Text Available BACKGROUND: Diabetes in pregnancy has been associated with a paradoxically reduced risk of neonatal death in twin pregnancies. Risk "shift" may be a concern in that the reduction in neonatal deaths may be due to an increase in fetal deaths (stillbirths. This study aimed to clarify the impact of diabetes on the risk of perinatal death (neonatal death plus stillbirth in twin pregnancies. METHODS: This was a retrospective cohort study of twin births using the largest available dataset on twin births (the U.S. matched multiple birth data 1995-2000; 19,676 neonates from diabetic pregnancies, 541,481 from non-diabetic pregnancies. Cox proportional hazard models were applied to estimate the adjusted hazard ratios (aHR of perinatal death accounting for twin cluster-level dependence. RESULTS: Comparing diabetic versus non-diabetic twin pregnancies, overall perinatal mortality rate was counterintuitively lower [2.1% versus 3.3%, aHR 0.70 (95% confidence intervals 0.63-0.78]. Individually, both stillbirth and neonatal mortality rates were lower in diabetic pregnancies, but we identified significant differences by gestational age and birth weight. Diabetes was associated with a survival benefit in pregnancies completed before 32 weeks [aHR 0.55 (0.48-0.63] or with birth weight =2500 g [aHR 2.20 (1.55-3.13]. CONCLUSIONS: Diabetes in pregnancy appears to be "protective" against perinatal death in twin pregnancies ending in very preterm or very low birth weight births. Prospective studies are required to clarify whether these patterns of risk are real, or they are artifacts of unmeasured confounders. Additional data correlating these outcomes with the types of diabetes in pregnancy are also needed to distinguish the effects of pre-gestational vs. gestational diabetes.

  4. Prevalence and factors influencing perinatal mortality in rural mysore, India.

    Science.gov (United States)

    Siddalingappa, Hugara; Murthy M R, Nrayana; Kulkarni, Praveen; N C, Ashok

    2013-12-01

    With decreasing Infant Mortality Rate, Perinatal Mortality is gaining importance as it takes into consideration most of the factors influencing child birth and its survival, mortality during this period is a better indicator of quality of Maternal and Child Health services. To estimate the Prevalence of perinatal mortality and its associated risk factors. Cross sectional community based study was carried out in rural field practice area catering 26,700 population. All births during 2010 among permanent residents of this area were included. House to house survey was conducted to collect details regarding Antenatal, intra-natal and post-natal history by interviewing mother using a pre-tested questionnaire. Hospital records were also referred when available. Nine perinatal deaths had occurred out of 314 births in a span of one year with a perinatal, early neonatal mortality rates of 28.93, 19.29 per 1000 live births respectively and still birth rate of 9.55 per 100 total births. Higher Perinatal Mortality Rate(PNMR) was observed in mothers who got married before 18 years, conceived during teenage, having anaemia, delivered at home, normal vaginal deliveries and having suffered by intra-partal and placental complications. Male babies, babies fed with prelacteal feeds, born out of intra-uterine complications, having low birth weight, had delayed first cry, premature births and twin births showed higher risk for mortality. The prevalence of perinatal mortality in the present study was 28.93 per 1000 live births. Even though this was well below the national and state values indicating improved quality of Maternal and Child Health care, it also gives way for relooking into strategies for further bringing down the perinatal deaths.

  5. Detecting the severity of perinatal anxiety with the Perinatal Anxiety Screening Scale (PASS).

    Science.gov (United States)

    Somerville, Susanne; Byrne, Shannon L; Dedman, Kellie; Hagan, Rosemary; Coo, Soledad; Oxnam, Elizabeth; Doherty, Dorota; Cunningham, Nadia; Page, Andrew C

    2015-11-01

    The Perinatal Anxiety Screening Scale (PASS; Somerville et al., 2014) reliably identifies perinatal women at risk of problematic anxiety when a clinical cut-off score of 26 is used. This study aimed to identify a severity continuum of anxiety symptoms with the PASS to enhance screening, treatment and research for perinatal anxiety. Antenatal and postnatal women (n=410) recruited from the antenatal clinics and mental health services at an obstetric hospital completed the Edinburgh Postnatal Depression Scale (EPDS), the Depression, Anxiety and Stress Scale (DASS-21), the Spielberg State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory II (BDI), and the PASS. The women referred to mental health services were assessed to determine anxiety diagnoses via a diagnostic interview conducted by an experienced mental health professional from the Department of Psychological Medicine - King Edward Memorial Hospital. Three normative groups for the PASS, namely minimal anxiety, mild-moderate anxiety, and severe anxiety, were identified based on the severity of anxiety indicated on the standardised scales and anxiety diagnoses. Two cut-off points for the normative groups were calculated using the Jacobson-Truax method (Jacobson and Truax, 1991) resulting in three severity ranges: 'minimal anxiety'; 'mild-moderate anxiety'; and 'severe anxiety'. The most frequent diagnoses in the study sample were adjustment disorder, mixed anxiety and depression, generalised anxiety, and post-traumatic stress disorder. This may limit the generalisability of the severity range results to other anxiety diagnoses including obsessive compulsive disorder and specific phobia. Severity ranges for the PASS add value to having a clinically validated cut-off score in the detection and monitoring of problematic perinatal anxiety. The PASS can now be used to identify risk of an anxiety disorder and the severity ranges can indicate developing risk for early referrals for further assessments

  6. Causes of death and associated conditions (Codac) - a utilitarian approach to the classification of perinatal deaths

    NARCIS (Netherlands)

    Froen, J. Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W.; Facchinetti, Fabio; Fretts, Ruth C.; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J.; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C.; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon C. S.; Torabi, Rozbeh

    2009-01-01

    A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose

  7. Evaluation of cardiopulmonary factors critical to successful emergency perinatal air transport.

    Science.gov (United States)

    1982-03-01

    Regionalization of specialized perinatal care is a fully viable and progressing concept. The two major components of regionalized care are the level III care facility and the air transport service. In descending importance, the medical transport team...

  8. A Consultation Phone Service for Patients With Total Joint Arthroplasty May Reduce Unnecessary Emergency Department Visits.

    Science.gov (United States)

    Hällfors, Eerik; Saku, Sami A; Mäkinen, Tatu J; Madanat, Rami

    2018-03-01

    Different measures for reducing costs after total joint arthroplasty (TJA) have gained attention lately. At our institution, a free-of-charge consultation phone service was initiated that targeted patients with TJA. This service aimed at reducing unnecessary emergency department (ED) visits and, thus, potentially improving the cost-effectiveness of TJAs. To our knowledge, a similar consultation service had not been described previously. We aimed at examining the rates and reasons for early postdischarge phone calls and evaluating the efficacy of this consultation service. During a 2-month period, we gathered information on every call received by the consultation phone service from patients with TJAs within 90 days of the index TJA procedure. Patients were followed for 2 weeks after making a call to detect major complications and self-initiated ED visits. Data were collected from electronic medical charts regarding age, gender, type of surgery, date of discharge, and length of hospital stay. We analyzed 288 phone calls. Calls were mostly related to medication (41%), wound complications (17%), and mobilization issues (15%). Most calls were resolved in the phone consultation. Few patients (13%) required further evaluation in the ED. The consultation service failed to detect the need for an ED visit in 2 cases (0.7%) that required further care. The consultation phone service clearly benefitted patients with TJAs. The service reduced the number of unnecessary ED visits and functioned well in detecting patients who required further care. Most postoperative concerns were related to prescribed medications, wound complications, and mobilization issues. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Improvement of perinatal outcome in diabetic pregnant women.

    Science.gov (United States)

    Szilagyi, A; Szabo, I

    2001-01-01

    Obstetrical and perinatal outcomes in newborns of diabetic pregnant women depend on metabolic control and fetal surveillance during pregnancy. The effects of fetal surveillance on perinatal mortality and morbidity was analyzed in diabetic pregnant women with appropriate glucose control in our regional center for diabetes and pregnancy. 480 deliveries complicated by frank or gestational diabetes occurred in our Department in the period of 1988-1999. Perinatal mortality and morbidity, prevalence of premature deliveries, methods of fetal surveillance, options for respiratory distress syndrome (RDS) profilaxis, cesarean section rate, timing of delivery and its indications and occurrence of malformations have been analyzed. It was found that malformation rate and perinatal mortality may be reduced to even lower level than that of in healthy pregnant women by appropriate glucose control and by using the latest methods of intrauterine fetal surveillance including cardiotocography (non stress test and oxytocin challenge test), doppler fetal artery velocimetry and fetal pulse oximetry. Timing of delivery was needed in 35% of the cases with IDDM and 15% of gestational diabetes due to chronic placental insufficiency. If labour induction was needed before the 38 weeks, amniocentesis was performed to test fetal lung maturity. Direct fetal glucocorticoid administration was used to enhance fetal lung maturation in 14 cases. C-section rate was slightly higher than that of in non diabetic pregnant women. Our perinatal morbidity data (macrosomia, hyperbilirubinemia, hypoglycemia, injuries, infections) are comparable with the data from the literature. Although perinatal mortality with the help of thorough fetal surveillance is even better in diabetic pregnant women than in non diabetic patients, future eye should be focused on factors affecting perinatal morbidity, because it is still higher than in newborns of healthy mothers.

  10. Increasing corn for biofuel production reduces biocontrol services in agricultural landscapes

    NARCIS (Netherlands)

    Landis, D.A.; Gardiner, M.M.; Werf, van der W.; Swinton, S.M.

    2008-01-01

    Increased demand for corn grain as an ethanol feedstock is altering U. S. agricultural landscapes and the ecosystem services they provide. From 2006 to 2007, corn acreage increased 19% nationally, resulting in reduced crop diversity in many areas. Biological control of insects is an ecosystem

  11. Perinatal support to protect maternal mental health.

    Science.gov (United States)

    McCaul, Anthony; Stokes, Jayne

    Family Action is a charity that helps more than 45,000 vulnerable families and children across England a year by offering emotional, practical and financial support. A pilot of a perinatal support project in Southwark, London was found to reduce mental health problems in vulnerable women and is now being extended. Such schemes complement the work of health visitors and other health professionals. Commissioners need to be aware of the long-term impact of such low-cost interventions in the early years.

  12. Analysis of Potential Impacts of Inclusion of Locally Supplied Services into Reduced VAT Rate on the Suppliers of these Services

    Directory of Open Access Journals (Sweden)

    Kateřina Randová

    2010-09-01

    Full Text Available Member States of the European Union are in accordance with the Community law allowed to include locally supplied services into reduced value added tax rates (hereinafter referred to as “VAT rates” without time restriction. In the Czech Republic there has not yet been a sufficient political will to implement this possibility into the legislation. The purpose of this paper is to analyse the potential impact of the relevant Directive implementation into the Czech VAT Act on the tax liability of the suppliers of these services. The paper is based on the comparison of the national legislation and the Community law, and their analysis. Moreover, the deductive method is used in this paper.

  13. Mortalidad perinatal y duelo materno

    Directory of Open Access Journals (Sweden)

    Eduardo Laverde Rubio

    1998-04-01

    Full Text Available Two groups of women whose children died during the perinatal period (28 weeks of gestation to 28 days after birth were studied from the medical-psychological point of view. The first group was formed by 20 patients who reacted to the loss of the child with a prolonged process of grief. The second group was formed by 20 patients (comparison group who elaborated the loss by means of an uncomplicated grief process. The general hypothesis that guided this investigation is the following: the link established between the mother and her real Child, in case the latter should die, makes elaboration of grief easier: on the other hand the insufficient link or lack of it with the real child increases the relation of the mother and her imaginary child, increases the relation with her imaginary child so that if that child dies the narcissistic-type internal, mother-baby relationship tends to complicate the mourning by distorting it and making it last longer. "Real child" refers to the child as an external object and "imaginary child" is the experienced representation of the child or internal object. This general hypothesis was sub-divided into five simple hypothesis, for operative aims. These variables are: visual contact, tactile contact between mother and child. Information about the baby's condition, mother's active participation in searching for a name for the child and her attendance to funerary rites. Results confirmed the basic hypothesis, on establishing that the indicating or facilitating variables of the link showed a significant difference from the statistical point of view between the two groups. Some practical suggestions are made for the personnel of maternity and perinatology services so as to propitiate and facilitate contact between the mother and her child, which at its turn activates the establishment of an emotional link and the elaboration of mourning of the loss of the baby in case he/she should perish.

  14. The AskIT Service Desk: A Model for Improving Productivity and Reducing Costs

    Energy Technology Data Exchange (ETDEWEB)

    Ashcraft, Phillip Lynn [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Fogle, Blythe G. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Cummings, Susan M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Lopez, Leon [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-07-29

    This was prepared for the business process improvement presentation to the Department of Energy. Los Alamos National Laboratory provides a single point of contact, the AskIT Service Desk, to address issues that impact customer productivity. At the most basic level, what customers want is for their calls to be received, to get a response from a knowledgeable analyst, and to have their issues resolved and their requests fulfilled. Providing a centralized, single point of contact service desk makes initiating technical or business support simple for the customer and improves the odds of immediately resolving the issue or correctly escalating the request to the next support level when necessary. Fulfilling customer requests through automated workflow also improves customer productivity and reduces costs. Finally, customers should be provided the option to solve their own problems through easy access to self-help resources such as frequently asked questions (FAQs) and how-to guides. To accomplish this, everyone who provides and supports services must understand how these processes and functions work together. Service providers and those who support services must “speak the same language” and share common objectives. The Associate Directorate for Business Innovation (ADBI) began the journey to improve services by selecting a known service delivery framework (Information Technology Infrastructure Library, or ITIL). From this framework, components that contribute significant business value were selected.

  15. Faith, Trust and the Perinatal Healthcare Maze in Urban India

    OpenAIRE

    S. Raman

    2014-01-01

    How women access and utilise health services through pregnancy, childbirth and infancy needs to be understood if we are to improve the delivery of and access to appropriate healthcare. Drawing on ethnographic observations of clinic encounters and in-depth interviews with women in Bangalore, South India, this paper reports on the complexities of negotiating healthcare throughout the perinatal continuum in urban India. Key themes identified include faith and trust in health services, confusion ...

  16. Improving perinatal outcome: towards individualized care

    NARCIS (Netherlands)

    Kazemier, B.M.

    2015-01-01

    Unfortunately not all pregnancies and deliveries take place without complications. Complications during pregnancy or delivery can lead to maternal morbidity and poor perinatal outcomes such as perinatal mortality or (severe) neonatal morbidity. First assessment in antenatal care is to distinguish

  17. Socioeconomic differences in perinatal health and disease

    DEFF Research Database (Denmark)

    Mortensen, Laust Hvas; Andersen, Anne-Marie Nybo; Helweg-Larsen, Karin

    2011-01-01

    been used to examine the influence of socioeconomic factors on perinatal health. Conclusion: Danish register data is an invaluable source of information on socioeconomic differences in perinatal health. Danish registers continue to provide excellent opportunities for research and surveillance...

  18. [Perinatal sources of stem cells].

    Science.gov (United States)

    Piskorska-Jasiulewicz, Magdalena Maria; Witkowska-Zimny, Małgorzata

    2015-03-08

    Recently, stem cell biology has become an interesting topic. Several varieties of human stem cells have been isolated and identified in vivo and in vitro. Successful application of hematopoietic stem cells in hematology has led to the search for other sources of stem cells and expanding the scale of their application. Perinatal stem cells are a versatile cell population, and they are interesting for both scientific and practical objectives. Stem cells from perinatal tissue may be particularly useful in the clinic for autologous transplantation for fetuses and newborns, and after banking in later stages of life, as well as for in utero transplantation in the case of genetic disorders. In this review paper we focus on the extraction and therapeutic potential of stem cells derived from perinatal tissues such as the placenta, the amnion, amniotic fluid, umbilical cord blood and Wharton's jelly.

  19. Perinatal sources of stem cells

    Directory of Open Access Journals (Sweden)

    Magdalena Maria Piskorska-Jasiulewicz

    2015-03-01

    Full Text Available Recently, stem cell biology has become an interesting topic. Several varieties of human stem cells have been isolated and identified in vivo and in vitro. Successful application of hematopoietic stem cells in hematology has led to the search for other sources of stem cells and expanding the scale of their application. Perinatal stem cells are a versatile cell population, and they are interesting for both scientific and practical objectives. Stem cells from perinatal tissue may be particularly useful in the clinic for autologous transplantation for fetuses and newborns, and after banking in later stages of life, as well as for in utero transplantation in the case of genetic disorders. In this review paper we focus on the extraction and therapeutic potential of stem cells derived from perinatal tissues such as the placenta, the amnion, amniotic fluid, umbilical cord blood and Wharton’s jelly.

  20. Can Housing and Service Interventions Reduce Family Separations for Families Who Experience Homelessness?

    Science.gov (United States)

    Shinn, Marybeth; Brown, Scott R; Gubits, Daniel

    2017-09-01

    Family break-up is common in families experiencing homelessness. This paper examines the extent of separations of children from parents and of partners from each other and whether housing and service interventions reduced separations and their precursors among 1,857 families across 12 sites who participated in the Family Options Study. Families in shelters were randomized to offers of one of three interventions: permanent housing subsidies that reduce expenditures for rent to 30% of families' income, temporary rapid re-housing subsidies with some services directed at housing and employment, and transitional housing in supervised facilities with extensive psychosocial services. Each group was compared to usual care families who were eligible for that intervention but received no special offer. Twenty months later, permanent housing subsidies almost halved rates of child separation and more than halved rates of foster care placements; the other interventions did not affect separations significantly. Predictors of separation were primarily homelessness and drug abuse (all comparisons), and alcohol dependence (one comparison). Although housing subsidies reduced homelessness, alcohol dependence, intimate partner violence, and economic stressors, the last three variables had no association with child separations in the subsidy comparison; thus subsidies had indirect effects via reductions in homelessness. No intervention reduced partner separations. © Society for Community Research and Action 2016.

  1. Peer supporters' experiences on an Australian perinatal mental health helpline.

    Science.gov (United States)

    Biggs, Laura J; McLachlan, Helen L; Shafiei, Touran; Small, Rhonda; Forster, Della A

    2018-01-16

    Perinatal mental health is an important public health issue, and peer support is a potentially important strategy for emotional well-being in the perinatal period. PANDA Perinatal Anxiety & Depression Australia provides support to individuals impacted by perinatal mental health issues via the National Perinatal Anxiety & Depression Helpline. Callers receive peer support from volunteers and counselling from paid professional staff. The views and experiences of PANDA peer support volunteers have not previously been studied. We conducted two focus groups and an online survey to explore the experiences of women providing volunteer peer support on the Helpline. Data collection took place in October and November 2013. Two social theories were used in framing and addressing the study aims and in interpreting our findings: the Empathy-Altruism Hypothesis, and the Helper Therapy Principle. All PANDA volunteers were invited to participate (n = 40). Eight volunteers attended a focus group, and 11 survey responses were received. Descriptive statistics were used to analyse quantitative data. All survey respondents 'strongly agreed' that they felt positive about being part of PANDA. Thematic analysis of data from focus groups and open-ended survey responses identified the following themes: motivated to help others, supported to support callers, helping to make a difference and emotional impacts for volunteers. Respondents described a strong desire to support others experiencing emotional distress as a motivator to volunteer. Although perinatal peer support services are designed to benefit those who receive support, this study suggests volunteers may also experience personal benefits from the role. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Perinatal mortality in Indonesia: an unfinished agenda

    Directory of Open Access Journals (Sweden)

    Riawati Jahja

    2011-10-01

    Full Text Available Perinatal mortality is a profound issue in maternal and child health due to its close relation with the maternal condition. There exist Millennium Development Goals (MDGs which are to be achieved by 2015. These are coupled with a continuing need for comprehensively monitoring and identifying factors associated with perinatal mortality, which is a primary concern for developing countries inclusive of Indonesia. Previous and on-going health programs could have brought about strategic interventions but as different attributes can emerge due to epidemiological transition, and given the fact that associated factors may remain persistent, forward thinking strategies in public health are forever in need of renewal.     Results from our research show that educational variables, poor awareness towards proper antenatal care visits and weak services at the front-line of healthcare delivery (community outreach worsen the condition of childbearing women, raising the question of biological risk factors in line with socio-economic variables.

  3. California's historic effort to reduce the stigma of mental illness: the Mental Health Services Act.

    Science.gov (United States)

    Clark, Wayne; Welch, Stephanie N; Berry, Sandra H; Collentine, Ann M; Collins, Rebecca; Lebron, Dorthy; Shearer, Amy L

    2013-05-01

    In a historic effort to reduce the stigma of mental illness, California voters approved the Mental Health Services Act in 2004. The law funds a comprehensive statewide prevention initiative that places stigma and discrimination reduction at its center, with 25 projects providing interventions at the institutional, societal, and individual levels. Stakeholders selected specific strategies from the research-based California Strategic Plan on Reducing Stigma and Discrimination. Strategies range from social marketing to increase public knowledge to capacity building at the local level, including training that emphasizes participation by consumers of mental health services and cultural competence. Collectively, these strategies aim to foster permanent change in the public perception of mental illness and in the individual experience of stigma. We examined the context, planning, programming, and evaluation of this effort.

  4. ENHANCING VOLUNTARY COMPLIANCE BY REDUCING COMPLIANCE COSTS: A TAXPAYER SERVICE APPROACH

    OpenAIRE

    Glenn Jenkins; EDWIN FORLEMU

    1993-01-01

    In this paper an overview is made of the determinants of voluntary tax compliance. Unlike previous treatments of this subject, the cost of taxpayer compliance is considered as an important determinant of overall level of voluntary compliance in a country. A number of ways that tax authorities reduce compliance are discussed, and the most common uses of information technology in providing taxpayer service is described. Finally, the paper considers some of the ways that such activities might be...

  5. FACTORS CONTRIBUTING TO PERINATAL MORTALITY : OPTIMIZING OUTCOME

    Directory of Open Access Journals (Sweden)

    Lakshmi

    2015-03-01

    Full Text Available OBJECTIVE: To evaluate the various causes of perinatal deaths and adopt strategies to improve perinatal outcome at a referral teaching hospital in North Kerala. METHODS: A prospective observational study conducted at Institute of Maternal and Child Health, Government Medical College, Kozhikode. All perinatal deaths during the period January 2013 to December 2014 were analysed and from this factors responsible for perinatal deaths were identified. RESULTS: Out of total 30,042 deliveries , there were 966 perinatal deaths during the study period. 566 were still births and 400 early neonatal deaths. The perinatal mortality rate was 31.1 per 1000 live births. Perinatal asphyxia was the major cause of perinatal mortality. The important factors contributing to perinatal asphyxia were prematurity (39%, abruptio placenta (19% and MSAF ( 12%. Among the antenatal factors, hypertensive disorders of pregnancy leading to iatrogenic elective preterm delivery were the most important. CONCLUSION: Perinatal asphyxia due to prematurity and low birth weight emerged as the most important cause of perinatal mortality in this study and hypertensive disorders of pregnancy were the most important antenatal complication leading to prematurity

  6. [Maternal and perinatal health].

    Science.gov (United States)

    1991-01-01

    After a year-long diagnosis of Chile's health situation, the Ministry of Health in 1991 formulated a new maternal-child health program designed to assure that all pregnancies would be desired and would occur under optimal conditions. Orientation for responsible parenthood will be an important part of the process. Other objectives include reducing the incidence of adolescent pregnancy and of sexually transmitted diseases. The pregnancy rate for young women 15-19 changed very little in Chile between 1952-82, because of the lack of sex education and family planning services. Family planning programs designed especially for adolescents would help to combat unwanted pregnancies and could offer the methods most suitable for young women. The well-known longitudinal study in Czechoslovakia which followed the development of children whose mothers were denied legal abortions in the 1960s showed the children to be at increased risk of unsatisfactory social adjustment in later life and suggested some consequences of unwanted pregnancy. A study of unwanted pregnancy in Chile was initiated in 4 prenatal care centers in a working class area of Santiago in 1984. 2485 women in the 6th or 7th month of pregnancy were classified according to their existing family sizes. Only 33.1% of the women desired the pregnancy at that time and 38.4% desired it but at a later time. 28.5% did not desire it at all. Women who did not desire the pregnancy waited significantly longer to obtain prenatal care than women who desired it. Age, economic problems, being single, family conflicts, already having the desired number of children, and short intervals since the most recent birth were associated with not desiring the current pregnancy. Of the 1663 women who did not desire the pregnancy, only 13.1% of those single, 35.8% of those in union, and 44.0% of those married used a contraceptive method. 2133 of the mothers were interviewed 6 months and 1977 12 months after delivery. Birth weights did not vary

  7. Effect of reducing cost sharing for outpatient care on children's inpatient services in Japan.

    Science.gov (United States)

    Kato, Hirotaka; Goto, Rei

    2017-08-15

    Assessing the impact of cost sharing on healthcare utilization is a critical issue in health economics and health policy. It may affect the utilization of different services, but is yet to be well understood. This paper investigates the effects of reducing cost sharing for outpatient services on hospital admissions by exploring a subsidy policy for children's outpatient services in Japan. Data were extracted from the Japanese Diagnosis Procedure Combination database for 2012 and 2013. A total of 366,566 inpatients from 1390 municipalities were identified. The impact of expanding outpatient care subsidy on the volume of inpatient care for 1390 Japanese municipalities was investigated using the generalized linear model with fixed effects. A decrease in cost sharing for outpatient care has no significant effect on overall hospital admissions, although this effect varies by region. The subsidy reduces the number of overall admissions in low-income areas, but increases it in high-income areas. In addition, the results for admissions by type show that admissions for diagnosis increase particularly in high-income areas, but emergency admissions and ambulatory-care-sensitive-condition admissions decrease in low-income areas. These results suggest that outpatient and inpatient services are substitutes in low-income areas but complements in high-income ones. Although the subsidy for children's healthcare would increase medical costs, it would not improve the health status in high-income areas. Nevertheless, it could lead to some health improvements in low-income areas and, to some extent, offset costs by reducing admissions in these regions.

  8. A perinatal care quality and safety initiative: are there financial rewards for improved quality?

    Science.gov (United States)

    Kozhimannil, Katy B; Sommerness, Samantha A; Rauk, Phillip; Gams, Rebecca; Hirt, Charles; Davis, Stanley; Miller, Kristi K; Landers, Daniel V

    2013-08-01

    Although costs of providing care may decrease with hospital initiatives to improve obstetric and neonatal outcomes, the accompanying reduced adverse outcomes may negatively affect hospital revenues. In 2008 a Minnesota-based hospital system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which used evidence-based care bundles to guide management of obstetric services. A pre-post analysis of financial impacts of ZBI was conducted by using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009-2011) the initiative. For the Fairview Health Services hospitals, after adjusting for relevant covariates, implementation of ZBI was associated with a mean 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (adjusted odds ratio [AOR] = 0.89, p = .076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008. Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering improved quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize QI. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost.

  9. Systematic analysis of research underfunding in maternal and perinatal health.

    Science.gov (United States)

    Fisk, N M; Atun, R

    2009-02-01

    Little published evidence supports the widely held contention that research in pregnancy is underfunded compared with other disease areas. To assess absolute and relative government and charitable funding for maternal and perinatal research in the UK and internationally. SEARCH STRATEGY, SELECTION CRITERIA, DATA COLLECTION, AND ANALYSIS: Major research funding bodies and alliances were identified from an Internet search and discussions with opinion leaders/senior investigators. Websites and annual reports were reviewed for details of strategy, research spend, grants awarded, and allocation to maternal and/or perinatal disease using generic and disease-specific search terms. Within the imprecision in the data sets, global philanthropy concentrated on service provision rather than research. Although research expenditure has been deemed as appropriate for 'reproductive health' disease burden in the UK, there are no data on the equity of maternal/perinatal research spend against disease burden, which globally may justify a manyfold increase. This systematic review of research expenditure and priorities from national and international funding bodies suggests relative underinvestment in maternal/perinatal health. Contributing factors include the low political priority given to women's health, the challenging nature of clinical research in pregnancy, and research capacity dearth as a consequence of chronic underinvestment.

  10. Using perinatal morbidity scoring tools as a primary study outcome.

    Science.gov (United States)

    Hutcheon, Jennifer A; Bodnar, Lisa M; Platt, Robert W

    2017-11-01

    Perinatal morbidity scores are tools that score or weight different adverse events according to their relative severity. Perinatal morbidity scores are appealing for maternal-infant health researchers because they provide a way to capture a broad range of adverse events to mother and newborn while recognising that some events are considered more serious than others. However, they have proved difficult to implement as a primary outcome in applied research studies because of challenges in testing if the scores are significantly different between two or more study groups. We outline these challenges and describe a solution, based on Poisson regression, that allows differences in perinatal morbidity scores to be formally evaluated. The approach is illustrated using an existing maternal-neonatal scoring tool, the Adverse Outcome Index, to evaluate the safety of labour and delivery before and after the closure of obstetrical services in small rural communities. Applying the proposed Poisson regression to the case study showed a protective risk ratio for adverse outcome following closures as compared with the original analysis, where no difference was found. This approach opens the door for considerably broader use of perinatal morbidity scoring tools as a primary outcome in applied population and clinical maternal-infant health research studies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. A multiple soil ecosystem services approach to evaluate the sustainability of reduced tillage systems

    Science.gov (United States)

    Pérès, Guénola; Menasseri, Safya; Hallaire, Vincent; Cluzeau, Daniel; Heddadj, Djilali; Cotinet, Patrice; Manceau, Olivier; Pulleman, Mirjam

    2017-04-01

    In the current context of soil degradation, reduced tillage systems (including reduced soil disturbance, use of cover crops and crop rotation, and improved organic matter management) are expected to be good alternatives to conventional system which have led to a decrease of soil multi-functionality. Many studies worldwide have analysed the impact of tillage systems on different soil functions, but overran integrated view of the impact of these systems is still lacking. The SUSTAIN project (European SNOWMAN programme), performed in France and the Netherlands, proposes an interdisciplinary collaboration. The goals of SUSTAIN are to assess the multi-functionality of soil and to study how reduced-tillage systems impact on multiple ecosystem services such as soil biodiversity regulation (earthworms, nematodes, microorganisms), soil structure maintenance (aggregate stability, compaction, soil erosion), water regulation (run-off, transfer of pesticides) and food production. Moreover, a socio-economic study on farmer networks has been carried out to identify the drivers of adoption of reduced-tillage systems. Data have been collected in long-term experimental fields (5 - 13 years), representing conventional and organic farming strategies, and were complemented with data from farmer networks. The impact of different reduced tillage systems (direct seeding, minimum tillage, non-inverse tillage, superficial ploughing) were analysed and compared to conventional ploughing. Measurements (biological, chemical, physical, agronomical, water and element transfer) have been done at several dates which allow an overview of the evolution of the soil properties according to climate variation and crop rotation. A sociological approach was performed on several farms covering different production types, different courses (engagement in reduced tillage systems) and different geographical locations. Focusing on French trials, this multiple ecosystem services approach clearly showed that

  12. Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country

    Directory of Open Access Journals (Sweden)

    Ali Mohammed

    2011-06-01

    Full Text Available Abstract Background In developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh. Methods A total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at women's home. Results Overall 43% (95% CI: 33.7-51.8% of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9% with healthy babies (p = Conclusions This study highlights the greatly increased vulnerability of women with perinatal death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

  13. Evaluating Ecosystem Services for Reducing Groundwater Nitrate Contamination: Nitrate Attenuation in the Unsaturated and Saturated Zones

    Science.gov (United States)

    Wang, J.

    2013-12-01

    Nitrates are the most common type of groundwater contamination in agricultural regions. Environmental policies targeting nitrates have focused on input control (e.g., restricted fertilizer application), intermediate loads control (e.g., reduce nitrate leached from crop fields), and final loads control (e.g., reduce catchment nitrate loads). Nitrate loads can be affected by hydrological processes in both unsaturated and saturated zones. Although many of these processes have been extensively investigated in literature, they are commonly modeled as exogenous to farm management. A couple of recent studies by scientists from the Lawrence Livermore National Laboratory show that in some situations nitrate attenuation processes in the unsaturated/saturated zone, particularly denitrification, can be intensified by certain management practices to mitigate nitrate loads. Therefore, these nitrate attenuation processes can be regarded as a set of ecosystem services that farmers can take advantage of to reduce their cost of complying with environmental policies. In this paper, a representative California dairy farm is used as a case study to show how such ecosystem attenuation services can be framed within the farm owner's decision-making framework as an option for reducing groundwater nitrate contamination. I develop an integrated dynamic model, where the farmer maximizes discounted net farm profit over multiple periods subject to environmental regulations. The model consists of three submodels: animal-waste-crop, hydrologic, and economic model. In addition to common choice variables such as irrigation, fertilization, and waste disposal options, the farmer can also endogenously choose from three water sources: surface water, deep groundwater (old groundwater in the deep aquifer that is not affected by farm effluent in the short term), and shallow groundwater (drainage water that can be recycled via capture wells at the downstream end of the farm). The capture wells not only

  14. An assessment of the impact of climate adaptation measures to reduce flood risk on ecosystem services.

    Science.gov (United States)

    Verburg, Peter H; Koomen, Eric; Hilferink, Maarten; Pérez-Soba, Marta; Lesschen, Jan Peter

    Measures of climate change adaptation often involve modification of land use and land use planning practices. Such changes in land use affect the provision of various ecosystem goods and services. Therefore, it is likely that adaptation measures may result in synergies and trade-offs between a range of ecosystems goods and services. An integrative land use modelling approach is presented to assess such impacts for the European Union. A reference scenario accounts for current trends in global drivers and includes a number of important policy developments that correspond to on-going changes in European policies. The reference scenario is compared to a policy scenario in which a range of measures is implemented to regulate flood risk and protect soils under conditions of climate change. The impacts of the simulated land use dynamics are assessed for four key indicators of ecosystem service provision: flood risk, carbon sequestration, habitat connectivity and biodiversity. The results indicate a large spatial variation in the consequences of the adaptation measures on the provisioning of ecosystem services. Synergies are frequently observed at the location of the measures itself, whereas trade-offs are found at other locations. Reducing land use intensity in specific parts of the catchment may lead to increased pressure in other regions, resulting in trade-offs. Consequently, when aggregating the results to larger spatial scales the positive and negative impacts may be off-set, indicating the need for detailed spatial assessments. The modelled results indicate that for a careful planning and evaluation of adaptation measures it is needed to consider the trade-offs accounting for the negative effects of a measure at locations distant from the actual measure. Integrated land use modelling can help land use planning in such complex trade-off evaluation by providing evidence on synergies and trade-offs between ecosystem services, different policy fields and societal

  15. Using action research to develop midwives' skills to support women with perinatal mental health needs.

    Science.gov (United States)

    Madden, Deirdre; Sliney, Annmarie; O'Friel, Aoife; McMackin, Barbara; O'Callaghan, Bernie; Casey, Kate; Courtney, Lisa; Fleming, Valerie; Brady, Vivienne

    2018-02-01

    The aim of the research was to identify and develop midwives' skills to support women with mental health needs during pregnancy, using an action research approach. A review of perinatal mental health services in a large Dublin maternity unit revealed a high number of referred women who 'did not attend' the perinatal mental health service with few guidelines in place to support midwives in identifying and referring women for specialist help. Action research using cooperative inquiry involved a mental health nurse specialist and a team of midwives, who were drawn to each other in mutual concern about an area of practice. Data were gathered from three Cooperative Inquiry meetings, which incorporated one main Action Research Cycle of constructing, planning, taking and evaluating action. Data were analysed using a thematic content analysis framework. Participants experienced varying levels of uncertainty about how to support women with perinatal mental health needs. Cooperative inquiry supported participants in making sense of how they understood perinatal mental health and how they managed challenges experienced when caring for women with perinatal mental health issues. Participants developed a referral pathway, highlighted the significance of education to support women with perinatal mental health issues and identified the value of using open questions to promote conversation with pregnant women about mental health. Midwives value education and support to identify and refer women at risk of perinatal mental health issues. Cooperative inquiry, with a focus on action and shared reflection, facilitated the drawing together of two professional groups with diverse knowledge bases to work together to develop practice in an area of mutual concern. Perinatal mental health is a significant public health issue and midwives need support to make psychosocial assessments and to negotiate access to specialist services where available and when required. © 2017 John Wiley & Sons

  16. Development of picture quality monitoring system for IPTV service based on the reduced reference framework

    Science.gov (United States)

    Sugimoto, Osamu; Kawada, Ryoichi; Koike, Atsushi

    2006-01-01

    The authors developed a software-based realtime IPTV monitoring system based on Reduced Reference framework, and evaluated the proposed system. One of the quality issues of the IPTV service is the picture quality degradation caused by packet loss. The proposed system precisely estimates the PSNR of the corrupted received picture by extracting and comparing image features from transmission and receiver side. Computer simulations show that PSNR estimation with a 0.945 correlation coefficient at a data channel bitrate of 36kbps is possible using the proposed system.

  17. Improving Service Coordination and Reducing Mental Health Disparities Through Adoption of Electronic Health Records.

    Science.gov (United States)

    McGregor, Brian; Mack, Dominic; Wrenn, Glenda; Shim, Ruth S; Holden, Kisha; Satcher, David

    2015-09-01

    Despite widespread support for removing barriers to the use of electronic health records (EHRs) in behavioral health care, adoption of EHRs in behavioral health settings lags behind adoption in other areas of health care. The authors discuss barriers to use of EHRs among behavioral health care practitioners, suggest solutions to overcome these barriers, and describe the potential benefits of EHRs to reduce behavioral health care disparities. Thoughtful and comprehensive strategies will be needed to design EHR systems that address concerns about policy, practice, costs, and stigma and that protect patients' privacy and confidentiality. However, these goals must not detract from continuing to challenge the notion that behavioral health and general medical health should be treated as separate and distinct. Ultimately, utilization of EHRs among behavioral health care providers will improve the coordination of services and overall patient care, which is essential to reducing mental health disparities.

  18. Reducing Math Anxiety: Findings from Incorporating Service Learning into a Quantitative Reasoning Course at Seattle University

    Directory of Open Access Journals (Sweden)

    Allison Henrich

    2011-07-01

    Full Text Available How might one teach mathematics to math-anxious students and at the same time reduce their math anxiety? This paper describes what we found when we incorporated a service learning component into a quantitative reasoning course at Seattle University in Fall 2010 (20 students and Spring 2011 (28 students. The course is taken primarily by humanities majors, many of whom would not take a course in math if they didn’t need to satisfy the university’s core requirement. For the service learning component, each student met with and tutored children at local schools for 1-2 hours per week (total about 15 service hours, kept a weekly journal reflecting on the experience, and wrote a five-page final paper on the importance and reasonable expectations of mathematics literacy. The autobiographies, self-description at the beginning of the class, focus group interviews at the end of the term, journal entries, final essays, and student evaluations indicated that the students gained confidence in their mathematical abilities, a greater interest in mathematics, and a broader sense of the importance of math literacy in modern society. One notable finding was that students discovered that the act of manufacturing enthusiasm about math as a tool for tutoring the children made them more enthusiastic about math in their own courses.

  19. Increase plant safety and reduce cost by implementing risk-informed in-service inspection programs

    International Nuclear Information System (INIS)

    Billington, A.; Monette, P.

    2001-01-01

    The idea behind the program is that it is possible to 'inspect less, but inspect better'. In other words, the risk-informed In-Service Inspection (ISI) process is used to improve the effectiveness of examination of piping components, i.e. concentrate inspection resources and enhance inspection strategies on high safety significant locations, and reduce inspection requirements on others. The Westinghouse Owners Group (WOG) risk-informed ISI process has already been applied for full scope (Millstone 3, Surry 1) and limited scope (Beznau, Ringhals 4, Asco, Turkey Point 3). By examining the high safety significant piping segments for the different fluid piping systems, the total piping core damage frequency is reduced. In addition, more than 80% of the risk associated with potential pressure boundary failures is addressed with the WOG risk-informed ISI process, while typically less that 50% of this same risk is addressed by the current inspection programs. The risk-informed ISI processes are used to improve the effectiveness of inspecting safety-significant piping components, to reduce inspection requirements on other piping components, to evaluate improvements to plant availability and enhanced safety measures, including reduction of personnel radiation exposure, and to reduce overall Operation and Maintenance (O and M) costs while maintaining regulatory compliance. A description of the process as well as benefits from past projects is presented, since the methodology is applicable for WWER plant design. (author)

  20. Increase plant safety and reduce cost by implementing risk-informed In-Service Inspection programs

    International Nuclear Information System (INIS)

    Billington, A.; Monette, P.; Doumont, C.

    2000-01-01

    The idea behind the program is that it is possible to 'inspect less, but inspect better'. In other words, the risk-informed In-Service Inspection (ISI) process is used to improve the effectiveness of examination of piping components, i.e. concentrate inspection resources and enhance inspection strategies on high safety significant locations, and reduce inspection requirements on others. The Westinghouse Owners Group (WOG) risk-informed ISI process has already been applied for full scope (Millstone 3, Surry 1) and limited scope (Beznau, Ringhals 4, Asco, Turkey Point 3). By examining the high safety significant piping segments for the different fluid piping systems, the total piping core damage frequency is reduced. In addition, more than 80% of the risk associated with potential pressure boundary failures is addressed with the WOG risk-informed ISI process, while typically less than 50% of this same risk is addressed by the current inspection programs. The risk-informed ISI processes are used: to improve the effectiveness of inspecting safety-significant piping components; to reduce inspection requirements on other piping components; to evaluate improvements to plant availability and enhanced safety measures, including reduction of personnel radiation exposure; and to reduce overall Operation and Maintenance (O and M) costs while maintaining regulatory compliance. A description of the process as well as benefits of past projects is presented, since the methodology is applicable for VVER plant design. (author)

  1. Reducing barriers associated with delivering health care services to migratory agricultural workers.

    Science.gov (United States)

    Schmalzried, Hans D; Fallon, L Fleming

    2012-01-01

    Between one and two million migratory agricultural workers (MAWs), primarily from Mexico and Central America, leave their homes each year to plant, cultivate, harvest and pack fruits, vegetables, and nuts in the USA. While in the USA, most lack health insurance, a permanent residence, and a regular healthcare provider. Publications over the past two decades in the USA have reported that a majority of MAWs encounter barriers to receiving medical services. Migratory agricultural workers experience high rates of occupational illness and injury. Poor access to medical care continues to exacerbate health problems among members of this population related to their working environments. In most studies concerning healthcare access issues for this population, researchers collected their information from healthcare service providers; rarely have they included input from migratory agricultural workers. This study was different in that opinions about healthcare access issues were collected directly from MAWs. The primary purpose of this study was to describe issues related to barriers associated with the delivery of healthcare services to migratory agricultural workers. A secondary purpose was to suggest strategies for reducing these barriers. In this study, data from focus group sessions were used to develop a survey questionnaire. Four certified bilingual interpreters were trained to administer the questionnaire. A total of 157 usable questionnaires were returned from MAWs living in employer-provided camps in Northwest Ohio. The statistical analyses were primarily descriptive. The most significant barriers hampering access to medical services among the 157 respondents were cost (n=113; 72.0%), crop demands (n=102; 65.0%), the lack of an interpreter (n=98; 62.4%), travel distance (n=88; 56.1%) and transportation (n=82; 52.2%). Approximately half (n=82; 52.2%) said that they had access to transportation for traveling to a medical clinic. As a group, respondents were willing to

  2. [Application of Epigenetics in Perinatal Nursing Care].

    Science.gov (United States)

    Chou, Hsueh-Fen; Kao, Chien-Huei; Gau, Meei-Ling

    2017-04-01

    Epigenetics is a field of biomedicine that expanded tremendously during the 1980s. Epigenetics is the study of heritable changes in gene expression independent of underlying DNA (DeoxyriboNucleic Acid) sequence, which not only affect this generation but will be passed to subsequent generations. Although conception is the critical moment for making decisions regarding gene mapping and fetal health, studies have shown that perinatal nursing care practices also affect the genetic remodeling processes and the subsequent health of the mother and her offspring. To optimize maternal-infant and the offspring health, it is important to ensure that the new mother get adequate nutrition, reduce stress levels, adopt gentle birth practices, facilitate exclusive breastfeeding, and avoid contacting toxic substances.

  3. ProvenCare perinatal: a model for delivering evidence/ guideline-based care for perinatal populations.

    Science.gov (United States)

    Berry, Scott A; Laam, Leslie A; Wary, Andrea A; Mateer, Harry O; Cassagnol, Hans P; McKinley, Karen E; Nolan, Ruth A

    2011-05-01

    Geisinger Health System (GHS) has applied its ProvenCare model to demonstrate that a large integrated health care delivery system, enabled by an electronic health record (EHR), could reengineer a complicated clinical process, reduce unwarranted variation, and provide evidence-based care for patients with a specified clinical condition. In 2007 GHS began to apply the model to a more complicated, longer-term condition of "wellness"--perinatal care. ADAPTING PROVENCARE TO PERINATAL CARE: The ProvenCare Perinatal initiative was more complex than the five previous ProvenCare endeavors in terms of breadth, scope, and duration. Each of the 22 sites created a process flow map to depict the current, real-time process at each location. The local practice site providers-physicians and mid-level practitioners-reached consensus on 103 unique best practice measures (BPMs), which would be tracked for every patient. These maps were then used to create a single standardized pathway that included the BPMs but also preserved some unique care offerings that reflected the needs of the local context. A nine-phase methodology, expanded from the previous six-phase model, was implemented on schedule. Pre- to postimplementation improvement occurred for all seven BPMs or BPM bundles that were considered the most clinically relevant, with five statistically significant. In addition, the rate of primary cesarean sections decreased by 32%, and birth trauma remained unchanged as the number of vaginal births increased. Preliminary experience suggests that integrating evidence/guideline-based best practices into work flows in inpatient and outpatient settings can achieve improvements in daily patient care processes and outcomes.

  4. The National Ecosystem Services Classification System: A Framework for Identifying and Reducing Relevant Uncertainties

    Science.gov (United States)

    Rhodes, C. R.; Sinha, P.; Amanda, N.

    2013-12-01

    In recent years the gap between what scientists know and what policymakers should appreciate in environmental decision making has received more attention, as the costs of the disconnect have become more apparent to both groups. Particularly for water-related policies, the EPA's Office of Water has struggled with benefit estimates held low by the inability to quantify ecological and economic effects that theory, modeling, and anecdotal or isolated case evidence suggest may prove to be larger. Better coordination with ecologists and hydrologists is being explored as a solution. The ecosystem services (ES) concept now nearly two decades old links ecosystem functions and processes to the human value system. But there remains no clear mapping of which ecosystem goods and services affect which individual or economic values. The National Ecosystem Services Classification System (NESCS, 'nexus') project brings together ecologists, hydrologists, and social scientists to do this mapping for aquatic and other ecosystem service-generating systems. The objective is to greatly reduce the uncertainty in water-related policy making by mapping and ultimately quantifying the various functions and products of aquatic systems, as well as how changes to aquatic systems impact the human economy and individual levels of non-monetary appreciation for those functions and products. Primary challenges to fostering interaction between scientists, social scientists, and policymakers are lack of a common vocabulary, and the need for a cohesive comprehensive framework that organizes concepts across disciplines and accommodates scientific data from a range of sources. NESCS builds the vocabulary and the framework so both may inform a scalable transdisciplinary policy-making application. This talk presents for discussion the process and progress in developing both this vocabulary and a classifying framework capable of bridging the gap between a newer but existing ecosystem services classification

  5. Utility of local health registers in measuring perinatal mortality: a case study in rural Indonesia.

    Science.gov (United States)

    Burke, Leona; Suswardany, Dwi Linna; Michener, Keryl; Mazurki, Setiawaty; Adair, Timothy; Elmiyati, Catur; Rao, Chalapati

    2011-03-17

    Perinatal mortality is an important indicator of obstetric and newborn care services. Although the vast majority of global perinatal mortality is estimated to occur in developing countries, there is a critical paucity of reliable data at the local level to inform health policy, plan health care services, and monitor their impact. This paper explores the utility of information from village health registers to measure perinatal mortality at the sub district level in a rural area of Indonesia. A retrospective pregnancy cohort for 2007 was constructed by triangulating data from antenatal care, birth, and newborn care registers in a sample of villages in three rural sub districts in Central Java, Indonesia. For each pregnancy, birth outcome and first week survival were traced and recorded from the different registers, as available. Additional local death records were consulted to verify perinatal mortality, or identify deaths not recorded in the health registers. Analyses were performed to assess data quality from registers, and measure perinatal mortality rates. Qualitative research was conducted to explore knowledge and practices of village midwives in register maintenance and reporting of perinatal mortality. Field activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Stillbirth rates for the study population were about four times the rates reported in the routine Maternal and Child Health program information system. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting. Local maternal and child health registers are a useful source of information on perinatal mortality in rural Indonesia. Suitable training, supervision, and quality control, in conjunction with computerisation to

  6. Multiple endocrine disrupting effects in rats perinatally exposed to butylparaben

    DEFF Research Database (Denmark)

    Boberg, Julie; Petersen, Marta Axelstad; Svingen, Terje

    2016-01-01

    ) expression was reduced in prepubertal, but not adult animals exposed to butylparaben. In adult testes, Nr5a1 expression was reduced at all doses, indicating persistent disruption of steroidogenesis. Prostate histology was altered at prepuberty and adult prostate weights were reduced in the high dose group......Parabens comprise a group of preservatives commonly added to cosmetics, lotions and other consumer products. Butylparaben has estrogenic and anti-androgenic properties and is known to reduce sperm counts in rats following perinatal exposure. Whether butylparaben exposure can affect other endocrine...

  7. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    Directory of Open Access Journals (Sweden)

    James Robert Langabeer

    2016-11-01

    Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  8. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments.

    Science.gov (United States)

    Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-11-01

    Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  9. Mortalidad perinatal y duelo materno

    OpenAIRE

    Laverde Rubio, Eduardo

    2011-01-01

    Se investigaron desde el punto de vista médico-psicológico dos grupos de madres cuyos hijos murieran durante el periodo perinatal (entre 28 semanas de gestación y 28 días de nacido). EI primer grupo de estudio lo configuraban 20 pacientes que reaccionaron con un duelo prolongado ante la perdida de su hijo. EI segundo grupo esta conformado por 20 pacientes (grupo de comparación) que elaboraron la perdida de su hijo mediante un duelo no complicado. La hipótesis general que obtento este trabajo ...

  10. Value of the perinatal autopsy : Critique

    NARCIS (Netherlands)

    Gordijn, SJ; Erwich, JJHM; Khong, TY

    2002-01-01

    In consenting to a perinatal autopsy, the primary motive of parents may be to find the exact cause of death. A critical review on the value of perinatal autopsies was performed to see whether parents could be counseled regarding their main motive. A literature search was performed in MEDLINE,

  11. Reducing Health Services for Refugees Through Reforms to the Interim Federal Health Program

    Directory of Open Access Journals (Sweden)

    Andrew C. Stevenson

    2018-04-01

    Full Text Available Since 1957 the Interim Federal Health Program (IFHP has provided temporary health care coverage to refugees and refugee claimants, but in 2012 the Conservative government reformed the IFHP, reducing, or eliminating access to health services for these groups. The government framed the changes around fairness and safety, stating that it would save tax payers $100 million over five years, reduce incentive for migrants with unfounded refugee claims from coming to Canada, protect public health and safety, and defend the integrity of the immigration system. With a Conservative majority, the reform was easily implemented despite a lack of evidence supporting these claims. In 2014, the Federal Court rejected the government's notion of fairness and safety, ruling that the cuts were cruel and unusual treatment of an already vulnerable population. The government appealed this ruling but, in 2016, the Liberals took power and restored funding to the IFHP to pre-2012 levels. Ad hoc evaluations predicted inequitable and adverse impacts on refugees, negative impacts on health, and increased costs to refugees, provincial governments, and health providers. Overall the threats and weaknesses of this reform clearly outweighed the few and unconvincing opportunities and strengths of the program, leading to its demise.

  12. Perinatal safety: from concept to nursing practice.

    Science.gov (United States)

    Lyndon, Audrey; Kennedy, Holly Powell

    2010-01-01

    Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians' individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient's best interest can be viewed as their "agency for safety." However, collective agency for safety and commitment to support nurses in their role of advocacy is missing in many perinatal care settings. This article draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse's role in maintaining safety during labor and birth in acute care settings and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care.

  13. Perinatal Safety: From Concept to Nursing Practice

    Science.gov (United States)

    Kennedy, Holly Powell

    2010-01-01

    Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians’ individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient’s best interest can be viewed as their “agency for safety.” However, collective agency for safety and commitment to support nurses in their advocacy role is missing in many perinatal care settings. This paper draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse’s role in maintaining safety during labor and birth in acute care settings, and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care. PMID:20147827

  14. The Social Nature of Perceived Illness Representations of Perinatal Depression in Rural Uganda

    Directory of Open Access Journals (Sweden)

    Nandini D. P. Sarkar

    2018-06-01

    Full Text Available While the global health community advocates for greater integration of mental health into maternal health agendas, a more robust understanding of perinatal mental health, and its role in providing integrated maternal health care and service delivery, is required. The present study uses the Illness Representation Model, a theoretical cognitive framework for understanding illness conceptualisations, to qualitatively explore multiple stakeholder perspectives on perinatal depression in rural Uganda. A total of 70 in-depth interviews and 9 focus group discussions were conducted with various local health system stakeholders, followed by an emergent thematic analysis using NVivo 11. Local communities perceived perinatal depression as being both the fault of women, and not. It was perceived as having socio-economic and cultural causal factors, in particular, as being partner-related. In these communities, perinatal depression was thought to be a common occurrence, and its negative consequences for women, infants and the community at large were recognised. Coping and help-seeking behaviours prescribed by the participants were also primarily socio-cultural in nature. Placing the dynamics and mechanisms of these local conceptualisations of perinatal depression alongside existing gaps in social and health care systems highlights both the need of, and the opportunities for, growth and prioritisation of integrated perinatal biomedical, mental, and social health programs in resource-constrained settings.

  15. The Social Nature of Perceived Illness Representations of Perinatal Depression in Rural Uganda.

    Science.gov (United States)

    Sarkar, Nandini D P; Bardaji, Azucena; Peeters Grietens, Koen; Bunders-Aelen, Joske; Baingana, Florence; Criel, Bart

    2018-06-07

    While the global health community advocates for greater integration of mental health into maternal health agendas, a more robust understanding of perinatal mental health, and its role in providing integrated maternal health care and service delivery, is required. The present study uses the Illness Representation Model, a theoretical cognitive framework for understanding illness conceptualisations, to qualitatively explore multiple stakeholder perspectives on perinatal depression in rural Uganda. A total of 70 in-depth interviews and 9 focus group discussions were conducted with various local health system stakeholders, followed by an emergent thematic analysis using NVivo 11. Local communities perceived perinatal depression as being both the fault of women, and not. It was perceived as having socio-economic and cultural causal factors, in particular, as being partner-related. In these communities, perinatal depression was thought to be a common occurrence, and its negative consequences for women, infants and the community at large were recognised. Coping and help-seeking behaviours prescribed by the participants were also primarily socio-cultural in nature. Placing the dynamics and mechanisms of these local conceptualisations of perinatal depression alongside existing gaps in social and health care systems highlights both the need of, and the opportunities for, growth and prioritisation of integrated perinatal biomedical, mental, and social health programs in resource-constrained settings.

  16. Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country.

    Science.gov (United States)

    Gausia, Kaniz; Moran, Allisyn C; Ali, Mohammed; Ryder, David; Fisher, Colleen; Koblinsky, Marge

    2011-06-09

    In developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh. A total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B) at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at women's home. Overall 43% (95% CI: 33.7-51.8%) of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9%) with healthy babies (p = death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

  17. Globalization and perinatal medicine--how do we respond?

    Science.gov (United States)

    Kurjak, Asim; Di Renzo, Gian Carlo; Stanojevic, Milan

    2010-04-01

    Globalization is both inevitable and usually desirable and contains advantageous and disadvantageous issues. It is a source of both hope and of apprehension and is an accelerating process in flow of information, technology, goods and services, and production means. Globalization has a complex influence on perinatal health. The bonds that link perinatologists together transcend geographic, political, religious, and lingual differences, resulting in a globalization that optimizes perinatal care. In this review, we will discuss some of the global problems facing modern perinatologists. Close to 1.5 billion people in the world, live in extreme poverty, a situation which is particularly stark in the developing world, where 80% of them live. Poor people have little or no access to qualified health services and education, and do not participate in the decisions critical to their day-to-day lives. Poverty cannot be defined solely in terms of lack of income. A person, a family, even a nation is not deemed poor only because of low economic resources. Little or no access to health services, lack of access to safe water and adequate nutrition, illiteracy or low educational level, and a distorted perception of rights and needs are also essential components of poverty. Expression of poverty in perinatal health care in developing countries are high maternal death and morbidity rates, huge perinatal and childhood losses, and high birth rates. There are good reasons to define it as a global tragedy in our time. Although the mankind has come quite far because the development of civilization and more advances in the health care were made during the past 100 years than in all previous human history, some inhabitants of our planet are not able to experience it. According to some data, every 3 s a newborn dies, and every minute a pregnant woman dies in the globalized world. All together over 10 million deaths every year, which indicates that health security is not strong enough. It is

  18. Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam

    Directory of Open Access Journals (Sweden)

    Thanh Duong Cong

    2012-11-01

    Full Text Available Abstract Background Seeking and utilisation of HIV prevention, treatment, care, and support services for people living with HIV is often hampered by HIV-related stigma. The study aimed to explore the perceptions and experiences regarding treatment, care, and support amongst people living with HIV in Viet Nam, where the HIV epidemic is concentrated among injecting drug users, sex workers, and men who have sex with men. Methods In-depth interviews and focus group discussions were conducted during September 2007 in 6 districts in Hai Phong with a very high HIV prevalence among injecting drug users. The information obtained was analysed and merged within topic areas. Illustrative quotes were selected. Results Stigma and discrimination against people living with HIV in the community and healthcare settings was commonly reported, and substantially hampered the seeking and the utilisation of HIV-related services. The informants related the high level of stigma to the way the national HIV preventive campaigns played on fear, by employing a “scare tactic” mainly focusing on drug users and sex workers, who were defined as “social evils” in the anti-drug and anti-prostitution policy. There was a strong exclusion effect caused by the stigma, with serious implications, such as loss of job opportunities and isolation. The support and care provided by family members was experienced as vital for the spirit and hope for the future among people living with HIV. Conclusions A comprehensive care and support programme is needed. The very high levels of stigma experienced seem largely to have been created by an HIV preventive scare tactic closely linked to the “social evil“ approach in the national policy on drug and prostitution. In order to reduce the stigma and create more effective interventions, this tactic will have to be replaced with approaches that create better legal and policy environments for drug users and sex workers.

  19. Monitoring of services with non-relational databases and map-reduce framework

    International Nuclear Information System (INIS)

    Babik, M; Souto, F

    2012-01-01

    Service Availability Monitoring (SAM) is a well-established monitoring framework that performs regular measurements of the core site services and reports the corresponding availability and reliability of the Worldwide LHC Computing Grid (WLCG) infrastructure. One of the existing extensions of SAM is Site Wide Area Testing (SWAT), which gathers monitoring information from the worker nodes via instrumented jobs. This generates quite a lot of monitoring data to process, as there are several data points for every job and several million jobs are executed every day. The recent uptake of non-relational databases opens a new paradigm in the large-scale storage and distributed processing of systems with heavy read-write workloads. For SAM this brings new possibilities to improve its model, from performing aggregation of measurements to storing raw data and subsequent re-processing. Both SAM and SWAT are currently tuned to run at top performance, reaching some of the limits in storage and processing power of their existing Oracle relational database. We investigated the usability and performance of non-relational storage together with its distributed data processing capabilities. For this, several popular systems have been compared. In this contribution we describe our investigation of the existing non-relational databases suited for monitoring systems covering Cassandra, HBase and MongoDB. Further, we present our experiences in data modeling and prototyping map-reduce algorithms focusing on the extension of the already existing availability and reliability computations. Finally, possible future directions in this area are discussed, analyzing the current deficiencies of the existing Grid monitoring systems and proposing solutions to leverage the benefits of the non-relational databases to get more scalable and flexible frameworks.

  20. [Perinatal mortality in dogs. Clinical, bacteriological and pathological studies].

    Science.gov (United States)

    Sager, M; Remmers, C

    1990-08-01

    1. In intensively operated dog breeding kennels bacterial infections are very significant in perinatal mortality. 2. Staph. aureus, Streptococci (type G) and also beta-haemolytic E. coli were transmitted intra-uterine or by the infected genital tract to the puppies. In many cases they are the cause of septicaemic death of the puppies. 3. A second important cause of infection is subclinical mastitis of the bitch, leading to septicaemic death of newborn puppies. 4. Prophylactic hygienic measures make possible a prognosis concerning the risk of perinatal death. This includes examinations of the dog and the bitch ante coitum, bacteriological examination of the genital tract of the bitch, and a bacteriological examination of the milk before the date of birth. 5. Prophylactic hygienic measures in combination with antibiotic treatment of the bitch or the puppies could reduce the losses of puppies to less than 10%.

  1. PELAYANAN KESEHATAN PERINATAL DI DAERAH PEDESAAN UJUNG BERUNG

    Directory of Open Access Journals (Sweden)

    Anna Alisjahbana

    2012-09-01

    Full Text Available A survey on perinatal care in a rural area at Ujung Berung district, located 15—20 km outside Bandung, West Java was conducted. Three villages with a population of 40,787 were selected. Health services were provided by one health post and several family planning posts. In this study 1303 pregnant women were followed throughout the 28 weeks of pregnancy until the infant is 28 days of age. Among the 1303 pregnant women 5.7% had received tetanus toxoid immunization. Perinatal mortality rate (PMR was 43.6 per thousand and incidence of low birth weight was 14.3 percent. Only 12.8% pregnant women were using some kind of contraception before the last pregnancy. The PMR decreased in spite of the low percentage users. The main causes of death during perinatal period vece asphyxia neonatorum and infections. The incidence of tetanus neonatorum during neonatal period was 17 per thousand live births. An evaluation of health service activities showed 47.5% of these pregnant women had antenatal care. Care during delivery and early postnatal period was carried out by TBAs. No significant difference was found between the PMR of trained and untrained TBAs. Another aspect of health service activities is referral to the health centre or hospital. A total of 3.8 percent infants were referred because of neo­natal problems; among these, refusal was 12.5% due to the totalistic attitude of the parents in the village. The results showed that coverage of pregnant women and their infants by safe health care services is very low. This may be due to lack of facilities and health personnel, and probably also due to the confidence of village people for traditional health care providers. Thus, education and training as well as supervision of traditional health care providers and their integration into the formal health care structure is of extreme importance.  

  2. Improving the patient booking service to reduce the number of missed appointments at East London NHS Foundation Trust Community Musculoskeletal Physiotherapy Service.

    Science.gov (United States)

    Tan, Elizabeth; Shah, Amar; De Souza, Warren; Harrison, Mark; Chettur, Chris; Onathukattil, Maimoona; Smart, Michelle; Mata, Marlon; Chitewe, Auzewell; Binley, Emma

    2017-01-01

    The East London National Health Service Foundation Trust (ELFT) Community Musculoskeletal (MSK) Physiotherapy Service had reported a high rate of non-attendance at scheduled appointments. This was leading to delayed access to treatment for patients and a reduced capacity for service users, as well as a waste of clinical resources. The aim of this quality improvement project was therefore to reduce the percentage of missed appointments within this department. This study was undertaken by the ELFT community MSK service, with support from the ELFT Quality Improvement team. To begin with, patient complaints were explored; these indicated that the main reason for missing appointments was due to issues with the patient booking service. Baseline data were initially collected for both new referrals and follow-up patients. The proposed changes were then introduced, which included text message reminders, first via a manual platform and then via an automated system. Ongoing data were recorded to note the effectiveness of these changes. Following the intervention, non-attendance of newly referred patients reduced by 43.35% (23.76%-13.46%) after both cycles. Non-attendance of follow-up patients reduced by 44.14% (23.74%-13.26%) after the second cycle alone. By listening to the opinions of service users, it was possible to improve the patient booking system and the flexibility of appointments. This resulted in a reduction in the percentage of appointments missed. These changes will continue to be monitored within this department to ensure sustainability but there is also now potential for similar interventions to be trialled in other health service departments.

  3. A Systematic Review of the Physical, Mental, Social, and Economic Problems of Immigrant Women in the Perinatal Period in Japan.

    Science.gov (United States)

    Kita, Sachiko; Minatani, Mariko; Hikita, Naoko; Matsuzaki, Masayo; Shiraishi, Mie; Haruna, Megumi

    2015-12-01

    The perinatal mortality of immigrants in Japan is higher than that of Japanese women. However, details of the problems of immigrant perinatal women that contribute to worsening of their health are still unknown. This review describes the physical, psychological, social, and economic problems of immigrant women during the perinatal period in Japan. Medline, CINAHL, PsycINFO, and Igaku-Chuo Zasshi were searched and 36 relevant articles were reviewed. The related descriptions were collected and analyzed by using content analysis. The results showed that immigrant perinatal women in Japan experienced the following problems: language barriers, a problematic relationship with a partner, illegal residency, emotional distress, physical distress, adjustment difficulties, lack of utilization of services, social isolation, lack of support, lack of information, low economic status, unsatisfactory health care, and discrimination. These results indicated that multilingual services, strengthening of social and support networks, and political action are necessary to resolve their problems.

  4. Reducing wait time in a hospital pharmacy to promote customer service.

    Science.gov (United States)

    Slowiak, Julie M; Huitema, Bradley E; Dickinson, Alyce M

    2008-01-01

    The purpose of this study was to compare the effects of 2 different interventions on wait times at a hospital outpatient pharmacy: (1) giving feedback to employees about customer satisfaction with wait times and (2) giving a combined intervention package that included giving more specific feedback about actual wait times and goal setting for wait time reduction in addition to the customer satisfaction feedback. The relationship between customer satisfaction ratings and wait times was examined to determine whether wait times affected customer service satisfaction. Participants were 10 employees (4 pharmacists and 6 technicians) of an outpatient pharmacy. Wait times and customer satisfaction ratings were collected for "waiting customers." An ABCBA' within-subjects design was used to assess the effects of the interventions on both wait time and customer satisfaction, where A was the baseline (no feedback and no goal setting); B was the customer satisfaction feedback; C was the customer satisfaction feedback, the wait time feedback, and the goal setting for wait time reduction; and A' was a follow-up condition that was similar to the original baseline condition. Wait times were reduced by approximately 20%, and there was concomitant increased shift in levels of customer satisfaction, as indicated by the correlation between these variables (r = -0.57 and P customer's wait time. Data from this study may provide useful preliminary benchmarking data for standard pharmacy wait times.

  5. [Reducing patient waiting time for the outpatient phlebotomy service using six sigma].

    Science.gov (United States)

    Kim, Yu Kyung; Song, Kyung Eun; Lee, Won Kil

    2009-04-01

    One of the challenging issues of the outpatient phlebotomy services at most hospitals is that patients have a long wait. The outpatient phlebotomy team of Kyungpook National University Hospital applied six sigma breakthrough methodologies to reduce the patient waiting time. The DMAIC (Define, Measure, Analyze, Improve, and Control) model was employed to approach the project. Two hundred patients visiting the outpatient phlebotomy section were asked to answer the questionnaires at inception of the study to ascertain root causes. After correction, we surveyed 285 patients for same questionnaires again to follow-up the effects. A defect was defined as extending patient waiting time so long and at the beginning of the project, the performance level was 2.61 sigma. Using fishbone diagram, all the possible reasons for extending patient waiting time were captured, and among them, 16 causes were proven to be statistically significant. Improvement plans including a new receptionist, automatic specimen transport system, and adding one phlebotomist were put into practice. As a result, the number of patients waited more than 5 min significantly decreased, and the performance level reached 3.0 sigma in December 2007 and finally 3.35 sigma in July 2008. Applying the six sigma, the performance level of waiting times for blood drawing exceeding five minutes were improved from 2.61 sigma to 3.35 sigma.

  6. The City MISS: development of a scale to measure stigma of perinatal mental illness.

    Science.gov (United States)

    Moore, Donna; Ayers, Susan; Drey, Nicholas

    2017-07-01

    This study aimed to develop and validate a scale to measure perceived stigma for perinatal mental illness in women. Stigma is one of the most frequently cited barriers to seeking treatment and many women with perinatal mental illness fail to get the treatment they need. However, there is no psychometric scale that measures how women may experience the unique aspects of perinatal mental illness stigma. A draft scale of 30 items was developed from a literature review. Women with perinatal mental illness (n = 279) were recruited to complete the City Mental Illness Stigma Scale. Concurrent validity was measured using the Internalised Stigma of Mental Illness Scale. Factor analysis was used to create the final scale. The final 15-item City Mental Illness Stigma Scale has a three-factor structure: perceived external stigma, internal stigma and disclosure stigma. The scale accounted for 54% of the variance and had good internal reliability and concurrent validity. The City Mental Illness Stigma Scale appears to be a valid measure which provides a potentially useful tool for clinical practice and research in stigma and perinatal mental illness, including assessing the prevalence and characteristics of stigma. This research can be used to inform interventions to reduce or address the stigma experienced by some women with perinatal mental illness.

  7. Trends in perinatal health after assisted reproduction

    DEFF Research Database (Denmark)

    Henningsen, Anna-Karina Aaris; Gissler, M.; Skjaerven, R.

    2015-01-01

    STUDY QUESTIONS Has the perinatal outcome of children conceived after assisted reproductive technology (ART) improved over time? SUMMARY ANSWER The perinatal outcomes in children born after ART have improved over the last 20 years, mainly due to the reduction of multiple births. WHAT IS KNOWN...... with ART outcome and health data from Denmark, Finland, Norway and Sweden. PARTICIPANTS, SETTING AND METHODS We analysed the perinatal outcome of 62 379 ART singletons and 29 758 ART twins, born from 1988 to 2007 in four Nordic countries. The ART singletons were compared with a control group of 362 215...

  8. Perinatal risk factors including malformation

    International Nuclear Information System (INIS)

    Brachner, A.; Grosche, B.

    1991-10-01

    The study gives a survey of the factors most frequently mentioned in the literature as factors likely to adversely affect a pregnancy. One essential aspect is the discussion of those factors that can be counted among the causes of malformations, as among others, prenatal radiation exposure. The study prepared within the framework of the research project 'Radiobiological environmental monitoring in Bavaria' is intended to serve as a basis for a retrospective and prospective evaluation of infant mortality, perinatal conditions and occurrence of malformations in Bavaria, with the principal idea of drawing up an environment - related health survey. The study therefore, in addition to ionizing radiation also takes into account other detectable risks within the ecologic context, as e.g. industrial installations, refuse incineration plants or waste dumps, or urbanity. (orig./MG) [de

  9. [Chorionicity and adverse perinatal outcome].

    Science.gov (United States)

    Ferreira, Isabel; Laureano, Carla; Branco, Miguel; Nordeste, Ana; Fonseca, Margarida; Pinheiro, Adelaide; Silva, Maria Isabel; Almeida, Maria Céu

    2005-01-01

    Considering the highest rate of morbidity and mortality in diamniotic monochorionic twins, the authors evaluated and compared the adverse obstetric and perinatal outcome in twin pregnancies according to chorionicity. A retrospective study was conducted in all twin deliveries that occurred in the Obstetric Unit of Maternidade Bissaya-Barreto, for a period of tree years (from the 1st of January 1999 until the 31st of December 2001). From de 140 diamniotic twin pregnancies studied, we considered two groups according to the chorionicity: monochorionic and dichorionic. We compared multiple parameters as, epidemiologic data, adverse obstetric outcome, gestacional delivery age, type of delivery and the morbidity, the mortality and the follow-up of the newborn. The statistic tests used were the X2 and the t student. From the 140 twin pregnancies included in the study, 66% (92 cases) presented dichorionic placentation and 34% (48 cases) were monochorionic. In the group of monochorionic pregnancies, we observed highly difference related to pathology of amniotic fluid (14.5% vs 2.2%), discordant fetal growth (41.6% vs 22.8%) and rate of preterm delivery (66.6% vs 32.6%). Related to the newborn we verified that they had a lower average birth weight (1988g vs 2295g), a highly rate of weight discordancy (23% vs 15.3%), intraventricular haemorrhage (2.2% vs 0%) and IUGR (6.6% vs 1.6%), statistically significant in the monochorionic group. Also the perinatal mortality rate was significantly higher in the monochorionic pregnancies (93.7 per thousand vs 21.7 per thousand). The high rate of morbidity and mortality related to the monochorionic twin pregnancies, implies the need of a correct identification of the type of chorionicity and also a high standard of prenatal surveillance in prenatal specialised health centers.

  10. Reducing barriers to energy efficiency in the German energy service companies sector. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Koewener, D.; Schleich, J.

    2000-12-01

    This report describes the empirical research conducted in the German energy service sector to assess to what extent energy service companies (ESCOs) can help overcome the barriers to energy in the higher education, brewing and mechanical engineering sectors. This report complements the sector for Germany within the BARRIERS project (Sorrell et al., 2000; Schleich/Boede 2000a; Schleich/Boede 2000b; Schleich et al., 2000). The report characterises the German energy service sector, contains a description and analysis of four case studies in the energy service sector, identifies the main barriers and chances for ESCOs in the higher education, brewery and mechanical engineering sectors, and concludes with brief recommendations on how these barriers may be overcome. The results of the study are summarised here under the following headings: Characterising the energy service sector in Germany; - Case studies of energy service companies in Germany; - The role of ESCOs in the case-study sectors; - Policy implications. (orig.)

  11. Perinatal Outcomes in Pregnant Women Users of Illegal Drugs.

    Science.gov (United States)

    Oliveira, Tenilson Amaral; Bersusa, Ana Aparecida Sanches; Santos, Tatiana Fiorelli Dos; Aquino, Márcia Maria Auxiliadora de; Mariani Neto, Corintio

    2016-04-01

    Objective The purpose of this study was to evaluate the perinatal outcomes in pregnant women who use illicit drugs. Methods A retrospective observational study of patients who, at the time of delivery, were sent to or who spontaneously sought a public maternity hospital in the eastern area of São Paulo city. We compared the perinatal outcomes of two distinct groups of pregnant women - illicit drugs users and non-users - that gave birth in the same period and analyzed the obstetric and neonatal variables. We used Student's t-test to calculate the averages among the groups, and the Chi-square test or Fisher's exact test to compare categorical data from each group. Results We analyzed 166 women (83 users and 83 non-users) in both groups with a mean of age of 26 years. Ninety-five percent of the drug users would use crack or pure cocaine alone or associated with other psychoactive substances during pregnancy. Approximately half of the users group made no prenatal visit, compared with 2.4% in the non-users group (p illicit drugs. Conclusions The use of illicit drugs, mainly crack cocaine, represents an important perinatal risk. Any medical intervention in this population should combine adherence to prenatal care with strategies for reducing maternal exposure to illicit drugs. Thieme Publicações Ltda Rio de Janeiro, Brazil.

  12. Reducing health inequities: the contribution of core public health services in BC

    Science.gov (United States)

    2013-01-01

    Background Within Canada, many public health leaders have long identified the importance of improving the health of all Canadians especially those who face social and economic disadvantages. Future improvements in population health will be achieved by promoting health equity through action on the social determinants of health. Many Canadian documents, endorsed by government and public health leaders, describe commitments to improving overall health and promoting health equity. Public health has an important role to play in strengthening action on the social determinants and promoting health equity. Currently, public health services in British Columbia are being reorganized and there is a unique opportunity to study the application of an equity lens in public health and the contribution of public health to reducing health inequities. Where applicable, we have chosen mental health promotion, prevention of mental disorders and harms of substance use as exemplars within which to examine specific application of an equity lens. Methods/design This research protocol is informed by three theoretical perspectives: complex adaptive systems, critical social justice, and intersectionality. In this program of research, there are four inter-related research projects with an emphasis on both integrated and end of grant knowledge translation. Within an overarching collaborative and participatory approach to research, we use a multiple comparative case study research design and are incorporating multiple methods such as discourse analysis, situational analysis, social network analysis, concept mapping and grounded theory. Discussion An important aim of this work is to help ensure a strong public health system that supports public health providers to have the knowledge, skills, tools and resources to undertake the promotion of health equity. This research will contribute to increasing the effectiveness and contributions of public health in reducing unfair and inequitable differences

  13. Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services

    Science.gov (United States)

    Daff, Bocar Mamadou; Seck, Cheikh; Belkhayat, Hassan; Sutton, Perri

    2014-01-01

    Contraceptive use in Senegal is among the lowest in the world and has barely increased over the past 5 years, from 10% of married women in 2005 to 12% in 2011. Contraceptive stockouts in public facilities, where 85% of women access family planning services, are common. In 2011, we conducted a supply chain study of 33 public-sector facilities in Pikine and Guediawaye districts of the Dakar region to understand the magnitude and root causes of stockouts. The study included stock audits, surveys with 156 consumers, and interviews with facility staff, managers, and other stakeholders. At the facility level, stockouts of injectables and implants occurred, on average, 43% and 83% of the year, respectively. At least 60% of stockouts occurred despite stock availability at the national level. Data from interviews revealed that the current “pull-based” distribution system was complex and inefficient. In order to reduce stockout rates to the commercial-sector standard of 2% or less, the Government of Senegal and the Senegal Urban Reproductive Health Initiative developed the informed push distribution model (IPM) and pilot-tested it in Pikine district between February 2012 and July 2012. IPM brings the source of supply (a delivery truck loaded with supplies) closer to the source of demand (clients in health facilities) and streamlines the steps in between. With a professional logistician managing stock and deliveries, the health facilities no longer need to place and pick up orders. Stockouts of contraceptive pills, injectables, implants, and intrauterine devices (IUDs) were completely eliminated at the 14 public health facilities in Pikine over the 6-month pilot phase. The government expanded IPM to all 140 public facilities in the Dakar region, and 6 months later stockout rates throughout the region dropped to less than 2%. National coverage of the IPM is expected by July 2015. PMID:25276582

  14. Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services.

    Science.gov (United States)

    Daff, Bocar Mamadou; Seck, Cheikh; Belkhayat, Hassan; Sutton, Perri

    2014-05-01

    Contraceptive use in Senegal is among the lowest in the world and has barely increased over the past 5 years, from 10% of married women in 2005 to 12% in 2011. Contraceptive stockouts in public facilities, where 85% of women access family planning services, are common. In 2011, we conducted a supply chain study of 33 public-sector facilities in Pikine and Guediawaye districts of the Dakar region to understand the magnitude and root causes of stockouts. The study included stock audits, surveys with 156 consumers, and interviews with facility staff, managers, and other stakeholders. At the facility level, stockouts of injectables and implants occurred, on average, 43% and 83% of the year, respectively. At least 60% of stockouts occurred despite stock availability at the national level. Data from interviews revealed that the current "pull-based" distribution system was complex and inefficient. In order to reduce stockout rates to the commercial-sector standard of 2% or less, the Government of Senegal and the Senegal Urban Reproductive Health Initiative developed the informed push distribution model (IPM) and pilot-tested it in Pikine district between February 2012 and July 2012. IPM brings the source of supply (a delivery truck loaded with supplies) closer to the source of demand (clients in health facilities) and streamlines the steps in between. With a professional logistician managing stock and deliveries, the health facilities no longer need to place and pick up orders. Stockouts of contraceptive pills, injectables, implants, and intrauterine devices (IUDs) were completely eliminated at the 14 public health facilities in Pikine over the 6-month pilot phase. The government expanded IPM to all 140 public facilities in the Dakar region, and 6 months later stockout rates throughout the region dropped to less than 2%. National coverage of the IPM is expected by July 2015.

  15. Potential Utility of Melatonin in Preeclampsia, Intrauterine Fetal Growth Retardation, and Perinatal Asphyxia.

    Science.gov (United States)

    Marseglia, Lucia; D'Angelo, Gabriella; Manti, Sara; Reiter, Russel J; Gitto, Eloisa

    2016-08-01

    Reactive oxygen species play an important role in the pathogenesis of several diseases during gestation and the perinatal period. During pregnancy, increased oxygen demand augments the rate of production of free radicals. Oxidative stress is involved in pregnancy disorders including preeclampsia and intrauterine fetal growth retardation (IUGR). Moreover, increased levels of oxidative stress and reduced antioxidative capacities may contribute to the pathogenesis of perinatal asphyxia. Melatonin, an efficient antioxidant agent, diffuses through biological membranes easily and exerts pleiotropic actions on every cell and appears to be essential for successful gestation. This narrative review summarizes current knowledge concerning the role of melatonin in reducing complications during human pregnancy and in the perinatal period. Melatonin levels are altered in women with abnormally functioning placentae during preeclampsia and IUGR. Short-term melatonin therapy is highly effective and safe in reducing complications during pregnancy and in the perinatal period. Because melatonin has been shown to be safe for both mother and fetus, it could be an attractive therapy in pregnancy and is considered a promising neuroprotective agent in perinatal asphyxia. We believe that the use of melatonin treatment during the late fetal and early neonatal period might result in a wide range of health benefits, improved quality of life, and may help limit complications during the critical periods prior to, and shortly after, delivery. © The Author(s) 2015.

  16. Perinatal brain damage : The term infant

    NARCIS (Netherlands)

    Hagberg, Henrik; David Edwards, A.; Groenendaal, Floris

    2016-01-01

    Perinatal brain injury at term is common and often manifests with neonatal encephalopathy including seizures. The most common aetiologies are hypoxic–ischaemic encephalopathy, intracranial haemorrhage and neonatal stroke. Besides clinical and biochemical assessment the diagnostic evaluation rely

  17. Redefining Perinatal Experience: A Philosophical Exploration of a Hypothetical Case of Gender-Diversity in Labour and Birth.

    Science.gov (United States)

    Richardson, Brianna; Price, Sheri; Campbell-Yeo, Marsha

    2018-05-18

    Using a queer phenomenological approach, the objective of this philosophical analysis is to explore the transgender experience in highly gendered clinical areas, such as the birth unit, and make recommendations on how to provide perinatal care that is inclusive of gender diversity within these areas. This paper aims to describes a hypothetical clinical experience to provide insight on the institutional barriers that currently exist and to provide nurses and midwives with pragmatic strategies to enhance gender-diverse care in general and gendered clinical areas. Currently, general healthcare providers are not sufficiently educated on how to care for and meet the needs of people who identify as lesbian, gay, bisexual, trans, queer, queer or questioning and other communities (LGBTQ+). This vulnerable population continually faces stigma, discrimination, and marginalization, which act as barriers to accessing healthcare services. Although transgender people often have difficulty accessing healthcare in general settings, they experience an even greater challenge within traditionally gendered clinical care areas. Queer Phenomenology was used to guide a critical philosophical analysis of hypothetical case reflecting a clinical scenario regarding a transgender man's experience in labour and birth. Healthcare professionals often provide insufficient care to transgender persons, inadvertently leading to further marginalization of this vulnerable population. Special consideration to provide gender-diverse care throughout the perinatal period is needed. Structures and supports are essential to enhance the care from providers in attending to the unique needs of transgender individuals and reduce oppressive effects from heteronormative environments. Nurses and midwives are leading exemplars of providing person-centered care and are capable of advocating for equitable care amongst all populations to influence systemic change. Strategies for implementing changes that address LGBTQ

  18. Improving perinatal outcome: towards individualized care

    OpenAIRE

    Kazemier, B.M.

    2015-01-01

    Unfortunately not all pregnancies and deliveries take place without complications. Complications during pregnancy or delivery can lead to maternal morbidity and poor perinatal outcomes such as perinatal mortality or (severe) neonatal morbidity. First assessment in antenatal care is to distinguish women who require standard care from those requiring special attention. At the moment, we can make some global risk assessments, but are not able to give a women a risk assessment that is adapted for...

  19. Genetic and perinatal effects of abused substances

    Energy Technology Data Exchange (ETDEWEB)

    Brande, M.C.; Zimmerman, A.M.

    1987-01-01

    This book provides an overview of the effects of several abused drugs, including opiates, cannabinoids, alcohol, nicotine, and cocaine, with special emphasis on the actions of these substances at the molecular and cellular levels. The first half deals with genetic effects, including molecular genetics, biochemical genetics, pharmacogenetics, cytogenetics, and genetic toxicity. The second half focuses on perinatal effects and covers: drug abuse during pregnancy; biochemical aspects of marihuana on male reproduction; and long-term behavioral and neuroendocrine effects of perinatal alcohol exposure.

  20. Perinatal transport: problems in neonatal intensive care capacity.

    Science.gov (United States)

    Gill, A B; Bottomley, L; Chatfield, S; Wood, C

    2004-05-01

    To assess the quantity and nature of transfers within the Yorkshire perinatal service, with the aim of identifying suitable outcome measures for the assessment of future service improvements. Collection of data on perinatal transfers from all neonatal and maternity units located in the Yorkshire region of the United Kingdom from May to November 2000. Expectant mothers (in utero transfers) and neonates (ex utero transfers). None Quantification of in utero and ex utero transfers; the reasons for and resources required to support transfers; the nature of each transfer (acute, specialist, non-acute, into or out of region). In the period studied, there were 800 transfers (337 in utero; 463 ex utero); 306 transfers were "acute" (80% of transfers in utero), 214 because of specialist need, and 280 "non-acute". Some 37% of capacity transfers occurred from the two level 3 units in the region. Of 254 transfers out of the 14 neonatal units for intensive care, 44 (17.3%) were transferred to hospitals outside the normal neonatal commissioning boundaries. The study highlights a continuing apparent lack of capacity within the neonatal service in the Yorkshire region, resulting in considerable numbers of neonatal and maternal transfers.

  1. An Investigation of the Impact of an Intervention to Reduce Academic Procrastination Using Short Message Service (SMS) Technology

    Science.gov (United States)

    Davis, Darrel R.; Abbitt, Jason T.

    2013-01-01

    This mixed-method pilot study investigated the impact of a custom Short Message Service (SMS) reminder system developed to help students reduce procrastination and increase performance on weekly content-related quizzes in a high-enrollment hybrid online course. Text message reminders were sent to three students with high procrastination and low…

  2. Implementing the Fundamental Principle of Islamic Finance PLS in Order to Reduce Moral Hazard on the Financial Services Market

    OpenAIRE

    Dariusz Piotrowski

    2014-01-01

    Moral hazard is a situation where agent takes a risky actions, knowing that potential costs will be born by principal. In finance, moral hazard arises when advisers take risky decisions come to believe that they will not have to carry the full burden of potential loses. Implementing the fundamental principle of Islamic finance PLS could reduce moral hazard on financial services market.

  3. Comparison of cigarette smoking knowledge, attitudes, and practices among staff in perinatal and other substance abuse treatment settings.

    Science.gov (United States)

    Miller-Thomas, Tonya; Leoutsakos, Jeannie-Marie S; Terplan, Mishka; Brigham, Emily P; Chisolm, Margaret S

    2014-01-01

    Despite the high prevalence and known morbidity and mortality caused by cigarette smoking, 60% to 70% of substance abuse treatment programs lack smoking cessation counseling or fail to offer pharmacotherapy for smoking cessation, including those programs designed to meet the needs of drug-dependent pregnant patients. Previous studies of staff knowledge, attitudes, and practices (S-KAP) at general substance abuse/HIV treatment programs have suggested that staff may contribute to the deficiency in smoking cessation treatment in these settings. It is not known whether similar deficiencies exist at perinatal substance abuse treatment programs. This study compared cigarette S-KAP in perinatal substance abuse (n = 41) and general substance abuse/HIV treatment (Veterans Affairs [VA] medical center, hospital-, and community-based) workforce samples (n = 335). Significant differences were seen between the 2 groups on all measures, but perinatal staff compared favorably to general staff only on measures of barriers to smoking cessation services. Perinatal staff compared unfavorably on all other measures: knowledge, beliefs/attitudes, self-efficacy, and smoking cessation practices. Pair-wise comparisons of knowledge and beliefs/attitudes revealed a significant difference between perinatal and VA staff; of self-efficacy, between perinatal and staff at all other settings; and of smoking cessation practices, between perinatal and VA and community-based staff. These results-showing deficiencies of perinatal staff on most S-KAP measures-are concerning and suggest that identifying gaps in and improving S-KAP in perinatal substance abuse programs is urgently needed, for which the VA may provide an efficacious model.

  4. Faith, Trust and the Perinatal Healthcare Maze in Urban India

    Directory of Open Access Journals (Sweden)

    S. Raman

    2014-05-01

    Full Text Available How women access and utilise health services through pregnancy, childbirth and infancy needs to be understood if we are to improve the delivery of and access to appropriate healthcare. Drawing on ethnographic observations of clinic encounters and in-depth interviews with women in Bangalore, South India, this paper reports on the complexities of negotiating healthcare throughout the perinatal continuum in urban India. Key themes identified include faith and trust in health services, confusion over right to healthcare; and the contested nature of choice for women. What is revealed is a socially restrictive framework that results in choices that seem arbitrary, irrational and self-defeating; poor women being particularly vulnerable. Given the current policy support for public-private-partnerships in reproductive healthcare delivery in India, both public and private health services need to move substantially to achieve true partnership and provide care that is respectful and valued by women and children in urban India.

  5. The long-term psychiatric and medical prognosis of perinatal mental illness.

    Science.gov (United States)

    Meltzer-Brody, Samantha; Stuebe, Alison

    2014-01-01

    The perinatal period provides an important window into a woman's long-term health. Perinatal mental illness is a common condition conferring potential serious long-term psychiatric and medical consequences for the mother and family. It is known that childbirth acts as a powerful trigger for depressive episodes in some women, and that women with histories of a mood disorder are particularly vulnerable. Some evidence links perinatal mental illness with obstetrical complications and reduced lactation initiation and duration. Therefore, perinatal mental illness may be a marker for long-term risk, and may contribute directly to subsequent cardiometabolic disease through both neuroendocrine mechanisms and the effects of mental illness on health behaviours. In clinical practice, these associations underscore the importance of screening and treating women with perinatal mental illness to ensure best possible long-term outcomes. Early screening and treatment may both mitigate the primary disease process and reduce the risk of comorbid medical conditions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Restriction of therapy mainly explains lower thrombolysis rates in reduced stroke service levels.

    Science.gov (United States)

    Gumbinger, Christoph; Reuter, Björn; Hacke, Werner; Sauer, Tamara; Bruder, Ingo; Diehm, Curt; Wiethölter, Horst; Schoser, Karin; Daffertshofer, Michael; Neumaier, Stephan; Drewitz, Elke; Rode, Susanne; Kern, Rolf; Hennerici, Michael G; Stock, Christian; Ringleb, Peter

    2016-05-24

    To assess the influence of preexisting disabilities, age, and stroke service level on standardized IV thrombolysis (IVT) rates in acute ischemic stroke (AIS). We investigated standardized IVT rates in a retrospective registry-based study in 36,901 patients with AIS from the federal German state Baden-Wuerttemberg over a 5-year period. Patients admitted within 4.5 hours after stroke onset were selected. Factors associated with IVT rates (patient-level factors and stroke service level) were assessed using robust Poisson regression modeling. Interactions between factors were considered to estimate risk-adjusted mortality rates and potential IVT rates by service level (with stroke centers as benchmark). Overall, 10,499 patients (28.5%) received IVT. The IVT rate declined with service level from 44.0% (stroke center) to 13.1% (hospitals without stroke unit [SU]). Especially patients >80 years of age and with preexisting disabilities had a lower chance of being treated with IVT at lower stroke service levels. Interactions between stroke service level and age group, preexisting disabilities, and stroke severity (all p < 0.0001) were observed. High IVT rates seemed not to increase mortality. Estimated potential IVT rates ranged between 41.9% and 44.6% depending on stroke service level. Differences in IVT rates among stroke service levels were mainly explained by differences administering IVT to older patients and patients with preexisting disabilities. This indicates considerable further potential to increase IVT rates. Our findings support guideline recommendations to admit acute stroke patients to SUs. © 2016 American Academy of Neurology.

  7. Improving Quality of Service and Reducing Power Consumption with WAN accelerator in Cloud Computing Environments

    OpenAIRE

    Shin-ichi Kuribayashi

    2013-01-01

    The widespread use of cloud computing services is expected to deteriorate a Quality of Service and toincrease the power consumption of ICT devices, since the distance to a server becomes longer than before. Migration of virtual machines over a wide area can solve many problems such as load balancing and power saving in cloud computing environments. This paper proposes to dynamically apply WAN accelerator within the network when a virtual machine is moved to a distant center, in order to preve...

  8. New Fathers' Perinatal Depression and Anxiety-Treatment Options: An Integrative Review.

    Science.gov (United States)

    O'Brien, Anthony P; McNeil, Karen A; Fletcher, Richard; Conrad, Agatha; Wilson, Amanda J; Jones, Donovan; Chan, Sally W

    2017-07-01

    More than 10% of fathers experience depression and anxiety during the perinatal period, but paternal perinatal depression (PPND) and anxiety have received less attention than maternal perinatal mental health problems. Few mainstream treatment options are available for men with PPND and anxiety. The aim of this literature review was to summarize the current understanding of PPND and the treatment programs specifically designed for fathers with perinatal depression. Eight electronic databases were searched using a predefined strategy, and reference lists were also hand searched. PPND and anxiety were identified to have a negative impact on family relationships, as well as the health of mothers and children. Evidence suggests a lack of support and tailored treatment options for men having trouble adjusting to the transition to fatherhood. Of the limited options available, cognitive behavioral therapy, group work, and blended delivery programs, including e-support approaches appear to be most effective in helping fathers with perinatal depression and anxiety. The review findings have important implications for the understanding of PPND and anxiety. Future research is needed to address the adoption of father-inclusive and father-specific models of care to encourage fathers' help-seeking behavior. Inclusion of male-specific requirements into support and treatment options can improve the ability of services to engage new fathers. Psychotherapeutic intervention could assist to address the cognitive differences and dissonance for men adjusting to the role of father, including male identity and role expectations.

  9. Neonatal intracranial hemorrhages (perinatal onset)

    International Nuclear Information System (INIS)

    Ban, Sadahiko; Ogata, Masahiro; Yamamoto, Toyoshiro; Nakao, Satoshi; Mizue, Hidenari; Kobayashi, Yutaka.

    1982-01-01

    1. We have reviewed 34 cases of neonatal intracranial hemorrhages (perinatal onset, 23 mature and 11 premature infants) experienced in 10-year period from 1971 to 1980, with special reference to gestational age, birth weight, type of delivery, presence or absence of asphyxia, symptoms and cause of death. 2. Regarding 9 autopsied cases and 7 cases diagnosed by CT-scan, 10 mature infants composed of 3 subarachnoid hemorrhages, 2 intraventricular hemorrhages, 2 subdural hematomas, 2 intracerebral and 1 subependymal hemorrhage; 6 premature infants consisted of 4 subependymal hemorrhages with ventricular rupture and 2 subarachnoid hemorrhages. Most of them presented with respiratory distress, vomiting and convulsive seizures which developed within 5 days after birth. 3. Poor outcome including death amounted 49% of mature and 63% of premature infants. Along with degree of intracranial hematoma, prematurity and pulmonary complication were felt to be important prognostic factors. 4. Introduction of CT-scan led to prompt diagnosis and treatment, thus lowering mortality rate of neonatal intracranial hemorrhages. (author)

  10. Congenital and perinatal cytomegalovirus infection

    Directory of Open Access Journals (Sweden)

    Chun Soo Kim

    2010-01-01

    Full Text Available Cytomegalovirus (CMV is currently the most common agent of congenital infection and the leading infectious cause of brain damage and hearing loss in children. Symptomatic congenital CMV infections usually result from maternal primary infection during early pregnancy. One half of symptomatic infants have cytomegalic inclusion disease (CID, which is characterized by involvement of multiple organs, in particular, the reticuloendothelial and central nervous system (CNS. Moreover, such involvement may or may not include ocular and auditory damage. Approximately 90% of infants with congenital infection are asymptomatic at birth. Preterm infants with perinatal CMV infection can have symptomatic diseases such as pneumonia, hepatitis, and thrombocytopenia. Microcephaly and abnormal neuroradiologic imaging are associated with a poor prognosis. Hearing loss may occur in both symptomatic and asymptomatic infants with congenital infection and may progress through childhood. Congenital infection is defined by the isolation of CMV from infants within the first 3 weeks of life. Ganciclovir therapy can be considered for infants with symptomatic congenital CMV infection involving the CNS. Pregnant women of seronegative state should be counseled on the importance of good hand washing and other control measures to prevent CMV infection. Heat treatment of infected breast milk at 72?#608;for 5 seconds can eliminate CMV completely.

  11. DEVELOPMENT AND EVALUATION OF MEASURES TO REDUCE COSTS OF REGIONAL LOANS SERVICING

    Directory of Open Access Journals (Sweden)

    Pavel Arkadyevitch Galanskiy

    2014-10-01

    Full Text Available The paper discusses major problems of current concern connected with controlling direct obligations of Russian regions (the model of debt servicing cost parameter optimization has been worked out, and their key solutions. The methods offered to analyze debts and manage them are applicable to any Russian Federation regions characterized by budget deficit and forced to cover it using borrowed funds. The important leverage found and their impacts on sub-federal debt servicing cost are also treated in the article.Objective: to identify the direction and impact degree of various parameters on the cost of sub-federal loans.Methodology: there were used general scientific methods: analysis and synthesis, comparison, generalization, systematic approach.Results: main parameters that influence the cost of sub-federal loans servicing and allow its most effective reduction have been identified.

  12. Perinatal mortality rate in the Netherlands compared to other European countries: a secondary analysis of Euro-PERISTAT data.

    Science.gov (United States)

    de Jonge, Ank; Baron, Ruth; Westerneng, Myrte; Twisk, Jos; Hutton, Eileen K

    2013-08-01

    the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality rate at term in the Netherlands contributes to its poor ranking. secondary analyses using published data from the Euro-PERISTAT study. women that gave birth in 2004 in the 29 European regions and countries called 'countries' included in the Euro-PERISTAT study (4,328,441 women in total and 1,940,977 women at term). odds ratios and 95% confidence intervals were calculated for the comparison of perinatal mortality rates between European countries and the Netherlands, through logistic regression analyses using summary country data. combined perinatal mortality rates overall and at term. Perinatal deaths below 28 weeks, between 28 and 37 weeks and from 37 weeks onwards per 1000 total births. compared to the Netherlands, perinatal mortality rates at term were significantly higher for Denmark and Latvia and not significantly different compared to seven other countries. Eleven countries had a significantly lower rate, and for eight the term perinatal mortality rate could not be compared. The Netherlands had the highest number of perinatal deaths before 28 weeks per 1000 total births (4.3). the relatively high perinatal mortality rate in the Netherlands is driven more by extremely preterm births than births at term. Although the PERISTAT data cannot be used to show that the Dutch maternity care system is safe, neither should they be used to argue that the system is unsafe. The PERISTAT data alone do not support changes to the Dutch maternity care system that reduce the possibility for women to choose a home birth while benefits of these changes are uncertain. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Perinatal mortality and socio-spatial inequalities

    Directory of Open Access Journals (Sweden)

    Eunice Francisca Martins

    2013-09-01

    Full Text Available OBJECTIVE: to analyze the social inequalities in the distribution of perinatal mortality in Belo Horizonte. MATERIAL AND METHODS: the perinatal deaths of residents in Belo Horizonte in the period 2003 to 2007 were studied on the basis of the Information Systems on Mortality and Newborns. The space analysis and the Health Vulnerability Index were used to identify existing inequalities in the sanitary districts regarding coverage and risk, determined by the Odds Ratio and a value p<0.05. The multivariate analysis was used to describe a model for perinatal mortality. RESULTS: there was a proved variation in the numbers of perinatal mortality per one thousand total births in the sanitary districts (12.5 to 19.4, coverage areas (5.3 to 49.4 and areas of risk (13.2 to 20.7. The mortality rate diminished as the maternal schooling increased. The death rates deriving from asphyxia/hypoxia and non-specified fetal death grew with the increase of risk in the area. CONCLUSION: it was verified that the perinatal deaths are distributed in a differentiated form in relation to the space and the social vulnerabilities. The confrontation of this complex problem requires the establishment of intersecting partnerships.

  14. Perinatal Practices & Traditions Among Asian Indian Women.

    Science.gov (United States)

    Goyal, Deepika

    2016-01-01

    As the population in the United States grows more diverse, nurses caring for childbearing women must be aware of the many cultural traditions and customs unique to their patients. This knowledge and insight supports women and their families with the appropriate care, information, and resources. A supportive relationship builds trust, offers guidance, and allows for the new family to integrate information from nurses and other healthcare providers with the practice of certain perinatal cultural traditions. The Asian Indian culture is rich in tradition, specifically during the perinatal period. To support the cultural beliefs and practices of Asian Indian women during this time, nurses need to be aware of and consider multiple factors. Many women are navigating the new role of motherhood while making sense of and incorporating important cultural rituals. The purpose of this article is to provide an overview of perinatal cultural practices and traditions specific to the Asian Indian culture that perinatal nurses may observe in the clinical setting. Cultural traditions and practices specific to the pregnancy and postpartum period are described together with symbolism and implications for nursing practice. It is important to note that information regarding perinatal customs is provided in an effort to promote culturally sensitive nursing care and may not pertain to all Asian Indian women living in the United States.

  15. Prairie dog decline reduces the supply of ecosystem services and leads to desertification of semiarid grasslands.

    Directory of Open Access Journals (Sweden)

    Lourdes Martínez-Estévez

    Full Text Available Anthropogenic impacts on North American grasslands, a highly endangered ecosystem, have led to declines of prairie dogs, a keystone species, over 98% of their historical range. While impacts of this loss on maintenance of grassland biodiversity have been widely documented, much less is known about the consequences on the supply of ecosystem services. Here we assessed the effect of prairie dogs in the supply of five ecosystem services by comparing grasslands currently occupied by prairie dogs, grasslands devoid of prairie dogs, and areas that used to be occupied by prairie dogs that are currently dominated by mesquite scrub. Groundwater recharge, regulation of soil erosion, regulation of soil productive potential, soil carbon storage and forage availability were consistently quantitatively or qualitatively higher in prairie dog grasslands relative to grasslands or mesquite scrub. Our findings indicate a severe loss of ecosystem services associated to the absence of prairie dogs. These findings suggest that contrary to a much publicize perception, especially in the US, prairie dogs are fundamental in maintaining grasslands and their decline have strong negative impacts in human well - being through the loss of ecosystem services.

  16. Using Query Languages and Mobile Code to Reduce Service Invocation Costs

    National Research Council Canada - National Science Library

    Szymanski, R; Palmer, N; Chase, T

    2006-01-01

    .... As a concrete example, this paper describes work being performed by CERDEC C2D (Communications Electronics Research, Development, and Engineering Center - Command and Control Directorate) at Fort Monmouth, NJ to expose a military mission plan as a web service through the use of simple SQL-like (Structured Query Language) statements optimized for mission data query.

  17. Perinatal death audits in a peri-urban hospital in Kampala, Uganda ...

    African Journals Online (AJOL)

    Background: The perinatal mortality of 70 deaths per 1,000 total births in Uganda is unacceptably high. Perinatal death audits are important for improvement of perinatal care and reduction of perinatal morality. We integrated perinatal death audits in routine care, and describe its effect on perinatal mortality rate at Nsambya ...

  18. Is quality of care a key predictor of perinatal health care utilization and patient satisfaction in Malawi?

    Science.gov (United States)

    Creanga, Andreea A; Gullo, Sara; Kuhlmann, Anne K Sebert; Msiska, Thumbiko W; Galavotti, Christine

    2017-05-22

    The Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Efforts to sustain or increase current levels of perinatal service utilization may not achieve desired gains if the quality of care provided is neglected. This study examined predictors of perinatal service utilization and patients' satisfaction with these services with a focus on quality of care. We used baseline, two-stage cluster sampling household survey data collected between November and December, 2012 before implementation of CARE's Community Score Card© intervention in Ntcheu district, Malawi. Women with a birth during the last year (N = 1301) were asked about seeking: 1) family planning, 2) antenatal, 3) delivery, and 4) postnatal care; the quality of care received; and their overall satisfaction with the care received. Specific quality of care items were assessed for each type of service, and up to five such items per type of service were used in analyses. Separate logistic regression models were fitted to examine predictors of family planning, antenatal, delivery, and postnatal service utilization and of complete satisfaction with each of these services; all models were adjusted for women's socio-demographic characteristics, perceptions of the closest facility to their homes, service use indicators, and quality of care items. We found higher levels of perinatal service use than previously documented in Malawi (baseline antenatal care 99.4%; skilled birth attendance 97.3%; postnatal care 77.5%; current family planning use 52.8%). Almost 73% of quality of perinatal care items assessed were favorably reported by > 90% of women. Women reported high overall satisfaction (≥85%) with all types of services examined, higher for antenatal and postnatal care than for family planning and delivery care. We found significant associations between perceived and actual quality of care and both women's use and satisfaction with the perinatal health

  19. Social and cultural factors associated with perinatal grief in Chhattisgarh, India.

    Science.gov (United States)

    Roberts, Lisa R; Montgomery, Susanne; Lee, Jerry W; Anderson, Barbara A

    2012-06-01

    Stillbirth is a globally significant public health problem with many medical causes. There are also indirect causal pathways including social and cultural factors which are particularly salient in India's traditional society. The purpose of this study was to explore women's perceptions of stillbirth and to determine how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India. Structured interviews were done face-to-face in 21 randomly selected villages among women of reproductive age (N=355) who had experienced stillbirth (n=178) and compared to those who had not (n=177), in the Christian Hospital, Mungeli catchment area. Perinatal grief was significantly higher among women with a history of stillbirth. Greater perinatal grief was associated with lack of support, maternal agreement with social norms, and younger maternal age. These predictors must be understood in light of an additional finding-distorted sex ratios, which reflect gender discrimination in the context of Indian society. The findings of this study will allow the development of a culturally appropriate health education program which should be designed to increase social support and address social norms, thereby reducing psychological distress to prevent complicated perinatal grief. Perinatal grief is a significant social burden which impacts the health women.

  20. Methadone and perinatal outcomes: a prospective cohort study.

    LENUS (Irish Health Repository)

    Cleary, Brian J

    2012-08-01

      Methadone use in pregnancy has been associated with adverse perinatal outcomes and neonatal abstinence syndrome (NAS). This study aimed to examine perinatal outcomes and NAS in relation to (i) concomitant drug use and (ii) methadone dose.

  1. Perinatal mortality in the Cape Province, 1989 - 1991

    African Journals Online (AJOL)

    1995-05-05

    May 5, 1995 ... ... of deliveries, the low- birth-weight rate and the perinatal mortality rate at ... mortality rates were in the northern and eastern Cape. Conclusion. The perinatal ..... World Health Organisation. World Health Statistics Annual. Vol.

  2. Responding to the challenge of adolescent perinatal depression ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Evidence shows that a critical gap exists in the management of perinatal ... intervention program for adolescent perinatal depression, and determine the factors required ... Affairs Canada, IDRC, and the Canadian Institutes of Health Research.

  3. Pyelonephritis in Pregnancy: Clinical and Laboratorial Aspects and Perinatal Results.

    Science.gov (United States)

    Zanatta, Djulie Anne de Lemos; Rossini, Mariane de Mello; Trapani Júnior, Alberto

    2017-12-01

    Objective  To identify the prevalence of pyelonephritis during pregnancy and to analyze the clinical and laboratorial aspects, perinatal results and complications. Methods  A transversal study of 203 pregnant women who had pyelonephritis during pregnancy and whose labor took place between 2010 and 2016 at a hospital in the state of Santa Catarina, Brazil. The analysis was based on medical records as well as on the hospital's database. Clinical and laboratory conditions, antibiotics, bacterial resistance, perinatal outcomes and complications were all taken into account. The data was compared using the Mann-Whitney test and the Chi-square test. Results  A prevalence of 1.97% with pyelonephritis was evidenced, with most patients having it during the second trimester of gestation. The bacteria most commonly found in the urine cultures was Escherichia coli , in 76.6% of cases, followed by Klebsiella pneumoniae (8.7%). Ceftriaxone had the lowest bacterial resistance (only 3.5% of the cases). On the other hand, ampicillin and cephalothin presented higher bacterial resistance, 52% and 36.2%, respectively. The risk of very premature delivery was more than 50% higher in patients with pyelonephritis. Conclusion  Ampicillin and first-generation cephalosporins are associated with a higher bacterial resistance while ceftriaxone proved to have a high efficacy for the treatment of pyelonephritis due to low bacterial resistance. Patients with pyelonephritis showed a higher risk for very premature delivery (< 32 weeks). In this casuistry, there were no others significant differences in the overall perinatal outcomes when compared with the routine service series. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

  4. Perinatal Chicken Pox (Varicella Zoster Virus Infection

    Directory of Open Access Journals (Sweden)

    Ali Annagur

    2013-04-01

    Full Text Available Chickenpox is due to infection with the varicella zoster virus (VZV, a human alphaherpervirus found worldwide. Classically, the cinical disease is a febrile illness with a pruritic vesicular rash. Maternal chickenpox between 5 days before delivery to 2 days after delivery (perinatal varicella can cause severe and even fatal illness in the newborn. A 7-day old girl baby presented on day 4 of postnatal with the complaints of widespread vesicular rash and non-suckling. Mother of the baby also had a similar eruption four day prior to delivery, which was clinically characteristic of varicella. Considering history and clinical presentation, a diagnosis of perinatal chickenpox was considered and the baby was treated with acyclovir which she responded and recovered. Herein, the clinical feasures and treatment of chickenpox infection in the perinatal period have been emphasized with this case report. [Cukurova Med J 2013; 38(2.000: 311-314

  5. [Perinatal mortality in foreign workers (author's transl)].

    Science.gov (United States)

    Höfling, H J; Jonas, R; Brusis, E; Lochmüller, H; Selbmann, H K; Holzmann, K; Zander, J

    1975-03-01

    From 1970 to 1972, there were 216 perinatal deaths among 5595 newborns at the I. Frauenklinik der Universität München. 54 of these deaths were children of foreign workers (so-called "Gastarbeiter"). The data have been processed on punch cards and analysed by a computer. The differences noted underwent significance testing by the CHI-Quadrat test. Only statistical significant results are published. The perinatal mortality in the above period shows no difference between foreign and German ward patients. There is, however, a significant lower perinatal mortality in private patients. We feel that this difference is due to a significant lower rate of prematures in the private patient group. The cocial status as well as higher interest and motivation in health resulting in better prenatal care are discussed as causal reasons for this fact.

  6. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    OpenAIRE

    Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-01-01

    Introduction Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. T...

  7. Applying Service Performance Guarantees to Reduce Risk Perception in the Purchase and Consumption of Higher Education

    Directory of Open Access Journals (Sweden)

    Nooraini Mohamad Sheriff

    2006-12-01

    Full Text Available The intangible nature of education is one contributor to consumers’ perception of risk prior to their purchase and consumption. This risk includes: functional risk, financial risk, temporal risk, physical risk, psychological risk and social risk. The presence of these risks often makes consumer evaluation prior to purchase and consumption difficult. Invoking a service guarantee is a platform available to enable higher educational institutions to minimize such risk perception so as to induce purchase. Specifically, service guarantee for higher education entails the application of teaching performance guarantee. This form of guarantee focuses on two important customer groups of higher educational institutions namely, students and faculty members, and focuses only on a specific performance aspect such as instructor’s performance. Thus, if students are dissatisfied with an instructor’s performance they are entitled to receive their money back. The imposition of such a teaching performance guarantee would implicate instructor’s accountability for certain aspects of their performance. It also establishes a mechanism to solicit feedback to better understand why and how instructors fail. Consequently, service performance guarantee creates a high level of customer focus and signals instructors’ care towards students

  8. Reducing uncertainty in sustainable interpersonal service relationships: the role of aesthetics.

    Science.gov (United States)

    Xenakis, Ioannis

    2018-05-01

    Sustainable interpersonal service relationships (SISRs) are the outcome of a design process that supports situated meaningful interactions between those being served and those in service. Service design is not just directed to simply satisfy the ability to perceive the psychological state of others, but more importantly, it should aim at preserving these relationships in relation to the contextual requirements that they functionally need, in order to be or remain sustainable. However, SISRs are uncertain since they have many possibilities to be in error in the sense that the constructed, situated meanings may finally be proven unsuccessful for the anticipations and the goals of those people engaged in a SISR. The endeavor of this paper is to show that aesthetic behavior plays a crucial role in the reduction of the uncertainty that characterizes such relationships. Aesthetic behavior, as an organized network of affective and cognitive processes, has an anticipatory evaluative function with a strong influence on perception by providing significance and value for those aspects in SISRs that exhibit many possibilities to serve goals that correspond to sustainable challenges. Thus, aesthetic behavior plays an important role in the construction of meanings that are related to both empathic and contextual aspects that constitute the entire situation in which a SISR takes place. Aesthetic behavior has a strong influence in meaning-making, motivating the selection of actions that contribute to our initial goal of interacting with uncertainty, to make the world a bit less puzzling and, thus, to improve our lives, or in other words, to design.

  9. Implementation of a chest pain management service improves patient care and reduces length of stay.

    Science.gov (United States)

    Scott, Adam C; O'Dwyer, Kristina M; Cullen, Louise; Brown, Anthony; Denaro, Charles; Parsonage, William

    2014-03-01

    Chest pain is one of the most common complaints in patients presenting to an emergency department. Delays in management due to a lack of readily available objective tests to risk stratify patients with possible acute coronary syndromes can lead to an unnecessarily lengthy admission placing pressure on hospital beds or inappropriate discharge. The need for a co-ordinated system of clinical management based on enhanced communication between departments, timely and appropriate triage, clinical investigation, diagnosis, and treatment was identified. An evidence-based Chest Pain Management Service and clinical pathway were developed and implemented, including the introduction of after-hours exercise stress testing. Between November 2005 and March 2013, 5662 patients were managed according to a Chest Pain Management pathway resulting in a reduction of 5181 admission nights by more timely identification of patients at low risk who could then be discharged. In addition, 1360 days were avoided in high-risk patients who received earlier diagnosis and treatment. The creation of a Chest Pain Management pathway and the extended exercise stress testing service resulted in earlier discharge for low-risk patients; and timely treatment for patients with positive and equivocal exercise stress test results. This service demonstrated a significant saving in overnight admissions.

  10. [Tobacco control policies and perinatal health].

    Science.gov (United States)

    Peelen, M J; Sheikh, A; Kok, M; Hajenius, P; Zimmermann, L J; Kramer, B W; Hukkelhoven, C W; Reiss, I K; Mol, B W; Been, J V

    2017-01-01

    Study the association between the introduction of tobacco control policies in the Netherlands and changes in perinatal outcomes. National quasi-experimental study. We used Netherlands Perinatal Registry data (now called Perined) for the period 2000-2011. We studied whether the introduction of smoke-free legislation in workplaces plus a tobacco tax increase and mass media campaign in January 2004, and extension of the smoke-free law to the hospitality industry accompanied by another tax increase and media campaign in July 2008, was associated with changes in perinatal outcomes. We studied all singleton births (gestational age: 24+0 to 42+6 weeks). Our primary outcome measures were: perinatal mortality, preterm birth and being small-for-gestational-age (SGA). Interrupted time series logistic regression analyses were performed to investigate changes in these outcomes occurred after the introduction of the aforementioned tobacco control policies (ClinicalTrials.gov: NCT02189265). Among 2,069,695 singleton births, 13,027 (0.6%) perinatal deaths, 116,043 (5.6%) preterm live-births and 187,966 (9.1%) SGA live-births were observed. The policies introduced in January 2004 were not associated with significant changes in any of the primary outcome measures. A -4.4% (95% CI: -6.4 to -2.4; p hospitality industry, a further tax increase and another media campaign. This translates to an estimated over 500 cases of SGA being averted per year. A reduction in SGA births, but not preterm birth or perinatal mortality, was observed in the Netherlands after extension of the smoke-free workplace law to include bars and restaurants, in conjunction with a tax increase and media campaign in 2008.

  11. Barriers to midwives and nurses addressing mental health issues with women during the perinatal period: The Mind Mothers study.

    Science.gov (United States)

    Higgins, Agnes; Downes, Carmel; Monahan, Mark; Gill, Ailish; Lamb, Stephen A; Carroll, Margaret

    2018-01-03

    To explore barriers to midwives and nurses addressing mental health issues with women during the perinatal period. Perinatal mental health is considered an important public health issue with health policy internationally identifying the importance of psychological support for women in the perinatal period. Midwives and primary care nurses are ideally positioned to detect mental distress early, but evidence suggests that they are reluctant to discuss mental health issues with women during pregnancy or in the postnatal period. The research used a descriptive design. A total of 809 midwives and nurses completed an anonymous, online or hard copy survey. Designed by the research team, the survey listed 26 potential barriers to the provision of perinatal mental health care. Participants identified organisational factors as presenting the greatest barriers. Organisational barriers included lack of perinatal mental health services, absence of care pathways, heavy workload, lack of time, lack of privacy and not seeing women regularly enough to build a relationship. Over 50% of participants identified practitioner-related barriers, such as lack of knowledge on perinatal mental health and cultural issues; lack of skill, in particular, skills to respond to a disclosure of a mental health issue; and fears of causing women offence and distress. Findings also indicated that the context of care and education influenced the degree to which participants perceived certain items as barriers. Midwives and primary care nurses encounter many organisational- and practitioner-related barriers that negatively impact on their ability to incorporate mental health care into their practice. Midwifery and nursing services need to develop strategies to address system- and practitioner-related barriers, including the development of services and care pathways, and the provision of culturally sensitive education on perinatal mental health in order to support practitioners to address issues with

  12. Perinatal mortality and associated risk factors: a case control study ...

    African Journals Online (AJOL)

    BACKGROUND: Perinatal mortality is reported to be five times higher in developing than in developed nations. Little is known about the commonly associated risk factors for perinatal mortality in Southern Nations National Regional State of Ethiopia. METHODS: A case control study for perinatal mortality was conducted in ...

  13. Verbal autopsy in establishing cause of perinatal death | Iriya | East ...

    African Journals Online (AJOL)

    Introduction: Perinatal mortality is a sensitive indicator of health status of a community and is also highly amenable to intervention. The causes of perinatal deaths in developing countries are often difficult to establish. Verbal autopsy has been used in several countries for children and adults, but seldom for perinatal cause.

  14. Perinatal Mortality Among Twins In Lagos University Teaching ...

    African Journals Online (AJOL)

    Background: Perinatal mortality rate is reported to be higher in twins than in singletons. More than two decades ago, Abudu and Agarin reported a twinning rate of 21.1/1000 maternities and perinatal mortality rate of 142.6/1000 among twins in Lagos. Objective: To determine the current perinatal mortality rate and risk factors ...

  15. Perinatal Mortality Trends in Ethiopia | Berhan | Ethiopian Journal of ...

    African Journals Online (AJOL)

    BACKGROUND: Although the magnitude of perinatal mortality in Ethiopia was among the highest in Sub Saharan Africa, there was no systematic review done to assess the trend and causes of perinatal death. The objective of this review was to assess the trend of perinatal mortality rate (PMR) and the causes attributed to ...

  16. Low cerebral blood flow in hypotensive perinatal distress

    DEFF Research Database (Denmark)

    Lou, H C; Lassen, N A; Friis-Hansen, B

    1977-01-01

    was used for the cerebral blood flow measurements. The study confirmed that perinatal distress may be associated with low arterial blood pressure, and it was shown that cerebral blood flow is very low, 20 ml/100 g/min or less, in hypotensive perinatal distress. It is concluded that cerebral ischaemia plays...... a crucial role in the development of perinatal hypoxic brain injury....

  17. Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.

    Science.gov (United States)

    Miller, Margaret; Hearn, Lydia; van der Pligt, Paige; Wilcox, Jane; Campbell, Karen J

    2014-01-01

    Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

  18. Reaching Perinatal Women Online: The Healthy You, Healthy Baby Website and App

    Directory of Open Access Journals (Sweden)

    Lydia Hearn

    2014-01-01

    Full Text Available Overwhelming evidence reveals the close link between unwarranted weight gain among childbearing women and childhood adiposity. Yet current barriers limit the capacity of perinatal health care providers (PHCPs to offer healthy lifestyle counselling. In response, today’s Internet savvy women are turning to online resources to access health information, with the potential of revolutionising health services by enabling PHCPs to guide women to appropriate online resources. This paper presents the findings of a project designed to develop an online resource to promote healthy lifestyles during the perinatal period. The methodology involved focus groups and interviews with perinatal women and PHCPs to determine what online information was needed, in what form, and how best it should be presented. The outcome was the development of the Healthy You, Healthy Baby website and smartphone app. This clinically-endorsed, interactive online resource provides perinatal women with a personalised tool to track their weight, diet, physical activity, emotional wellbeing, and sleep patterns based on the developmental stage of their child with links to quality-assured information. One year since the launch of the online resource, data indicates it provides a low-cost intervention delivered across most geographic and socioeconomic strata without additional demands on health service staff.

  19. Religio-cultural factors contributing to perinatal mortality and morbidity in mountain villages of Nepal: Implications for future healthcare provision

    Science.gov (United States)

    Javanparast, Sara; Dasvarma, Gouranga; Newman, Lareen

    2018-01-01

    Objective and the context This paper examines the beliefs and experiences of women and their families in remote mountain villages of Nepal about perinatal sickness and death and considers the implications of these beliefs for future healthcare provision. Methods Two mountain villages were chosen for this qualitative study to provide diversity of context within a highly disadvantaged region. Individual in-depth interviews were conducted with 42 women of childbearing age and their family members, 15 health service providers, and 5 stakeholders. The data were analysed using a thematic analysis technique with a comprehensive coding process. Findings Three key themes emerged from the study: (1) ‘Everyone has gone through it’: perinatal death as a natural occurrence; (2) Dewata (God) as a factor in health and sickness: a cause and means to overcome sickness in mother and baby; and (3) Karma (Past deeds), Bhagya (Fate) or Lekhanta (Destiny): ways of rationalising perinatal deaths. Conclusion Religio-cultural interpretations underlie a fatalistic view among villagers in Nepal’s mountain communities about any possibility of preventing perinatal deaths. This perpetuates a silence around the issue, and results in severe under-reporting of ongoing high perinatal death rates and almost no reporting of stillbirths. The study identified a strong belief in religio-cultural determinants of perinatal death, which demonstrates that medical interventions alone are not sufficient to prevent these deaths and that broader social determinants which are highly significant in local life must be considered in policy making and programming. PMID:29544226

  20. Religio-cultural factors contributing to perinatal mortality and morbidity in mountain villages of Nepal: Implications for future healthcare provision.

    Science.gov (United States)

    Paudel, Mohan; Javanparast, Sara; Dasvarma, Gouranga; Newman, Lareen

    2018-01-01

    This paper examines the beliefs and experiences of women and their families in remote mountain villages of Nepal about perinatal sickness and death and considers the implications of these beliefs for future healthcare provision. Two mountain villages were chosen for this qualitative study to provide diversity of context within a highly disadvantaged region. Individual in-depth interviews were conducted with 42 women of childbearing age and their family members, 15 health service providers, and 5 stakeholders. The data were analysed using a thematic analysis technique with a comprehensive coding process. Three key themes emerged from the study: (1) 'Everyone has gone through it': perinatal death as a natural occurrence; (2) Dewata (God) as a factor in health and sickness: a cause and means to overcome sickness in mother and baby; and (3) Karma (Past deeds), Bhagya (Fate) or Lekhanta (Destiny): ways of rationalising perinatal deaths. Religio-cultural interpretations underlie a fatalistic view among villagers in Nepal's mountain communities about any possibility of preventing perinatal deaths. This perpetuates a silence around the issue, and results in severe under-reporting of ongoing high perinatal death rates and almost no reporting of stillbirths. The study identified a strong belief in religio-cultural determinants of perinatal death, which demonstrates that medical interventions alone are not sufficient to prevent these deaths and that broader social determinants which are highly significant in local life must be considered in policy making and programming.

  1. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services.

    Science.gov (United States)

    Chersich, Matthew F; Luchters, Stanley; Ntaganira, Innocent; Gerbase, Antonio; Lo, Ying-Ru; Scorgie, Fiona; Steen, Richard

    2013-03-04

    Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes. We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs) and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers' access to care and antiretroviral treatment (ART), but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers' control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services - including peer interventions, condom promotion and STI screening - would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are required to enhance access to HIV testing and ART for

  2. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services

    Science.gov (United States)

    Chersich, Matthew F; Luchters, Stanley; Ntaganira, Innocent; Gerbase, Antonio; Lo, Ying-Ru; Scorgie, Fiona; Steen, Richard

    2013-01-01

    Introduction Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes. Results We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs) and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers’ access to care and antiretroviral treatment (ART), but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers’ control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. Conclusions There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services – including peer interventions, condom promotion and STI screening – would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are

  3. Partial HELLP Syndrome: maternal and perinatal outcome

    Directory of Open Access Journals (Sweden)

    Joelcio Francisco Abbade

    Full Text Available CONTEXT: HELLP syndrome is a severe complication of pregnancy characterized by hemolysis, elevated liver enzymes and low platelet count. Some pregnant women develop just one or two of the characteristics of this syndrome, which is termed Partial HELLP Syndrome (PHS. OBJECTIVE: The objective of this study was to evaluate the repercussions on maternal and perinatal outcomes among women that developed PHS and to compare these women with those whose gestational hypertension or preeclampsia did not show alterations for HELLP syndrome in laboratory tests. DESIGN: Observational, retrospective and analytical study. SETTING: Maternity Department of Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil. SAMPLE: Pregnant or post-delivery women who had a blood pressure elevation that was first detected after mid-pregnancy, with or without proteinuria, between January 1990 and December 1995. MAIN MEASUREMENTS: Analysis was made of maternal age, race, parity, hypertension classification, gestational age at the PHS diagnosis, alterations in laboratory tests for HELLP syndrome, time elapsed to discharge from hospital, maternal complications, mode of delivery, incidence of preterm birth, intrauterine growth restriction, stillborn and neonatal death. RESULTS: Three hundred and eighteen women were selected; forty-one women (12.9% had PHS and 277 of them (87.1% did not develop any of the alterations of the HELLP syndrome diagnosis. Preeclampsia was a more frequent type of hypertension in the PHS group than in the hypertension group. None of the women with isolated chronic hypertension developed PHS. The rate of cesarean delivery, eclampsia, and preterm delivery was significantly greater in the PHS group than in the hypertension group. CONCLUSION: We observed that aggressive procedures had been adopted for patients with PHS. These resulted in immediate interruption of pregnancy, with elevated cesarean

  4. Seeking help for perinatal psychological distress: a meta-synthesis of women's experiences.

    Science.gov (United States)

    Button, Susan; Thornton, Alexandra; Lee, Suzanne; Shakespeare, Judy; Ayers, Susan

    2017-10-01

    Women may not seek help for perinatal psychological distress, despite regular contact with primary care services. Barriers include ignorance of symptoms, inability to disclose distress, others' attitudes, and cultural expectations. Much of the evidence has been obtained from North American populations and may not, therefore, extrapolate to the UK. To understand the factors affecting women's decision to seek help for perinatal distress. Meta-synthesis of the available published qualitative evidence on UK women's experiences of seeking help for perinatal distress. Systematic searches were conducted in accordance with PRISMA guidelines. Databases searched were PubMed, Scopus, PsycINFO, PsycARTICLES, CINAHL, and Academic Search Complete. Searches of grey literature and references were also conducted. Studies were eligible for inclusion if they reported qualitative data on UK women's experiences of perinatal distress and contact with healthcare professionals. The synthesis was conducted using meta-ethnography. In all, 24 studies were eligible for inclusion. Metasynthesis identified three main themes: identifying a problem, the influence of healthcare professionals, and stigma. These themes build on current understanding of help seeking by identifying the need for women to be able to frame their experience, for healthcare professionals to educate women about their roles, the need for continuity of care, and the way that being seen as a 'bad mother' causes women to self-silence. Perinatal care provision needs to allow for continuity of care and for staff training that facilitates awareness of factors that influence women's help seeking. Further research is required, particularly in relation to effective means of identifying perinatal psychological distress. © British Journal of General Practice 2017.

  5. Causes of death and associated conditions (Codac): a utilitarian approach to the classification of perinatal deaths.

    Science.gov (United States)

    Frøen, J Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W; Facchinetti, Fabio; Fretts, Ruth C; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon C S; Torabi, Rozbeh

    2009-06-10

    A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes.We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions.The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal).For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured.The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the most

  6. Management of Sodium-reduced Meals at Worksite Cafeterias: Perceptions, Practices, Barriers, and Needs among Food Service Personnel.

    Science.gov (United States)

    Lee, Jounghee; Park, Sohyun

    2016-04-01

    The sodium content of meals provided at worksite cafeterias is greater than the sodium content of restaurant meals and home meals. The objective of this study was to assess the relationships between sodium-reduction practices, barriers, and perceptions among food service personnel. We implemented a cross-sectional study by collecting data on perceptions, practices, barriers, and needs regarding sodium-reduced meals at 17 worksite cafeterias in South Korea. We implemented Chi-square tests and analysis of variance for statistical analysis. For post hoc testing, we used Bonferroni tests; when variances were unequal, we used Dunnett T3 tests. This study involved 104 individuals employed at the worksite cafeterias, comprised of 35 men and 69 women. Most of the participants had relatively high levels of perception regarding the importance of sodium reduction (very important, 51.0%; moderately important, 27.9%). Sodium reduction practices were higher, but perceived barriers appeared to be lower in participants with high-level perception of sodium-reduced meal provision. The results of the needs assessment revealed that the participants wanted to have more active education programs targeting the general population. The biggest barriers to providing sodium-reduced meals were use of processed foods and limited methods of sodium-reduced cooking in worksite cafeterias. To make the provision of sodium-reduced meals at worksite cafeterias more successful and sustainable, we suggest implementing more active education programs targeting the general population, developing sodium-reduced cooking methods, and developing sodium-reduced processed foods.

  7. Nutrient cycling in salt marshes: An ecosystem service to reduce eutrophication

    DEFF Research Database (Denmark)

    Lillebø, A. I.; Sousa, A. I.; Flindt, M. R.

    2013-01-01

    and sequestration in salt marshes. This chapter will thus emphasise that salt marsh halophytes have a crucial role on nutrient cycling and sequestration, providing ecological services that contribute to maintain the ecosystem health. © 2012 Nova Science Publishers, Inc. All rights reserved.......Salt marshes are classified as sensitive habitat under the Habitats Directive (92/43/EEC), which aims to promote the maintenance of biodiversity. Worldwide, the reduction of salt marsh areas, as a result of anthropogenic disturbance is of major concern, and several studies on the ecology...

  8. Poor perinatal care practices in urban slums: Possible role of social mobilization networks

    Directory of Open Access Journals (Sweden)

    Khan Zulfia

    2009-01-01

    Full Text Available Background: Making perinatal care accessible to women in marginalized periurban areas poses a public health problem. Many women do not utilize institutional care in spite of physical accessibility. Home-based care by traditional birth attendants (TBA is hazardous. Inappropriate early neonatal feeding practices are common. Many barriers to perinatal care can be overcome by social mobilization and capacity building at the community level. Objectives: To determine the existing perinatal practices in an urban slum and to identify barriers to utilization of health services by mothers. Study Design: This is a cross-sectional descriptive study. Setting and Participants: The high-risk periurban areas of Nabi Nagar, Aligarh has a population of 40,000 living in 5,480 households. Mothers delivering babies in September 2007 were identified from records of social mobilization workers (Community Mobilization Coordinators or CMCs already working in an NGO in the area. A total of 92 mothers were interviewed at home. Current perinatal practices and reasons for utilizing or not utilizing health services were the topics of inquiry. Statistical Analysis: Data was tabulated and analyzed using SPSS 12. Results: Analyses revealed that 80.4% of mothers had received antenatal care. However, this did not translate into safe delivery practices as more than 60% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (41.9% or related to economics (30.7%. A total of 56% of the deliveries were conducted in the squatting position and in 25% of the cases, the umbilical cord was cut using the edge of a broken cup. Although breast-feeding was universal, inappropriate early neonatal feeding practices were common. Prelacteal feeds were given to nearly 50% of the babies and feeding was delayed beyond 24 hours in 8% of the cases. Several mothers had breastfeeding problems

  9. Maternal care receptivity and its relation to perinatal and neonatal mortality. A rural study.

    Science.gov (United States)

    Bhardwaj, N; Hasan, S B; Zaheer, M

    1995-04-01

    A longitudinal study was conducted on 212 pregnant women from May 1987 to April 1988. Maternal Care Receptivity (MCR) "an innovative approach" was adopted for the assessment of maternal care services provided to pregnant mothers at their door steps. During follow-up, scores were allotted to each of the services rendered and antenatal status of pregnant women. Depending on the score--MCR was classified as high (11 to 8), moderate (7 to 4) or poor (3 to 0). Perinatal and neonatal deaths were recorded and an inverse relationship between MCR and perinatal and mortalities was observed (z = 5.46, p women with high MCR. One of the most important cause of high PNMR and neonatal mortality rate in developing countries is poor MCR, i.e., under utilization of even the existing maternal health services. The main reasons for this under utilization appear to be poverty, illiteracy, ignorance and lack of faith in modern medicine.

  10. Monitoring of services with non-relational databases and map-reduce framework

    CERN Document Server

    Babik, M; CERN. Geneva. IT Department

    2012-01-01

    Service Availability Monitoring (SAM) is a well-established monitoring framework that performs regular measurements of the core site services and reports the corresponding availability and reliability of the Worldwide LHC Computing Grid (WLCG) infrastructure. One of the existing extensions of SAM is Site Wide Area Testing (SWAT), which gathers monitoring information from the worker nodes via instrumented jobs. This generates quite a lot of monitoring data to process, as there are several data points for every job and several million jobs are executed every day. The recent uptake of non-relational databases opens a new paradigm in the large-scale storage and distributed processing of systems with heavy read-write workloads. For SAM this brings new possibilities to improve its model, from performing aggregation of measurements to storing raw data and subsequent re-processing. Both SAM and SWAT are currently tuned to run at top performance, reaching some of the limits in storage and processing power of their exi...

  11. Effect of revised IOM weight gain guidelines on perinatal outcomes.

    Science.gov (United States)

    Halloran, Donna R; Wall, Terry C; Guild, Camelia; Caughey, Aaron B

    2011-03-01

    We sought to examine perinatal outcomes in women with a body mass index (BMI) of 25 kg/m(2) comparing those whose weight gain met 2009 IOM guidelines to women meeting 1990 IOM guidelines. This is a retrospective cohort study utilizing birth records linked to hospital discharge data for all term, singleton infants born to overweight, Missouri residents (2000-2006) with a BMI of 25 kg/m(2). We excluded congenital anomalies, mothers with diabetes, hypertension, or previous cesarean delivery. Fourteen thousand nine hundred fifty-five women gained 25-35 lbs (1990 guidelines); 1.6% delivered low birth weight (LBW) infants and 1.1% delivered macrosomic infants. Eight thousand three hundred fifty women gained 15-25 lbs (2009 guidelines); 3.4% delivered LBW infants and 0.6% delivered macrosomic infants. Women who gained 15-25 lbs were 1.99 (95% CI 1.67, 2.38) times more likely to have a LBW infant and 0.59 (95% CI 0.40, 0.76) times less likely to deliver a macrosomic infant. Limiting weight gain in women with a BMI of 25 kg/m(2), per the 2009 guidelines, increases the risk of LBW deliveries and decreases the risk of macrosomia but does not reduce associated adverse perinatal outcomes. Further studies should explore the optimal weight gain to reduce these outcomes.

  12. Gestational, perinatal and family findings of patients with Patau syndrome

    Directory of Open Access Journals (Sweden)

    Rafael Fabiano M. Rosa

    2013-12-01

    Full Text Available OBJECTIVE: To describe gestational, perinatal and family findings of patients with Patau syndrome (PS. METHODS: The study enrolled patients with PS consecutively evaluated during 38 years in a Clinical Genetics Service of a pediatric referral hospital in Southern Brazil. The clinical data and the results of cytogenetic analysis were collected from the medical records. For statistical analysis, the two-tailed Fisher's exact test and the chi-square test with Yates' correction were used, being significant p<0.05. RESULTS: The sample was composed of 27 patients, 63% were male, with a median age of nine days at the first evaluation. Full trisomy of chromosome 13 was the main cytogenetic finding (74%. Only six patients were submitted to obstetric ultrasound and none had prenatal diagnosis of PS. The patients' demographic characteristics, compared to born alive infants in the same Brazilian state showed a higher frequency of: mothers with 35 years old or more (37.5%; multiparous mothers (92.6%; vaginal delivery (77%; preterm birth (34.6%; birth weight <2500g (33.3%, and Apgar scores <7 in the 1st (75% and in the 5th minute (42.9%. About half of them (53% died during the first month of life. CONCLUSIONS: The understanding of the PS patients' gestational, perinatal and family findings has important implications, especially on the decision about the actions to be taken in relation to the management of these patients.

  13. Children and young people with perinatal HIV in Europe

    DEFF Research Database (Denmark)

    Grarup, Jesper; Kirk, Ole; Lundgren, Jens

    2016-01-01

    undertook an online survey of HIV cohort studies participating in the EuroCoord Network of Excellence to ascertain the number of perinatally HIV-infected (pHIV) patients included, to compare it with those published by the European Centre for Disease Prevention and Control (ECDC) and the World Health......Accurate ascertainment of the number of children living with human immunodeficiency virus (HIV) is important to plan paediatric and adolescent health services. In Europe, the first generation of perinatally HIV-infected survivors are transferring to adult care and their health needs are unknown. We...... Organization (WHO) and to assess the ability of countries to follow up pHIV patients after transfer to adult care. At the end of 2013, 16 countries in EuroCoord reported 8,229 pHIV patients in follow-up in cohorts, compared with 5,160 cumulative diagnoses reported by the ECDC in the same area. Follow-up of pHIV...

  14. The Effectiveness of Mindfulness-Based Interventions on Maternal Perinatal Mental Health Outcomes: a Systematic Review.

    Science.gov (United States)

    Shi, Zhenrong; MacBeth, Angus

    2017-01-01

    Presenting with common mental health difficulties, particularly depression and anxiety, there is also preliminary evidence that mindfulness-based interventions (MBIs) including mindfulness-based cognitive therapy (MBCT), mindfulness-based stress reduction (MBSR) and integrated mindfulness yoga practices may also be effective in reducing common mental health difficulties during pregnancy. We systematically reviewed and synthesized the current literature on the effectiveness of MBIs in reducing severity of perinatal anxiety and depression. Databases including PubMed, Cochrane Library, IndMED and PsychoInfo were searched for relevant studies. Manual searches were conducted in relevant articles and Google Scholar. Seventeen cohorts representing 18 studies were included. Pre-post effect sizes were reported for both treatment and control groups. Seven randomized controlled trials (RCTs), two non-randomized controlled trials and nine treatment evaluations were included. Maternal participation in an MBI was associated with reductions in perinatal anxiety of moderate to large magnitude. Results for the effect of MBIs on depression were less consistent, with pre-post treatment reductions of moderate magnitude, but no significant differences in depression scores when MBI was compared with a control group. There was some evidence that MBIs were associated with increased mindfulness. Risk of bias in studies was variable. Our review offers preliminary evidence for the effectiveness of MBIs in reducing perinatal anxiety, with more equivocal findings with regard to perinatal depressive symptoms. Further methodologically rigorous evaluation using RCTs and longer follow-up periods are recommended.

  15. Cash for carbon: A randomized trial of payments for ecosystem services to reduce deforestation.

    Science.gov (United States)

    Jayachandran, Seema; de Laat, Joost; Lambin, Eric F; Stanton, Charlotte Y; Audy, Robin; Thomas, Nancy E

    2017-07-21

    We evaluated a program of payments for ecosystem services in Uganda that offered forest-owning households annual payments of 70,000 Ugandan shillings per hectare if they conserved their forest. The program was implemented as a randomized controlled trial in 121 villages, 60 of which received the program for 2 years. The primary outcome was the change in land area covered by trees, measured by classifying high-resolution satellite imagery. We found that tree cover declined by 4.2% during the study period in treatment villages, compared to 9.1% in control villages. We found no evidence that enrollees shifted their deforestation to nearby land. We valued the delayed carbon dioxide emissions and found that this program benefit is 2.4 times as large as the program costs. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

  16. La mortalidad perinatal según 2 fuentes de información Perinatal mortality according to 2 information sources

    Directory of Open Access Journals (Sweden)

    Adriana Freitas Ramírez

    2008-08-01

    Full Text Available Objetivo: Evaluar la diferencia en muertes perinatales (MP ocurridas en Cataluña y su evolución según 2 fuentes de información sanitaria. Métodos: Los datos proceden de la estadística de mortalidad (Departament de Salut e Institut d'Estadística de Catalunya y del Conjunto Mínimo Básico de Datos de Altas Hospitalarias (CMBDAH del Servei Català de la Salut del período 2000-2003. Se describen las frecuencias totales de MP según si cumplen o no criterio legal de declaración. Resultados: La estadística de mortalidad registró un 27,2% menos de MP, un 44,77% menos de muertes fetales y un 13,5% más de muertes neonatales precoces que el CMBDAH. Estos porcentajes son menores considerando sólo los casos con criterios legales de declaración. Conclusión: Las diferencias de casos entre ambas fuentes están relacionadas con características del recién nacido: bajo peso al nacer, prematuridad y lugar en que se produjo. Los datos hospitalarios podrían mejorar la estadística de mortalidad perinatal.Objective: To evaluate differences in the number of cases of perinatal mortality in Catalonia (Spain recorded in 2 health information systems, as well as trends in this phenomenon. Methods: Data were obtained from the mortality statistics (Health Department and the Catalan Institute of Statistics and the minimum data set (MDS for hospital discharges of the Catalan Health Service from 2000-2003. The frequencies are given for the cases reported and for cases following the legal criteria for reporting. Results: The mortality statistics registered 27.2% fewer perinatal deaths, 44.77% fewer fetal deaths and 13.5% more early neonatal deaths than the MDS. These percentages were lower when only the cases following the legal criteria for reporting were considered. Conclusion: The differences between the two sources were related to low birth weight, prematurity, and the place of occurrence. Use of hospital data might improve the quality of perinatal

  17. [Studies on flomoxef in the perinatal period].

    Science.gov (United States)

    Cho, N; Fukunaga, K; Kunii, K; Kobayashi, I

    1991-06-01

    Pharmacokinetic, bacteriological and clinical studies on flomoxef (FMOX) in the perinatal period were carried out with the following summary of the results. Antibacterial effects of FMOX on the growth of methicillin-resistant Staphylococcus aureus (MRSA, MIC 400 micrograms/ml), methicillin-sensitive S. aureus (MSSA, MIC 0.78 microgram/ml), Escherichia coli (MIC 3.13 micrograms/ml and MIC 0.20 microgram/ml) in amniotic fluid were determined and it was found that the activity of FMOX was enhanced in the amniotic fluid. FMOX rapidly penetrated into tissues and sera of pregnant women upon intravenous injection and its maternal serum concentrations reached their peak levels shortly after administration. Placental penetration of FMOX to the fetus was good and, after single intravenous injection of 1 g, the concentrations of FMOX in the umbilical cord serum and amniotic fluid exceeded MICs against major causative organisms of perinatal infections. These results indicate that single intravenous injection of FMOX 1 g twice a day is effective for the treatment and prophylaxis of perinatal infections. Injection of FMOX for the treatment of 14 cases of puerperal infections showed excellent clinical effectiveness with 100% clinical effect and 81.8% bacteriological response. No side-effect was observed in any case. All of these results suggested clinical usefulness of FMOX in the perinatal period.

  18. Maternal and Perinatal Outcomes among Eclamptic Patients ...

    African Journals Online (AJOL)

    , pulmonary oedema (10.5%), maternal stroke (8.8%), HELLP syndrome (50.9%), and Disseminated Intravascular Coagulopathy (3.5%). Perinatal deaths were caused by prematurity (42.9%) and birth asphyxia (57.1%). Forty-eight babies had ...

  19. Teenage Pregnancy and Perinatal Outcomes: Experience from ...

    African Journals Online (AJOL)

    Context: Teenage pregnancy is known as a risk factor for preterm birth, low birth weight and perinatal deaths, thus considered public health problem. In South Africa, most teenage pregnancy is found within the context of unstable relationship and unplanned or unwanted pregnancies. A high rate of teenage pregnancy is ...

  20. Relationship between maternal hemoglobin and perinatal outcome

    International Nuclear Information System (INIS)

    Bakhtiar, U.J.; Khan, Y.; Nisar, R.

    2007-01-01

    To Study the Relationship between Maternal Hemoglobin and Perinatal outcome in a cohort of 860 pregnant women and to highlight the importance of antenatal care regarding maternal health and fetal outcome. All Singleton pregnancies delivering at Pakistan Railway Hospital Rawalpindi from January 2004 to December 2005 that fulfilled the required criteria were included. Out of the 860 patients, 402 were anemic (<11gm/dl) and 458 were non anemic. Perinatal outcome included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low apgr scores and intrauterine fetal deaths. Risk of preterm and Low birth weight among anemic women was 3.4 and 1.8 times more than non anaemic women. The neonates of anemic woman also had 1.7 times increased risk of having low apgr scores at 1 min. Among anemic women there was 2.2 times greater risk of intrauterine fetal death than the non-anemic women. Regular antenatal care from first trimester has a vital role in assessing and managing maternal anemia timely and it directly affects the perinatal outcome. The patients with anemia have also higher risk of having low birth weight, preterm births and intra uterine fetal death. (author)

  1. Perinatal Outcomes after Assisted Reproductive Technology

    Directory of Open Access Journals (Sweden)

    Setenay Arzu Yilmaz

    2014-08-01

    The aim of this review is to summarize perinatal outcomes and the congenital anomaly risk of IVF pregnancies and also examine the risks of different technologies including ICSI, blastocyst culture, and cryopreservation on this topic. [Archives Medical Review Journal 2014; 23(4.000: 575-586

  2. Ethical issues in perinatal mental health research.

    Science.gov (United States)

    Brandon, Anna R; Shivakumar, Geetha; Lee, Simon Craddock; Inrig, Stephen J; Sadler, John Z

    2009-11-01

    To review the background of current ethical standards for the conduct of perinatal mental health research and describe the ethical challenges in this research domain. Current literature reflects a growing sentiment in the scientific community that having no information regarding the impact of psychiatric treatment on the mother and developing fetus/infant poses dangers that may exceed the risks involved in research. However, without sufficient consensus across the scientific community, both regulatory bodies and perinatal researchers find themselves without a framework for decision making that satisfactorily limits the risks and facilitates the benefits of participation of pregnant and lactating women in clinical research. Psychiatric research in perinatal mental health is critically important as it enables clinicians and patients to participate in informed decision-making concerning treatment for psychiatric disorders. Specific areas of concern include fetal safety, maternal risk, the therapeutic misconception, commercial interests, forensic/legal issues, the informed consent process, and study design. Developing guidelines that address ethical challenges and include the views and concerns of multiple stakeholders could improve the access of perinatal women to the benefits of participation in mental health research in addition to providing evidence-based mental healthcare for this subpopulation.

  3. Does "Enhanced Support" for Offenders Effectively Reduce Custodial Violence and Disruption? An Evaluation of the Enhanced Support Service Pilot.

    Science.gov (United States)

    Camp, Jake; Joy, Kerry; Freestone, Mark

    2018-01-01

    This study aimed to examine the effectiveness of The Enhanced Support Service (ESS) pilot in reducing custodial violence and disruption, and the associated costs, by observing the behavioural change of the 35 service users who participated in ESS intervention within its first 22 months of operation. Frequencies of recorded incidents of aggressive behaviours, self-harming behaviours, noncompliance, and positive behaviours were counted from routine administrative systems using a coding structure developed in previous studies. The count data were analysed using nonparametric tests and Poisson regression models to derive an Incident Rate Ratio (IRR). Findings suggest the ESS is associated with a reduction in aggressive behaviours and noncompliance, with medium to large effect sizes ( r = .31-.53); however, it was not associated with a reduction in deliberate self-harm or increased positive behaviours. The Poisson models revealed that levels of pre-intervention behaviour, intervention length, intervention completion, and service location had varying effects on postintervention behaviour, with those who completed intervention demonstrating more favourable outcomes. The ESS service model was associated with a reduction in behaviour that challenges, which has implications for the reduction in associated social, economic, and political costs-as well as the commissioning of interventions and future research in this area.

  4. Perinatal mortality in eastern Uganda: a community based prospective cohort study.

    Science.gov (United States)

    Nankabirwa, Victoria; Tumwine, James K; Tylleskär, Thorkild; Nankunda, Jolly; Sommerfelt, Halvor

    2011-05-09

    To achieve a child mortality reduction according to millennium development goal 4, it is necessary to considerably reduce neonatal mortality. We report stillbirth and early neonatal mortality risks as well as determinants of perinatal mortality in Eastern Uganda. A community-based prospective cohort study was conducted between 2006 and 2008. A total of 835 pregnant women were followed up for pregnancy outcome and survival of their children until 7 days after delivery. Mother's residence, age, parity, bed net use and whether delivery took place at home were included in multivariable regression analyses to identify risk factors for perinatal death. The stillbirth risk was 19 per 1,000 pregnancies and the early neonatal death risk 22 per 1,000 live births. Overall, the perinatal mortality risk was 41 [95%CI: 27, 54] per 1,000 pregnancies. Of the deaths, 47% followed complicated deliveries and 24% preterm births. Perinatal mortality was 63/1,000 pregnancies among teenage mothers, 76/1,000 pregnancies among nulliparous women and 61/1,000 pregnancies among women delivering at home who, after controlling for potential confounders, had a 3.7 (95%CI: 1.8, 7.4) times higher perinatal mortality than women who gave birth in a health facility. This association was considerably stronger among nulliparous women [RR 8.0 (95%CI: 2.9, 21.6)] than among women with a previous live birth [RR 1.8 (95%CI: 0.7, 4.5)]. All perinatal deaths occurred among women who did not sleep under a mosquito net. Women living in urban slums had a higher risk of losing their babies than those in rural areas [RR: 2.7 (95%CI: 1.4, 5.3)]. Our findings strengthen arguments for ensuring that pregnant women have access to and use adequate delivery facilities and bed nets.

  5. Analysis of Health Facility Based Perinatal Verbal Autopsy of Electoral Constituency 2 of Arghakhanchi District, Nepal.

    Science.gov (United States)

    Manandhar, S R; Manandhar, D S; Adhikari, D; Shrestha, J; Rai, C; Rana, H; Paudel, M

    2015-01-01

    Verbal autopsy is a method to diagnose possible cause of death by analyzing factors associated with death through detailed questioning. This study is a part of the operational research program in electoral constituency no. 2 (EC 2) of Arghakhanchi district by MIRA and HealthRight International. Two day essential newborn care training followed by one day perinatal verbal autopsy training and later one day refresher verbal autopsy training was given for health staff of EC 2 of Arghakhanchi district in two groups. Stillbirths of >22wks or > 500 gms and Early neonatal deaths (newborns died within7 days of life) were included in this study. The Nepal Government approved verbal autopsy forms were used for performing autopsies. Perinatal deaths were classified according to Wigglesworth's Classification. Causes of Perinatal deaths were analyzed. Data were analyzed in the form of frequencies and tabulation in SPSS 16 . There were 41 cases of perinatal deaths (PND) were identified. Among them, 37 PNDs were from Arghakhanchi district hospital, 2 PNDs from Thada PHC, and one PND each from Subarnakhal and Pokharathok HPs. Among the 41 PNDs, 26 were stillbirths (SB) and 15 were early neonatal deaths (ENND). The perinatal mortality rate (PMR) of Arghakhanchi district hospital was 32.2 per 1,000 births and neonatal mortality rate (NMR) was 9.8 per 1,000 live births. Out of 26 stillbirths, 54% (14) were fresh SBs and 46% (12) were macerated stillbirths. The most common cause of stillbirth was obstetric complications (47%) where as birth asphyxia (53%) was the commonest cause of ENND. According to Wigglesworth's classification of perinatal deaths, Group IV (40%) was the commonest cause in the health facilities. Obstetric complication was the commonest cause of stillbirth and birth asphyxia was the commonest cause of early neonatal death. This study highlighted the need for regular antenatal check-ups and proper intrapartum fetal monitoring with timely and appropriate intervention to

  6. Perinatal mortality in eastern Uganda: a community based prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Victoria Nankabirwa

    2011-05-01

    Full Text Available To achieve a child mortality reduction according to millennium development goal 4, it is necessary to considerably reduce neonatal mortality. We report stillbirth and early neonatal mortality risks as well as determinants of perinatal mortality in Eastern Uganda.A community-based prospective cohort study was conducted between 2006 and 2008. A total of 835 pregnant women were followed up for pregnancy outcome and survival of their children until 7 days after delivery. Mother's residence, age, parity, bed net use and whether delivery took place at home were included in multivariable regression analyses to identify risk factors for perinatal death.The stillbirth risk was 19 per 1,000 pregnancies and the early neonatal death risk 22 per 1,000 live births. Overall, the perinatal mortality risk was 41 [95%CI: 27, 54] per 1,000 pregnancies. Of the deaths, 47% followed complicated deliveries and 24% preterm births. Perinatal mortality was 63/1,000 pregnancies among teenage mothers, 76/1,000 pregnancies among nulliparous women and 61/1,000 pregnancies among women delivering at home who, after controlling for potential confounders, had a 3.7 (95%CI: 1.8, 7.4 times higher perinatal mortality than women who gave birth in a health facility. This association was considerably stronger among nulliparous women [RR 8.0 (95%CI: 2.9, 21.6] than among women with a previous live birth [RR 1.8 (95%CI: 0.7, 4.5]. All perinatal deaths occurred among women who did not sleep under a mosquito net. Women living in urban slums had a higher risk of losing their babies than those in rural areas [RR: 2.7 (95%CI: 1.4, 5.3].Our findings strengthen arguments for ensuring that pregnant women have access to and use adequate delivery facilities and bed nets.

  7. Enabling big geoscience data analytics with a cloud-based, MapReduce-enabled and service-oriented workflow framework.

    Science.gov (United States)

    Li, Zhenlong; Yang, Chaowei; Jin, Baoxuan; Yu, Manzhu; Liu, Kai; Sun, Min; Zhan, Matthew

    2015-01-01

    Geoscience observations and model simulations are generating vast amounts of multi-dimensional data. Effectively analyzing these data are essential for geoscience studies. However, the tasks are challenging for geoscientists because processing the massive amount of data is both computing and data intensive in that data analytics requires complex procedures and multiple tools. To tackle these challenges, a scientific workflow framework is proposed for big geoscience data analytics. In this framework techniques are proposed by leveraging cloud computing, MapReduce, and Service Oriented Architecture (SOA). Specifically, HBase is adopted for storing and managing big geoscience data across distributed computers. MapReduce-based algorithm framework is developed to support parallel processing of geoscience data. And service-oriented workflow architecture is built for supporting on-demand complex data analytics in the cloud environment. A proof-of-concept prototype tests the performance of the framework. Results show that this innovative framework significantly improves the efficiency of big geoscience data analytics by reducing the data processing time as well as simplifying data analytical procedures for geoscientists.

  8. Enabling big geoscience data analytics with a cloud-based, MapReduce-enabled and service-oriented workflow framework.

    Directory of Open Access Journals (Sweden)

    Zhenlong Li

    Full Text Available Geoscience observations and model simulations are generating vast amounts of multi-dimensional data. Effectively analyzing these data are essential for geoscience studies. However, the tasks are challenging for geoscientists because processing the massive amount of data is both computing and data intensive in that data analytics requires complex procedures and multiple tools. To tackle these challenges, a scientific workflow framework is proposed for big geoscience data analytics. In this framework techniques are proposed by leveraging cloud computing, MapReduce, and Service Oriented Architecture (SOA. Specifically, HBase is adopted for storing and managing big geoscience data across distributed computers. MapReduce-based algorithm framework is developed to support parallel processing of geoscience data. And service-oriented workflow architecture is built for supporting on-demand complex data analytics in the cloud environment. A proof-of-concept prototype tests the performance of the framework. Results show that this innovative framework significantly improves the efficiency of big geoscience data analytics by reducing the data processing time as well as simplifying data analytical procedures for geoscientists.

  9. Enabling Big Geoscience Data Analytics with a Cloud-Based, MapReduce-Enabled and Service-Oriented Workflow Framework

    Science.gov (United States)

    Li, Zhenlong; Yang, Chaowei; Jin, Baoxuan; Yu, Manzhu; Liu, Kai; Sun, Min; Zhan, Matthew

    2015-01-01

    Geoscience observations and model simulations are generating vast amounts of multi-dimensional data. Effectively analyzing these data are essential for geoscience studies. However, the tasks are challenging for geoscientists because processing the massive amount of data is both computing and data intensive in that data analytics requires complex procedures and multiple tools. To tackle these challenges, a scientific workflow framework is proposed for big geoscience data analytics. In this framework techniques are proposed by leveraging cloud computing, MapReduce, and Service Oriented Architecture (SOA). Specifically, HBase is adopted for storing and managing big geoscience data across distributed computers. MapReduce-based algorithm framework is developed to support parallel processing of geoscience data. And service-oriented workflow architecture is built for supporting on-demand complex data analytics in the cloud environment. A proof-of-concept prototype tests the performance of the framework. Results show that this innovative framework significantly improves the efficiency of big geoscience data analytics by reducing the data processing time as well as simplifying data analytical procedures for geoscientists. PMID:25742012

  10. [Can implementation of intensified perinatal survey be effective in improving the quality of perinatal care?].

    Science.gov (United States)

    Troszyński, Michał

    2010-01-01

    Intensive scientific research and rapid technical progress have influenced the rapid fall in term newborn mortality. At the same time new problems have arisen such as saving the lives of infants with low and very low birth weight. Solving these problems needs reorganization of perinatal care, better equipment, especially in reference units and in outpatient clinics, as well as more intensive staff training. to obtain information whether implementation of intensified perinatal survey of fetus and newborn mortality can improve the quality of perinatal care in Poland. Implementation of the survey based on Central Statistics Office (GUS) data, Ministry of Health MZ-29 section X Document and the author's own studies. In the year 2008 newborn with birth weight less than 2500 g, constituted 6,06% liveborn infants, newborn weighing from 1000 to 2499 g - 5%, those with weight from 500 to 999 g - 0.51% of all live born infants. These figures differ according to voivodeship. The intensive survey concerning birth weight and perinatal mortality indeces in voivodeshipPoland, as well as in individual voivodeships, showed differences between data from the Central Statistics Office and data from the Ministry of Health MZ-29 document. This may be due to different methods of registrating newborn deaths eg. newborns transfered in the first weekoflife from the maternity ward to intensive care neonatal ward or to other specialistic departaments. Another reason for the difference may be discharge of the newborn data according to the place of birth or the mother's place of permanent domicile registration. This causes disturbances in flow of infomation resulting in ineffective analysis of perinatal mortality and of perinatal care evaluation. In the ongoing analysis it was found that in Poland stillbirths occur twice as often as perinatal deaths (4.3 per thousands) stillbirths and 2.15 per thousands perinatal deaths), with significant differences between voivodeships. This makes it

  11. KEMATIAN PERINATAL HUBUNGANNYA DENGAN FAKTOR PRAKTIK KESEHATAN IBU SELAMA KEHAMILAN DI KOTA BEKASI TAHUN 2001

    Directory of Open Access Journals (Sweden)

    Ning Sulistiyowati

    2012-11-01

    Full Text Available Infants mortality rate is one of the sensitive indicators to evaluate health level of a country. However Perinatal Mortality Rate (PMR as part of infant mortality rate did not show any decline in the last ten period. The National Household Survey 1995 reported that PMR was within 48 per 1000 life births. Mother and Child Health program had promoted intensive antenatal health care to cover all pregnancies. The purpose of this program is to improve early detection of high risk pregnancies as well as to increase coverage of postnatal care of new borns. Perinatal mortality is influenced by several maternal health service, (antenatal care and delivery assistance, maternal health status, social-economic and environmental background, and traditional behavior. The objective of this analysis is to find the relation between maternal health practice during pregnancy and perinatal mortality in city of Bekasi 2001. Mother's age at delivery, educational level, parity, birth interval, smoking habit, pregnancy complication, and sex of the new born were calculated as covariates. Using case-control method, cases are mothers with perinatal deaths, and control are mothers with 7 days surviving new borns (83 case and 83 control. Based on a statistical analysis with logistic regression test the maternal health practice during pregnancy showed no significant relationship with perinatal mortality. Controlling birth interval, pregnancy complications and mother's ageat delivery, the odds ratio was OR = 2,3 (confidence interval 0,89 - 3,99 with p = 0,029 at 95% probability;, which is not significant. This result may be caused by small sample size or poor quality health service.

  12. Caring too much? Lack of public services to older people reduces attendance at work among their children.

    Science.gov (United States)

    Gautun, Heidi; Bratt, Christopher

    2017-06-01

    The need to provide care for older people can put a strain on their adult children, potentially interfering with their work attendance. We tested the hypothesis that public care for older people (nursing homes or home care services) would moderate the association between having an older parent in need of care and reduced work attendance among the adult children. The analysis used data from a survey of Norwegian employees aged 45-65 ( N  = 529). Institutional care for older people in need of care (i.e. nursing homes) was associated with improved work attendance among their children-their daughters in particular. Data also indicated a moderating effect: the link between the parents' reduced health and reduced work attendance among the children was weaker if the parent lived in a nursing home. However, the results were very different for home-based care: data indicated no positive effects on adult children's work attendance when parents received non-institutionalised care of this kind. Overall, the results suggest that extending public care service to older people can improve their children's ability to combine work with care for parents. However, this effect seems to require the high level of care commonly provided by nursing homes. Thus, the current trend towards de-institutionalising care in Europe (and Norway in particular) might hamper work attendance among care-giving adult children, women in particular. Home care services to older people probably need to be extended if they are intended as a real alternative to institutional care.

  13. Improving communication at handover and transfer reduces retained swabs in maternity services.

    Science.gov (United States)

    Lean, Katie; Page, Bethan F; Vincent, Charles

    2018-01-01

    To reduce the incidence of retained vaginal swabs and near misses. A review of previous retained swab incidents and near misses in a large maternity unit identified handovers and transfers as a key point of vulnerability. Interventions were introduced to improve communication at handover from the delivery suite to theatre and from theatre to the high dependency unit. Process data was collected to monitor compliance. The outcome measures were the incidence of retained swab never events and the incidence of near misses. Chi-squared analysis was used to test the significance of the results. For transfers from delivery suite to theatre, verbal handover significantly increased from 28.8% to 75.6% (ptransfers to theatre post-intervention: in 88 (30.2%) of these transfers a vaginal swab was already in situ. In 70/88 (79.5%) of cases the presence of the swab was communicated to theatre staff in three ways (verbally, written and transfer of opened swab packets) according to the new policy. In the post-intervention period there were 56 women transferred from theatre to the high-dependency unit with a vaginal pack in situ: 52 (92.9%) of these women had a sticker in place serving as a constant reminder of the presence of the vaginal pack to staff. Following a baseline of four near misses in two months, there has been only one near miss in the 15 months since the interventions were implemented, (33.3% vs. 1.1%, pcommunication at handover and transfer can reduce the incidence of retained vaginal swabs and near misses. Further work is needed to raise the profile of swab counting in maternity settings: swab counting needs to be the responsibility of all disciplines, not just the responsibility of theatre staff. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  14. "Anything above marijuana takes priority": Obstetric providers' attitudes and counseling strategies regarding perinatal marijuana use.

    Science.gov (United States)

    Holland, Cynthia L; Nkumsah, Michelle Abena; Morrison, Penelope; Tarr, Jill A; Rubio, Doris; Rodriguez, Keri L; Kraemer, Kevin L; Day, Nancy; Arnold, Robert M; Chang, Judy C

    2016-09-01

    To describe obstetric provider attitudes, beliefs, approaches, concerns, and needs about addressing perinatal marijuana use with their pregnant patients. We conducted individual semi-structured interviews with obstetric providers and asked them to describe their thoughts and experiences about addressing perinatal marijuana use. Interviews were transcribed verbatim, coded and reviewed to identify themes. Fifty-one providers participated in semi-structured interviews. Providers admitted they were not familiar with identified risks of marijuana use during pregnancy, they perceived marijuana was not as dangerous as other illicit drugs, and they believed patients did not view marijuana as a drug. Most provider counseling strategies focused on marijuana's status as an illegal drug and the risk of child protective services being contacted if patients tested positive at time of delivery. When counseling about perinatal marijuana use, obstetric providers focus more on legal issues than on health risks. They describe needing more information regarding medical consequences of marijuana use during pregnancy. Provider training should include information about potential consequences of perinatal marijuana use and address ways to improve obstetric providers' counseling. Future studies should assess changes in providers' attitudes as more states consider the legalization of marijuana. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Perinatal phencyclidine administration decreases the density of cortical interneurons and increases the expression of neuregulin-1.

    Science.gov (United States)

    Radonjić, Nevena V; Jakovcevski, Igor; Bumbaširević, Vladimir; Petronijević, Nataša D

    2013-06-01

    Perinatal phencyclidine (PCP) administration in rat blocks the N-methyl D-aspartate receptor (NMDAR) and causes symptoms reminiscent of schizophrenia in human. A growing body of evidence suggests that alterations in γ-aminobutyric acid (GABA) interneuron neurotransmission may be associated with schizophrenia. Neuregulin-1 (NRG-1) is a trophic factor important for neurodevelopment, synaptic plasticity, and wiring of GABA circuits. The aim of this study was to determine the long-term effects of perinatal PCP administration on the projection and local circuit neurons and NRG-1 expression in the cortex and hippocampus. Rats were treated on postnatal day 2 (P2), P6, P9, and P12 with either PCP (10 mg/kg) or saline. Morphological studies and determination of NRG-1 expression were performed at P70. We demonstrate reduced densities of principal neurons in the CA3 and dentate gyrus (DG) subregions of the hippocampus and a reduction of major interneuronal populations in all cortical and hippocampal regions studied in PCP-treated rats compared with controls. For the first time, we show the reduced density of reelin- and somatostatin-positive cells in the cortex and hippocampus of animals perinatally treated with PCP. Furthermore, an increase in the numbers of perisomatic inhibitory terminals around the principal cells was observed in the motor cortex and DG. We also show that perinatal PCP administration leads to an increased NRG-1 expression in the cortex and hippocampus. Taken together, our findings demonstrate that perinatal PCP administration increases NRG-1 expression and reduces the number of projecting and local circuit neurons, revealing complex consequences of NMDAR blockade.

  16. The role of the Veterinary services in efforts to introduce measures to reduce harmful effects of the Chernobyl fallout

    International Nuclear Information System (INIS)

    Brynildsen, L.I.; Sandvik, O.; Ormstad, I.

    1995-01-01

    Apart from the former Sovjet Union, Norway was the country most widely and severely affected by the impact of radioactive fallout (137Cs+134Cs) from the Chernobyl nuclear reactor accident in April 1986. The fallout created considerable problems for sheep, goats and cattle grazing mountain pastures, and also for reindeer farming. Effective countermeasures, inter alia pre-slaughter feeding of livestock on uncountaminated fodder, and the use of caesium binders, had to be introduced. Further new methods to measure levels of radioactive caesium in live animals had to be developed, in order to alleviate the adverse effects on livestock and the human population. The veterinary services were, like other authorities involved, poorly prepared for this type of emergency. The Official Meat Inspection Acts and regulations and instructions issued in its pursuance, places the responsibility for protecting the public from hazards posed by contaminants in meat on the veterinary services. The veterinary authorities were therefore deeply involved in the development, management and implemention of measures to ensure that radioactivity levels in meat did not exceed official intervention levels. In this work, the veterinary services and individual veterinarians, benefitted from previous experience and training in contingency planning and tackling emergencies and were able to apply similar principles as these used to deal with emergency situations in the veterinary field, for example, outbreaks of serious infectious animal diseases. Efforts to reduce the detrimental impact of the Chernobyl radioactive fallout on agriculture and reindeer farming have been prolonged and comprehensive. So far, it seems fair to say that the veterinary services have born their share of responsibility and tackled the task to salvage as much meat as possible, in a reliable and economically justifiable manner

  17. Cultural processes in psychotherapy for perinatal loss: Breaking the cultural taboo against perinatal grief.

    Science.gov (United States)

    Markin, Rayna D; Zilcha-Mano, Sigal

    2018-03-01

    This paper argues that there is a cultural taboo against the public recognition and expression of perinatal grief that hinders parents' ability to mourn and their psychological adjustment following a loss. It is proposed that this cultural taboo is recreated within the therapy relationship, as feelings of grief over a perinatal loss are minimized or avoided by the therapist and parent or patient. Importantly, it is suggested that if these cultural dynamics are recognized within the therapy relationship, then psychotherapy has the immense opportunity to break the taboo by validating the parent's loss as real and helping the parent to mourn within an empathic and affect-regulating relationship. Specifically, it is suggested that therapists break the cultural taboo against perinatal grief and help parents to mourn through: acknowledging and not pathologizing perinatal grief reactions, considering intrapsychic and cultural factors that impact a parent's response to loss, exploring cultural reenactments within the therapy relationship, empathizing with the parent's experience of loss and of having to grieve within a society that does not recognize perinatal loss, coregulating the parent's feelings of grief and loss, and helping patients to create personally meaningful mourning rituals. Lastly, the impact of within and between cultural differences and therapist attitudes on the therapy process is discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  18. Perinatal Yellow Fever: A Case Report.

    Science.gov (United States)

    Diniz, Lilian Martins Oliveira; Romanelli, Roberta Maia Castro; de Carvalho, Andréa Lucchesi; Teixeira, Daniela Caldas; de Carvalho, Luis Fernando Andrade; Cury, Verônica Ferreira; Filho, Marcelo Pereira Lima; Perígolo, Graciele; Heringer, Tiago Pires

    2018-04-09

    An outbreak of yellow fever in Brazil made it possible to assess different presentations of disease such as perinatal transmission. A pregnant woman was admitted to hospital with yellow fever symptoms. She was submitted to cesarean section and died due to fulminant hepatitis. On the 6th day the newborn developed liver failure and died 13 days later. Yellow fever PCR was positive for both.

  19. Obstetric and perinatal outcome of teenage pregnancy.

    Science.gov (United States)

    Suwal, A

    2012-01-01

    Adolescents are at higher risk during childbirth than women between 20 to 25 years. Adolescent childbearing initiates a syndrome of failure: failure to complete one's education; failure in limiting family size; failure to establish a vocation and become independent. This study was done to find out the obstetric and perinatal outcome of teenage pregnancy along with factors contributing to teenage pregnancy. A prospective, cross sectional study was carried out in College of Medical Sciences Teaching Hospital (CMSTH), Bharatpur during the period for two years from September 2008 to August 2010. Pregnant girls ≤19 years admitted to labour ward were taken for the study. Cases planned for abortion and MTP were also taken. One hundred cases of pregnant teenagers were admitted in CMSTH during a period of two years. Incidence was 6.85%. In our study, most of the teenagers were unbooked, from low socioeconomic status and with no or inadequate education. They had little knowledge about contraception and less number of teenagers used temporary means of contraception. Because of our social custom of early marriage, most of the teenage mothers were married. All these factors were correlated with teenage pregnancy in present study. This study failed to show any statistically significant difference in the incidence of anaemia, LBW babies, preterm delivery, hypertensive disorder of pregnancy, mode of delivery in different ages of teenage mothers. However, there was significant difference in the incidence of perinatal death in different ages of teenage mothers indicating that perinatal deaths were more in younger teenagers.

  20. BLOOD BIOMARKERS FOR EVALUATION OF PERINATAL ENCEPHALOPATHY

    Directory of Open Access Journals (Sweden)

    Ernest Marshall Graham

    2016-07-01

    Full Text Available Recent research in identification of brain injury after trauma shows many possible blood biomarkers that may help identify the fetus and neonate with encephalopathy. Traumatic brain injury shares many common features with perinatal hypoxic-ischemic encephalopathy. Trauma has a hypoxic component, and one of the 1st physiologic consequences of moderate-severe traumatic brain injury is apnea. Trauma and hypoxia-ischemia initiate an excitotoxic cascade and free radical injury followed by the inflammatory cascade, producing injury in neurons, glial cells and white matter. Increased excitatory amino acids, lipid peroxidation products and alteration in microRNAs and inflammatory markers are common to both traumatic brain injury and perinatal encephalopathy. The blood-brain barrier is disrupted in both leading to egress of substances normally only found in the central nervous system. Brain exosomes may represent ideal biomarker containers, as RNA and protein transported within the vesicles are protected from enzymatic degradation. Evaluation of fetal or neonatal brain derived exosomes that cross the blood-brain barrier and circulate peripherally has been referred to as the liquid brain biopsy. A multiplex of serum biomarkers could improve upon the current imprecise methods of identifying fetal and neonatal brain injury such as fetal heart rate abnormalities, meconium, cord gases at delivery, and Apgar scores. Quantitative biomarker measurements of perinatal brain injury and recovery could lead to operative delivery only in the presence of significant fetal risk, triage to appropriate therapy after birth and measure the effectiveness of treatment.

  1. Effect of amnioinfusion for meconium stained amniotic fluid on perinatal outcome.

    Science.gov (United States)

    Ashfaq, F; Shah, A A

    2004-06-01

    To see the effect of amnioinfusion on perinatal outcome in cases of meconium staining of liquor. This study was conducted in department of Obstetrics and Gynaecology, unit 1, Jinnah Postgraduate Medical Centre, Karachi, from 1st January 1998 to 31st December 2000. Four hundred patients were included in this study, assigning 200 for amnioinfusion and 200 as control. All patients were matched in both the groups with respect to age, antenatal booking, parity, gestational age, stage of labour, colour of amniotic fluid and fetal birth weight. Both the groups were found to be comparable. The rate of Caesarean section was found to be 37% in amnioinfusion group, which collaborates with other international studies. The fetal outcome was better i.e. 91% alive and healthy, after amnioinfusion due to dilution of meconium stained amniotic fluid with physiological solutions. The perinatal outcome was recorded by Apgar score at 5 minutes. The perinatal morbidity and mortality both were significantly lowered and was found to be 6% as compared to 14% in control, which was also noticed by less number of admissions in nursery i.e. 12% and perinatal deaths. The incidence of meconium aspiration syndrome was found to be 56% in control and was reduced to 22% after amnioinfusion in the other arm of the study. These results are very encouraging and suggestion can be safely made that in future amnioinfusion will be the ideal method of preventing fetal distress due to meconium stained amniotic fluid.

  2. Risk factors for perinatal mortality in an urban area of Southern Brazil, 1993

    Directory of Open Access Journals (Sweden)

    Ana M. B. Menezes

    Full Text Available INTRODUCTION: Although there was a considerable reduction in infant mortality in Pelotas, Rio Grande do Sul in the last decade, its perinatal causes were reduced only by 28%. The associated factors of these causes were analised. MATERIAL AND METHOD: All hospital births and perinatal deaths were assessed by daily visits to all the maternity hospitals in the city, throughout 1993 and including the first week of 1994. RESULTS: The perinatal mortality rate was 22.1 per thousand births. The multivariate analysis showed the following risk factors: low socioeconomic level, male sex and maternal age above 35 years . Among multigravidae women, the fetal mortality rate was significantly increased for mothers with a previously low birthweight and a previous stillbirth. For early neonatal mortality the risk was significantly increased by a smaller number of antenatal visits than 5 and low birthweight. CONCLUSIONS: Main risk factors for perinatal mortality: low socioeconomic level, maternal age above 35 years and male sex. For early neonatal mortality the risk was significantly increased by a smaller number of antenatal visits than 5 and low birthweight.

  3. Perinatal methadone exposure affects dopamine, norepinephrine, and serotonin in the weanling rat.

    Science.gov (United States)

    Robinson, S E; Maher, J R; Wallace, M J; Kunko, P M

    1997-01-01

    On gestational day 7 pregnant rats were implanted with osmotic minipumps containing either methadone hydrochloride (initial dose, 9 mg/kg/day) or sterile water. Their offspring were cross-fostered so that they were exposed to methadone prenatally and/or postnatally. On postnatal day 21, dopamine (DA), norepinephrine (NE), serotonin (5-HT), and their metabolites were analyzed. Perinatal methadone exposure disrupted dopaminergic, noradrenergic, and serotonergic activity in a brain region- and gender-specific fashion. The ratio of the DA metabolite 3,4-dihydroxyphenylacetic acid (DOPAC) to DA was reduced in the frontal cortex of males exposed to methadone postnatally. No effects of perinatal methadone exposure were observed on DA and DOPAC in the striatum. The ratio of 3-methoxy-4-hydroxyphenylglycol (MOPEG) to NE in the hippocampus was increased significantly in males exposed to methadone prenatally. Striatal and parietal cortical 5-hydroxyindoleacetic acid (5-HIAA), but not its ratio to 5-HT, was increased slightly in rats exposed to methadone postnatally. Although parietal cortical 5-HT, 5-HIAA, and 5-hydroxytryptophan were all affected by perinatal methadone exposure, the ratios of metabolite and precursor to 5-HT were not affected. Effects of methadone exposure appeared to depend upon the developmental stage at which exposure occurred and did not appear to result from the phenomenon of neonatal withdrawal. Changes in activity of these three neurotransmitter systems may contribute to the effect of perinatal methadone on the activity of other neurons, such as cholinergic neurons.

  4. Domestic violence and perinatal mental disorders: a systematic review and meta-analysis.

    Science.gov (United States)

    Howard, Louise M; Oram, Sian; Galley, Helen; Trevillion, Kylee; Feder, Gene

    2013-01-01

    -quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period.

  5. Domestic violence and perinatal mental disorders: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Louise M Howard

    violence. High-quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period.

  6. Do Emotional Appeals in Public Service Advertisements Influence Adolescents' Intention to Reduce Consumption of Sugar-Sweetened Beverages?

    Science.gov (United States)

    Bleakley, Amy; Jordan, Amy B; Hennessy, Michael; Glanz, Karen; Strasser, Andrew; Vaala, Sarah

    2015-08-01

    Mass media campaigns are a commonly used approach to reduce sugary drink consumption, which is linked to obesity in children and adolescents. The present study investigated the direct and mediated effects of emotional appeals in public service advertisements (PSAs) that aired between 2010 and 2012 on adolescents' intention to reduce their sugar-sweetened beverage (SSB) consumption. An online randomized experiment was conducted with a national sample of adolescent respondents ages 13 to 17 years old (N = 805). Participants were randomly assigned to 1 of 4 conditions. Three experimental conditions represented PSAs with different emotional appeals: humor, fear, and nurturance, plus a fourth control condition. The outcome was adolescents' intention to cut back on SSBs. The direct effect of fear appeals on intention was mediated through adolescents' perception of the PSAs' argument strength; perceived argument strength was also the key mediator for the indirect effects of humor and nurturance on intention. Several hypothesized mediators influenced by the appeals were not associated with intention. This is the first study to test the effect of persuasive emotional appeals used in SSB-related PSAs. The perceived strength of the PSAs' arguments is important to consider in the communication of messages designed to reduce SSB consumption.

  7. Heparin-induced thrombocytopenia: reducing misdiagnosis via collaboration between an inpatient anticoagulation pharmacy service and hospital reference laboratory.

    Science.gov (United States)

    Burnett, Allison E; Bowles, Harmony; Borrego, Matthew E; Montoya, Tiffany N; Garcia, David A; Mahan, Charles

    2016-11-01

    Misdiagnosis of heparin-induced thrombocytopenia (HIT) is common and exposes patients to high-risk therapies and potentially serious adverse events. The primary objective of this study was to evaluate the impact of collaboration between an inpatient pharmacy-driven anticoagulation management service (AMS) and hospital reference laboratory to reduce inappropriate HIT antibody testing via pharmacist intervention and use of the 4T pre-test probability score. Secondary objectives included clinical outcomes and cost-savings realized through reduced laboratory testing and decreased unnecessary treatment of HIT. This was a single center, pre-post, observational study. The hospital reference laboratory contacted the AMS when they received a blood sample for an enzyme-linked immunosorbent HIT antibody (HIT Ab). Trained pharmacists prospectively scored each HIT Ab ordered by using the 4T score with subsequent communication to physicians recommending for or against processing and reporting of lab results. Utilizing retrospective chart review and a database for all patients with a HIT Ab ordered during the study period, we compared the incidence of HIT Ab testing before and after implementation of the pharmacy-driven 4T score intervention. Our intervention significantly reduced the number of inappropriate HIT Ab tests processed (176 vs. 63, p reference laboratories can result in reduction of misdiagnosis of HIT and significant cost savings with similar safety.

  8. Magnitude of income-related disparities in adverse perinatal outcomes

    OpenAIRE

    Shankardass, Ketan; O’Campo, Patricia; Dodds, Linda; Fahey, John; Joseph, KS; Morinis, Julia; Allen, Victoria M

    2014-01-01

    Background To assess and compare multiple measurements of socioeconomic position (SEP) in order to determine the relationship with adverse perinatal outcomes across various contexts. Methods A birth registry, the Nova Scotia Atlee Perinatal Database, was confidentially linked to income tax and related information for the year in which delivery occurred. Multiple logistic regression was used to examine odds ratios between multiple indicators of SEP and multiple adverse perinatal outcomes in 11...

  9. Género, salud materna y la paradoja perinatal

    Directory of Open Access Journals (Sweden)

    Simone Grilo DINIZ

    2010-12-01

    Full Text Available En los últimos 20 años mejoraron prácticamente todos los indicadores de salud materna en el Brasil, así como hubo un amplio acceso a los servicios de salud. Gender, maternal health and the perinatal paradox1 Gênero, saúde materna e o paradoxo perinatal Género, salud materna y la paradoja perinatal REFLEXÕES SOBRE HUMANIZAÇÃO E A REALIDADE DOS SERVIÇOS REFLECTIONS ON HUMANIZATION AND THE REALITY OF HEALTH SERVICES REFLEXIONES SOBRE LA HUMANIZACIÓN Y LA REALIDAD DE LOS SERVICIOS 50 // Rev Tempus Actas Saúde Col Paradoxalmente, no existe ninguna evidencia de mejora de la mortalidad materna. El objetivo de este texto es ofrecer elementos para comprender esta paradoja, a través de la evaluación de los modelos típicos de asistencia al parto, en el Sistema Único de Salud (SUS y en el sector privado. Analizaremos las propuestas de cambio para una asistencia basada en evidencias sobre la seguridad de estos modelos, su relación con los derechos de las mujeres, y con los conflictos de interés y resistencias al cambio de los modelos. Examinamos los presupuestos de género que modulan la asistencia y los sesgos de género en la investigación en este campo, que se expresan en la sobrevalorización de los beneficios de la tecnología, y en la subvalorización o en la negación de los desconfortos y efectos adversos de las intervenciones. Creencias de la cultura sexual no raramente son consideradas como explicaciones ‘científicas’ sobre el cuerpo, la parturición y la sexualidad, y se reflejan en la imposición de sufrimientos y riesgos innecesarios, en las intervenciones dañinas a la integridad genital, y en la negación del derecho a acompañantes. Este ‘pesimismo del parto’ es instrumento para favorecer, por comparación, el modelo de la cesárea de rutina. Por fin, discutimos como el uso de la categoría género puede contribuir para promover derechos y cambios institucionales, como en el caso de los acompañantes en el parto.

  10. Telemedicine to Reduce Medical Risk in Austere Medical Environments: The Virtual Critical Care Consultation (VC3) Service.

    Science.gov (United States)

    Powell, Douglas; McLeroy, Robert D; Riesberg, Jamie; Vasios, William N; Miles, Ethan A; Dellavolpe, Jeffrey; Keenan, Sean; Pamplin, Jeremy C

    One of the core capabilities of prolonged field care is telemedicine. We developed the Virtual Critical Care Consult (VC3) Service to provide Special Operations Forces (SOF) medics with on-demand, virtual consultation with experienced critical care physicians to optimize management and improve outcomes of complicated, critically injured or ill patients. Intensive-care doctors staff VC3 continuously. SOF medics access this service via phone or e-mail. A single phone call reaches an intensivist immediately. An e-mail distribution list is used to share information such as casualty images, vital signs flowsheet data, and short video clips, and helps maintain situational awareness among the VC3 critical care providers and other key SOF medical leaders. This real-time support enables direct communication between the remote provider and the clinical subject matter expert, thus facilitating expert management from near the point of injury until definitive care can be administered. The VC3 pilot program has been extensively tested in field training exercises and validated in several real-world encounters. It is an immediately available capability that can reduce medical risk and is scalable to all Special Operations Command forces. 2016.

  11. Potentially avoidable perinatal deaths in Denmark and Sweden 1991

    DEFF Research Database (Denmark)

    Langhoff-Roos, J; Borch-Christensen, H; Larsen, S

    1996-01-01

    to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths. MATERIAL AND METHODS: Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing......BACKGROUND: Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries...

  12. Potentially avoidable perinatal deaths in Denmark and Sweden 1991

    DEFF Research Database (Denmark)

    Langhoff-Roos, J; Borch-Christensen, H; Larsen, S

    1996-01-01

    BACKGROUND: Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries...... to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths. MATERIAL AND METHODS: Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing...

  13. Efectos de un programa de mejoramiento de la calidad en servicios materno perinatales en el Peru: la experiencia del proyecto 2000 Effects of a continuous quality improvement program in maternal and perinatal health services in Peru: the experience of Project 2000

    Directory of Open Access Journals (Sweden)

    Juan A. Seclen-Palacín

    2003-12-01

    Full Text Available OBJETIVOS: comparar la calidad de los servicios de salud materno perinatales (SMP de los establecimientos participantes en un programa de mejora de calidad (PMC y compararlos con un grupo control; evaluar comparativamente los conocimientos y actitudes de usuarias de servicios de salud materna; y determinar la contribución del PMC en los niveles de calidad. MÉTODOS: fue implementado un PMC en 74 establecimientos de salud seleccionados para mejorar la calidad. Se desarrolló un cuasiexperimento controlado en 74 hospitales, centros de salud y establecimientos periféricos. El análisis de la calidad de los SMP se realizó mediante comparación de promedios de escalas centesimales; los conocimientos y actitudes de las usuarias mediante análisis bivariado; y la predicción del nivel de calidad a través de análisis multivariado. RESULTADOS: al final de la intervención, la puntuación de los establecimientos con PMC tuvo un promedio de 61,8 puntos y de 37,5 en el grupo de comparación, (p OBJECTIVES: to compare the quality of the maternal-perinatal health services (MPHS between health facilities with a continuos quality improvement (CQI and those without such program; to evaluate the knowledge and attitudes of the users of maternal health services; to determine the contribution of the CQI on the level of quality. METHODS: it was conducted a CQI program in 74 selected health facilities from Perú (1996-2000 for improved the quality of MPHS. A controlled, quasiexperimental study in facilities health (hospital, health centers and peripheral facilities was conducted. The quality of care was measured by scores of the MPHS by comparing averages; the knowledge and attitudes of users by bivariate analysis, and the prediction of the quality level was studied through multivariate analysis. RESULTS: at the end of the intervention, CQI facilities score was 61,8 points and of 37,5 in the comparison group, (p <0,001. The average of obstetrical warms signs

  14. Surgical assessment clinic - One stop emergency out-patient clinic for rapid assessment, reduced admissions and improved acute surgical service: A quality improvement study

    Directory of Open Access Journals (Sweden)

    Christina A.W. Macano

    2017-11-01

    Conclusion: By providing suitable guidance for referring practitioners we have optimised our clinic use significantly and improved our acute ambulatory surgical care. We have reduced admissions, provided rapid treatment and have established a service that helps address the ever increasing demand on acute services within the NHS.

  15. Childhood adversity increases the risk of onward transmission from perinatal HIV-infected adolescents and youth in South Africa.

    Science.gov (United States)

    Kidman, Rachel; Nachman, Sharon; Dietrich, Janan; Liberty, Afaaf; Violari, Avy

    2018-05-01

    Repeated exposure to childhood adversity (abuse, neglect and other traumas experienced before age 18) can have lifelong impacts on health. For HIV-infected adolescents and youth, such impacts may include onward transmission of HIV. To evaluate this possibility, the current study measured the burden of childhood adversity and its influence on risky health behaviors among perinatally-infected adolescents and youth. We surveyed 250 perinatally-infected adolescents and youth (13-24 years) receiving care in Soweto, South Africa. Both male and female participants reported on childhood adversity (using the ACE-IQ), sexual behavior, and psychosocial state. Viral load was also abstracted from their charts. We used logistic regressions to test the association between cumulative adversity and behavioral outcomes. Half the sample reported eight or more adversities. Overall, 72% experienced emotional abuse, 59% experienced physical abuse, 34% experienced sexual abuse, 82% witnessed domestic violence, and 91% saw someone being attacked in their community. A clear gradient emerged between cumulative adversities and behavioral risk. Having experienced one additional childhood adversity raised the odds of risky sexual behavior by almost 30% (OR 1.27, 95% CI 1.09-1.48). Viral suppression was poor overall (31% had viral loads >400 copies/ml), but was not related to adversity. Adversity showed a robust relationship to depression and substance abuse. Childhood adversity is common, influences the current health of HIV-positive adolescents and youth, and puts their sexual partners at risk for HIV infection. Greater primary prevention of childhood adversity and increased access to support services (e.g., mental health) could reduce risk taking among HIV-positive adolescents and youth. Copyright © 2018 Elsevier Ltd. All rights reserved.

  16. Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs.

    Science.gov (United States)

    Nakku, Juliet E M; Okello, Elialilia S; Kizza, Dorothy; Honikman, Simone; Ssebunnya, Joshua; Ndyanabangi, Sheila; Hanlon, Charlotte; Kigozi, Fred

    2016-07-22

    Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda. Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach. Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training. This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.

  17. Lifesaving emergency obstetric services are inadequate in south-west Ethiopia: a formidable challenge to reducing maternal mortality in Ethiopia.

    Science.gov (United States)

    Girma, Meseret; Yaya, Yaliso; Gebrehanna, Ewenat; Berhane, Yemane; Lindtjørn, Bernt

    2013-11-04

    Most maternal deaths take place during labour and within a few weeks after delivery. The availability and utilization of emergency obstetric care facilities is a key factor in reducing maternal mortality; however, there is limited evidence about how these institutions perform and how many people use emergency obstetric care facilities in rural Ethiopia. We aimed to assess the availability, quality, and utilization of emergency obstetric care services in the Gamo Gofa Zone of south-west Ethiopia. We conducted a retrospective review of three hospitals and 63 health centres in Gamo Gofa. Using a retrospective review, we recorded obstetric services, documents, cards, and registration books of mothers treated and served in the Gamo Gofa Zone health facilities between July 2009 and June 2010. There were three basic and two comprehensive emergency obstetric care qualifying facilities for the 1,740,885 people living in Gamo Gofa. The proportion of births attended by skilled attendants in the health facilities was 6.6% of expected births, though the variation was large. Districts with a higher proportion of midwives per capita, hospitals and health centres capable of doing emergency caesarean sections had higher institutional delivery rates. There were 521 caesarean sections (0.8% of 64,413 expected deliveries and 12.3% of 4,231 facility deliveries). We recorded 79 (1.9%) maternal deaths out of 4,231 deliveries and pregnancy-related admissions at institutions, most often because of post-partum haemorrhage (42%), obstructed labour (15%) and puerperal sepsis (15%). Remote districts far from the capital of the Zone had a lower proportion of institutional deliveries (4% of deliveries, much higher than the average 1.9%). Based on a population of 1.7 million people, there should be 14 basic and four comprehensive emergency obstetric care (EmOC) facilities in the Zone. Our study found that only three basic and two comprehensive EmOC service qualifying facilities serve this large

  18. Services

    International Nuclear Information System (INIS)

    Hardeman, F.

    1998-01-01

    The objectives of the services section is (1) to offer complete services in health-physics measurements according to international quality standards, (2) to improve continuously these measurement techniques and to follow up international recommendations and legislation concerning the surveillance of workers, (3) to support and advise nuclear and non-nuclear industry on problems of radioactive contamination. Achievements related to gamma spectrometry, whole-body counting, beta and alpha spectrometry, dosimetry, radon measurements, calibration, instrumentation, and neutron activation analysis are described

  19. Agrochemicals indirectly increase survival of E. coli O157:H7 and indicator bacteria by reducing ecosystem services.

    Science.gov (United States)

    Staley, Zachery R; Rohr, Jason R; Senkbeil, Jacob K; Harwood, Valerie J

    Storm water and agricultural runoff frequently contain agrochemicals, fecal indicator bacteria (FIB), and zoonotic pathogens. Entry of such contaminants into aquatic ecosystems may affect ecology and human health. This study tested the hypothesis that the herbicide atrazine and the fungicide chlorothalonil indirectly affect the survival of FIB (Escherichia coli and Enterococcus faecalis) and a pathogen (E. coli O157:H7) by altering densities of protozoan predators or by altering competition from autochthonous bacteria. Streptomycin-resistant E. coli, En. faecalis, and E. coli O157:H7 were added to microcosms composed of Florida river water containing natural protozoan and bacterial populations. FIB, pathogen, and protozoan densities were monitored over six days. Known metabolic inhibitors, cycloheximide and streptomycin, were used to inhibit autochthonous protozoa or bacteria, respectively. The inhibitors made it possible to isolate the effects of predation or competition on survival of allochthonous bacteria, and each treatment increased the survival of FIB and pathogens. Chlorothalonil's effect was similar to that of cycloheximide, significantly reducing protozoan densities and elevating densities of FIB and pathogens relative to the control. Atrazine treatment did not affect protozoan densities, but, through an effect on competition, resulted in significantly greater densities of En. faecalis and E. coli O157:H7. Hence, by reducing predaceous protozoa and bacterial competitors that facilitate purifying water bodies of FIBs and human pathogens, chlorothalonil and atrazine indirectly diminished an ecosystem service of fresh water.

  20. Trends and correlates of good perinatal outcomes in assisted reproductive technology.

    Science.gov (United States)

    Joshi, Nikhil; Kissin, Dmitry; Anderson, John E; Session, Donna; Macaluso, Maurizio; Jamieson, Denise J

    2012-10-01

    To estimate trends in good perinatal outcomes (singleton live births at term with birthweight more than 2,500 g) among live births after assisted reproductive technology in the United States from 2000 to 2008, and associated factors among singletons in 2008. Using retrospective cohort data from the National Assisted Reproductive Technology Surveillance System from 2000 to 2008, we calculated relative change and χ tests for trend in the proportion of good perinatal outcomes among assisted reproductive technology live births (n=444,909) and liveborn singletons (n=222,500). We conducted univariable analyses followed by multiple logistic regression to estimate the effects of various characteristics on the outcome among singletons born in 2008 after fresh, nondonor assisted reproductive technology cycles (n=20,780). The proportion of good perinatal outcomes among all liveborn neonates increased from 38.6% in 2000 to 42.5% in 2008, whereas it declined marginally among singletons from 83.6% to 83.4%. One previous birth, transfer of fewer than three embryos, and the presence of fewer than three fetal hearts on 6-week ultrasound examination were associated with good perinatal outcome among singletons. Non-Hispanic black race, tubal factor infertility, uterine factor infertility, ovulatory disorder, and 5-day embryo culture were associated with reduced odds for a good outcome. The strongest association was the presence of one fetal heart compared with more than two (adjusted odds ratio 2.43, 95% confidence interval 1.73-3.42). From 2000 to 2008, good perinatal outcomes increased among assisted reproductive technology live births. Among singleton live births, odds for good outcome were greatest with the presence of a single fetal heart and lowest in women of non-Hispanic black race. II.

  1. The Change of Perinatal Mortality Over Three Decades in a Reference Centre in the Aegean Region: Neonatal Mortality has decreased but Foetal Mortality Remains Unchanged

    Directory of Open Access Journals (Sweden)

    Nilgün Kültürsay

    2017-12-01

    Full Text Available Background: Perinatal, foetal and neonatal mortality statistics are important to show the development of a health care system in a country. However, in our country there are very few national and regional data about the changing pattern of perinatal neonatal mortality along with the development of new technologies in this area. Aims: Evaluation of the changes in mortality rates and the causes of perinatal and neonatal deaths within years in a perinatal reference centre which serves a high-risk population. Study Design: Cross-sectional retrospective study. Methods: The perinatal, neonatal and foetal mortality rates in the years 1979-1980 (1st time point and 1988-1989 (2nd time point were compared with the year 2008 (3rd time point. The causes of mortality were assessed by Wigglesworth classification and death reports. The neonatal mortality in the neonatal intensive care unit was also calculated. Results: Foetal mortality rates were 44/1000, 31.4/1000 and 41.75/1000 births, perinatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 births, and neonatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 live births for the three study time points, respectively. The mortality rate in neonatal intensive care unit decreased consistently from 33%, to 22.6% and 10%, respectively, together with decreasing neonatal mortality rates. The causes of perinatal deaths were foetal death 85%, immaturity 4%, and lethal congenital malformations 8% according to Wigglesworth classification in 2008, showing the high impact of foetal deaths on this high perinatal mortality rate. Infectious causes of neonatal deaths decreased but congenital anomalies increased in the last decades. Conclusion: Although neonatal mortality rate decreased significantly; foetal mortality rate has stayed unchanged since the late eighties. In order to decrease foetal and perinatal mortality rates more efficiently, reducing consanguineous marriages and providing better antenatal care for

  2. Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications

    Directory of Open Access Journals (Sweden)

    Junichi Hasegawa

    2006-03-01

    Full Text Available In the maternal and child health statistics of Japan for 2003, perinatal deaths were most frequent in pregnant women with abnormalities of the placenta, umbilical cord, and fetal membrane. Despite advances in perinatal medicine, approximately 2% of low-risk pregnant women still require an emergency cesarean section after the onset of labor. Because it is likely that half of these cases are associated with placental and umbilical cord abnormalities, it is thought that prenatal detection of such abnormalities would reduce the number of emergency cesarean sections in low-risk women. In our previous studies, some abnormalities of the placenta and umbilical cord were associated with abnormalities of cord insertion. Furthermore, we reported that prenatal detection of velamentous cord insertion (VCI reduced the number of emergency cesarean sections in low-risk women. In this review, we describe the prenatal detection of abnormalities of umbilical cord insertion and the management of VCI based on our current clinical data.

  3. Substandard factors in perinatal care in The Netherlands : a regional audit of perinatal deaths

    NARCIS (Netherlands)

    Wolleswinkel-van den Bosch, JH; Vredevoogd, CB; Borkent-Polet, M; van Eyck, J; Fetter, WPF; Lagro-Janssen, TLM; Rosink, IH; Treffers, PE; Amelink, M; Richardus, JH; Verloove-Vanhorick, P; Mackenbach, JP

    Background. To determine: 1) whether substandard factors were present in cases of perinatal death, and to what extent another course of action might have resulted in a better outcome, and 2) whether there were differences in the frequency of substandard factors by level of care, particularly between

  4. The Multiple Facets of Lutein: A Call for Further Investigation in the Perinatal Period

    OpenAIRE

    Perrone, Serafina; Tei, Monica; Longini, Mariangela; Buonocore, Giuseppe

    2016-01-01

    Lutein may have important antioxidant actions in free-radical-mediated diseases, in addition to its well-known antioxidant and cytoprotective effects on macula and photoreceptors. The peculiar perinatal susceptibility to oxidative stress indicates that prophylactic use of antioxidants as lutein could help to prevent or at least to reduce oxidative stress related diseases in newborns. Since lutein is not synthesized by humans, the intake primarily depends on diet or supplementation. Newborns r...

  5. Perinatal exposure of mice to the pesticide DDT impairs energy expenditure and metabolism in adult female offspring.

    Directory of Open Access Journals (Sweden)

    Michele La Merrill

    Full Text Available Dichlorodiphenyltrichloroethane (DDT has been used extensively to control malaria, typhus, body lice and bubonic plague worldwide, until countries began restricting its use in the 1970s. Its use in malaria control continues in some countries according to recommendation by the World Health Organization. Individuals exposed to elevated levels of DDT and its metabolite dichlorodiphenyldichloroethylene (DDE have an increased prevalence of diabetes and insulin resistance. Here we hypothesize that perinatal exposure to DDT disrupts metabolic programming leading to impaired metabolism in adult offspring. To test this, we administered DDT to C57BL/6J mice from gestational day 11.5 to postnatal day 5 and studied their metabolic phenotype at several ages up to nine months. Perinatal DDT exposure reduced core body temperature, impaired cold tolerance, decreased energy expenditure, and produced a transient early-life increase in body fat in female offspring. When challenged with a high fat diet for 12 weeks in adulthood, female offspring perinatally exposed to DDT developed glucose intolerance, hyperinsulinemia, dyslipidemia, and altered bile acid metabolism. Perinatal DDT exposure combined with high fat feeding in adulthood further impaired thermogenesis as evidenced by reductions in core temperature and in the expression of numerous RNA that promote thermogenesis and substrate utilization in the brown adipose tissue of adult female mice. These observations suggest that perinatal DDT exposure impairs thermogenesis and the metabolism of carbohydrates and lipids which may increase susceptibility to the metabolic syndrome in adult female offspring.

  6. Perinatal Exposure of Mice to the Pesticide DDT Impairs Energy Expenditure and Metabolism in Adult Female Offspring

    Science.gov (United States)

    La Merrill, Michele; Karey, Emma; Moshier, Erin; Lindtner, Claudia; La Frano, Michael R.; Newman, John W.; Buettner, Christoph

    2014-01-01

    Dichlorodiphenyltrichloroethane (DDT) has been used extensively to control malaria, typhus, body lice and bubonic plague worldwide, until countries began restricting its use in the 1970s. Its use in malaria control continues in some countries according to recommendation by the World Health Organization. Individuals exposed to elevated levels of DDT and its metabolite dichlorodiphenyldichloroethylene (DDE) have an increased prevalence of diabetes and insulin resistance. Here we hypothesize that perinatal exposure to DDT disrupts metabolic programming leading to impaired metabolism in adult offspring. To test this, we administered DDT to C57BL/6J mice from gestational day 11.5 to postnatal day 5 and studied their metabolic phenotype at several ages up to nine months. Perinatal DDT exposure reduced core body temperature, impaired cold tolerance, decreased energy expenditure, and produced a transient early-life increase in body fat in female offspring. When challenged with a high fat diet for 12 weeks in adulthood, female offspring perinatally exposed to DDT developed glucose intolerance, hyperinsulinemia, dyslipidemia, and altered bile acid metabolism. Perinatal DDT exposure combined with high fat feeding in adulthood further impaired thermogenesis as evidenced by reductions in core temperature and in the expression of numerous RNA that promote thermogenesis and substrate utilization in the brown adipose tissue of adult female mice. These observations suggest that perinatal DDT exposure impairs thermogenesis and the metabolism of carbohydrates and lipids which may increase susceptibility to the metabolic syndrome in adult female offspring. PMID:25076055

  7. Perinatal Generalized Anxiety Disorder: Assessment and Treatment.

    Science.gov (United States)

    Misri, Shaila; Abizadeh, Jasmin; Sanders, Shawn; Swift, Elena

    2015-09-01

    Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

  8. Lessons learned from perinatal exposure to diethylstilbestrol

    Energy Technology Data Exchange (ETDEWEB)

    Newbold, Retha R

    2004-09-01

    The synthetic estrogen diethylstilbestrol (DES) is well documented to be a perinatal carcinogen in both humans and experimental animals. Exposure to DES during critical periods of differentiation permanently alters the programming of estrogen target tissues resulting in benign and malignant abnormalities in the reproductive tract later in life. Using the perinatal DES-exposed rodent model, cellular and molecular mechanisms have been identified that play a role in these carcinogenic effects. Although DES is a potent estrogenic chemical, effects of low doses of the compound are being used to predict health risks of weaker environmental estrogens. Therefore, it is of particular interest that developmental exposure to very low doses of DES has been found to adversely affect fertility and to increase tumor incidence in murine reproductive tract tissues. These adverse effects are seen at environmentally relevant estrogen dose levels. New studies from our lab verify that DES effects are not unique; when numerous environmental chemicals with weak estrogenic activity are tested in the experimental neonatal mouse model, developmental exposure results in an increased incidence of benign and malignant tumors including uterine leiomyomas and adenocarcinomas that are similar to those shown following DES exposure. Finally, growing evidence in experimental animals suggests that some adverse effects can be passed on to subsequent generations, although the mechanisms involved in these trans-generational events remain unknown. Although the complete spectrum of risks to DES-exposed humans are uncertain at this time, the scientific community continues to learn more about cellular and molecular mechanisms by which perinatal carcinogenesis occurs. These advances in knowledge of both genetic and epigenetic mechanisms will be significant in ultimately predicting risks to other environmental estrogens and understanding more about the role of estrogens in normal and abnormal development.

  9. Lessons learned from perinatal exposure to diethylstilbestrol

    International Nuclear Information System (INIS)

    Newbold, Retha R.

    2004-01-01

    The synthetic estrogen diethylstilbestrol (DES) is well documented to be a perinatal carcinogen in both humans and experimental animals. Exposure to DES during critical periods of differentiation permanently alters the programming of estrogen target tissues resulting in benign and malignant abnormalities in the reproductive tract later in life. Using the perinatal DES-exposed rodent model, cellular and molecular mechanisms have been identified that play a role in these carcinogenic effects. Although DES is a potent estrogenic chemical, effects of low doses of the compound are being used to predict health risks of weaker environmental estrogens. Therefore, it is of particular interest that developmental exposure to very low doses of DES has been found to adversely affect fertility and to increase tumor incidence in murine reproductive tract tissues. These adverse effects are seen at environmentally relevant estrogen dose levels. New studies from our lab verify that DES effects are not unique; when numerous environmental chemicals with weak estrogenic activity are tested in the experimental neonatal mouse model, developmental exposure results in an increased incidence of benign and malignant tumors including uterine leiomyomas and adenocarcinomas that are similar to those shown following DES exposure. Finally, growing evidence in experimental animals suggests that some adverse effects can be passed on to subsequent generations, although the mechanisms involved in these trans-generational events remain unknown. Although the complete spectrum of risks to DES-exposed humans are uncertain at this time, the scientific community continues to learn more about cellular and molecular mechanisms by which perinatal carcinogenesis occurs. These advances in knowledge of both genetic and epigenetic mechanisms will be significant in ultimately predicting risks to other environmental estrogens and understanding more about the role of estrogens in normal and abnormal development

  10. Vitamin B-12 and Perinatal Health.

    Science.gov (United States)

    Finkelstein, Julia L; Layden, Alexander J; Stover, Patrick J

    2015-09-01

    Vitamin B-12 deficiency (importance of adequate vitamin B-12 status periconceptionally and during pregnancy cannot be overemphasized, given its fundamental role in neural myelination, brain development, and growth. Infants born to vitamin B-12-deficient women may be at increased risk of neural tube closure defects, and maternal vitamin B-12 insufficiency (pregnancy complications, few prospective studies and, to our knowledge, only 1 randomized trial have examined the effects of vitamin B-12 supplementation during pregnancy. The role of vitamin B-12 in the etiology of adverse perinatal outcomes needs to be elucidated to inform public health interventions. © 2015 American Society for Nutrition.

  11. Undiagnosed xiphopagus twins: a perinatal malady

    Directory of Open Access Journals (Sweden)

    Gowri Dorairajan

    2012-02-01

    Full Text Available Conjoined twins are a very rare entity. It is associated with poor survival rate in the presence of vital organ sharing. The entity can be diagnosed as early as the first trimester. A conjoined twin diagnosed late in labor is a malady with high perinatal mortality and maternal morbidity. We present one such case of xiphopagus twins. The management of a case diagnosed late in labor can be very challenging. Such obstetric challenges can be avoided by a meticulous early scan with a high index of suspicion, especially in the absence of separating membrane while scanning multiple pregnancies.

  12. Perinatal transmission of human papilomavirus DNA

    Directory of Open Access Journals (Sweden)

    Serafini Eduardo P

    2009-06-01

    Full Text Available Abstract The purpose was to study the perinatal transmission of human papillomavirus DNA (HPV-DNA in 63 mother-newborn pairs, besides looking at the epidemiological factors involved in the viral DNA transmission. The following sampling methods were used: (1 in the pregnant woman, when was recruited, in cervix and clinical lesions of the vagina, vulva and perineal region; (2 in the newborn, (a buccal, axillary and inguinal regions; (b nasopharyngeal aspirate, and (c cord blood; (3 in the children, buccal was repeated in the 4th week and 6th and 12th month of life. HPV-DNA was identified using two methodologies: multiplex PCR (PGMY09 and MY11 primers and nested-PCR (genotypes 6/11, 16, 18, 31, 33, 42, 52 and 58. Perinatal transmission was considered when concordance was found in type-specific HPV between mother/newborn or mother/child. HPV-DNA genital was detected in 49 pregnant women submitted to delivery. Eleven newborns (22.4%, n = 11/49 were HPV-DNA positive. In 8 cases (16.3%, n = 8/49 there was type specific HPV concordance between mother/newborn samples. At the end of the first month of life three children (6.1%, n = 3/49 became HPV-DNA positive, while two remained positive from birth. In 3 cases (100%, n = 3/3 there was type specific HPV concordance between mother/newborn samples. In the 6th month, a child (2%, n = 1/49 had become HPV-DNA positive between the 1st and 6th month of life, and there was type specific HPV concordance of mother/newborn samples. All the HPV-DNA positive children (22.4%, n = 11/49 at birth and at the end first month of life (6.1%, n = 3/49 became HPV-DNA negative at the age of 6 months. The HPV-DNA positive child (2%, n = 1/49 from 1st to the 6th month of life became HPV-DNA negative between the 6th and 12th month of life and one child had anogenital warts. In the twelfth month all (100%, n = 49/49 the children studied were HPV-DNA negative. A positive and significant correlation was observed between perinatal

  13. Impact of perinatal asphyxia on the GABAergic and locomotor system.

    Science.gov (United States)

    Van de Berg, W D J; Kwaijtaal, M; de Louw, A J A; Lissone, N P A; Schmitz, C; Faull, R L M; Blokland, A; Blanco, C E; Steinbusch, H W M

    2003-01-01

    Perinatal asphyxia can cause neuronal loss and depletion of neurotransmitters within the striatum. The striatum plays an important role in motor control, sensorimotor integration and learning. In the present study we investigated whether perinatal asphyxia leads to motor deficits related to striatal damage, and in particular to the loss of GABAergic neurons. Perinatal asphyxia was induced in time-pregnant Wistar rats on the day of delivery by placing the uterus horns, containing the pups, in a 37 degrees C water bath for 20 min. Three motor performance tasks (open field, grip test and walking pattern) were performed at 3 and 6 weeks of age. Antibodies against calbindin and parvalbumin were used to stain GABAergic striatal projection neurons and interneurons, respectively. The motor tests revealed subtle effects of perinatal asphyxia, i.e. small decrease in motor activity. Analysis of the walking pattern revealed an increase in stride width at 6 weeks of age after perinatal asphyxia. Furthermore, a substantial loss of calbindin-immunoreactive (-22%) and parvalbumin-immunoreactive (-43%) cells was found in the striatum following perinatal asphyxia at two months of age. GABA(A) receptor autoradiography revealed no changes in GABA binding activity within the striatum, globus pallidus or substantia nigra. We conclude that perinatal asphyxia resulted in a loss of GABAergic projection neurons and interneurons in the striatum without alteration of GABA(A) receptor affinity. Despite a considerable loss of striatal neurons, only minor deficits in motor performance were found after perinatal asphyxia.

  14. Perinatal outcomes in 375 children born after oocyte donation

    DEFF Research Database (Denmark)

    Malchau, Sara S; Loft, Anne; Larsen, Elisabeth C

    2013-01-01

    To describe perinatal outcomes in children born after oocyte donation (OD) compared with in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and spontaneous conception (SC).......To describe perinatal outcomes in children born after oocyte donation (OD) compared with in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and spontaneous conception (SC)....

  15. Staffing Needs for Quality Perinatal Care in Tanzania

    African Journals Online (AJOL)

    Erah

    and the required nursing staff for perinatal care in 16 health institutions in Dar es ... attitudes, lack of morale, absenteeism, ... countries in Africa, Asia and Europe. ... midwives working in the perinatal care ... method. 10 . Registered nurses were those who according to the National ... would spend doing other related official.

  16. The value of incorporating avoidable factors into perinatal audits ...

    African Journals Online (AJOL)

    Objective. To assess whether incorporating a system of identifying, classifying and grading avoidable factors into a perinatal audit can be useful in identifying problem areas. Design. Descriptive study. Setting. Black urban population, Pretoria, South Africa. Subjects. All perinatal deaths of infants weighing more than 1 000 g ...

  17. Does perinatal asphyxia contribute to neurological dysfunction in preterm infants?

    NARCIS (Netherlands)

    van Iersel, Patricia A. M.; Bakker, Saskia C. M.; Jonker, Arnold J. H.; Hadders-Algra, Mijna

    Background: Children born preterm are known to be at risk for neurodevelopmental disorders. The role of perinatal asphyxia in this increased risk is still a matter of debate. Aim: To analyze the contribution of perinatal asphyxia in a population of preterm infants admitted to a secondary paediatric

  18. Total perinatally related losses at Tygerberg Hospital – a ...

    African Journals Online (AJOL)

    Objective. To determine the leading causes of perinatal deaths and to evaluate any changes, with the inclusion of placental histology. Method. At perinatal mortality meetings, primary and final causes of death were assigned for the period 1 July 2006 - 30 June 2007. All singleton babies born to women residing in the ...

  19. Relative and absolute addressability of global disease burden in maternal and perinatal health by investment in R&D.

    Science.gov (United States)

    Fisk, Nicholas M; McKee, Martin; Atun, Rifat

    2011-06-01

    Maternal and perinatal disease accounts for nearly 10% of the global burden of disease, with only modest progress towards achievement of the Millennium Development Goals. Despite a favourable new global health landscape in research and development (R&D) to produce new drugs for neglected diseases, R&D investment in maternal/perinatal health remains small and non-strategic. Investment in obstetric R&D by industry or the not-for-profit sector has lagged behind other specialties, with the number of registered pipeline drugs only 1-5% that for other major disease areas. Using a Delphi exercise with maternal/perinatal experts in global and translational research, we estimate that equitable pharmaceutical R&D and public sector research funding over the next 10-20 years could avert 1.1% and 1.9% of the global disease burden, respectively. In contrast, optimal uptake of existing research would prevent 3.0%, justifying the current focus on health service provision. Although R&D predominantly occurs in high-income countries, more than 98% of the estimated reduction in disease burden in this field would be in developing countries. We conclude that better pharmaceutical and public sector R&D would prevent around 1/3 and 2/3, respectively, of the disease burden addressable by optimal uptake of existing research. Strengthening R&D may be an important complementary strategy to health service provision to address global maternal and perinatal disease burden. © 2011 Blackwell Publishing Ltd.

  20. Satisfaction and sustainability: a realist review of decentralized models of perinatal surgery for rural women.

    Science.gov (United States)

    Kornelsen, Jude; McCartney, Kevin; Williams, Kim

    2016-01-01

    This article was developed as part of a larger realist review investigating the viability and efficacy of decentralized models of perinatal surgical services for rural women in the context of recent and ongoing service centralization witnessed in many developed nations. The larger realist review was commissioned by the British Columbia Ministry of Health and Perinatal Services of British Columbia, Canada. Findings from that review are addressed in this article specific to the sustainability of rural perinatal surgical sites and the satisfaction of providers that underpins their recruitment to and retention at such sites. A realist method was used in the selection and analysis of literature with the intention to iteratively develop a sophisticated understanding of how perinatal surgical services can best meet the needs of women who live in rural and remote environments. The goal of a realist review is to examine what works for whom under what circumstances and why. The high sensitivity search used language (English) and year (since 1990) limiters in keeping with both a realist and rapid review tradition of using reasoned contextual boundaries. No exclusions were made based on methodology or methodological approach in keeping with a realist review. Databases searched included MEDLINE, PubMed, EBSCO, CINAHL, EBM Reviews, NHS Economic Evaluation Database and PAIS International for literature in December 2013. Database searching produced 103 included academic articles. A further 59 resources were added through pearling and 13 grey literature reports were added on recommendation from the commissioner. A total of 42 of these 175 articles were included in this article as specific to provider satisfaction and service sustainability. Operative perinatal practice was found to be a lynchpin of sustainable primary and surgical services in rural communities. Rural shortages of providers, including challenges with recruitment and retention, were found to be a complex issue, with

  1. Causes of death and associated conditions (Codac – a utilitarian approach to the classification of perinatal deaths

    Directory of Open Access Journals (Sweden)

    Harrison Catherine

    2009-06-01

    Full Text Available Abstract A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD, although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes. We tested the Causes of Death and Associated Conditions (Codac classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions. The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies, two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy, a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal. For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured. The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions

  2. Causes of death and associated conditions (Codac) – a utilitarian approach to the classification of perinatal deaths

    Science.gov (United States)

    Frøen, J Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W; Facchinetti, Fabio; Fretts, Ruth C; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon CS; Torabi, Rozbeh

    2009-01-01

    A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes. We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions. The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal). For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured. The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the

  3. The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

    NARCIS (Netherlands)

    van Diem, M.T.; Timmer, A.; Bergman, K.A.; Bouman, K.; van Egmond, N.; Stant, D.A.; Ulkeman, L.H.M.; Veen, W.B.; Erwich, J.J.H.M.

    2012-01-01

    Background: Perinatal (mortality) audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in

  4. Perinatal risk factors and social withdrawal behaviour.

    Science.gov (United States)

    Guedeney, Antoine; Marchand-Martin, Laetitia; Cote, Sylvana J; Larroque, Béatrice

    2012-04-01

    The objectives of the study were (1) to assess prevalence of social withdrawal behaviour in infants aged 12 months included in the French Perinatal Risk Factor Study Eden; (2) To study the correlation between relational withdrawal and several perinatal and parental factors assessed in the EDEN study. A longitudinal study using the ADBB scale was conducted within the Eden Cohort in the year 2008. 1,586 infants were included in the study. Fourteen percent of the children who had an ADBB assessment had a score at 5 and over on the ADBB, a scale designed to assess social withdrawal behaviour at age 0-24 months. Social withdrawal at 12 months was associated with low birth weight, low gestational age and with intra uterine growth retardation. Social withdrawal was independently associated with several maternal and paternal risk factors. The level of social withdrawal behaviour increased with a score of maternal difficulties. This study on a large longitudinally followed volunteer sample demonstrate a clear association of social withdrawal behaviour at age one with low birth weight and preterm birth, possibly mediated by parental vulnerabilities. Social withdrawal behaviour seems to be an important alarm signal to detect early on particularly in premature and small for date babies. © Springer-Verlag 2012

  5. Kidney Disease and Perinatal Programming of Arterial Hypertension: the Results of Experimental Researches

    Directory of Open Access Journals (Sweden)

    Olga P. Kovtun

    2017-01-01

    Full Text Available Deterioration of development conditions in the perinatal period (starvation of the mother, excess sodium ions in her diet, exposure to glucocorticosteroids, placental insufficiency programs significant  changes in the excretion of sodium ions in the newborn and leads to the development of hypertension. Studies on experimental animals show  that unfavourable conditions of intrauterine development can reduce the effective area of glomerular filtration and its rate. These circumstances  increase the expression of membrane carriers of sodium ions in the  apical membranes, the production of superoxide radicals and enhance  the reabsorption of sodium. The article discusses the potential mechanisms of perinatal programming of renal hypertension in humans.

  6. Changes in Substance Use Symptoms Across Adolescence in Youth Perinatally Infected with HIV

    Science.gov (United States)

    Elkington, K. S.; Bauermeister, J. A.; Bucek, A.; Dolezal, C.; Leu, C. S.; Mellins, C. A.

    2016-01-01

    The paper utilizes data collected at three time points in a longitudinal study of perinatally HIV-infected (PHIV+) and a comparison group of perinatally exposed but HIV-uninfected (PHEU) youths in the United States (N = 325). Using growth curve modeling, the paper examines changes in substance use symptoms among PHIV+ and PHEU youths as they transition through adolescence, and assesses the individual and contextual factors associated with the rate of change in substance use symptoms. Findings indicate that substance use symptoms increased over time among PHIV+ youths, but not among PHEU youths. The rate of change in these symptoms was positively associated with an increasing number of negative life events. Study findings underscore the need for early, targeted interventions for PHIV+ youths, and interventions to reduce adversities and their deleterious effects in vulnerable populations. PMID:27371136

  7. The importance of perinatal autopsy. Review of the literature and series of cases.

    Science.gov (United States)

    Şorop-Florea, Maria; Ciurea, Raluca Niculina; Ioana, Mihai; Stepan, Alex Emilian; Stoica, George Alin; Tănase, Florentina; Comănescu, Maria Cristina; Novac, Marius Bogdan; Drăgan, Ioana; Pătru, Ciprian LaurenŢiu; Drăguşin, Roxana Cristina; Zorilă, George Lucian; Cărbunaru, Ovidiu Marian; Oprescu, NuŢi Daniela; Ceauşu, Iuliana; Vlădăreanu, Simona; Tudorache, Ştefania; Iliescu, Dominic Gabriel

    2017-01-01

    Perinatal autopsy remains the gold-standard procedure used to establish the fetal, neonatal or infant abnormalities. Progressively, perinatal pathology has become a specialized field with important roles of audit for fetal prenatal diagnostic tools, in parents counseling regarding future pregnancies, in scientific research, for epidemiology of congenital abnormalities and teaching. The differences between prenatal ultrasound and autopsy reports represent a strong argument for the autopsy examination following termination of pregnancy. The reasons for such discrepancies are related to the ultrasonographic or pathological examination conditions, the type of the anomalies, the expertise and availability of the operators. Several facts led to an undesirable increase of refusals from parents to consent to a conventional invasive autopsy: the centralization of pathology services, the poor counseling provided by non-experts in fetal medicine and the clinicians' over-appreciation of the importance of the ultrasound diagnostic investigation. Although non-invasive alternatives have been tested with promising results, conventional autopsy remains the gold standard technique for the prenatal diagnosis audit. We report and analyze several cases of prenatally diagnosed malformed fetuses with different particularities that underline the necessity of perinatal autopsy. We discuss the antenatal findings and management and post-mortem autopsies in the respective pregnancies.

  8. Perinatal market penetration rate. A tool to evaluate regional perinatal programs.

    Science.gov (United States)

    Powers, W F; McGill, L

    1987-01-01

    Very small babies born in tertiary centers fare better than outborn babies referred for tertiary care after birth. Viewing the 1001-1500 gm regional cohort of fetuses as a potential "market" for center delivery, and measuring a center's penetration into this market, quantitates how well a center draws to itself these small, high-risk fetuses for delivery. An Illinois center's annual penetration rate into its regional market for the years 1973-1983 is presented and significant increases are found. The penetration rates of nine Illinois perinatal centers are calculated and wide discrepancies are found. Defining a high-risk regional cohort as a market stresses a perinatal center's obligation to its region. The penetration rate into a defined market measures how well a center fulfills this obligation.

  9. Habitat eradication and cropland intensification may reduce parasitoid diversity and natural pest control services in annual crop fields

    Directory of Open Access Journals (Sweden)

    Deborah K. Letourneau

    2015-10-01

    Full Text Available Abstract California’s central coast differs from many agricultural areas in the U.S., which feature large tracts of monoculture production fields and relatively simple landscapes. Known as the nations salad bowl, and producing up to 90% of U.S. production of lettuces, broccoli and Brussels sprouts, this region is a mosaic of fresh vegetable fields, coastal meadow, chaparral shrubs, riparian and woodland habitat. We tested for relationships between the percent cover of crops, riparian and other natural landscape vegetation and the species richness of parasitic wasps and flies foraging in crops, such as broccoli, kale and cauliflower, and interpreted our results with respect to the decrease in natural habitat and increase in cropland cover prompted by a local microbial contamination event in 2006. Our key results are that: (1 as cropland cover in the landscape increased, fewer species of parasitoids were captured in the crop field, (2 parasitoid richness overall was positively associated with the amount of riparian and other natural vegetation in the surrounding 500m, (3 different groups of parasitoids were associated with unique types of natural vegetation, and (4 parasitism rates of sentinel cabbage aphid and cabbage looper pests were correlated with landscape vegetation features according to which parasitoids caused the mortality. Although individual species of parasitoids may thrive in landscapes that are predominantly short season crops, the robust associations found in this study across specialist and generalist parasitoids and different taxa (tachinid flies, ichneumon wasps, braconid wasps shows that recent food safety practices targeting removal of natural vegetation around vegetable fields in an attempt to eliminate wildlife may harm natural enemy communities and reduce ecosystem services. We argue that enhancing biological diversity is a key goal for transforming agroecosystems for future productivity, sustainability and public health.

  10. Association between hypoxia and perinatal arterial ischemic stroke: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Lili Luo

    Full Text Available Perinatal arterial ischemic stroke (AIS occurs in an estimated 17 to 93 per 100000 live births, yet the etiology is poorly understood. Although investigators have implicated hypoxia as a potential cause of AIS, the role of hypoxia in AIS remains controversial. The aim of this study was to estimate the association between perinatal hypoxia factors and perinatal arterial ischemic stroke through a meta-analysis of published observational studies.A systematic search of electronically available studies published through July 2013 was conducted. Publication bias and heterogeneity across studies were evaluated and summary odds ratios (ORs and 95% confidence intervals (CIs were calculated with fixed-effects or random-effects models.A total of 8 studies describing the association between perinatal hypoxia factors and neonatal arterial ischemic stroke (AIS met inclusion criteria, and 550 newborns with AIS were enrolled. The associations were found for AIS: preeclampsia (OR 2.14; 95% CI, 1.25 to 3.66, ventouse delivery (OR 2.23; 95% CI, 1.26 to 3.97, fetal heart rate abnormalities (OR 6.30; 95% CI, 3.84 to 10.34, reduced fetal movement (OR 5.35; 95% CI, 2.17 to 13.23, meconium-stained liquor (OR 3.05; 95% CI, 2.02 to 4.60, low Apgar score (OR 5.77; 95% CI, 1.66 to 20.04 and resuscitation at birth (OR 4.59; 95% CI, 3.23 to 6.52. Our data did not show any significant change of the mean risk estimate for oxytocin induction (OR 1.33; 95% CI, 0.84 to 2.11 and low arterial umbilical cord ph (OR 4.63; 95% CI 2.14 to 9.98.There is a significant association between perinatal hypoxia factors and AIS. The result indicates that perinatal hypoxia maybe one of causes of AIS. Large scale prospective clinical studies are still warranted.

  11. Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis.

    Science.gov (United States)

    Adams, N; Tudehope, D; Gibbons, K S; Flenady, V

    2018-01-01

    To examine whether disparities in stillbirth, and neonatal and perinatal mortality rates, between public and private hospitals are the result of differences in population characteristics and/or clinical practices. Retrospective cohort study. A metropolitan tertiary centre encompassing public and private hospitals. Women accessed care from either a private obstetrician or from public models of care - predominantly midwife-led care or care shared between midwives, general practitioners, and obstetricians. A total of 131 436 births during 1998-2013: 69 037 public and 62 399 private. Propensity score matching was used to select equal-sized public and private cohorts with similar characteristics. Logistic regression analysis was then used to explore the impact of public-private differences in the use of assisted reproductive technologies, plurality, major congenital anomalies, birth method, and gestational age. Stillbirth, and neonatal and perinatal mortality rates. After controlling for maternal and pregnancy factors, perinatal mortality rates were higher in the public than in the private cohort (adjusted odds ratio, aOR 1.53; 95% confidence interval, 95% CI 1.29-1.80; stillbirth aOR 1.56, 95% CI 1.26-1.94; neonatal death aOR 1.48, 95% CI 1.15-1.89). These disparities reduced by 15.7, 20.5, and 19.6%, respectively, after adjusting for major congenital anomalies, birth method, and gestational age. Perinatal mortality occurred more often among public than private births, and this disparity was not explained by population differences. Differences in clinical practices seem to be partly responsible. The impact of differences in clinical practices on maternal and neonatal morbidity was not examined. Further research is required. Private obstetrician-led care: more obstetric intervention and earlier births reduce perinatal mortality. Background Babies born in Australian public hospitals tend to die more often than those born in private hospitals. Our aim was to determine

  12. Information Architecture for Perinatal Registration in the Netherlands.

    Science.gov (United States)

    Goossen, William T F; Arns-Schiere, Anne Marieke

    In the Netherlands, the perinatal registry has undergone significant changes in the past decades. The purpose of this article is to describe the current health care information architecture for the national perinatal registry, including how the national data set is arranged and how electronic messages are used to submit data. We provide implications for women's health care providers based on the creation and implementation of the Dutch perinatal registry system. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  13. Mortality in mothers after perinatal loss

    DEFF Research Database (Denmark)

    Hvidtjørn, Dorte; Wu, C; Schendel, D

    2016-01-01

    OBJECTIVE: To assess whether mothers who lost a child from stillbirth or in the first week of life have an increased overall mortality and cause-specific mortality. DESIGN: A population based follow-up study. SETTING: Data from Danish national registers. POPULATION: All mothers in Denmark were...... included in the cohort at time of their first delivery from 1 January 1980 to 31 December 2008 and followed until 31 December 2009 or death, whichever came first. METHODS: The association between perinatal loss and total and cause-specific mortality in mothers was estimated with hazard ratios (HR) and 95......% confidence intervals (95% CI) calculated using Cox proportional hazards regression analyses. MAIN OUTCOME MEASURES: Overall mortality and cause-specific mortality. RESULTS: During the follow-up period, 838 331 mothers in the cohort gave birth to one or more children and 7690 mothers (0.92%) experienced...

  14. Current trends in Irish perinatal mortality.

    LENUS (Irish Health Repository)

    Mahony, R

    2010-06-01

    This was a retrospective review of normally formed perinatal deaths among 176,620 births at the National Maternity Hospital (1984-2007). Prelabor stillbirths were categorised by presumed cause of death including unexplained, intrauterine growth retardation (IUGR), placental abruption, red cell alloimmunisation (RCA) and deaths related to prematurity. Peripartum deaths included intrapartum and first week neonatal deaths. The post-mortem rate, initially almost 100%, fell to 60%. Data were analysed using the Mantel-Haenszel chi square test for trends. In the study period there was a significant reduction in the PNM, largely because of a fall in death related to prematurity, term peripartum death, death at 42 weeks or greater, placental abruption, death related to IUGR and RCA (P < 0.01). Overall the unexplained still birth rate was unchanged throughout the study period (p = 0.8) despite a highly significant (p < 0.001) increase in obstetric intervention particularly induction of labor and caesarean section.

  15. Preventing Workplace Injuries Among Perinatal Nurses.

    Science.gov (United States)

    Harolds, Laura; Hurst, Helen

    2016-01-01

    Many aspects of perinatal nursing put nurses at risk for injuries, including frequent repetitive bending, lifting of clients, and exposure to potentially large amounts of body fluids such as blood and amniotic fluid. Violence is also a potential risk with stressful family situations that may arise around childbirth. Workplace injuries put a health care facility at risk for staff turnover, decreases in the number of skilled nurses, client dissatisfaction, workers' compensation payouts, and employee lawsuits. Through the use of safety equipment, improved safety and violence training programs, "no manual lift" policies, reinforcement of personal protective equipment usage, and diligent staff training to improve awareness, these risks can be minimized. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

  16. Brain pertechnetate SPECT in perinatal asphyxia

    Energy Technology Data Exchange (ETDEWEB)

    Sfakianakis, G.; Curless, R.; Goldberg, R.; Clarke, L.; Saw, C.; Sfakianakis, E.; Bloom, F.; Bauer, C.; Serafini, A.

    1984-01-01

    Single photon emission computed tomography of the brain was performed in 6 patients with perinatal asphyxis aged 8-26 days. A single-head (LFOV) commercial SPECT system (Picker) was used and data were acquired 2-3 hr after an IV injection of 1-2 mCi Tc-99m-pertechnetate (360/sup 0/ rotation, 60 views, 64 x 64 matrix, 50K cts/view). Reconstruction in three planes was performed using MDS software (Hanning medium resolution filter, with or without attenuation correction using Sorenson's technique). For each clinical study, a ring type phantom source was used to identify the level of reconstruction noise in the tomographic planes. Abnormalities were found in all patients studied, 3 central (moderate intensity), 2 peripheral (1 severe, 1 moderate) and 1 diffuse (mild intensity). Despite use of oral perchlorate (50 mg) in one patient the choroid plexus was visible. Since attenuation correction tended to amplify noise, the clinical studies were interpreted both with and without this correction. All 3 patients with central lesions were found abnormal on early (1-4 mo) neurologic follow-up examination, whereas the others were normal. No correlation was found between SPECT and 24 hr blood levels of CPK, ammonia, base excess, or the Apgar scores. Ct scans were reported abnormal (3 diffuse, 1 peripheral, 1 central and 1 questionable). Planar scintigrams obtained immediately after SPECT were normal (2), questionable (2) and abnormal (2). Follow-up SPECT brain scintigrams in two of the patients showed partial resolution. SPECT of the brain appears promising in perinatal asphyxia but long-term correlation with patient development is necessary.

  17. Shifting paradigm of maternal and perinatal death review system in Bangladesh: A real time approach to address sustainable developmental goal 3 by 2030 [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Animesh Biswas

    2017-07-01

    Full Text Available Recently, Bangladesh has made remarkable progress in reducing maternal and neonatal morality, even though the millennium developmental goal to reduce maternal and neonatal mortality was not achieved. Sustainable Developmental Goal (SDG 3 has already been set for a new target to reduce maternal and neonatal deaths by 2030. The country takes this timely initiative to introduce a maternal and perinatal death review system. This review will discuss the shifting paradigm of the maternal and perinatal death review system in Bangladesh and its challenges in reaching the SDG on time. This review uses existing literature on the maternal and perinatal death review system in Bangladesh, and other systems in similar settings, as well as reports, case studies, news, government letters and meeting minutes. Bangladesh introduced the maternal and perinatal death review system in 2010. Prior to this there was no such comprehensive death review system practiced in Bangladesh. The system was established within the government health system and has brought about positive effects and outcomes. Therefore, the Ministry of Health and Family Welfare of Bangladesh gradually scaled up the maternal and perinatal death review system nationwide in 2016 within the government health system. The present death review system highlighted real-time data use, using the district health information software(DHIS-2. Health mangers are able to take remedial action plans and implement strategies based on findings in DHIS-2. Therefore, effective utilization of data can play a pivotal role in the reduction of maternal and perinatal deaths in Bangladesh. Overall, the maternal and perinatal death review system provides a great opportunity to achieve the SDG 3 on time. However, the system needs continuous monitoring at different levels to ensure its quality and validity of information, as well as effective utilization of findings for planning and implementation under a measureable

  18. Identification and Treatment of Adolescents With Perinatal Anxiety and Depression.

    Science.gov (United States)

    Hughes, Linda Paine; Austin-Ketch, Tammy; Volpe, Ellen M; Campbell-Heider, Nancy

    2017-06-01

    Perinatal mood and anxiety disorders (PMAD) are the most common, yet under-diagnosed and undertreated complication of pregnancy, affecting up to 50% of pregnant and parenting teens. PMAD are a global health issue that can have devastating effects on the mental, physical, emotional, developmental health, and social life of the mother, infant, and family. Adolescents present with similar symptoms of PMAD as their adult counterparts, but also experience isolation from their peer group and lack of resources and coping strategies, as well as difficulty sleeping and lack of concentration and ability to focus. Nurses and nurse practitioners are in an ideal position to assess preexisting risk factors for PMAD. The current applied evidence-based article addresses the diagnosis of PMAD, provides a conceptual framework for understanding the intra- and interpersonal dynamics affecting teens with PMAD, and suggests a new screening tool to guide diagnosis. An easy to recall mnemonic for diagnosis and referral (SAIL AHEAD) is proposed. By using the SAIL AHEAD mnemonic, providers will impact adolescents' parenting success and resiliency, thereby enhancing their future success in life. [Journal of Psychosocial Nursing and Mental Health Services, 55(6), 23-29.]. Copyright 2017, SLACK Incorporated.

  19. Perinatal Fluoxetine Exposure Impairs the CO2 Chemoreflex. Implications for Sudden Infant Death Syndrome.

    Science.gov (United States)

    Bravo, Karina; Eugenín, Jaime L; Llona, Isabel

    2016-09-01

    High serotonin levels during pregnancy affect central nervous system development. Whether a commonly used antidepressant such as fluoxetine (a selective serotonin reuptake inhibitor) taken during pregnancy may adversely affect respiratory control in offspring has not been determined. The objective was to determine the effect of prenatal-perinatal fluoxetine exposure on the respiratory neural network in offspring, particularly on central chemoreception. Osmotic minipumps implanted into CF-1 mice on Days 5-7 of pregnancy delivered 7 milligrams per kilogram per day of fluoxetine, achieving plasma levels within the range found in patients. Ventilation was assessed in offspring at postnatal Days 0-40 using head-out body plethysmography. Neuronal activation was evaluated in the raphe nuclei and in the nucleus tractus solitarius by c-Fos immunohistochemistry during normoxic eucapnia and hypercapnia (10% CO2). Respiratory responses to acidosis were evaluated in brainstem slices. Prenatal-perinatal fluoxetine did not affect litter size, birth weight, or the postnatal growth curve. Ventilation under eucapnic normoxic conditions was similar to that of control offspring. Fluoxetine exposure reduced ventilatory responses to hypercapnia at P8-P40 (P Fluoxetine applied acutely on control slices did not modify their respiratory response to acidosis. We concluded that prenatal-perinatal fluoxetine treatment impairs central respiratory chemoreception during postnatal life. These results are relevant in understanding the pathogenesis of respiratory failures, such as sudden infant death syndrome, associated with brainstem serotonin abnormalities and the failure of respiratory chemoreflexes.

  20. Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study

    Directory of Open Access Journals (Sweden)

    Maria de Lourdes de Souza

    Full Text Available ABSTRACT Objective: analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil. Methods: a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests. Results: differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; p<0.001, have an infant with low birthweight (OR:1.1; CI:1.10-1.15; p<0.001 and low Apgar score at 5 minutes (OR:1.4; CI:1.34-1.45; p<0.001 than mothers ≥20 years, with the odds for adverse outcomes greater for those aged 10-14 years. Conclusion: this study provides evidence of fertility rates among adolescents remaining higher in regions of social and economic deprivation. Adolescent mothers and their infants more likely to experience adverse perinatal outcomes. Nurses, public health practitioners, health and social care professionals and educators need to work collaboratively to better target strategies for adolescents at greater risk; to help reduce fertility rates and improve outcomes.

  1. The use of customised versus population-based birthweight standards in predicting perinatal mortality.

    Science.gov (United States)

    Zhang, X; Platt, R W; Cnattingius, S; Joseph, K S; Kramer, M S

    2007-04-01

    The objective of this study was to critically examine potential artifacts and biases underlying the use of 'customised' standards of birthweight for gestational age (GA). Population-based cohort study. Sweden. A total of 782,303 singletons > or =28 weeks of gestation born in 1992-2001 to Nordic mothers with complete data on birthweight; GA; and maternal age, parity, height, and pre-pregnancy weight. We compared perinatal mortality in four groups of infants based on the following classification of small for gestational age (SGA): non-SGA based on either population-based or customised standards (the reference group), SGA based on the population-based standard only, SGA based on the customised standard only, and SGA according to both standards. We used graphical methods to compare GA-specific birthweight cutoffs for SGA using the two standards and also used logistic regression to control for differences in GA and maternal pre-pregnancy body mass index (BMI) in the four groups. Perinatal mortality, including stillbirth and neonatal death. Customisation led to a large artifactual increase in the proportion of SGA infants born preterm. Adjustment for differences in GA and maternal BMI markedly reduced the excess risk among infants classified as SGA by customised standards only. The large increase in perinatal mortality risk among infants classified as SGA based on customised standards is largely an artifact due to inclusion of more preterm births.

  2. Sexual activity and sexual dysfunction of women in the perinatal period: a longitudinal study.

    Science.gov (United States)

    Wallwiener, Stephanie; Müller, Mitho; Doster, Anne; Kuon, Ruben Jeremias; Plewniok, Katharina; Feller, Sandra; Wallwiener, Markus; Reck, Corinna; Matthies, Lina Maria; Wallwiener, Christian

    2017-04-01

    Reduced sexual activity and dysfunctional problems are highly prevalent in the perinatal period, and there is a lack of data regarding the degree of normality during pregnancy. Several risk factors have been independently associated with a greater extent of Female Sexual Dysfunction (FSD). Therefore, this study aimed to assess the prevalence of sexual inactivity and sexual dysfunctions in German women during the perinatal period and the verification of potential risk factors. Questionnaires were administered to 315 women prenatally (TI 3rd trimester) and postpartum (TII 1 week, TIII 4 months), including the Female Sexual Function Index (FSFI), the Edinburgh Postnatal Depression Scale (EPDS), and the Questionnaire of Partnership (PFB). The frequency of sexual inactivity was 24% (TI), 40.5% (TII), and 19.9% (TIII). Overall, 26.5-34.8% of women were at risk of sexual dysfunction (FSFI score Sexual desire disorder was the most prevalent form of Female sexual dysfunction. Furthermore, especially breastfeeding and low partnership quality were revealed as significant risk factors for sexual dysfunctional problems postpartum. Depressive symptoms having a cesarean section and high maternal education were correlated with dysfunctional problems in several subdomains. Findings indicated that women at risk of FSD differed significantly in aspects of partnership quality, breastfeeding, mode of delivery, maternal education, and depressive symptoms. Aspects of perinatal sexuality should be routinely implemented in the counseling of couples in prenatal classes.

  3. Assessment of perinatal outcome after sustained tocolysis in early labour (APOSTEL-II trial

    Directory of Open Access Journals (Sweden)

    Scherjon Sicco A

    2009-09-01

    Full Text Available Abstract Background Preterm labour is the main cause of perinatal morbidity and mortality in the Western world. At present, there is evidence that tocolysis for 48 hours is useful in women with threatened preterm labour at least before 32 weeks. This allows transfer of the patient to a perinatal centre, and maximizes the effect of corticosteroids for improved neonatal survival. It is questionable whether treatment with tocolytics should be maintained after 48 hours. Methods/Design The APOSTEL II trial is a multicentre placebo-controlled study. Pregnant women admitted for threatened preterm labour who have been treated with 48 hours corticosteroids and tocolysis will be eligible to participate in the trial between 26+0 and 32+2 weeks gestational age. They will be randomly allocated to nifedipine (intervention or placebo (control for twelve days or until delivery, whatever comes first. Primary outcome is a composite of perinatal death, and severe neonatal morbidity up to evaluation at 6 months after birth. Secondary outcomes are gestational age at delivery, number of days in neonatal intensive care and total days of the first 6 months out of hospital. In addition a cost-effectiveness analysis will be performed. Analysis will be by intention to treat. The power calculation is based on an expected 11% difference in adverse neonatal outcome. This implies that 406 women have to be randomised (two sided test, β 0.2 at alpha 0.05. Discussion This trial will provide evidence as to whether maintenance tocolysis reduces severe perinatal morbidity and mortality in women with threatened preterm labour before 32 weeks. Trial Registration Clinical trial registration: http://www.trialregister.nl, NTR 1336, date of registration: June 3rd 2008.

  4. Paediatric and perinatal postmortem imaging: the need for a subspecialty approach

    Energy Technology Data Exchange (ETDEWEB)

    Arthurs, Owen J. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom); Rijn, Rick R. van [Emma Children' s Hospital - Academic Medical Centre, Department of Radiology, Amsterdam (Netherlands); Taylor, Andrew M. [Great Ormond Street Hospital for Children, Cardiorespiratory Unit, London (United Kingdom); UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London (United Kingdom); Sebire, Neil J. [Great Ormond Street Hospital for Children, Department of Pathology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom)

    2015-04-01

    Paediatric postmortem imaging is distinct and different from adult postmortem imaging due to differences in disease aetiology, pathology and imaging approaches, which require a particular skill set to maximise its yield and clinical utility. Practitioners need to have expertise in several aspects of radiology, including both plain radiographs and cross-sectional imaging modalities, knowledge of specialist techniques, and familiarity with the unique range of pathologies in this patient population, including perinatal pathology. Here we outline the training requirements that should be considered to establish such a service. (orig.)

  5. Reducing the cost of dissociative identity disorder: Measuring the effectiveness of specialized treatment by frequency of contacts with mental health services.

    Science.gov (United States)

    Lloyd, Mike

    2016-01-01

    It is important to understand and record the impact of therapy on severe mental health conditions through the use of clinical assessment measures. In this article, I propose to extend outcome evaluation by measuring service use and cost prior to and during the commencement of psychological therapy over a period of 4 years for 2 people diagnosed with dissociative identity disorder. The treatment was provided within an outpatient setting in a U.K. National Health Service hospital trust following therapeutic guidelines set out by the International Society for the Study of Trauma and Dissociation. Results show that service use in both inpatient and out-of-hours crisis services reduced as the 2 people received therapy over the 4-year time period. Based on these 2 cases, it appears to be cost effective to provide specialized therapy for dissociative identity disorder in outpatient settings.

  6. Internal curing as a new tool for infrastructural renewal : reducing repair congestion, increasing service life, and improving sustainability.

    Science.gov (United States)

    2014-04-01

    Internal curing has recently been developed as a new concrete technology that has the potential to : dramatically extend the service life of concrete infrastructure elements like bridge decks. Internal curing : uses prewetted lightweight aggregate in...

  7. [Perinatal clomiphene citrate treatment changes sexual orientations of male mice].

    Science.gov (United States)

    He, Feng-Qin; Zhang, Heng-Rui

    2013-10-01

    Perinatal period and adolescence are critical for brain development, which is the biological basis of an individual's sexual orientation and sexual behavior. In this study, animals were divided into two groups and their sexual orientations were observed: one group experienced drug treatments during the perinatal period, and the other group was castrated at puberty. The results showed that estradiol treatment had no effect on mature male offspring's sexual orientations, but 9 days and 14 days of clomiphene citrate treatment significantly increased the chance of homosexuality and effeminized behavior. In addition, the sexual orientation of mature normal male offspring, which were castrated when they were 21 days old,was not significant different from the control animals. These findings suggest that the inhibition of perinatal estrogen activities could suppress individual male-typical responses, enhance female-typical responses and induce homosexual orientations. Moreover, the masculinizing effects of estrogen were more obvious during perinatal period than adolescence.

  8. Perinatal asphyxia in a specialist hospital in Port Harcourt, Nigeria

    African Journals Online (AJOL)

    owner

    Accepted: 7th December 2012. West BA. Department of Paediatrics,. University of Port Harcourt ... oping countries with perinatal asphyxia and birth inju- ries together ... age, sex, birth weight, gestational age of recruited ba- bies, parity, booking ...

  9. Perinatal outcomes in pregnant women presenting with preterm ...

    African Journals Online (AJOL)

    Perinatal outcomes in pregnant women presenting with preterm premature rupture of membranes at a ... Journal Home > Vol 23, No 2 (2017) > ... in sepsis rates, the need for ventilation and the duration of hospital stay between the two groups.

  10. Cognitive outcome in childhood after unilateral perinatal brain injury

    NARCIS (Netherlands)

    van Buuren, L.M.; van der Aa, N.E.; Dekker, H.C.; Vermeulen, R.J.; van Nieuwenhuizen, O.; van Schooneveld, M.M.J.; de Vries, L.S.

    2013-01-01

    Aim: The aim of the study was to assess cognitive outcome in children with periventricular haemorrhagic infarction (PVHI) or perinatal arterial ischaemic stroke (PAIS) and relate these findings to early developmental outcome and neonatal magnetic resonance imaging findings. Method: A

  11. The impact of the Perinatal Education Programme on cognitive ...

    African Journals Online (AJOL)

    Assessment of cognitive knowledge by means of multiple-choice ... midwives use the Perinatal Education Programme in an outreach ... used the Afrikaans translation of the Programme, because .... improvements in patient care practices.

  12. Competitive service centers location in the cities with aim to reduce traffic (Case study: Health centers location in the city if Isfahan

    Directory of Open Access Journals (Sweden)

    Hamid Moradi

    2011-03-01

    Full Text Available Abstract   Distribution of goods and services in cities is of utmost importance. Selecting appropriate venues for different service centers in a city not only enables the citizens to access these services much more easily, but also reduces the traffic load caused by trips made to reach them. Unfortunately, the lack of a correct urban planning has led to inappropriate formation of many cities around the world in terms of the locations assumed for different service centers. Since the private sector has been given the responsibility to construct most of these centers, changing their current locations may be restricted due to legal obligations. Therefore, it seems necessary for the government to construct new service centers with high competitive facilities to attract customers and to compete with those built by the private sector. In this paper, the selection of appropriate locations to construct new service centers has been studied. Such locations have been selected in a way to fulfill goals such as rapid and easy accessibility for the customers and reduction of traffic drawbacks caused by the related trips. In this regard, a model for service centers with restricted capacity has been designed and a parallel simulated annealing algorithm has been proposed to solve it. Finally, the proposed algorithm has been utilized to locate the health centers around the city of Isfahan and its efficiency has been investigated. The findings highlight the accuracy and speed of the proposed algorithm in location of the health centers of Isfahan.

  13. Perinatal-lethal Gaucher disease presenting as hydrops fetalis.

    Science.gov (United States)

    BenHamida, Emira; Ayadi, Imene; Ouertani, Ines; Chammem, Maroua; Bezzine, Ahlem; BenTmime, Riadh; Attia, Leila; Mrad, Ridha; Marrakchi, Zahra

    2015-01-01

    Perinatal-lethal Gaucher disease is very rare and is considered a variant of type 2 Gaucher disease that occurs in the neonatal period. The most distinct features of perinatal-lethal Gaucher disease are non-immune hydrops fetalis. Less common signs of the disease are hepatosplenomegaly, ichthyosis and arthrogryposis. We report a case of Gaucher's disease (type 2) diagnosed in a newborn who presented with Hydrops Fetalis.

  14. Stimulation of Functional Vision in Children with Perinatal Brain Damage

    OpenAIRE

    Alimović, Sonja; Mejaški-Bošnjak, Vlatka

    2011-01-01

    Cerebral visual impairment (CVI) is one of the most common causes of bilateral visual loss, which frequently occurs due to perinatal brain injury. Vision in early life has great impact on acquisition of basic comprehensions which are fundamental for further development. Therefore, early detection of visual problems and early intervention is necessary. The aim of the present study is to determine specific visual functioning of children with perinatal brain damage and the influence of visual st...

  15. Management of renal dysfunction following term perinatal hypoxia-ischaemia.

    LENUS (Irish Health Repository)

    Sweetman, Deirdre U

    2013-03-01

    Acute kidney injury frequently develops following the term perinatal hypoxia-ischaemia. Quantifying the degree of acute kidney injury is difficult, however, as the methods currently in use are suboptimal. Acute kidney injury management is largely supportive with little evidence basis for many interventions. This review discusses management strategies and novel biomarkers that may improve diagnosis and management of renal injury following perinatal hypoxia-ischaemia.

  16. Tei index in neonatal respiratory distress and perinatal asphyxia

    OpenAIRE

    Ahmed Anwer Attia Khattab

    2015-01-01

    Cardiovascular compromise is a common complication of neonatal respiratory distress and perinatal asphyxia. Tei index is a Doppler-derived index for the assessment of overall left ventricular function that combines systolic and diastolic time intervals. Aim: Assess the role of MPI versus cardiac troponin I as early indicator of hypoxic cardiac damage in neonates with respiratory distress or perinatal asphyxia. The present work was conducted on forty neonates, 15 with neonatal respiratory dist...

  17. A current landscape of provincial perinatal data collection in Canada.

    Science.gov (United States)

    Massey, Kiran A; Magee, Laura A; Dale, Sheryll; Claydon, Jennifer; Morris, Tara J; von Dadelszen, Peter; Liston, Robert M; Ansermino, J Mark

    2009-03-01

    The Canadian Perinatal Network (CPN) was launched in 2005 as a national perinatal database project designed to identify best practices in maternity care. The inaugural project of CPN is focused on interventions that optimize maternal and perinatal outcomes in women with threatened preterm birth at 22+0 to 28+6 weeks' gestation. To examine existing data collection by perinatal health programs (PHPs) to inform decisions about shared data collection and CPN database construction. We reviewed the database manuals and websites of all Canadian PHPs and compiled a list of data fields and their definitions. We compared these fields and definitions with those of CPN and the Canadian Minimal Dataset, proposed as a common dataset by the Canadian Perinatal Programs Coalition of Canadian PHPs. PHPs collect information on 2/3 of deliveries in Canada. PHPs consistently collect information on maternal demographics (including both maternal and neonatal personal identifiers), past obstetrical history, maternal lifestyle, aspects of labour and delivery, and basic neonatal outcomes. However, most PHPs collect insufficient data to enable identification of obstetric (and neonatal) practices associated with improved maternal and perinatal outcomes. In addition, there is between-PHP variability in defining many data fields. Construction of a separate CPN database was needed although harmonization of data field definitions with those of the proposed Canadian Minimal Dataset was done to plan for future shared data collection. This convergence should be the goal of researchers and clinicians alike as we construct a common language for electronic health records.

  18. Evaluating the quality of perinatal anxiety information available online.

    Science.gov (United States)

    Kirby, Paige L; Reynolds, Kristin A; Walker, John R; Furer, Patricia; Pryor, Teaghan A M

    2018-06-22

    The Internet is an easily accessible source of information for women experiencing anxiety in pregnancy and/or postpartum to use when seeking health information. However, the Internet has several drawbacks, including inaccurate content that may be perceived as being accurate, non-biased, and evidence-based. Prior research indicates that anxiety and postpartum mental health websites have poor quality in terms of describing treatment options. There is a lack of research and knowledge in the area of perinatal anxiety, and an absence of research evaluating perinatal anxiety websites. The purpose of this study was to evaluate the quality of information regarding perinatal anxiety available on the Internet. Websites concerning perinatal anxiety were selected using the Google search engine. Each website was evaluated based on quality of health information, website usability, and readability. The 20 websites included in this study had low to moderate quality scores based on the DISCERN tool. There were no associations found between website order and website quality, or between website readability and website quality. Many websites had high PEMAT scores for the understandability section, which included content, style, and layout of information; however, most did not use visual aids to enhance comprehension. Most websites had low actionability scores, suggesting that information may not be useful in describing what actions may be taken to manage perinatal anxiety. This study highlights the need for high-quality websites concerning perinatal anxiety that are easy to navigate and provide the public with evidence-based information.

  19. Magnitude of income-related disparities in adverse perinatal outcomes.

    Science.gov (United States)

    Shankardass, Ketan; O'Campo, Patricia; Dodds, Linda; Fahey, John; Joseph, Ks; Morinis, Julia; Allen, Victoria M

    2014-03-04

    To assess and compare multiple measurements of socioeconomic position (SEP) in order to determine the relationship with adverse perinatal outcomes across various contexts. A birth registry, the Nova Scotia Atlee Perinatal Database, was confidentially linked to income tax and related information for the year in which delivery occurred. Multiple logistic regression was used to examine odds ratios between multiple indicators of SEP and multiple adverse perinatal outcomes in 117734 singleton births between 1988 and 2003. Models for after tax family income were also adjusted for neighborhood deprivation to gauge the relative magnitude of effects related to SEP at both levels. Effects of SEP were stratified by single- versus multiple-parent family composition, and by urban versus rural location of residence. The risk of small for gestational age and spontaneous preterm birth was higher across all the indicators of lower SEP, while risk for large for gestational age was lower across indicators of lower SEP. Higher risk of postneonatal death was demonstrated for several measures of lower SEP. Higher material deprivation in the neighborhood of residence was associated with increased risk for perinatal death, small for gestational age birth, and iatrogenic and spontaneous preterm birth. Family composition and urbanicity were shown to modify the association between income and some perinatal outcomes. This study highlights the importance of understanding the definitions of SEP and the mechanisms that lead to the association between income and poor perinatal outcomes, and broadening the types of SEP measures used in some cases.

  20. Maternal nutritional status & practices & perinatal, neonatal mortality in rural Andhra Pradesh, India.

    Science.gov (United States)

    Bamji, Mahtab S; V S Murthy, P V; Williams, Livia; Vardhana Rao, M Vishnu

    2008-01-01

    Despite a vast network of primary health centres and sub-centres, health care outreach in rural parts of India is poor. The Dangoria Charitable Trust (DCT), Hyderabad, has developed a model of health care outreach through trained Village Health and Nutrition Entrepreneur and Mobilisers (HNEMs) in five villages of Medak district in Andhra Pradesh, not serviced by the Integrated Child Development Scheme (ICDS) of the Government of India. Impact of such a link worker on perinatal/ neonatal mortality has been positive. The present study attempts to examine the association of maternal nutrition and related factors with perinatal, and neonatal mortality in these villages. Women from five selected villages who had delivered between June 1998 and September 2003, were identified. Those who had lost a child before one month (28 days), including stillbirths, (group 1- mortality group), who could be contacted and were willing to participate, were compared with those who had not lost a child (group II- no mortality), through a structured questionnaire and physical examination for anthropometric status and signs and symptoms of nutritional deficiency. Categorical data were analysed using Pearson chi square analysis. Continuous data were analysed using Student's t test. Mortality during perinatal, neonatal period was 8.2 per cent of all births. Malnutrition was rampant. Over 90 per cent women had 3 or more antenatal check-ups, had taken tetanus injections and had complied with regular consumption of iron-folic acid tablets. Higher percentage of women in group I (mortality group) tended to have height less than 145 cm (high risk) and signs and symptoms of micronutrient deficiencies. However, differences between groups I and II were not statistically significant. Pre-term delivery, difficult labour (use of forceps), first parity, birth asphyxia (no cry at birth) and day of initiating breastfeeding showed significant association with mortality. Significant association between signs

  1. A hospital-based palliative care service for patients with advanced organ failure in sub-Saharan Africa reduces admissions and increases home death rates.

    Science.gov (United States)

    Desrosiers, Taylor; Cupido, Clint; Pitout, Elizabeth; van Niekerk, Lindi; Badri, Motasim; Gwyther, Liz; Harding, Richard

    2014-04-01

    Despite emerging data of cost savings under palliative care in various regions, no such data have been generated in response to the high burden of terminal illness in Africa. This evaluation of a novel hospital-based palliative care service for patients with advanced organ failure in urban South Africa aimed to determine whether the service reduces admissions and increases home death rates compared with the same fixed time period of standard hospital care. Data on admissions and place of death were extracted from routine hospital activity records for a fixed period before death, using standard patient daily expense rates. Data from the first 56 consecutive deaths under the new service (intervention group) were compared with 48 consecutive deaths among patients immediately before the new service (historical controls). Among the intervention and control patients, 40 of 56 (71.4%) and 47 of 48 (97.9%), respectively, had at least one admission (P home death was achieved by 33 of 56 (58.9%) and nine of 48 (18.8%), respectively (P ≤ 0.001). These data demonstrate that an outpatient hospital-based service reduced admissions and improved the rate of home deaths and offers a feasible and cost-effective model for such settings. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  2. The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

    Directory of Open Access Journals (Sweden)

    van Diem Mariet Th

    2012-07-01

    Full Text Available Abstract Background Perinatal (mortality audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in mortality are usually part of the audit group. This makes such an audit a delicate matter. Methods The purpose of this study was to implement unit-based perinatal mortality audit in all 15 perinatal cooperation units in the northern region of the Netherlands between September 2007 and March 2010. These units consist of hospital-based and independent community-based perinatal caregivers. The implementation strategy encompassed an information plan, an organization plan, and a training plan. The main outcomes are the number of participating perinatal cooperation units at the end of the project, the identified substandard factors (SSF, the actions to improve care, and the opinions of the participants. Results The perinatal mortality audit was implemented in all 15 perinatal cooperation units. 677 different caregivers analyzed 112 cases of perinatal mortality and identified 163 substandard factors. In 31% of cases the guidelines were not followed and in 23% care was not according to normal practice. In 28% of cases, the documentation was not in order, while in 13% of cases the communication between caregivers was insufficient. 442 actions to improve care were reported for ‘external cooperation’ (15%, ‘internal cooperation’ (17%, ‘practice organization’ (26%, ‘training and education’ (10%, and ‘medical performance’ (27%. Valued aspects of the audit meetings were: the multidisciplinary character (13%, the collective and non-judgmental search for substandard factors (21%, the perception of safety (13%, the motivation to reflect on one’s own professional performance (5%, and the inherent postgraduate education (10%. Conclusion

  3. Brain susceptibility to oxidative stress in the perinatal period.

    Science.gov (United States)

    Perrone, Serafina; Tataranno, Luisa M; Stazzoni, Gemma; Ramenghi, Luca; Buonocore, Giuseppe

    2015-11-01

    Oxidative stress (OS) occurs at birth in all newborns as a consequence of the hyperoxic challenge due to the transition from the hypoxic intrauterine environment to extrauterine life. Free radical (FRs) sources such as inflammation, hyperoxia, hypoxia, ischaemia-reperfusion, neutrophil and macrophage activation, glutamate and free iron release, all increases the OS during the perinatal period. Newborns, and particularly preterm infants, have reduced antioxidant defences and are not able to counteract the harmful effects of FRs. Energy metabolism is central to life because cells cannot exist without an adequate supply of ATP. Due to its growth, the mammalian brain can be considered as a steady-state system in which ATP production matches ATP utilisation. The developing brain is particularly sensitive to any disturbances in energy generation, and even a short-term interruption can lead to long-lasting and irreversible damage. Whenever energy failure develops, brain damage can occur. Accumulating evidence indicates that OS is implicated in the pathogenesis of many neurological diseases, such as intraventricular haemorrhage, hypoxic-ischaemic encephalopathy and epilepsy.

  4. Perinatal asphyxia and medical professional liability: A case series

    Directory of Open Access Journals (Sweden)

    Andrea Verzeletti

    2016-12-01

    Full Text Available In the context of medical professional liability, obstetrics is one of the most involved medical specialties because the unfavorable outcome of a pregnancy is difficult to accept for parents, who tend to reduce it to inappropriate care that occurred during pregnancy or birth. 32 cases of perinatal asphyxia were evaluated by the Institute of Forensic Medicine in Brescia during the period between 1999 and 2014 (13 in Civil Court and 19 in Penal Court. 9 out of the 32 pregnancies were twins, so the considerations were carried out on a total of 41 fetuses/newborns. Profiles of inadequacy were identified in 66% of cases (85% of the cases evaluated in Civil Court; 53% of the cases evaluated in Penal Court. The existence of a causal relationship between the medical conduct and the onset of asphyxia was recognized in 79% of civil cases and in 38% of penal cases. There is a “greater rigor” in the verification of causal relationship and malpractice profiles in penal cases compared to civil ones: this is in harmony with the most recent Italian Court decisions, characterized by compelling suspect’s protection in the presence of a reasonable doubt in criminal matters and by victim’s protection in civil ones.

  5. Influence of paternal age on perinatal outcomes.

    Science.gov (United States)

    Hurley, Emily G; DeFranco, Emily A

    2017-11-01

    There is an increasing trend to delay childbearing to advanced parental age. Increased risks of advanced maternal age and assisted reproductive technologies are widely accepted. There are limited data regarding advanced paternal age. To adequately counsel patients on risk, more research regarding advanced paternal age is necessary. We sought to determine the influence of paternal age on perinatal outcomes, and to assess whether this influence differs between pregnancies achieved spontaneously and those achieved with assisted reproductive technology. A population-based retrospective cohort study of all live births in Ohio from 2006 through 2012 was completed. Data were evaluated to determine if advanced paternal age is associated with an increased risk of adverse outcomes in pregnancies. The analysis was stratified by status of utilization of assisted reproductive technology. Generalized linear regression models assessed the association of paternal age on pregnancy complications in assisted reproductive technology and spontaneously conceived pregnancies, after adjusting for maternal age, race, multifetal gestation, and Medicaid status, using Stata software (Stata, Release 12; StataCorp, College Station, TX). Paternal age was documented in 82.2% of 1,034,552 live births in Ohio during the 7-year study period. Paternal age ranged from 12-87 years, with a median of 30 (interquartile range, 26-35) years. Maternal age ranged from 11-62 years, with a median of 27 (interquartile range, 22-31) years. The use of assisted reproductive technology in live births increased as paternal age increased: 0.1% 60 years, P risk factors, increased paternal age was not associated with a significant increase in the rate of preeclampsia, preterm birth, fetal growth restriction, congenital anomaly, genetic disorder, or neonatal intensive care unit admission. The influence of paternal age on pregnancy outcomes was similar in pregnancies achieved with and without assisted reproductive

  6. MATERNAL AND PERINATAL OUTCOME IN ABRUPTIO PLACENTA

    Directory of Open Access Journals (Sweden)

    Prabha Janakiram

    2017-08-01

    Full Text Available BACKGROUND Antepartum Haemorrhage (APH is the leading cause of vaginal bleeding. It is also the important cause of maternal morbidity as well as perinatal morbidity. APH is defined as bleeding per vagina occurring after 28 weeks of gestation and before the birth of the baby. Among APH, abruptio placenta and placenta previa are the leading cause that endanger the life of the mother and a great risk to high unfavourable perinatal outcome. Placental abruption is the bleeding from the premature separation of the normally implanted placenta after 20 weeks of gestations and prior to the birth of the foetus/foetuses. It is the major contribution of obstetric haemorrhage and complicates 0.8 to 1% of pregnancies worldwide. Placental abruption is the premature separation of implanted placenta before the delivery of foetus/foetuses. The aim of the study is to analyse the risk factors associated with abruption and hence methods can be formulated to prevent maternal mortality and morbidity. MATERIALS AND METHODS The present study is a retrospective study and was done in the Department of Obstetrics and Gynaecology from July to December, 2016, for a period of 6 months in the year 2016 at Government K.A.P.V. Medical College, Trichy, South India. RESULTS The total number of abruption placenta cases reported during the study period- June 2016 to November 2016 were 40. The total number of livebirth during same period was 5,348. The stillbirth rate was 42.5% and neonatal death rate was 22.5%. Clinical information were collected, maternal age, parity, gestational age at parity, prior history of abruption, clinical presentation like pain, bleeding, type of abruption like concealed or revealed amount of retroplacental clots and its size and degree of abruption associated with hypertensive disorders, mode of delivery, abruption-delivery interval, maternal complications, requirement of blood transfusions and immediate neonatal outcome. The results of studies were

  7. Exposure to a high fat diet during the perinatal period alters vagal motoneurone excitability, even in the absence of obesity.

    Science.gov (United States)

    Bhagat, Ruchi; Fortna, Samuel R; Browning, Kirsteen N

    2015-01-01

    brainstem slices from rats that were exposed to either a control diet or HFD from pregnancy day 13. Our data demonstrate that following perinatal HFD: (i) DMV neurones had decreased excitability and input resistance with a reduced ability to fire action potentials; (ii) the proportion of DMV neurones excited by cholecystokinin (CCK) was unaltered but the proportion of neurones in which CCK increased excitatory glutamatergic synaptic inputs was reduced; (iii) the tonic activation of presynaptic group II metabotropic glutamate receptors on inhibitory nerve terminals was attenuated, allowing modulation of GABAergic synaptic transmission; and (iv) the size and dendritic arborization of gastric-projecting DMV neurones was increased. These results suggest that perinatal HFD exposure compromises the excitability and responsiveness of gastric-projecting DMV neurones, even in the absence of obesity, suggesting that attenuation of vago-vagal reflex signalling may precede the development of obesity. © 2014 The Authors. The Journal of Physiology © 2014 The Physiological Society.

  8. Collaborative survey of perinatal loss in planned and unplanned home births. Northern Region Perinatal Mortality Survey Coordinating Group.

    Science.gov (United States)

    1996-11-23

    To document the outcome of planned and unplanned births outside hospital. Confidential review of every pregnancy ending in stillbirth or neonatal death in which plans had been made for home delivery, irrespective of where delivery eventually occurred. The review was part of a sustained collaborative survey of all perinatal deaths. Northern Regional Health Authority area. All 558,691 registered births to women normally resident in the former Northern Regional Health Authority area during 1981-94. Perinatal death. The estimated perinatal mortality during 1981-94 among women booked for a home birth was 14 deaths in 2888 births. This was less than half that among all women in the region. Only three of the 14 women delivered outside hospital. Independent review suggested that two of the 14 deaths might have been averted by different management. Both births occurred in hospital, and in only one was management before admission of the mother judged inappropriate. Perinatal loss to the 64 women who booked for hospital delivery but delivered outside and to the 67 women who delivered outside hospital without ever making arrangements to receive professional care during labour accounted for the high perinatal mortality (134 deaths in 3466 deliveries) among all births outside hospital. The perinatal hazard associated with planned home birth in the few women who exercised this option (unplanned delivery outside hospital.

  9. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services

    NARCIS (Netherlands)

    M. Chersich (Matthew); S. Luchters (Stanley); I. Ntaganira (Innocent); A. Gerbase (Antonio); Y-R. Lo (Ying-Ru); F. Scorgie (Fiona); R. Steen (Richard)

    2012-01-01

    textabstractIntroduction: Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods: We systematically reviewed studies reporting interventions for

  10. Reducing the use of out-of-hours primary care services: A survey among Dutch general practitioners

    NARCIS (Netherlands)

    Keizer, E.; Maassen, I.; Smits, M.; Wensing, M.; Giesen, P.

    2016-01-01

    BACKGROUND: Out-of-hours primary care services have a high general practitioner (GP) workload with increasing costs, while half of all contacts are non-urgent. OBJECTIVES: To identify views of GPs to influence the use of the out-of-hours GP cooperatives. METHODS: Cross-sectional survey study among a

  11. Reducing the Boundaries between the Community and the Academy with a Full-Time Service Learning Capstone

    Science.gov (United States)

    Ballard, Andy

    2013-01-01

    The purpose of this paper is to share my experiences as the instructor of a full-time, single semester, service-learning capstone course. In this innovative course students already volunteering in the Students in Free Enterprise (SIFE) organization work in teams to identify community needs and address them using their business skills and knowledge…

  12. Ethical issues of perinatal human gene therapy.

    Science.gov (United States)

    Fletcher, J C; Richter, G

    1996-01-01

    This paper examines some key ethical issues raised by trials of human gene therapy in the perinatal period--i.e., in infants, young children, and the human fetus. It describes five resources in ethics for researchers' considerations prior to such trials: (1) the history of ethical debate about gene therapy, (2) a literature on the relevance of major ethical principles for clinical research, (3) a body of widely accepted norms and practices, (4) knowledge of paradigm cases, and (5) researchers' own professional integrity. The paper also examines ethical concerns that must be met prior to any trial: benefits to and safety of subjects, informed assent of children and informed parental permission, informed consent of pregnant women in fetal gene therapy, protection of privacy, and concerns about fairness in the selection of subjects. The paper criticizes the position that cases of fetal gene therapy should be restricted only to those where the pregnant woman has explicitly refused abortion. Additional topics include concerns about genetic enhancement and germ-line gene therapy.

  13. Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model.

    Science.gov (United States)

    Moore, Donna; Drey, Nicholas; Ayers, Susan

    2017-02-20

    Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-seeking behavior, potentially because they have a role in challenging stigma. This study draws from these findings and theoretical concepts to present a model of forum use, stigma, and disclosure. This study tested a model that measured the mediating role of stigma between online forum use and disclosure of affective symptoms to health care providers. A Web-based survey of 200 women who were pregnant or had a child younger than 5 years and considered themselves to be experiencing psychological distress was conducted. Women were recruited through social media and questions measured forum usage, perinatal mental illness stigma, disclosure to health care providers, depression and anxiety symptoms, barriers to disclosure, and demographic information. There was a significant positive indirect effect of length of forum use on disclosure of symptoms through internal stigma, b=0.40, bias-corrected and accelerated (BCa) 95% CI 0.13-0.85. Long-term forum users reported higher levels of internal stigma, and higher internal stigma was associated with disclosure of symptoms to health care providers when controlling for symptoms of depression and anxiety. Internal stigma mediates the relationship between length of forum use and disclosure to health care providers. Findings suggest that forums have the potential to enable women to recognize and reveal their internal stigma, which may in turn lead to greater disclosure of symptoms to health care providers. Clinicians could refer clients to trustworthy and

  14. Paradoxical centrally increased diffusivity in perinatal arterial ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Stence, Nicholas V.; Mirsky, David M.; Deoni, Sean C.L. [University of Colorado Anschutz School of Medicine, Department of Radiology, Aurora, CO (United States); Children' s Hospital Colorado, Department of Radiology, Aurora, CO (United States); Armstrong-Wells, Jennifer [University of Colorado Anschutz School of Medicine, Department of Pediatrics (Neurology) and OB/GYN, Aurora, CO (United States); University of Colorado Hemophilia and Thrombosis Center, Aurora, CO (United States)

    2016-01-15

    Restricted diffusion on acute MRI is the diagnostic standard for perinatal arterial ischemic stroke. In a subset of children with perinatal arterial ischemic stroke, primarily those with large infarct volumes, we noted a core of centrally increased diffusivity with a periphery of restricted diffusion. Given the paradoxical diffusion-weighted imaging (DWI) appearance observed in some children with perinatal arterial ischemic stroke, we sought to determine its significance and hypothesized that: (1) centrally increased diffusivity is associated with larger infarcts in perinatal arterial ischemic stroke and (2) this tissue is irreversibly injured (infarcted). We reviewed all perinatal arterial ischemic stroke cases in a prospective cohort study from Aug. 1, 2000, to Jan. 1, 2012. Infarct volumes were measured by drawing regions of interest around the periphery of the area of restricted diffusion on DWI. The Mann-Whitney U test was used to compare means between groups. Of 25 eligible cases, centrally increased diffusivity was seen in 4 (16%). Cases with centrally increased diffusivity had larger average infarct volumes (mean 117,182 mm{sup 3} vs. 36,995 mm{sup 3}; P = 0.008), higher average apparent diffusion coefficient (ADC) values in the infarct core (1,679 x 10{sup -6} mm{sup 2}/s vs. 611 x 10{sup -6} mm{sup 2}/s, P < 0.0001), and higher ADC ratio (1.2 vs. 0.5, P < 0.0001). At last clinical follow-up, children with perinatal arterial ischemic stroke and centrally increased diffusivity were more often treated for ongoing seizures (75% vs. 0%; P < 0.001) than those without. Centrally increased diffusivity was associated with larger stroke volume and the involved tissue was confirmed to be infarcted on follow-up imaging. Radiologists should be aware of this unusual appearance of perinatal arterial ischemic stroke in order to avoid underestimating infarct volume or making an incorrect early diagnosis. (orig.)

  15. Paradoxical centrally increased diffusivity in perinatal arterial ischemic stroke

    International Nuclear Information System (INIS)

    Stence, Nicholas V.; Mirsky, David M.; Deoni, Sean C.L.; Armstrong-Wells, Jennifer

    2016-01-01

    Restricted diffusion on acute MRI is the diagnostic standard for perinatal arterial ischemic stroke. In a subset of children with perinatal arterial ischemic stroke, primarily those with large infarct volumes, we noted a core of centrally increased diffusivity with a periphery of restricted diffusion. Given the paradoxical diffusion-weighted imaging (DWI) appearance observed in some children with perinatal arterial ischemic stroke, we sought to determine its significance and hypothesized that: (1) centrally increased diffusivity is associated with larger infarcts in perinatal arterial ischemic stroke and (2) this tissue is irreversibly injured (infarcted). We reviewed all perinatal arterial ischemic stroke cases in a prospective cohort study from Aug. 1, 2000, to Jan. 1, 2012. Infarct volumes were measured by drawing regions of interest around the periphery of the area of restricted diffusion on DWI. The Mann-Whitney U test was used to compare means between groups. Of 25 eligible cases, centrally increased diffusivity was seen in 4 (16%). Cases with centrally increased diffusivity had larger average infarct volumes (mean 117,182 mm 3 vs. 36,995 mm 3 ; P = 0.008), higher average apparent diffusion coefficient (ADC) values in the infarct core (1,679 x 10 -6 mm 2 /s vs. 611 x 10 -6 mm 2 /s, P < 0.0001), and higher ADC ratio (1.2 vs. 0.5, P < 0.0001). At last clinical follow-up, children with perinatal arterial ischemic stroke and centrally increased diffusivity were more often treated for ongoing seizures (75% vs. 0%; P < 0.001) than those without. Centrally increased diffusivity was associated with larger stroke volume and the involved tissue was confirmed to be infarcted on follow-up imaging. Radiologists should be aware of this unusual appearance of perinatal arterial ischemic stroke in order to avoid underestimating infarct volume or making an incorrect early diagnosis. (orig.)

  16. Anxiety measures validated in perinatal populations: a systematic review.

    Science.gov (United States)

    Meades, Rose; Ayers, Susan

    2011-09-01

    Research and screening of anxiety in the perinatal period is hampered by a lack of psychometric data on self-report anxiety measures used in perinatal populations. This paper aimed to review self-report measures that have been validated with perinatal women. A systematic search was carried out of four electronic databases. Additional papers were obtained through searching identified articles. Thirty studies were identified that reported validation of an anxiety measure with perinatal women. Most commonly validated self-report measures were the General Health Questionnaire (GHQ), State-Trait Anxiety Inventory (STAI), and Hospital Anxiety and Depression Scales (HADS). Of the 30 studies included, 11 used a clinical interview to provide criterion validity. Remaining studies reported one or more other forms of validity (factorial, discriminant, concurrent and predictive) or reliability. The STAI shows criterion, discriminant and predictive validity and may be most useful for research purposes as a specific measure of anxiety. The Kessler 10 (K-10) may be the best short screening measure due to its ability to differentiate anxiety disorders. The Depression Anxiety Stress Scales 21 (DASS-21) measures multiple types of distress, shows appropriate content, and remains to be validated against clinical interview in perinatal populations. Nineteen studies did not report sensitivity or specificity data. The early stages of research into perinatal anxiety, the multitude of measures in use, and methodological differences restrict comparison of measures across studies. There is a need for further validation of self-report measures of anxiety in the perinatal period to enable accurate screening and detection of anxiety symptoms and disorders. Copyright © 2010 Elsevier B.V. All rights reserved.

  17. Effects of Administration of Perinatal Bupropion on the Population Spike Amplitude in Neonatal Rat Hippocampal Slice

    Directory of Open Access Journals (Sweden)

    Soomaayeh Heysieat-talab

    2010-09-01

    Full Text Available Objective(sBupropion is an atypical antidepressant that is widely used in smoke cessation under FDA approval. The study of synaptic effects of bupropion can help to finding out its mechanism(s for stopping nicotine dependence. In this study the effects of perinatal bupropion on the population spike (PS amplitude of neonates were investigated. Materials and Methods Hippocampal slices were prepared from 18-25 days old rat pups. The experimental groups included control and bupropion-treated. Bupropion (40 mg/Kg, i.p. was applied daily in perinatal period as pre-treatment. Due to the studying acute effects, bupropion was also added to the perfusion medium (10, 50, 200 μM for 30 min. The evoked PS was recorded from pyramidal layer of CA1 area, following stimulation of Schaffer collaterals. ResultsA concentration of 10 μM bupropion had no significant effects on the PS amplitude. The 50 μM concentration of bupropion reduced the amplitude of responses in 50% of the studied cases. At a concentration of 200 μM, the recorded PS amplitudes were reduced in all slices (n= 22. Amplitude was completely abolished in 8 out of the 22 slices. The decrease of the PS amplitude was found to be more in the non-pre-treated slices than in the pre-treated slices when both were perfused with 200 μM bupropion.Conclusion The results showed the perinatal exposure to bupropion and its acute effects while indicating that at concentrations of 50 and 200 μM bupropion reduced the PS amplitude. It was also found that there was evidence of synaptic adaptation in comparison of bupropion-treated and non-treated slices whereas they were both perfused with 200 µM.

  18. Long-term safety and efficacy of perinatal probiotic intervention: Evidence from a follow-up study of four randomized, double-blind, placebo-controlled trials.

    Science.gov (United States)

    Lundelin, Krista; Poussa, Tuija; Salminen, Seppo; Isolauri, Erika

    2017-03-01

    Societies worldwide are faced with a progressive increase in immune-mediated health problems such as allergic, autoimmune, and inflammatory diseases, as well as obesity. Perinatal administration of specific probiotic bacteria is an attractive approach in reducing the risk of these conditions, but long-term efficacy and safety data are lacking. The aim here was to evaluate the clinical benefit and long-term safety of specific probiotics administered during the perinatal period. The probiotic strains used were Lactobacillus rhamnosus GG, Bifidobacterium lactis Bb-12, Lactobacillus paracasei ST11, and Bifidobacterium longum BL999. The children involved have subsequently undergone prospective long-term follow-up. In addition to physical examination, data were collected by structured questionnaires on non-communicable diseases and continued probiotic use, and growth data from welfare clinics and school nurses. Altogether 303 mother-infant pairs were included in the analysis. Seventy-six of 163 (47%) children receiving perinatal probiotics had developed allergic disease compared with 79 of 140 (56%) receiving placebo (OR 0.67, 95% confidence intervals [CI] 0.43-1.06, p = 0.09). Fifty-nine of 133 (44%) children receiving L. rhamnosus GG perinatally had developed allergic disease, OR 0.62, 95% CI 0.38-0.99, p = 0.047, as compared to placebo. We found no differences in growth or non-communicable disease prevalence between children receiving perinatally probiotics or placebo. Perinatal probiotic administration is safe in long-term follow-up. Children receiving L. rhamnosus GG perinatally tended to have decreased allergy prevalence. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Evaluation of responsible beverage service to reduce impaired driving by 21- to 34-year-old drivers.

    Science.gov (United States)

    2017-04-01

    Despite progress in reducing impaired driving, young adult drivers 21 to 34 remain a particularly high-risk group for : involvement in impaired-driving-related crashes. A number of studies have revealed that approximately half of : intoxicated driver...

  20. Maternal endometrial oedema may increase perinatal mortality of cloned and transgenic piglets

    DEFF Research Database (Denmark)

    Schmidt, Mette; Winter, K.D.; Dantzer, Vibeke

    2011-01-01

    The perinatal mortality of cloned animals is a well-known problem. In the present retrospective study, we report on mortality of cloned transgenic or non-transgenic piglets produced as part of several investigations. Large White (LW) sows (n = 105) received hand-made cloned LW or minipig...... endometrial oedema in sows pregnant with cloned and transgenic piglets, as well as in empty recipients, at term. The growth of certain organs in some of the cloned piglets was reduced and the rate of stillborn piglets was greater in cloned and transgenic piglets delivered vaginally, possibly because of oedema...

  1. Perinatal brain injury, visual motor function and poor school outcome of regional low birth weight survivors at age nine.

    Science.gov (United States)

    Zhang, Jun; Mahoney, Ashley Darcy; Pinto-Martin, Jennifer A

    2013-08-01

    To explore the relationship between perinatal brain injury, visual motor function (VMF) and poor school outcome. Little is known about the status and underlying mechanism of poor school outcome as experienced by low birth weight survivors. This is a secondary data analysis. The parental study recruited 1104 low birth weight (LBW) infants weighing ≤ 2000 g from three medical centres of Central New Jersey between 1984 and 1987. Seven hundred and seventy-seven infants survived the neonatal period, and their developmental outcomes had been following up regularly until now. The development data of the survivors were used to achieve the research aims. Initial school outcome assessment was carried out in 9-year-old, using the Woodcock-Johnson Academic Achievement Scale. The severity and range of perinatal brain injury was determined by repeated neonatal cranial ultrasound results obtained at 4 hours, 24 hours and 7 days of life. Seventeen and a half per cent of the sample experienced poor school performance at age 9 as defined by lower than one standard deviation (SD) of average performance score. Children with the most severe injury, PL/VE, had the lowest mathematics (F = 14·54, p = 0·000) and reading (anova results: F = 11·56, p = 0·000) performances. Visual motor function had a significant effect on children's overall school performance (Hotelling's trace value was 0·028, F = 3·414, p = 0·018), as well as subtest scores for reading (p = 0·006) and mathematics (p = 0·036). However, visual motor function was not a mediator in the association of perinatal brain injury and school outcome. Perinatal brain injury had a significant long-term effect on school outcome. Low birth weight infants with history of perinatal brain injury need be closely monitored to substantially reduce the rates of poor school outcome and other neurodevelopmental disabilities. © 2012 Blackwell Publishing Ltd.

  2. Kinesthetic deficits after perinatal stroke: robotic measurement in hemiparetic children.

    Science.gov (United States)

    Kuczynski, Andrea M; Semrau, Jennifer A; Kirton, Adam; Dukelow, Sean P

    2017-02-15

    While sensory dysfunction is common in children with hemiparetic cerebral palsy (CP) secondary to perinatal stroke, it is an understudied contributor to disability with limited objective measurement tools. Robotic technology offers the potential to objectively measure complex sensorimotor function but has been understudied in perinatal stroke. The present study aimed to quantify kinesthetic deficits in hemiparetic children with perinatal stroke and determine their association with clinical function. Case-control study. Participants were 6-19 years of age. Stroke participants had MRI confirmed unilateral perinatal arterial ischemic stroke or periventricular venous infarction, and symptomatic hemiparetic cerebral palsy. Participants completed a robotic assessment of upper extremity kinesthesia using a robotic exoskeleton (KINARM). Four kinesthetic parameters (response latency, initial direction error, peak speed ratio, and path length ratio) and their variabilities were measured with and without vision. Robotic outcomes were compared across stroke groups and controls and to clinical measures of sensorimotor function. Forty-three stroke participants (23 arterial, 20 venous, median age 12 years, 42% female) were compared to 106 healthy controls. Stroke cases displayed significantly impaired kinesthesia that remained when vision was restored. Kinesthesia was more impaired in arterial versus venous lesions and correlated with clinical measures. Robotic assessment of kinesthesia is feasible in children with perinatal stroke. Kinesthetic impairment is common and associated with stroke type. Failure to correct with vision suggests sensory network dysfunction.

  3. Midwifery care: a perinatal mental health case scenario.

    Science.gov (United States)

    Marnes, Joanne; Hall, Pauline

    2013-12-01

    The establishment of the National Perinatal Depression Initiative (NPDI, 2008-2013) has brought a focus across Australia for the need to identify women at risk of perinatal mental health disorders, suggesting that routine screening by relevant health professionals may aid earlier detection, better care and improved outcomes. Midwives are frequently the primary point of contact in the perinatal period and thus ideally placed to identify, interpret and manage complex situations, including screening for perinatal mental health disorders. This paper offers strategies that could be implemented into daily midwifery practice in order to achieve the goals consistent with the National Perinatal Depression Initiative. A case study (Jen) and discussion, guided by recommendations from the Australian Nursing and Midwifery Competency standards and beyondblue Clinical Practice Guidelines, are used to demonstrate how midwifery care can be provided. In accordance with her legal obligations, the midwife should act within her scope of practice to undertake a series of psychosocial and medical assessments in order to best determine how midwifery care and support can be of benefit to Jen, her infant and her family. Suggestions described include administration of validated screening questionnaires, clinical interview, physical assessment, discussion with partner, awareness of the mother-infant interactions and questioning around baby's sleep and feeding. Based on evaluation of the information gained from a bio-psycho-social assessment, suggestions are made as to the midwifery care options that could be applied. Copyright © 2013 Australian College of Midwives. All rights reserved.

  4. A nutrition strategy to reduce the burden of diet related disease: access to dietician services must complement population health approaches.

    Science.gov (United States)

    Segal, Leonie; Opie, Rachelle S

    2015-01-01

    Poor diet quality is implicated in almost every disease and health issue. And yet, in most advanced market economies diet quality is poor, with a minority meeting guidelines for healthy eating. Poor diet is thus responsible for substantial disease burden. Societies have at their disposal a range of strategies to influence diet behaviors. These can be classified into: (i) population level socio-educational approaches to enhance diet knowledge; (ii) pricing incentives (subsidies on healthy foods, punitive taxes on unhealthy foods); (iii) regulations to modify the food environment, and (iv) the provision of clinical dietetic services. There is little evidence that societies are active in implementing the available strategies. Advertising of "junk foods" is largely unchecked, contrasting with strict controls on advertising tobacco products, which also attract punitive taxes. Access to dieticians is restricted in most countries, even in the context of universal health care. In Australia in 2011 there were just 2,969 practicing dieticians/nutritionists or 1.3 clinicians per 10,000 persons, compared with 5.8 physiotherapists per 10,000 persons, 14.8 general practitioners (family physicians) per 10,000 persons or 75 nurses per 10,000 persons. It is time to implement comprehensive national nutrition strategies capable of effecting change. Such strategies need to be multi-component, incorporating both public health approaches and expanded publicly funded dietetic services. Access to individualized dietetic services is needed by those at risk, or with current chronic conditions, given the complexity of the diet message, the need for professional support for behavior change and to reflect individual circumstances. The adoption of a comprehensive nutrition strategy offers the promise of substantial improvement in diet quality, better health and wellbeing and lower health care costs.

  5. A nutrition strategy to reduce the burden of diet related disease: Access to dietician services must complement population health approaches

    Directory of Open Access Journals (Sweden)

    Leonie eSegal

    2015-08-01

    Full Text Available Poor diet quality is implicated in almost every disease and health issue. And yet, in most advanced market economies diet quality is poor, with a minority meeting guidelines for healthy eating. Poor diet is thus responsible for substantial disease burden.Societies have at their disposal a range of strategies to influence diet behaviors. These can be classified into; i population level socio-educational approaches to enhance diet knowledge; ii pricing incentives (subsidies on healthy foods, punitive taxes on unhealthy foods; iii regulations to modify the food environment, and iv the provision of clinical dietetic services. There is little evidence that societies are active in implementing the available strategies. Advertising of ‘junk foods’ is largely unchecked, contrasting with strict controls on advertising tobacco products, which also attract punitive taxes. Access to dieticians is restricted in most countries, even in the context of universal health care. In Australia in 2011 there were just 2,969 practicing dieticians/nutritionists or 1.3 clinicians per 10,000 persons, compared with 5.8 physiotherapists per 10,000 persons, 14.8 general practitioners (family physicians per 10,000 persons or 75 nurses per 10,000 persons.Given the major role of diet in health it is time to implement comprehensive national nutrition strategies capable of effecting change. Such strategies need to be multi-component, incorporating both public health approaches and expanded publicly funded dietetic services. Access to individualized dietetic services is needed by those at risk, or with current chronic conditions, given the complexity of the diet message, the need for professional support for behavior change and to reflect individual circumstances. The adoption of a comprehensive nutrition strategy offers the promise of substantial improvement in diet quality, better health and wellbeing and lower health care costs.

  6. Obstetric and perinatal outcome of multiple pregnancy

    International Nuclear Information System (INIS)

    Qazi, G.

    2011-01-01

    To determine the obstetric and perinatal outcome in multiple pregnancies at a teaching hospital. The analysis included data on all women between 20 and 35 years of age with 24 completed weeks gestation having multiple pregnancies during the study period after applying the exclusion criteria. The data retrieved from the hospital-based maternal health medical records included demographic details, complications of pregnancy, and maternal and neonatal outcomes. The data was expressed as frequencies, percentages, mean and standard deviation. Normal distribution of continuous variables was determined by Shapiro Wilk test. The differences in the mean birth weight of the first and second twin were compared by student's t-test considering a p-value less than 0.05 as statistically significant. There were a total of 161 multiple pregnancies with the overall incidence of 37.1 per 1,000 births (3.2%) during the study period. One hundred and twenty two cases had the inclusion criteria applicable. There were 9 triplets among these of whom seven were received as intrauterine death and the other two were lost to follow-up. The four leading maternal adverse outcomes were anemia (74.6%), preterm delivery (31%), pregnancy - induced hypertension (30%) and preterm premature rupture of membranes (26.2%). Median gestational age at delivery was 37 weeks. Most common route of delivery was caesarean section (53.3%). Most common neonatal complication was low birth weight. Prematurity was the most common cause of neonatal death. Multiple pregnancy have high maternal and neonatal complications, especially preterm delivery that increases risk of significant neonatal morbidity and mortality. (author)

  7. Perinatal Outcomes in Advanced Age Pregnancies

    Directory of Open Access Journals (Sweden)

    Ertuğrul Yılmaz

    2016-06-01

    Full Text Available Objective: The aim of this study is to evaluate the impact of advanced maternal age on pregnancy outcomes Methods: A retrospective analysis of 951 birth registry records of Zeynep Kamil Hospital, were analyzed between Janu­ary 2003 and December 2007. Study group was made up of women ≥40 years old and control group was made up of women younger than 40 years. Results: Mean maternal age was 41.48 years in the study group and 26.41 years in the control group. Mean gesta­tional age at the time of delivery is 37.73 weeks in study group and 38.10 weeks in the control group. There was no statistical difference in terms of preterm delivery, multiple pregnancy, fetal anomaly, IUGR, superimpose preeclampsia oligohidramnios, presentation anomaly and placenta previa rates between the study and control groups. Incidence of preeclampsia (p=0.041, Chronic hypertension (p=0.001, GDM (p= 0.003,is found to be higher in study group. Cesar­ean birth rate is higher (p<0.05 and hospitalization time is longer in study group (p=0.001. 1st minute and 5th minute APGAR scores of the study group (6.99±2, 8.27±2 was lower than the 1st minute and 5th Minutes APGAR scores of the control group (7.38±1.6, 8.58±1.7. Neonatal intensive care unit administration rate is seen also higher in study group (p<0.01. Conclusion: Advanced maternal age was related to increased pregnancy complications and poor perinatal outcome. Preeclampsia, GDM, chronic hypertension is seen more common in advanced age pregnancies. Neonatal intensive care administration is higher and APGAR scores are lower; cesarean delivery was performed more common, and hospitaliza­tion time was longer in advanced age pregnancies. J Clin Exp Invest 2016; 7 (2: 157-162

  8. Perinatal development and adult blood pressure

    Directory of Open Access Journals (Sweden)

    N. Ashton

    2000-07-01

    Full Text Available A growing body of evidence supports the concept of fetal programming in cardiovascular disease in man, which asserts that an insult experienced in utero exerts a long-term influence on cardiovascular function, leading to disease in adulthood. However, this hypothesis is not universally accepted, hence animal models may be of value in determining potential physiological mechanisms which could explain how fetal undernutrition results in cardiovascular disease in later life. This review describes two major animal models of cardiovascular programming, the in utero protein-restricted rat and the cross-fostered spontaneously hypertensive rat. In the former model, moderate maternal protein restriction during pregnancy induces an increase in offspring blood pressure of 20-30 mmHg. This hypertensive effect is mediated, in part, by fetal exposure to excess maternal glucocorticoids as a result of a deficiency in placental 11-ß hydroxysteroid dehydrogenase type 2. Furthermore, nephrogenesis is impaired in this model which, coupled with increased activity of the renin-angiotensin system, could also contribute to the greater blood pressure displayed by these animals. The second model discussed is the cross-fostered spontaneously hypertensive rat. Spontaneously hypertensive rats develop severe hypertension without external intervention; however, their adult blood pressure may be lowered by 20-30 mmHg by cross-fostering pups to a normotensive dam within the first two weeks of lactation. The mechanisms responsible for this antihypertensive effect are less clear, but may also involve altered renal function and down-regulation of the renin-angiotensin system. These two models clearly show that adult blood pressure is influenced by exposure to one of a number of stimuli during critical stages of perinatal development.

  9. Stillbirth: The other half of perinatal mortality

    LENUS (Irish Health Repository)

    Murphy, JFA

    2012-01-01

    Stillbirth is fetal death after 20 weeks gestation1. There are a number of definitions and classifications. WHO defines a stillbirth as a baby BW ≥500g, ≥22 weeks gestation who died before or during birth. However for international comparisons it recommends that reporting be restricted to those with BW>1000g and gestation ≥28 weeks. In Ireland stillbirths must be registered, the definition being BW≥500g or having reached a gestational age ≥ 24 weeks. Stillbirth affects 1 in 160 pregnancies2 and numerically it equals the number of infant deaths in the first year of life. At the beginning of the third trimester of pregnancy the baby weighs 1 Kg and the risk of stillbirth is 1- 2%. The possibility of a stillbirth increases with maturity throughout the third trimester and is 3 times greater at 40 weeks than at earlier gestational ages3. This is relevant for the 5-10% of pregnancies that continue ≥42 weeks. If managed expectantly one in 400 post-term pregnancies will end in a stillbirth. Since 2003 the stillbirth rate has remained static in the US at 3.0 stillbirths per 1000 births. Prior to 2003 the stillbirth rate had declined 1.4% annually while the infant mortality rate fell twice as fast at 2.8%. Globally there are 2.6 million stillbirths annually. In Ireland the stillbirth rate is 3.3 per 1000 births which equates to 230 deaths per year. Despite its frequent occurrence stillbirth has been a relatively neglected component of perinatal medicine. Because a definitive cause cannot be identified in many cases, counselling is very difficult. This lack of scientific causation data has resulted in professional fatalism towards the stillbirth problem.

  10. 78 FR 41857 - Simplified Cost Accounting and Other Actions To Reduce Paperwork in the Summer Food Service...

    Science.gov (United States)

    2013-07-12

    ... CFR Parts 210 and 225 RIN 0584-AD84 Simplified Cost Accounting and Other Actions To Reduce Paperwork... Consolidated Appropriations Act, 2008. The changes extend simplified cost accounting and reporting procedures... nondiscretionary simplified cost accounting and reporting procedures established in the Consolidated Appropriations...

  11. Late preterm infants – impact of perinatal factors on neonatal results. A clinical study

    Directory of Open Access Journals (Sweden)

    Grzegorz Jakiel

    2015-09-01

    Full Text Available Introduction. Infants born between the 34[sup]th[/sup] – 36[sup]th[/sup] week of pregnancy account for 75% of all preterm infants. Their seemingly slight immaturity is related to serious health problems. Objective. The aim of the study was to analyse perinatal factors that influence the occurrence in infants of such problems as respiratory failure, metabolic problems and early onset sepsis (EOS. Materials and method. The material for the study included all mothers and their late preterm infants: 34+0 – 36+6 born in our hospital (a tertiary referral academic centre in 2010 and 2011. The course of pregnancy and delivery, the type of delivery, applied preventive measures and treatment, as well as demographic data and the clinical state of infants were all analysed. Data from individual documentation of each mother and infant were collected by 5 designated people and data reliability was independently monitored by a random control of the documentation conducted by the supervising person. Results. A statistically significant relationship between the occurrence of respiratory distress syndrome and infant immaturity, bad state after birth and sepsis in infants were confirmed. Sepsis was more common in the case of vaginal delivery, and coexisted with respiratory distress syndrome. The mother’s diseases during pregnancy, a perinatal preventive antibiotic therapy, and possible delivery complications did not influence the infection. Perinatal asphyxia in an infant positively correlated with a Caesarean section and respiratory distress syndrome after birth. Conclusions. It is necessary to thoroughly establish the type of delivery of a late preterm infant in order to prevent an infection in the newborn child. The improvement of diagnosis of intrauterine hypoxia may reduce the number of Caesarean sections. The decision about late preterm delivery should be based on indices of the mother’s state of health. Premature delivery is related to the

  12. Socioeconomic status affects the prevalence, but not the perinatal outcomes, of in vitro fertilization pregnancies

    DEFF Research Database (Denmark)

    Räisänen, Sari; Randell, Kaisa; Nielsen, Henriette Svarre

    2013-01-01

    Does maternal socioeconomic status (SES) confound or modify the association between IVF and perinatal outcome among singleton births?......Does maternal socioeconomic status (SES) confound or modify the association between IVF and perinatal outcome among singleton births?...

  13. Medicare Part D is associated with reducing the financial burden of health care services in Medicare beneficiaries with diagnosed diabetes.

    Science.gov (United States)

    Li, Rui; Gregg, Edward W; Barker, Lawrence E; Zhang, Ping; Zhang, Fang; Zhuo, Xiaohui; Williams, Desmond E; Soumerai, Steven B

    2013-10-01

    Medicare Part D, implemented in 2006, provided coverage for prescription drugs to all Medicare beneficiaries. To examine the effect of Part D on the financial burden of persons with diagnosed diabetes. We conducted an interrupted time-series analysis using data from the 1996 to 2008 Medical Expenditure Panel Survey (11,178 persons with diabetes who were covered by Medicare, and 8953 persons aged 45-64 y with diabetes who were not eligible for Medicare coverage). We then compared changes in 4 outcomes: (1) annual individual out-of-pocket expenditure (OOPE) for prescription drugs; (2) annual individual total OOPE for all health care services; (3) annual total family OOPE for all health care services; and (4) percentage of persons with high family financial burden (OOPE ≥10% of income). For Medicare beneficiaries with diabetes, Part D was associated with a 28% ($530) decrease in individual annual OOPE for prescription drugs, a 23% ($560) reduction in individual OOPE for all health care, a 23% ($863) reduction in family OOPE for all health care, and a 24% reduction in the percentage of families with high financial burden in 2006. There were similar reductions in 2007 and 2008. By 2008, the percentage of Medicare beneficiaries with diabetes living in high financial burden families was 37% lower than it would have been had Part D not been in place. Introduction of Part D coverage was associated with a substantial reduction in the financial burden of Medicare beneficiaries with diabetes and their families.

  14. Low cerebral blood flow in hypotensive perinatal distress

    International Nuclear Information System (INIS)

    Lou, H.C.; Lassen, N.A.; Friis-Hansen, B.

    1977-01-01

    Hypoxic brain injury is the most important neurological problem in the neonatal period and accounts for more neurological deficits in children than any other lesion. The neurological deficits are notably mental retardation, epilepsy and cerebral palsy. The pathogenesis has hitherto been poorly understood. Arterial hypoxia has been taken as the obvious mechanism but this does not fully explain the patho-anatomical findings. In the present investigation we have examined the arterial blood pressure and the cerebral blood flow in eight infants a few hours after birth. The 133Xe clearance technique was used for the cerebral blood flow measurements. The study confirmed that perinatal distress may be associated with low arterial blood pressure, and it was shown that cerebral blood flow is very low, 20 ml/100 g/min or less, in hypotensive perinatal distress. It is concluded that cerebral ischaemia plays a crucial role in the development of perinatal hypoxic brain injury. (author)

  15. Nursing diagnosis of grieving: content validity in perinatal loss situations.

    Science.gov (United States)

    Paloma-Castro, Olga; Romero-Sánchez, José Manuel; Paramio-Cuevas, Juan Carlos; Pastor-Montero, Sonia María; Castro-Yuste, Cristina; Frandsen, Anna J; Albar-Marín, María Jesús; Bas-Sarmiento, Pilar; Moreno-Corral, Luis Javier

    2014-06-01

    To validate the content of the NANDA-I nursing diagnosis of grieving in situations of perinatal loss. Using the Fehring's model, 208 Spanish experts were asked to assess the adequacy of the defining characteristics and other manifestations identified in the literature for cases of perinatal loss. The content validity index was 0.867. Twelve of the 18 defining characteristics were validated, seven as major and five as minor. From the manifestations proposed, "empty inside" was considered as major. The nursing diagnosis of grieving fits in content to the cases of perinatal loss according to experts. The results have provided evidence to support the use of the diagnosis in care plans for said clinical situation. © 2013 NANDA International.

  16. Perinatal depression and screening among Aboriginal Australians in the Kimberley.

    Science.gov (United States)

    Kotz, Jayne; Munns, Ailsa; Marriott, Rhonda; Marley, Julia V

    2016-02-01

    Adhoc culturally questionable perinatal mental-health screening among Aboriginal women in the Kimberley. Mental-health issues, substance abuse and suicide attempts are high among young Aboriginal women in Australia. There is no evidence that the Edinburgh Postnatal Depression Scale (EPDS) is effective or culturally safe. Screening practices are complicated by limited understanding of the complex cultural interface between Western and Aboriginal beliefs and notions about health and mental-health. What is the current context of perinatal mental-health screening practices among Aboriginal women in the Kimberley and what might be considered a culturally safe approach? A review of the literature and exploration of current screening practices preceded community participatory action research (CPAR) of perinatal mental-health screening. More than 100 Kimberley women and 72 health practitioners contributed to this joint strategic body of work. Recommendations for practice include one single culturally appropriate Kimberley version of the EPDS.

  17. Characteristics that perinatal nurse managers desire in new nurse hires.

    Science.gov (United States)

    Falls, Emily; Hensel, Desiree

    2012-04-01

    Nursing leaders have proposed that nurses must have the Quality and Safety Education for Nurses (QSEN) competencies to work in complex health care systems. Using the QSEN framework, this study explored what characteristics perinatal nurse managers desired most in new nurses. This study used a survey design and a convenience sample of perinatal nurse managers working in Indiana hospitals (N = 46). Managers were more likely to hire nurses with experience, positive references, and excellent attendance. Of the QSEN competencies, managers looked most for teamwork and collaboration, followed by safety and patient-centered care. In addition to the traditional qualities desired in new nurses, the QSEN competencies are gaining importance among perinatal managers. Copyright 2012, SLACK Incorporated.

  18. Perinatal Programming of Asthma: The Role of Gut Microbiota

    Directory of Open Access Journals (Sweden)

    Meghan B. Azad

    2012-01-01

    Full Text Available Perinatal programming, a dominant theory for the origins of cardiovascular disease, proposes that environmental stimuli influence developmental pathways during critical periods of prenatal and postnatal development, inducing permanent changes in metabolism. In this paper, we present evidence for the perinatal programming of asthma via the intestinal microbiome. While epigenetic mechanisms continue to provide new explanations for the programming hypothesis of asthma development, it is increasingly apparent that the intestinal microbiota plays an independent and potentially interactive role. Commensal gut bacteria are essential to immune system development, and exposures disrupting the infant gut microbiota have been linked to asthma. This paper summarizes the recent findings that implicate caesarean delivery, breastfeeding, perinatal stress, probiotics, and antibiotics as modifiers of infant gut microbiota in the development of asthma.

  19. Integration of EEG lead placement templates into traditional technologist-based staffing models reduces costs in continuous video-EEG monitoring service.

    Science.gov (United States)

    Kolls, Brad J; Lai, Amy H; Srinivas, Anang A; Reid, Robert R

    2014-06-01

    The purpose of this study was to determine the relative cost reductions within different staffing models for continuous video-electroencephalography (cvEEG) service by introducing a template system for 10/20 lead application. We compared six staffing models using decision tree modeling based on historical service line utilization data from the cvEEG service at our center. Templates were integrated into technologist-based service lines in six different ways. The six models studied were templates for all studies, templates for intensive care unit (ICU) studies, templates for on-call studies, templates for studies of ≤ 24-hour duration, technologists for on-call studies, and technologists for all studies. Cost was linearly related to the study volume for all models with the "templates for all" model incurring the lowest cost. The "technologists for all" model carried the greatest cost. Direct cost comparison shows that any introduction of templates results in cost savings, with the templates being used for patients located in the ICU being the second most cost efficient and the most practical of the combined models to implement. Cost difference between the highest and lowest cost models under the base case produced an annual estimated savings of $267,574. Implementation of the ICU template model at our institution under base case conditions would result in a $205,230 savings over our current "technologist for all" model. Any implementation of templates into a technologist-based cvEEG service line results in cost savings, with the most significant annual savings coming from using the templates for all studies, but the most practical implementation approach with the second highest cost reduction being the template used in the ICU. The lowered costs determined in this work suggest that a template-based cvEEG service could be supported at smaller centers with significantly reduced costs and could allow for broader use of cvEEG patient monitoring.

  20. Requirements Elicitation of Passengers With Reduced Mobility for the Design of High Quality, Accessible and Inclusive Public Transport Services

    Directory of Open Access Journals (Sweden)

    Starzyńska Beata

    2015-09-01

    Full Text Available In this article the authors present the methodology adopted and the results obtained in the first stage of the research encompassing focus group interviews (FGI about the needs of public transport users in a selected city (Poznań. The elicitation and assessment of the requirements were carried out for three groups of people with disabilities using public transport in the city of Poznań: blind and partially sighted people, deaf and hearing-impaired people, as well as people with locomotor dysfunctions. A study carried out on the basis of a scenario especially designed for the FGI purpose has made it possible to identify barriers for people with disabilities and, consequently, to formulate their pre-trip,on-trip and post-trip requirements when it comes to urban public transport services. The results will be used to construct a questionnaire to be used further on in the project.

  1. Reducing stigma in healthcare and law enforcement: a novel approach to service provision for street level sex workers.

    Science.gov (United States)

    Bodkin, Kate; Delahunty-Pike, Alannah; O'Shea, Tim

    2015-04-09

    Providing services for street level sex workers requires a multidisciplinary approach, addressing both health and safety concerns typical of their age and gender and those that arise specific to their line of work. Despite being a diverse population, studies have identified some specific health needs for sex workers including addictions treatment, mental health. Additionally, studies have shown a higher risk of physical and sexual assault for this population. The Persons at Risk program (PAR) in London, Ontario, Canada was started in 2005 to address the specific needs of street level sex workers by using a harm-reduction model for policing and healthcare provision. This qualitative study evaluated this model of care in terms of improving access to healthcare and essential police services for street level sex workers. A total of 14 semi-structured interviews were conducted with current and former female street level sex workers enrolled in the PAR program. In addition, 3 semi-structured interviews were conducted with health and law enforcement professionals. The research team then analyzed and coded the transcripts using qualitative description to identify key themes in the data. Results indicated that participants represent a vulnerable population with increased safety concerns and healthcare needs relating to addictions, mental health and infectious disease. Despite this, participants reported avoiding healthcare workers and police officers in the past because of fear of stigma or repercussions. All participants identified the harm reduction approach of the PAR program as being essential to their continued engagement with the program. Other important aspects included flexible hours, the location of the clinic, streamlined access to mental health and addictions treatment and the female gender of the police and healthcare worker. The PAR program provides sex workers access to much needed primary healthcare that is flexible and without judgment. In addition, they are

  2. Perinatal outcomes of pregnancies conceived by assisted reproductive technologies

    Directory of Open Access Journals (Sweden)

    Šljivančanin Tamara

    2015-01-01

    Full Text Available Introduction. Recent epidemiological studies showed significantly higher incidence of perinatal complications in newborns and women after the use of assisted reproductive technologies (ART. Multiple pregnancies are more frequent after the use of ART. Singleton pregnancies following ART are more prone to preterm birth, low and very low birth weight (LBW and VLBW, small for gestational age (SGA and perinatal mortality. Objective. The aim of this study was to summarize the results of relevant articles and to evaluate whether the mode of conception is the determining factor for different pregnancy outcomes after assisted and natural conceptions. Methods. Eleven studies were included in this review. The following outcomes were observed: preterm and very preterm birth, SGA, LBW, VLBW, perinatal mortality, admission to neonatal intensive care unit (NICU, and Apgar score (As ≤7 at fifth minute. Qualitative analysis and quantitative assessment were performed. Results. For singletons, odds ratios were 1.794 (95% confidence interval 1.660-1.939 for preterm birth, 1.649 (1.301-2.089 for LBW, 1.265 (1.048-1.527 for SGA. Admission to NICU, As≤7 at fifth minute and perinatal mortality showed significantly different frequency after assisted conception. Summary of results for twin gestations showed no significant difference between ART and spontaneous conception for preterm birth (32-36 weeks, very preterm birth (<32 weeks, LBW and VLBW. Conclusion. Analyzed studies showed that infants from ART have significantly worse perinatal outcome compared with natural conception. More observational studies should be conducted in order to establish the exact mechanism leading to more frequent perinatal morbidity and mortality after the use of ART.

  3. Neuroradiological findings in perinatally HIV-infected children. Neuroradiologische Befunde bei perinatal HIV-infizierten Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Spreer, J [Radiologische Abt., Universitaetsklinik Koeln (Germany); Enenkel-Stoodt, S [Abt. fuer Allgemeine Paediatrie 2, Universitaetsklinik Frankfurt am Main (Germany); Funk, M [Abt. fuer Paediatrische Haematologie und Onkologie, Universitaetsklinik Frankfurt am Main (Germany); Fiedler, A [Abt. fuer Paediatrische Neurologie, Universitaetsklinik Frankfurt am Main (Germany); Simone, A de [Neuroradiologische Abt., Universitaetsklinik Frankfurt am Main (Germany); Hacker, H [Neuroradiologische Abt., Universitaetsklinik Frankfurt am Main (Germany)

    1994-08-01

    The neuroradiological studies (CT, MRI, angiography) in 21 children with perinatal HIV infection were reviewed retrospectively. No patient showed an intracranial mass lesion; after intravenous contrast medium application there was no case with disturbed blood-brain barrier. Common non-specific findings were atrophy and delayed myelination. In 7 cases atrophy was combined with multifocal nearly symmetric white matter lesions, which characteristically spared the U-fibres. Further findings included an intramedullary ring-shaped structure in the cervical cord, an AIDS-associated vasculopathy and symmetric calcifications in the basal ganglia. The spectrum of neuroradiological findings in paediatric AIDS patients differs from that in adults. Knowledge of these age-specific findings is important because the number of HIV-infected children is rising. (orig.)

  4. Perinatal outcomes among Asian-white interracial couples.

    Science.gov (United States)

    Nystrom, Michael J; Caughey, Aaron B; Lyell, Deirdre J; Druzin, Maurice L; El-Sayed, Yasser Y

    2008-10-01

    To investigate whether perinatal outcomes among interracial Asian-white couples are different than among Asian-Asian and white-white couples. This was a retrospective study of Asian, white, and Asian-white couples delivered at the Lucile Packard Children's Hospital from 2000-2005. Asian-white couples were subdivided into white-mother/Asian-father or Asian-mother/white-father. Perinatal outcomes included gestational diabetes, hypertensive disorders of pregnancy, preterm delivery, birth weight >4000 g and interracial Asian-white couples.

  5. Asfixia perinatal y proteína S100B

    OpenAIRE

    Barrero Montoya, Ivan Ricardo

    2016-01-01

    La asfixia perinatal es la principal causa de muerte en la primera semana de vida la nivel mundial, los niños que sufren esta complicación y sobreviven pueden presentar trastornos neurológicos de diferente nivel de compromiso que inciden en su desarrollo personal y social. Las cifras de muerte por este problema de salud han disminuido de manera importante, sin embargo en el reporte de la Organización Mundial de Salud (OPS) del 2010, la asfixia perinatal es causa del 29% de muertes infantiles ...

  6. Is screening for depression in the perinatal period enough? The co-occurrence of depression, substance abuse, and intimate partner violence in culturally diverse pregnant women.

    Science.gov (United States)

    Connelly, Cynthia D; Hazen, Andrea L; Baker-Ericzén, Mary J; Landsverk, John; Horwitz, Sarah McCue

    2013-10-01

    The perinatal period provides unique opportunities to identify and intervene with the co-occurrence of perinatal depression, intimate partner violence (IPV), and substance use problems. Psychosocial screening recommended for women seen in maternal child health settings tends to target single rather than multiple risk factors; there is limited research examining the co-occurrence of these issues especially in racially and ethnically diverse women across the perinatal period. These analyses explore the relationships of sociodemographic, psychosocial, and behavioral characteristics in a large, diverse sample of women. Women receiving perinatal services at routinely scheduled visits, including the 6-week postpartum visit, were recruited from 10 community obstetric/gynecologic clinics. Data were collected on perinatal depression, IPV, maternal substance use, and sociodemographic characteristics by bilingual, bicultural research assistants. A total of 1868 women were screened, 1526 (82%) Latina, 1099 (58.8%) interviewed in Spanish; 20.4% (n=382) screened positive for depressive symptoms based on an Edinburgh Postnatal Depression Scale score of 10 or above, 20.9% reported harmful drinking, 4.3% reported drug use, 23% reported substance use problems, and 3.5% reported current or recent IPV. Women who were Black, Asian, Pacific Islander, or other race/ethnicity had greater odds for depressive symptoms relative to women who were Hispanic or Latino (odds ratio [OR]=1.81, p=0.005). Women reporting substance use problems (OR=2.37, p<0.0001) and IPV (OR=3.98, p<0.0001) had higher odds for depressive symptoms. In a predominately Latina sample, 1 in 5 mothers (20.4%) screened positive for depressive symptoms and over one third (36.7%) reported one or more psychosocial issues during the perinatal period. Screening for multiple risk factors rather than just one can help clinicians tailor interventions for the successful management of psychosocial issues.

  7. Staff Training Reduces the Use of Physical Restraint in Mental Health Service, Evidence-based Reflection for China.

    Science.gov (United States)

    Ye, Junrong; Xiao, Aixiang; Yu, Lin; Guo, Jianxiong; Lei, Huawei; Wei, Hongmei; Luo, Wei

    2018-06-01

    The purpose of this article was to synthesize the evidence regarding the reduction of physical restraint, and to seek some practical recommendations based on the current situation in China. Nine databases were retrieved; these were PubMed, CINAHL, MEDLINE, Trip Database, PsysINFO, Cochrane Library, CNKI (Chinese database), Wanfang (Chinese database) and CBM (Chinese database) respectively. The selected articles were screened manually, and the identified researches were appraised through Review manager 5.3. Eight studies (four randomized controlled trials and four quasi-experimental studies) published between June 2013 and May 2017 were selected. Risk ratios (RRs) with 95% confidence intervals (CIs) were used as the effect index for dichotomous variables. The standardized mean differences (SMDs) with 95% CIs were calculated as the pooled continuous effect. The outcome of meta-analysis suggested staff training reduced the duration (IV=-0.88; 95% CIs=-1.65 to -0.10; Z=2.22; p=0.03) and adverse effect (RR, 0.16; 95% CIs=0.09 to 0.30; Z=5.96; pstaff training had no effects on the incidence of physical restraint. (RR, 1.01; 95% CIs=0.45 to 2.24; Z=0.02; p=0.99) CONCLUSION: Staff training was an effective measure to minimize the duration and adverse effects of physical restraint. More studies are needed to examine the effectiveness of staff training in relation to reduce the prevalence of physical restraint. Furthermore, considering the nurse's education background in China, it is recommended to conduct a compulsory training program to reduce the unnecessary restraint. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. The impacts on U.S. energy markets and the economy of reducing oil imports. Service report

    International Nuclear Information System (INIS)

    1996-09-01

    The General Accounting Office (GAO) has responded to a request from Representative John Kasich by requesting that the Energy Information Administration (EIA) use the National Energy Modeling System (NEMS) to estimate the cost to the U.S. economy of reducing oil imports. The analysis summarized by this paper focuses on two approaches toward a target reduction in oil imports: (1) a set of cases with alternative world crude oil price trajectories, and (2) two cases which investigates the use of an oil import fee

  9. Recent status and improvement of reduced-activation ferritic-martensitic steels for high-temperature service

    Energy Technology Data Exchange (ETDEWEB)

    Tan, L., E-mail: tanl@ornl.gov [Oak Ridge National Laboratory, Oak Ridge, TN, 37831 (United States); Katoh, Y. [Oak Ridge National Laboratory, Oak Ridge, TN, 37831 (United States); Tavassoli, A.-A.F.; Henry, J. [DMN/Dir, DEN, CEA Saclay, 91191, Gif-sur-Yvette Cedex (France); Rieth, M. [Karlsruhe Institute of Technology, Karlsruhe, 76021 (Germany); Sakasegawa, H. [National Institutes for Quantum and Radiological Science and Technology, Rokkasho, Aomori, 039-3212 (Japan); Oak Ridge National Laboratory, Oak Ridge, TN, 37831 (United States); Tanigawa, H. [National Institutes for Quantum and Radiological Science and Technology, Rokkasho, Aomori, 039-3212 (Japan); Huang, Q. [Institute of Nuclear Energy Safety Technology, Chinese Academy of Sciences, Hefei, Anhui, 230031 (China)

    2016-10-15

    Reduced-activation ferritic-martensitic (RAFM) steels, candidate structural materials for fusion reactors, have achieved technological maturity after about three decades of research and development. The recent status of a few developmental aspects of current RAFM steels, such as aging resistance, plate thickness effects, fracture toughness, and fatigue, is updated in this paper, together with ongoing efforts to develop next-generation RAFM steels for superior high-temperature performance. In addition to thermomechanical treatments, including nonstandard heat treatment, alloy chemistry refinements and modifications have demonstrated some improvements in high-temperature performance. Castable nanostructured alloys (CNAs) were developed by significantly increasing the amount of nanoscale MX (M = V/Ta/Ti, X = C/N) precipitates and reducing coarse M{sub 23}C{sub 6} (M = Cr). Preliminary results showed promising improvement in creep resistance and Charpy impact toughness. Limited low-dose neutron irradiation results for one of the CNAs and China low activation martensitic are presented and compared with data for F82H and Eurofer97 irradiated up to ∼70 displacements per atom at ∼300–325 °C.

  10. The Multiple Facets of Lutein: A Call for Further Investigation in the Perinatal Period.

    Science.gov (United States)

    Perrone, Serafina; Tei, Monica; Longini, Mariangela; Buonocore, Giuseppe

    Lutein may have important antioxidant actions in free-radical-mediated diseases, in addition to its well-known antioxidant and cytoprotective effects on macula and photoreceptors. The peculiar perinatal susceptibility to oxidative stress indicates that prophylactic use of antioxidants as lutein could help to prevent or at least to reduce oxidative stress related diseases in newborns. Since lutein is not synthesized by humans, the intake primarily depends on diet or supplementation. Newborns receive lutein exclusively from breast milk. Lutein supplementation in term newborns has been reported to reduce oxidative stress and increase antioxidant capacities in the first days of life. Innovative frontiers concerning lutein supplementation are orientated toward cardiometabolic health improvement and cognitive benefits. The safety of lutein as an antioxidant agent has been confirmed in experimental and clinical studies, but its routine use is not recommended in perinatal period. This review summarizes what is known about the role of lutein as an antioxidant and anti-inflammatory agent in animal model and humans.

  11. The Multiple Facets of Lutein: A Call for Further Investigation in the Perinatal Period

    Directory of Open Access Journals (Sweden)

    Serafina Perrone

    2016-01-01

    Full Text Available Lutein may have important antioxidant actions in free-radical-mediated diseases, in addition to its well-known antioxidant and cytoprotective effects on macula and photoreceptors. The peculiar perinatal susceptibility to oxidative stress indicates that prophylactic use of antioxidants as lutein could help to prevent or at least to reduce oxidative stress related diseases in newborns. Since lutein is not synthesized by humans, the intake primarily depends on diet or supplementation. Newborns receive lutein exclusively from breast milk. Lutein supplementation in term newborns has been reported to reduce oxidative stress and increase antioxidant capacities in the first days of life. Innovative frontiers concerning lutein supplementation are orientated toward cardiometabolic health improvement and cognitive benefits. The safety of lutein as an antioxidant agent has been confirmed in experimental and clinical studies, but its routine use is not recommended in perinatal period. This review summarizes what is known about the role of lutein as an antioxidant and anti-inflammatory agent in animal model and humans.

  12. Nitrergic system and plasmatic methylarginines: Evidence of their role in the perinatal programming of cardiovascular diseases.

    Science.gov (United States)

    Bassareo, Pier Paolo; Mussap, Michele; Bassareo, Valentina; Flore, Giovanna; Mercuro, Giuseppe

    2015-12-07

    Atherosclerosis, in turn preceded by endothelial dysfunction, underlies a series of important cardiovascular diseases. Reduced bioavailability of endothelial nitric oxide, by increasing vascular tone and promoting platelet aggregation, leukocyte adhesion, and smooth muscle cell proliferation, plays a key role in the onset of the majority of cardiovascular diseases. In addition, high blood levels of asymmetric dimethylarginine, a potent inhibitor of nitric oxide synthesis, are associated with future development of adverse cardiovascular events and cardiac death. Recent reports have demonstrated that another methylarginine, i.e., symmetric dimethylarginine, is also involved in the onset of endothelial dysfunction and hypertension. Almost a decade ago, prematurity at birth and intrauterine growth retardation were first associated with a potential negative influence on the cardiovascular apparatus, thus constituting risk factors or leading to early onset of cardiovascular diseases. This condition is referred to as cardiovascular perinatal programming. Accordingly, cardiovascular morbidity and mortality are higher among former preterm adults than in those born at term. The aim of this paper was to undertake a comprehensive literature review focusing on cellular and biochemical mechanisms resulting in both reduced nitric oxide bioavailability and increased methylarginine levels in subjects born preterm. Evidence of the involvement of these compounds in the perinatal programming of cardiovascular risk are also discussed. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Utilizing leadership to achieve high reliability in the delivery of perinatal care

    Directory of Open Access Journals (Sweden)

    Parrotta C

    2012-11-01

    Full Text Available Carmen Parrotta,1 William Riley,1 Les Meredith21School of Public Health, University of Minnesota, Minneapolis, MN, 2Premier Insurance Management Services Inc, Charlotte, NC, USAAbstract: Highly reliable care requires standardization of clinical practices and is a prerequisite for patient safety. However, standardization in complex hospital settings is extremely difficult to attain and health care leaders are challenged to create care delivery processes that ensure patient safety. Moreover, once high reliability is achieved in a hospital unit, it must be maintained to avoid process deterioration. This case study examines an intervention to implement care bundles (a collection of evidence-based practices in four hospitals to achieve standardized care in perinatal units. The results show different patterns in the rate and magnitude of change within the hospitals to achieve high reliability. The study is part of a larger nationwide study of 16 hospitals to improve perinatal safety. Based on the findings, we discuss the role of leadership for implementing and sustaining high reliability to ensure freedom from unintended injury.Keywords: care bundles, evidence-based practice, standardized care, process improvement

  14. Recent trends in the incidence of multiple births and its consequences on perinatal problems in Korea.

    Science.gov (United States)

    Choi, Sun Hee; Park, Young Sil; Shim, Kye Shik; Choi, Yong Sung; Chang, Ji Young; Hahn, Won Ho; Bae, Chong-Woo

    2010-08-01

    The aim of this study was to survey multiple birth data and to analyze the recent trends of multiple births and its consequences on perinatal problems in Korea from 1991 to 2008. Data were obtained from the Korean Statistical Information Service. The total number of multiple births showed increasing trends. The multiple birth rate was maintained within less than 10.0 for the decade from 1981 to 1990. However, it increased gradually to reach 27.5 in 2008. The maternal age for multiple births was higher than for total live births. The mean birth weight of the total live births was 3.23 kg; for the multiple births it was 2.40 kg in 2008. The incidence of low birth weight infants (LBWI) among total live births was 3.8% in 2000 and 4.9% in 2008. For multiple births it was 49.2% and 53.0% during the same years. The incidence of preterm births among total live births was 3.8% in 2000 and 5.5% in 2008; for the multiple births it was 38.3% and 51.5% during the same years. The incidence of multiple births and its consequences on perinatal problems (preterm, LBWI, and advanced-maternal age) have been increased steadily over the last two decades in Korea.

  15. Factors affecting implementation of perinatal mental health screening in women of refugee background.

    Science.gov (United States)

    Nithianandan, Nishani; Gibson-Helm, Melanie; McBride, Jacquie; Binny, Amanda; Gray, Kylie M; East, Christine; Boyle, Jacqueline A

    2016-11-18

    For women of refugee background, the increased risk of mental illness associated with pregnancy is compounded by pre- and post-settlement stressors. In Australia, antenatal screening for depression and anxiety symptoms using the Edinburgh Postnatal Depression Scale is recommended for all women. Despite this, screening is not routinely implemented and little is known about barriers and enablers to implementation for women of refugee background. Semi-structured interviews were conducted with a range of health professionals (n = 28: midwives, obstetricians, perinatal mental health and refugee health experts, interpreters) and women of refugee background (n = 9). Themes generated from thematic analysis were examined in relation to the Theoretical Domains Framework and Cultural Competence Conceptual Framework, followed by identification of effective behaviour change techniques to address the barriers and enablers identified by participants. These techniques formed the basis of recommendations to inform sustainable implementation of screening and referral. Almost all participants perceived perinatal mental health screening to be necessary and most recognised the importance of post-traumatic stress disorder (PTSD) screening. Barriers and enablers were identified and related to eight domains: knowledge, skills, professional roles, beliefs about capabilities and consequences, environmental context, social influences and behavioural regulation. This research clarifies how mental health screening may be integrated into routine antenatal care for women of refugee background, in order to improve provision of recommended care. These theory-informed recommendations include an inter-disciplinary approach, coordinating care within and across services, addition of PTSD screening, and effective communication with women.

  16. Perinatal and infant mortality in urban slums under I.C.D.S. scheme.

    Science.gov (United States)

    Thora, S; Awadhiya, S; Chansoriya, M; Kaul, K K

    1986-08-01

    Perinatal and infant mortality during the year 1985 was analyzed through a prospective study conducted in 12 Anganwadis (total population of 13,054) located in slum areas of India's Jabalpur city. Overall, the infant mortality rate was 128.7/1000 live births and the perinatal mortality rate was 88.5/1000 live births. 58.5% of deaths occurred in the neonatal period. Causes of neonatal deaths included prematurity, respiratory distress syndrome, birth asphyxia, septicemia, and neonatal tetanus. Postneonatal deaths were largely attributable to dehydration from diarrhea, bronchopneumonia, malnutrition, and infectious diseases. All mortality rates were significantly higher in Muslims than among Hindus. Muslims accounted for 28% of the study population, but contributed 63% of stillbirths and 55% of total infant deaths. This phenomenon appears attributable to the large family size among Muslims coupled with inadequate maternal-child health care. The national neonatal and postneonatal mortality rates are 88/1000 and 52/1000, respectively. The fact that the neonatal mortality rate in the study area was slightly lower than the national average may reflect the impact of ICDS services.

  17. Maternal and perinatal outcomes after bariatric surgery: a case control study.

    Science.gov (United States)

    de Alencar Costa, Laura Arrais Sydrião; Araujo Júnior, Edward; de Lucena Feitosa, Francisco Edson; Dos Santos, Andréa Cavalcante; Moura Júnior, Luiz Gonzaga; Costa Carvalho, Francisco Herlânio

    2016-05-01

    To compare the results of maternal and perinatal pregnancies of obese women after bariatric surgery. A retrospective cross-sectional study was carried out on 63 women who had undergone bariatric surgery and 73 obese women (control). Demographic data, the characteristics of the bariatric surgery, and the maternal and perinatal results were evaluated. The Student's t-test and chi-square test (χ2) were used to compare the groups. The gestational complications of the prevalence of gestational diabetes mellitus, anemia, and preeclampsia were analyzed using simple and multivariate logistical regression and odd ratios (OD) with their respective confidence intervals (CI) of 95%. The average body mass index (BMI) at the 1st prenatal appointment of the control group was 34.6±3.3 kg/m2 and that of the post-surgical group was 26.5±4.2 kg/m2. The Roux-en-Y Gastric Bypass was used in 100% of cases; no complications were observed during or after the surgeries. The average weight loss in patients with a prior bariatric surgery was statistically significant (P=0.000). The average weight at birth of the control group was significantly higher than in the post-bariatric surgery group (P=0.017). The women who had a prior bariatric surgery had a higher chance of anemia (OR=3.5; CI 95%: 1.5-8.3) and a reduced chance of macrosomia (OR=0.2; CI 95%:0.1-0.5), and prematurity (OR=0.3; CI 95%:0.1-0.7). Those women who had been submitted to bariatric surgery presented better maternal and perinatal results when compared to obese women.

  18. WHO Global Survey on Maternal and Perinatal Health in Latin America: classifying caesarean sections

    Directory of Open Access Journals (Sweden)

    Faúndes Anibal

    2009-10-01

    Full Text Available Abstract Background Caesarean section rates continue to increase worldwide with uncertain medical consequences. Auditing and analysing caesarean section rates and other perinatal outcomes in a reliable and continuous manner is critical for understanding reasons caesarean section changes over time. Methods We analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 2004-2005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10-group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates. Results The overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3 represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5 represented only 11.4% of the obstetric population, this group was the largest contributor to the overall caesarean section rate (26.7% of all the caesarean sections. The second and third largest contributors to the overall caesarean section rate were nulliparous women with single cephalic pregnancy at term either in spontaneous labour (group 1 or induced or delivered by caesarean section before labour (group 2, which were responsible for 18.3% and 15.3% of all caesarean deliveries, respectively. Conclusion The 10-group classification could be easily applied to a multicountry dataset without problems of inconsistencies or misclassification. Specific groups of women were clearly identified as the main contributors to the overall caesarean section rate. This classification could help health care

  19. Enduring effects of perinatal nicotine exposure on murine sleep in adulthood.

    Science.gov (United States)

    Borniger, Jeremy C; Don, Reuben F; Zhang, Ning; Boyd, R Thomas; Nelson, Randy J

    2017-09-01

    The long-term consequences of early life nicotine exposure are poorly defined. Approximately 8-10% of women report smoking during pregnancy, and this may promote aberrant development in the offspring. To this end, we investigated potential enduring effects of perinatal nicotine exposure on murine sleep and affective behaviors in adulthood (~13-15 wk of age) in C57Bl6j mice. Mothers received a water bottle containing 200 µg/ml nicotine bitartrate dihydrate in 2% wt/vol saccharin or pH-matched 2% saccharin with 0.2% (vol/vol) tartaric acid throughout pregnancy and before weaning. Upon reaching adulthood, offspring were tested in the open field and elevated plus maze, as well as the forced swim and sucrose anhedonia tests. Nicotine-exposed male (but not female) mice had reduced mobility in the open field, but no differences were observed in anxiety-like or depressive-like responses. Upon observing this male-specific phenotype, we further assessed sleep-wake states via wireless EEG/EMG telemetry. Following baseline recording, we assessed whether mice exposed to nicotine altered their homeostatic response to 5 h of total sleep deprivation and whether nicotine influenced responses to a powerful somnogen [i.e., lipopolysaccharides (LPS)]. Males exposed to perinatal nicotine decreased the percent time spent awake and increased time in non-rapid eye movement (NREM) sleep, without changes to REM sleep. Nicotine-exposed males also displayed exaggerated responses (increased time asleep and NREM spectral power) to sleep deprivation. Nicotine-exposed animals additionally had blunted EEG slow-wave responses to LPS administration. Together, our data suggest that perinatal nicotine exposure has long-lasting effects on normal sleep and homeostatic sleep processes into adulthood. Copyright © 2017 the American Physiological Society.

  20. Domestic Violence Enhanced Perinatal Home Visits: The DOVE Randomized Clinical Trial.

    Science.gov (United States)

    Sharps, Phyllis W; Bullock, Linda F; Campbell, Jacquelyn C; Alhusen, Jeanne L; Ghazarian, Sharon R; Bhandari, Shreya S; Schminkey, Donna L

    2016-11-01

    Perinatal intimate partner violence (IPV) is common and has significant negative health outcomes for mothers and infants. This study evaluated the effectiveness of an IPV intervention in reducing violence among abused women in perinatal home visiting programs. This assessor-blinded multisite randomized control trial of 239 women experiencing perinatal IPV was conducted from 2006 to 2012 in U.S. urban and rural settings. The Domestic Violence Enhanced Home Visitation Program (DOVE) intervention group (n = 124) received a structured abuse assessment and six home visitor-delivered empowerment sessions integrated into home visits. All participants were screened for IPV and referred appropriately. IPV was measured by the Conflicts Tactics Scale2 at baseline through 24 months postpartum. There was a significant decrease in IPV over time (F = 114.23; p < 0.001) from baseline to 1, 3, 6, 12, 18, and 24 months postpartum (all p < 0.001). Additional models examining change in IPV from baseline indicated a significant treatment effect (F = 6.45; p < 0.01). Women in the DOVE treatment group reported a larger mean decrease in IPV scores from baseline compared to women in the usual care group (mean decline 40.82 vs. 35.87). All models accounted for age and maternal depression as covariates. The DOVE intervention was effective in decreasing IPV and is brief, thereby facilitating its incorporation within well-woman and well-child care visits, as well as home visiting programs, while satisfying recommendations set forth in the Affordable Care Act for IPV screening and brief counseling.

  1. Maternal and Perinatal Outcomes among Eclamptic Patients ...

    African Journals Online (AJOL)

    HP

    1Department of Obstetrics and Gynaecology, Bugando Medical Centre, Mwanza, ... (10.5%), pulmonary oedema (10.5%), maternal stroke (8.8%), HELLP syndrome (50.9%), and Disseminated ..... health care services and medical attention.

  2. Do smoke-free environment policies reduce smoking on hospital grounds? Evaluation of a smoke-free health service policy at two Sydney hospitals.

    Science.gov (United States)

    Poder, Natasha; Carroll, Therese; Wallace, Cate; Hua, Myna

    2012-05-01

    To evaluate the compliance of hospital staff, inpatients and visitors with Sydney South West Area Health Service's Smoke-free Environment Policy. Six sites were observed at two Sydney hospitals 2 weeks before implementation of the policy and at 2 weeks, 6 months, 12 months, 18 months and 2 years after implementation. There was an overall significant 36% (P≤0.05) reduction in observed smoking incidents on hospital grounds 2 years after implementation. Two years after implementation, observed smoking incidents reduced by 44% (P≤0.05) in staff, 37% (P≤0.05) in visitors and remained unchanged among inpatients. The Smoke-free Environment Policy was effective in reducing visitors and staff observed smoking on hospital grounds, but had little effect on inpatients' smoking. Identifying strategies to effectively manage nicotine addiction and promote cessation amongst hospital inpatients remains a key priority.

  3. Analysis of HIV early infant diagnosis data to estimate rates of perinatal HIV transmission in Zambia.

    Directory of Open Access Journals (Sweden)

    Kwasi Torpey

    Full Text Available Mother-to-child transmission of HIV (MTCT remains the most prevalent source of pediatric HIV infection. Most PMTCT (prevention of mother-to-child transmission of HIV programs have concentrated monitoring and evaluation efforts on process rather than on outcome indicators. In this paper, we review service data from 28,320 children born to HIV-positive mothers to estimate MTCT rates.This study analyzed DNA PCR results and PMTCT data from perinatally exposed children zero to 12 months of age from five Zambian provinces between September 2007 and July 2010.The majority of children (58.6% had a PCR test conducted between age six weeks and six months. Exclusive breastfeeding (56.8% was the most frequent feeding method. An estimated 45.9% of mothers were below 30 years old and 93.3% had disclosed their HIV status. In terms of ARV regimen for PMTCT, 32.7% received AZT+single dose NVP (sdNVP, 30.9% received highly active antiretroviral treatment (HAART, 19.6% received sdNVP only and 12.9% received no ARVs. Transmission rates at six weeks when ARVs were received by both mother and baby, mother only, baby only, and none were 5.8%, 10.5%, 15.8% and 21.8% respectively. Transmission rates at six weeks where mother received HAART, AZT+sd NVP, sdNVP, and no intervention were 4.2%, 6.8%, 8.7% and 20.1% respectively. Based on adjusted analysis including ARV exposures and non ARV-related parameters, lower rates of positive PCR results were associated with 1 both mother and infant receiving prophylaxis, 2 children never breastfed and 3 mother being 30 years old or greater. Overall between September 2007 and July 2010, 12.2% of PCR results were HIV positive. Between September 2007 and January 2009, then between February 2009 and July 2010, proportions of positive PCR results were 15.1% and 11% respectively, a significant difference.The use of ARV drugs reduces vertical transmission of HIV in a program setting. Non-chemoprophylactic factors also play a significant

  4. Preventing perinatal HIV transmission - nowisthe time to act!

    African Journals Online (AJOL)

    been met with denial, procrastination and bungling. From a public health point of view this has been a disaster. Will we again miss the chance to act decisively when it comes to perinatal transmission? For African scientists to try to politicise criticism of placebo trials as intervention from the. West is wrong. Rather, they must ...

  5. Perinatal outcomes in pregnant women presenting with preterm ...

    African Journals Online (AJOL)

    There was no statistical significance in sepsis rates, the need for ventilation and the ... complicated by PPROM between HIV-negative and HIV-positive women on ART except ... School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa ... of preterm deliveries, low birth weights and perinatal deaths as.

  6. Perinatal stroke and the risk of developing childhood epilepsy

    Science.gov (United States)

    Golomb, Meredith R.; Garg, Bhuwan P.; Carvalho, Karen S.; Johnson, Cynthia S.; Williams, Linda S.

    2008-01-01

    Objectives To describe the prevalence of epilepsy after 6 months-of-age in children with perinatal stroke and examine whether perinatal data predict epilepsy onset and resolution. Study design A retrospective review of 64 children with perinatal stroke. In children with at least 6 months of follow-up data, Kaplan-Meier curves, univariate log-rank tests, and Cox proportional hazards models were used to examine predictors of time to development of seizures, and time to resolution of seizures in children with epilepsy. The association of risk factors with the presence of epilepsy at any time after 6 months-of-age was examined using Fisher’s exact test. Results Forty-one of the 61 children with at least 6 months of follow-up data (67%) had epilepsy between 6 months-of-age and last follow-up, but in 13 of 41 seizures eventually resolved and anticonvulsants were discontinued. Infarct on prenatal ultrasound (p=0.0065) and family history of epilepsy (p=0.0093) were significantly associated with time to development of seizures after 6 months-of-age in the univariate analysis. No assessed variables were associated with time to resolution of epilepsy or with the presence of epilepsy after 6 months-of-age. Conclusions Childhood epilepsy is frequent after perinatal stroke. Evidence of infarction on prenatal ultrasound and a family history of epilepsy predict earlier onset of active seizures. PMID:17889079

  7. The perinatal autopsy : Pertinent issues in multicultural Western Europe

    NARCIS (Netherlands)

    Gordijn, Sanne J.; Erwich, Jan Jaap H. M.; Khong, T. Yee

    Western Europe is in a demographic transition with increasing multicultural societies. Health professionals have to understand the background, religious and cultural aspects of parents to counsel them regarding an autopsy in the event of a perinatal loss. Autopsy rates have declined over the past

  8. Risk Factors For Perinatal Mortality In Arua Regional Referral ...

    African Journals Online (AJOL)

    baby born after 28 weeks of gestation either as a still birth or born alive but died within 7 days post delivery. A control was any baby born after 28 weeks of gestation and survived the first seven days of life. Control mothers were followed at home after one week to check if any perinatal death occurred. Logistic regression ...

  9. Trends in Perinatal Care and Implications for Frontline Nurse Leaders.

    Science.gov (United States)

    Crenshaw, Jeannette T; Adams, Ellise D; Amis, Debby

    2016-01-01

    The perinatal trends presented in this article are based on recent topics from conferences, journals, the media, as well as from input from perinatal nurses. Trends in patient care are influenced by evidence known for decades, new research, emerging and innovative concepts in healthcare, patient and family preferences, and the media. Trends discussed in this article are rethinking the due date, birth outside the hospital setting, obstetric hospitalists as birth attendants, nitrous oxide for pain in childbirth, hydrotherapy and waterbirth in the hospital setting, delayed cord clamping, disrupters of an optimal infant microbiome, skin-to-skin care during cesarean surgery, and breast-sleeping and the breast-feeding dyad. In addition, the authors developed implications for perinatal nurses related to each trend. The goal is to stimulate reflection on evidence that supports or does not support current practice and to stimulate future research by discussing some of the current trends that may influence the care that perinatal nurses provide during the birthing year.

  10. Determinants of Perinatal Mortality in Twins at Ibadan | Olayemi ...

    African Journals Online (AJOL)

    Context: Twinning being a very important high-risk condition in our environment requires detailed study. There are several studies reviewing factors in twin perinatal mortality in our environment but there is a need to ascertain the relative contributions of each of these factors. Objectives: To assess the relative contributions of ...

  11. Perinatal mortality in a rural community | Ewah | East African Medical ...

    African Journals Online (AJOL)

    Objective: To determine the peri-natal mortality rate (PMR), still birth rate (SBR) and early neonatal death rate (ENDR) in Igueben Local Government Area (LGA) of Edo State. Design: A descriptive cross-sectional study. Setting: Igueben LGA is a rural governmental unit in mid-western Nigeria. Subjects: All women of ...

  12. Comparison of perinatal and obstetrics outcomes among early ...

    African Journals Online (AJOL)

    Objectives: Adolescent pregnancies are known to be associated with increased risk of adverse outcomes. The objectives were to calculate the incidences of the obstetric and perinatal complications at the time of delivery of early adolescent and late adolescent mothers and then compare the same with adult pregnant ...

  13. Perinatal systemic gene delivery using adeno-associated viral vectors

    Directory of Open Access Journals (Sweden)

    Rajvinder eKarda

    2014-11-01

    Full Text Available Neurodegenerative monogenic diseases can also affect a broad range of tissues and organs throughout the body. An effective treatment would require a systemic approach. The intravenous administration of novel therapies is ideal but is hampered by the inability of such drugs to cross the blood-brain barrier and precludes efficacy in the central nervous system. A number of these early lethal intractable diseases also present devastating irreversible pathology at birth or soon after. Therefore, any therapy would ideally be administered during the perinatal period to prevent, stop or ameliorate disease progression. The concept of perinatal gene therapy has moved a step further towards being a feasible approach to treating such disorders. This has primarily been driven by the recent discoveries that particular serotypes of adeno-associated virus (AAV gene delivery vectors have the ability to cross the blood-brain barrier following intravenous administration. Furthermore, this has been safely demonstrated in perinatal mice and non-human primates. This review focuses on the progress made in using AAV to achieve systemic transduction and what this means for developing perinatal gene therapy for early lethal neurodegenerative diseases.

  14. Compensatory cerebral motor control following presumed perinatal ischemic stroke

    NARCIS (Netherlands)

    van der Hoorn, Anouk; Potgieser, Adriaan R E; Brouwer, Oebele F; de Jong, Bauke M

    Case: A fifteen year-old left-handed girl presented with right-sided focal motor seizures. Neuroimaging showed a large left hemisphere lesion compatible with a middle cerebral artery stroke of presumed perinatal origin. She was not previously diagnosed with a motor deficit, although neurological

  15. Prenatal, perinatal and postnatal factors associated with autism spectrum disorder

    Directory of Open Access Journals (Sweden)

    Imen Hadjkacem

    2016-11-01

    Conclusions: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others, as determinant variables for the genesis of ASD.

  16. Perinatal characteristics, older siblings, and risk of ankylosing spondylitis

    DEFF Research Database (Denmark)

    Lindström, Ulf; Forsblad-d'Elia, Helena; Askling, Johan

    2016-01-01

    BACKGROUND: The effect of circumstances and exposures early in life on the risk of developing ankylosing spondylitis (AS) is largely unknown. The purpose of this study was to determine whether perinatal characteristics predict development of AS. METHODS: AS cases (n = 1960; 59 % men) were defined...

  17. Ethics in Perinatal Medicine | Adinma | Nigerian Journal of Paediatrics

    African Journals Online (AJOL)

    Background: The current trend in perinatal medicine addresses the challenge posed to newborn survival by newborn prematurity and other morbidities requiring neonatal newborn intensive care. These ethical concerns span through the spectrum of education, clinical practice and research, domicile in obstetrics and ...

  18. Mothers' perinatal and infant mental health knowledge in a ...

    African Journals Online (AJOL)

    Objective: This paper examines maternal knowledge regarding perinatal and infant mental health amongst mothers in Alexandra township, Johannesburg. ... the denial of negative maternal affect post-birth to elevated levels of post-natal depression found amongst South African mothers parenting in adverse circumstances.

  19. Effect of the maternal care manual from the perinatal education ...

    African Journals Online (AJOL)

    Objectives. To assess changes in the quality of antenatal and intrapartum care rendered by midwives following intervention with the Maternal Care Manual from the Perinatal Education Programme (PEP). Design. A prospective controlled study. Setting. A study town and two control towns in the Eastern Cape. Subjects.

  20. Mental health trajectories and related factors among perinatal women.

    Science.gov (United States)

    Lin, Pei-Chao; Hung, Chich-Hsiu

    2015-06-01

    To investigate Taiwanese women's mental health trajectories from the third trimester of pregnancy to four weeks postpartum and the correlations of these trajectories with perceived social support and demographic characteristics. Previous studies have reported differences between prenatal and postpartum mental health status. A repeated design study was conducted in a medical hospital in Southern Taiwan. One-hundred and ninety-four Taiwanese women completed the Chinese Health Questionnaire and Social Support Scale at the 36th prenatal week and first and fourth week postpartum. Three linear mental health trajectories for perinatal women were identified. Consistently poor perinatal mental health was reported by 16·0% of the participants. Less social support was associated with lower prenatal mental health scores. Younger age was a risk factor for consistently poor perinatal health. Vaginal delivery was associated with improved mental health after childbirth. Mental health was worse in the third trimester of pregnancy than postpartum. Less social support was associated with lower prenatal mental health scores, and this association was similarly distributed between women with consistently poor and improved mental health after birth. Health care providers should assess women's mental health status and provide timely interventions during the perinatal period. Social support should be provided for pregnant women, especially younger women or those with lower perceived social support. © 2015 John Wiley & Sons Ltd.

  1. Maternal and perinatal mortality figures in 249 South African ...

    African Journals Online (AJOL)

    the PMR for the black population is considerably hi9her than for the other ethnic groups. That said, perinatal mortality levels in South African blacks still compare favourably with figures from other African cQuntries.12. In conclusion, the MMRs and PMRs found in our survey of. 249 South African hospitals - though not truly.

  2. The potential for preventing the delivery and perinatal mortality of ...

    African Journals Online (AJOL)

    Objective. To determine the potentiaJ for preventing the delivery and perinatal mortality of low-birth-weight (LBW) babies in a black urban population. Design. Cross-sectionaJ descriptive study. Setting. All women delivering babies weighing less than 2 500 g at Kalafong Hospital in a 6-month period (December 1991 - May ...

  3. Perinatal Asphyxia: A Review from a Metabolomics Perspective

    Directory of Open Access Journals (Sweden)

    Claudia Fattuoni

    2015-04-01

    Full Text Available Perinatal asphyxia is defined as an oxygen deprivation that occurs around the time of birth, and may be caused by several perinatal events. This medical condition affects some four million neonates worldwide per year, causing the death of one million subjects. In most cases, infants successfully recover from hypoxia episodes; however, some patients may develop HIE, leading to permanent neurological conditions or impairment of different organs and systems. Given its multifactor dependency, the timing, severity and outcome of this disease, mainly assessed through Sarnat staging, are of difficult evaluation. Moreover, although the latest newborn resuscitation guideline suggests the use of a 21% oxygen concentration or room air, such an approach is still under debate. Therefore, the pathological mechanism is still not clear and a golden standard treatment has yet to be defined. In this context, metabolomics, a new discipline that has described important perinatal issues over the last years, proved to be a useful tool for the monitoring, the assessment, and the identification of potential biomarkers associated with asphyxia events. This review covers metabolomics research on perinatal asphyxia condition, examining in detail the studies reported both on animal and human models.

  4. Prenatal and Perinatal Risk Factors for Autism in China

    Science.gov (United States)

    Zhang, Xin; Lv, Cong-Chao; Tian, Jiang; Miao, Ru-Juan; Xi, Wei; Hertz-Picciotto, Irva; Qi, Lihong

    2010-01-01

    We conducted a case-control study using 190 Han children with and without autism to investigate prenatal and perinatal risk factors for autism in China. Cases were recruited through public special education schools and controls from regular public schools in the same region (Tianjin), with frequency matching on sex and birth year. Unadjusted…

  5. Trichomonas infection in pregnancy does it affect perinatal outcome ...

    African Journals Online (AJOL)

    Trichomonas infection in pregnancy does it affect perinatal outcome? S.M. Ross, A. van Middelkoop. Abstract. Antenatal patients free of Trichomonas vaginalis vaginal infection were compared with infected patients, half of whom were treated and half left untreated. The treated group was given. benzoyl metronidazole 50 ml ...

  6. Perinatal asphyxia in a specialist hospital in Port Harcourt, Nigeria ...

    African Journals Online (AJOL)

    For outborn babies with no Apgar score recording, a history of poor cry from birth with either poor colour, respiratory distress, floppiness or loss of primitive reflexes were used. Results: One hundred and fifty seven of 630 babies admitted had perinatal asphyxia giving a prevalence of 29.4%. Mean gestational age of affected ...

  7. Reducing stillbirths: interventions during labour

    Science.gov (United States)

    Darmstadt, Gary L; Yakoob, Mohammad Yawar; Haws, Rachel A; Menezes, Esme V; Soomro, Tanya; Bhutta, Zulfiqar A

    2009-01-01

    Background Approximately one million stillbirths occur annually during labour; most of these stillbirths occur in low and middle-income countries and are associated with absent, inadequate, or delayed obstetric care. The low proportion of intrapartum stillbirths in high-income countries suggests that intrapartum stillbirths are largely preventable with quality intrapartum care, including prompt recognition and management of intrapartum complications. The evidence for impact of intrapartum interventions on stillbirth and perinatal mortality outcomes has not yet been systematically examined. Methods We undertook a systematic review of the published literature, searching PubMed and the Cochrane Library, of trials and reviews (N = 230) that reported stillbirth or perinatal mortality outcomes for eight interventions delivered during labour. Where eligible randomised controlled trials had been published after the most recent Cochrane review on any given intervention, we incorporated these new trial findings into a new meta-analysis with the Cochrane included studies. Results We found a paucity of studies reporting statistically significant evidence of impact on perinatal mortality, especially on stillbirths. Available evidence suggests that operative delivery, especially Caesarean section, contributes to decreased stillbirth rates. Induction of labour rather than expectant management in post-term pregnancies showed strong evidence of impact, though there was not enough evidence to suggest superior safety for the fetus of any given drug or drugs for induction of labour. Planned Caesarean section for term breech presentation has been shown in a large randomised trial to reduce stillbirths, but the feasibility and consequences of implementing this intervention routinely in low-/middle-income countries add caveats to recommending its use. Magnesium sulphate for pre-eclampsia and eclampsia is effective in preventing eclamptic seizures, but studies have not demonstrated impact

  8. Antenatal interpersonal sensitivity is more strongly associated than perinatal depressive symptoms with postnatal mother-infant interaction quality.

    Science.gov (United States)

    Raine, Karen; Cockshaw, Wendell; Boyce, Philip; Thorpe, Karen

    2016-10-01

    Maternal mental health has enduring effects on children's life chances and is a substantial cost driver for child health, education and social services. A key linking mechanism is the quality of mother-infant interaction. A body of work associates maternal depressive symptoms across the antenatal and postnatal (perinatal) period with less-than-optimal mother-infant interaction. Our study aims to build on previous research in the field through exploring the association of a maternal personality trait, interpersonal sensitivity, measured in early pregnancy, with subsequent mother-infant interaction quality. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine the association between antenatal interpersonal sensitivity and postnatal mother-infant interaction quality in the context of perinatal depressive symptoms. Interpersonal sensitivity was measured during early pregnancy and depressive symptoms in the antenatal year and across the first 21 months of the postnatal period. In a subsample of the ALSPAC, mother-infant interaction was measured at 12 months postnatal through a standard observation. For the subsample that had complete data at all time points (n = 706), hierarchical regression examined the contribution of interpersonal sensitivity to variance in mother-infant interaction quality. Perinatal depressive symptoms predicted little variance in mother-infant interaction. Antenatal interpersonal sensitivity explained a greater proportion of variance in mother-infant interaction quality. The personality trait, interpersonal sensitivity, measured in early pregnancy, is a more robust indicator of subsequent mother-infant-interaction quality than perinatal depressive symptoms, thus affording enhanced opportunity to identify vulnerable mother-infant relationships for targeted early intervention.

  9. Acoustic alterations of ultrasonic vocalization in rat pups induced by perinatal hypothyroidism.

    Science.gov (United States)

    Wada, Hiromi

    2017-03-01

    Perinatal hypothyroidism causes serious damage to auditory functions that are essential for vocalization development. In rat pups, perinatal hypothyroidism potentially affects the development of ultrasonic vocalization (USV) as a result of hearing deficits. This study examined the effect of perinatal hypothyroidism on the development of USVs in rat pups. Twelve pregnant rats were divided into three groups and treated with the anti-thyroid drug methimazole (MMI) via drinking water, from gestational day 15 to postnatal day (PND) 21. The MMI concentration (w/v) was 0% (control group), 0.01% (low-dose group), or 0.015% (high-dose group). After birth, the pups were individually separated from the dam and littermates on PNDs 5, 10, 15, and 20, and their USVs were recorded for 5min. On PNDs 5 and 10, compared with the control group, the low- and high-dose groups exhibited reductions of both frequency-modulated and downward USVs. On PND 15, however, the low- and high-dose groups displayed increases in number, duration, and amplitude of USVs compared with those in the control group. Lower body weights were observed for the low- and high-dose groups than for the control group. Total thyroxine concentrations in plasma were dose-dependently reduced. The onset of auditory functions appeared on PNDs 11-14. Thus, the rat pups were unable to hear externally produced USVs before PND 11. USVs emitted on PNDs 5 and 10 might have been spontaneous and independent of the pups' own or littermate-emitted USVs. The developmental retardation of vocalization-related organs or muscles might underlie the acoustic alterations of USVs on PNDs 5 and 10. The greater number, duration, and amplitude of USVs on PND 15, after which the hearing onset occurred, suggested that the elevation of auditory thresholds occurred as a result of hearing deficits in the low- and high-dose groups. Perinatal hypothyroidism appears to have caused acoustic alterations in the USV development. Copyright © 2016 Elsevier

  10. Interventions to reduce dependency in personal activities of daily living in community dwelling adults who use homecare services: a systematic review.

    Science.gov (United States)

    Whitehead, Phillip J; Worthington, Esme J; Parry, Ruth H; Walker, Marion F; Drummond, Avril E R

    2015-11-01

    To identify interventions that aim to reduce dependency in activities of daily living (ADL) in homecare service users. To determine: content; effectiveness in improving ability to perform ADL; and whether delivery by qualified occupational therapists influences effectiveness. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, OTseeker, PEDro, Web of Science, CIRRIE, and ASSIA. We included: randomised controlled trials, non-randomised controlled trials and controlled before and after studies. Two reviewers independently screened studies for inclusion, assessed risk of bias and extracted data. A narrative synthesis of the findings was conducted. Thirteen studies were included, totalling 4975 participants. Ten (77%) were judged to have risk of bias. Interventions were categorised as those termed 're-ablement' or 'restorative homecare' (n=5/13); and those involving separate components which were not described using this terminology (n=8/13). Content of the intervention and level of health professional input varied within and between studies. Effectiveness on ADL: eight studies included an ADL outcome, five favoured the intervention group, only two with statistical significance, both these were controlled before and after studies judged at high risk of bias. ADL outcome was reported using seven different measures. Occupational therapy: there was insufficient evidence to determine whether involvement of qualified occupational therapists influenced effectiveness. There is limited evidence that interventions targeted at personal ADL can reduce homecare service users' dependency with activities, the content of evaluated interventions varies greatly. © The Author(s) 2015.

  11. Psychosocial impact of perinatal loss among Muslim women

    Directory of Open Access Journals (Sweden)

    Sutan Rosnah

    2012-06-01

    Full Text Available Abstract Background Women of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women. Methods A qualitative study was conducted in a specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was collected by focus group discussion and in-depth unstructured interview until the saturation point met. Sixteen mothers who had recent perinatal loss of wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre participated for the study. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy. Results Two out of sixteen showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support. The majority agreed that the decision makers were husbands and families instead of themselves. The respondents felt that repetitive reminder of whatever happened was a test from God improved their sense of self-worth. They appreciated this reminder especially when it came from husband, family or friends closed to them. Conclusion Muslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Husbands and family members were the main decision makers for Muslim women. Health care providers should provide psychosocial support during antenatal, delivery and postnatal care. On-going support involving husband should be available where needed.

  12. Prenatal, perinatal and postnatal factors associated with autism spectrum disorder.

    Science.gov (United States)

    Hadjkacem, Imen; Ayadi, Héla; Turki, Mariem; Yaich, Sourour; Khemekhem, Khaoula; Walha, Adel; Cherif, Leila; Moalla, Yousr; Ghribi, Farhat

    To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD) by comparing them to their siblings without autistic disorders. The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014). It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p=0.03 and p=0.042). In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases), long duration of delivery and prematurity (18% of cases for each factor), while postnatal factors were represented principally by respiratory infections (24%). As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others), as determinant variables for the genesis of ASD. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  13. The evaluation of perinatal outcomes in pregnancies complicated with thrombophilias

    Directory of Open Access Journals (Sweden)

    Yusuf Taner Kafadar

    2014-06-01

    Full Text Available Aim: In our study we included pregnant patients diagnosed with thrombophilia and evaluated their follow up by thromboprophylaxy for perinatal outcomes. (pregnancy loss, preclampsia,small for gestational age, preterm labour, venous thrombosis. In addition to our study group we aimed to evaluate a control group with negative thrombophilia screen results and hypothesized similar perinatal outcomes in comparison with the study group. Materials-Methods: Pregnant subjects that applied to Çukurova University Hospital, between June 2010 - February 2012 were recruited in the study. Patients with a positive thrombophilia screen for primary and secondary recurrent pregnancy loss were initiated a thromboprophylaxia protocol in the first trimester and their demographic backgrounds and past obstetric histories were also recorded. In addition to this, the type of thrombophilia and number of thrombophilia defects were also noted and the route of birth and perinatal outcomes were evaluated prospectively. The control group included patients who had a history of recurrent unexplained miscarriages, with a negative thrombophilia screen. Differences between both groups were statistically significant at a p value <0.05. Results: 60 patients diagnosed thrombophilia were included in the study group, while 50 patients with unexplained recurrent miscarriage composed the control group. When the perinatal outcomes were compared; pregnancy loss, development of preeclampsia/eclampsia (p=0.257, small for gestational age birth rate (p=0.619, preterm birth rate (p=0.232 and the incidence of venous thrombosis (p=0.246 did not differ significantly. The cesarean section rate in the study group was 55% and 18% in the study group (p=0.000 and it was statistically significant between both groups. Discussion: Our study discovered similar findings and perinatal outcomes in patients with and without thrombophilia. The only significant difference between both groups was the difference in

  14. Eating disorders and trauma history in women with perinatal depression.

    Science.gov (United States)

    Meltzer-Brody, Samantha; Zerwas, Stephanie; Leserman, Jane; Holle, Ann Von; Regis, Taylor; Bulik, Cynthia

    2011-06-01

    Although the prevalence of perinatal depression (depression occurring during pregnancy and postpartum) is 10%, little is known about psychiatric comorbidity in these women. We examined the prevalence of comorbid eating disorders (ED) and trauma history in women with perinatal depression. A research questionnaire was administered to 158 consecutive patients seen in a perinatal psychiatry clinic during pregnancy (n=99) or postpartum (n=59). Measures included Structured Clinical Interview for DSM (SCID) IV-based questions for lifetime eating psychopathology and assessments of comorbid psychiatric illness including the State/Trait Anxiety Inventory (STAI), Patient Health Questionnaire (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS), and Trauma Inventory. In this cohort, 37.1% reported a putative lifetime ED history; 10.1% reported anorexia nervosa (AN), 10.1% reported bulimia nervosa (BN), 10.1% reported ED not otherwise specified-purging subtype (EDNOS-P), and 7.0% reported binge eating disorder (BED). Women with BN reported more severe depression (EPDS score, 19.1, standard deviation [SD 4.3], p=0.02; PHQ-severity 14.5, SD 7.4, p=0.02) than the referent group of women with perinatal depression and no ED history (EPDS 13.3, SD=6.1; PHQ 9.0, SD=6.2). Women with AN were more likely to report sexual trauma history than the referent group (62.5% vs. 29.3%, pdepression and histories of physical and sexual trauma. Screening for histories of eating psychopathology is important in women with perinatal depression.

  15. Prenatal, perinatal and postnatal factors associated with autism spectrum disorder

    Directory of Open Access Journals (Sweden)

    Imen Hadjkacem

    Full Text Available Abstract Objective: To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD by comparing them to their siblings without autistic disorders. Method: The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014. It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. Results: Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p = 0.03 and p = 0.042. In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases, long duration of delivery and prematurity (18% of cases for each factor, while postnatal factors were represented principally by respiratory infections (24%. As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. Conclusions: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others, as determinant variables for the genesis of ASD.

  16. US and territory telemedicine policies: identifying gaps in perinatal care

    Science.gov (United States)

    Okoroh, Ekwutosi M.; Kroelinger, Charlan D.; Smith, Alexander M.; Goodman, David A.; Barfield, Wanda D.

    2016-01-01

    BACKGROUND Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). OBJECTIVE We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. STUDY DESIGN We conducted a 2014 systematic World Wide Web–based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N=59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. RESULTS Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. CONCLUSION The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource

  17. Executive Functioning in Children and Adolescents With Perinatal HIV Infection and Perinatal HIV Exposure.

    Science.gov (United States)

    Nichols, Sharon L; Chernoff, Miriam C; Malee, Kathleen M; Sirois, Patricia A; Woods, Steven P; Williams, Paige L; Yildirim, Cenk; Delis, Dean; Kammerer, Betsy

    2016-12-01

    Executive functions (EFs) are critical for management of life activities, but few studies have evaluated EFs in children and adolescents with perinatally acquired HIV (PHIV), who are at risk for problems in academics, behavior, and medication adherence. We compared EFs in youth with PHIV and in perinatally HIV-exposed but uninfected (PHEU) youth. Four Delis-Kaplan Executive Function System (D-KEFS) subtests were administered to 173 youth with PHIV and 85 PHEU youth, aged 9 to Executive Functioning Study. Youth with PHIV, with or without history of a Centers for Disease Control and Prevention Class C (AIDS-defining) condition (PHIV/C [n = 45] and PHIV/non-C [n = 128], respectively), were compared with each other and with PHEU youth. Among youth with PHIV, associations with measures of current and past disease severity were evaluated using adjusted linear regression models. The PHIV/C group (mean age, 15.5 years), compared with the PHIV/non-C and PHEU groups (mean ages, 14.5 and 12.9 years, respectively), were significantly slower on the Inhibition and Color Naming/Reading Combined conditions of the Color-Word Interference subtest and made more errors on Inhibition; differences between the PHIV/C and PHEU groups persisted in adjusted models. No differences in adjusted means for fluency or problem-solving were found. The PHIV/non-C and PHEU groups did not differ on any measure. Associations of specific EF measures with HIV RNA viral load, CD4-positive T-lymphocyte percentage, and age at greatest disease severity were observed. Youth with PHIV and previous AIDS-defining conditions performed more poorly on some EF measures. Relationships of EF development with the degree and timing of disease severity require further study. Implications for long-term outcomes and interventions are important avenues for follow-up. © The Author 2016. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e

  18. Perinatal Depression Algorithm: A Home Visitor Step-by-Step Guide for Advanced Management of Perinatal Depressive Symptoms

    Science.gov (United States)

    Laszewski, Audrey; Wichman, Christina L.; Doering, Jennifer J.; Maletta, Kristyn; Hammel, Jennifer

    2016-01-01

    Early childhood professionals do many things to support young families. This is true now more than ever, as researchers continue to discover the long-term benefits of early, healthy, nurturing relationships. This article provides an overview of the development of an advanced practice perinatal depression algorithm created as a step-by-step guide…

  19. Women's Preferences for Treatment of Perinatal Depression and Anxiety: A Discrete Choice Experiment.

    Directory of Open Access Journals (Sweden)

    Jemimah Ride

    Full Text Available Perinatal depression and anxiety (PNDA are an international healthcare priority, associated with significant short- and long-term problems for women, their children and families. Effective treatment is available but uptake is suboptimal: some women go untreated whilst others choose treatments without strong evidence of efficacy. Better understanding of women's preferences for treatment is needed to facilitate uptake of effective treatment. To address this issue, a discrete choice experiment (DCE was administered to 217 pregnant or postnatal women in Australia, who were recruited through an online research company and had similar sociodemographic characteristics to Australian data for perinatal women. The DCE investigated preferences regarding cost, treatment type, availability of childcare, modality and efficacy. Data were analysed using logit-based models accounting for preference and scale heterogeneity. Predicted probability analysis was used to explore relative attribute importance and policy change scenarios, including how these differed by women's sociodemographic characteristics. Cost and treatment type had the greatest impact on choice, such that a policy of subsidising effective treatments was predicted to double their uptake compared with the base case. There were differences in predicted uptake associated with certain sociodemographic characteristics: for example, women with higher educational attainment were more likely to choose effective treatment. The findings suggest policy directions for decision makers whose goal is to reduce the burden of PNDA on women, their children and families.

  20. Women's Preferences for Treatment of Perinatal Depression and Anxiety: A Discrete Choice Experiment.

    Science.gov (United States)

    Ride, Jemimah; Lancsar, Emily

    2016-01-01

    Perinatal depression and anxiety (PNDA) are an international healthcare priority, associated with significant short- and long-term problems for women, their children and families. Effective treatment is available but uptake is suboptimal: some women go untreated whilst others choose treatments without strong evidence of efficacy. Better understanding of women's preferences for treatment is needed to facilitate uptake of effective treatment. To address this issue, a discrete choice experiment (DCE) was administered to 217 pregnant or postnatal women in Australia, who were recruited through an online research company and had similar sociodemographic characteristics to Australian data for perinatal women. The DCE investigated preferences regarding cost, treatment type, availability of childcare, modality and efficacy. Data were analysed using logit-based models accounting for preference and scale heterogeneity. Predicted probability analysis was used to explore relative attribute importance and policy change scenarios, including how these differed by women's sociodemographic characteristics. Cost and treatment type had the greatest impact on choice, such that a policy of subsidising effective treatments was predicted to double their uptake compared with the base case. There were differences in predicted uptake associated with certain sociodemographic characteristics: for example, women with higher educational attainment were more likely to choose effective treatment. The findings suggest policy directions for decision makers whose goal is to reduce the burden of PNDA on women, their children and families.

  1. Women’s Preferences for Treatment of Perinatal Depression and Anxiety: A Discrete Choice Experiment

    Science.gov (United States)

    Ride, Jemimah; Lancsar, Emily

    2016-01-01

    Perinatal depression and anxiety (PNDA) are an international healthcare priority, associated with significant short- and long-term problems for women, their children and families. Effective treatment is available but uptake is suboptimal: some women go untreated whilst others choose treatments without strong evidence of efficacy. Better understanding of women’s preferences for treatment is needed to facilitate uptake of effective treatment. To address this issue, a discrete choice experiment (DCE) was administered to 217 pregnant or postnatal women in Australia, who were recruited through an online research company and had similar sociodemographic characteristics to Australian data for perinatal women. The DCE investigated preferences regarding cost, treatment type, availability of childcare, modality and efficacy. Data were analysed using logit-based models accounting for preference and scale heterogeneity. Predicted probability analysis was used to explore relative attribute importance and policy change scenarios, including how these differed by women’s sociodemographic characteristics. Cost and treatment type had the greatest impact on choice, such that a policy of subsidising effective treatments was predicted to double their uptake compared with the base case. There were differences in predicted uptake associated with certain sociodemographic characteristics: for example, women with higher educational attainment were more likely to choose effective treatment. The findings suggest policy directions for decision makers whose goal is to reduce the burden of PNDA on women, their children and families. PMID:27258096

  2. A longitudinal investigation of perfectionism and repetitive negative thinking in perinatal depression.

    Science.gov (United States)

    Egan, Sarah J; Kane, Robert T; Winton, Karen; Eliot, Catherine; McEvoy, Peter M

    2017-10-01

    Repetitive negative thinking and perfectionism have both been proposed as processes that are related to depressive symptoms. The purpose of this study was to investigate concurrent and prospective relationships between antenatal and postnatal depression, perfectionism, and repetitive negative thinking. A longitudinal design was used and 71 women were followed from their third trimester of pregnancy to six weeks post birth. A structural equation model was tested with antenatal perfectionism predicting antenatal repetitive negative thinking, perfectionism predicting postnatal depression, and antenatal repetitive negative thinking predicting antenatal and postnatal depression. The final model provided an adequate fit to the data but the pathway from antenatal repetitive negative thinking to postnatal depression was not significant. The findings provide support for the role of perfectionism and repetitive negative thinking in the onset and maintenance of perinatal symptoms of depression. It is suggested that future research investigates the efficacy of targeting repetitive negative thinking and perfectionism in pregnancy to examine if this can reduce perinatal depression. Copyright © 2017. Published by Elsevier Ltd.

  3. A case of Hydrops fetalis due to Kell alloimmunization: A perinatal approach to a rare case

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    Arzu Akdag

    2012-03-01

    Full Text Available Introduction: While the routine administration of Rhesus immunoglobulin has significantly reduced the incidence of this type of alloimmunization, maternal alloimmunization to other red cell antigens continues to contribute to perinatal morbidity and mortality. Although the Kell antigen is found on the red cells of only 9% of the population, attention has increasingly been focused on Kell antibodies. Case Report: We present a case of fetal hydrops who was sonographically detected at 30th week of pregnancy. Antenatal tests for evaluation of fetal condition clearly showed the critical level of hemolytic disease but the baby was delivered prematurely due to fetal distress. The combination of anemia, reticulocytopenia, hydrops fetalis, and positive indirect Coombs test suggested Kell isoimmunization. The baby was treated by exchange transfusion with the Kell-negative packed red cell succesfully, and was discharged on postnatal 30th day. Conclusion: Here we describe a case of hydrops fetalis caused by Kell alloimmunization that was determined in postnatal period, and thus we plan to discuss the perinatal approach to the Kell immunization.

  4. Eating soup with nails of pig: thematic synthesis of the qualitative literature on cultural practices and beliefs influencing perinatal nutrition in low and middle income countries.

    Science.gov (United States)

    Raman, Shanti; Nicholls, Rachel; Ritchie, Jan; Razee, Husna; Shafiee, Samaneh

    2016-07-28

    The perinatal period, i.e. pregnancy, childbirth and early infancy, is a significant transition period where the biological and the social strongly intersect. In low and middle-income countries the disease burden arising from the perinatal period, is still substantial. The perinatal period is also a crucial window of opportunity for reducing undernutrition and its long term adverse effects. We explored qualitative research conducted in low resource settings around the perinatal continuum over the past two decades, with a particular focus on the 'cultural' realm, to identify common themes influencing maternal and infant nutrition. We systematically searched electronic databases from 1990 to 2014, including MEDLINE, EMBASE, PsycINFO, Scopus and Cumulative Index to Nursing and Allied Health Literature, using relevant search terms including traditional beliefs, practices, pregnancy, childbirth, developing countries etc. Adapted Consolidated Criteria for Reporting Qualitative Health Research and Critical Appraisal Skills Programme criteria were used to determine quality of studies. We synthesised the literature thematically, enabled by NVivo 10 software. Most studies showed cultural support for breastfeeding, although most traditional societies delayed breastfeeding due to colostrum being considered 'dirty'. A range of restrictive practices through pregnancy and the post- partum period were revealed in Asia, Latin America and Africa. There was a strong cultural understanding of the healing power of everyday foods. A wide range of good foods and bad foods continued to have currency through the perinatal continuum, with little consensus between groups of what was beneficial versus harmful. Cross-cutting themes that emerged were 1) the role of the woman/mother/wife as strong and good; 2) poverty restricting women's nutrition choices; 3) change being constant, but the direction of change unpredictable. A rich and diverse repertoire of cultural practices and beliefs

  5. Influence of culture and community perceptions on birth and perinatal care of immigrant women: doulas' perspective.

    Science.gov (United States)

    Kang, Hye-Kyung

    2014-01-01

    A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influence of cultural and community beliefs on immigrant women's birth and perinatal care, as well as their own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural brokers, and emotional and social support. Also, doulas share a consistent set of professional values, including empowerment, informed choice, cultural relativism, and scientific/evidence-based practice, but do not always recognize these values as culturally based. More emphasis on cultural self-awareness in doula training, expanding community doula programs, and more integration of doula services in health-care settings are recommended.

  6. Influence of Culture and Community Perceptions on Birth and Perinatal Care of Immigrant Women: Doulas’ Perspective

    Science.gov (United States)

    Kang, Hye-Kyung

    2014-01-01

    A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influence of cultural and community beliefs on immigrant women’s birth and perinatal care, as well as their own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural brokers, and emotional and social support. Also, doulas share a consistent set of professional values, including empowerment, informed choice, cultural relativism, and scientific/evidence-based practice, but do not always recognize these values as culturally based. More emphasis on cultural self-awareness in doula training, expanding community doula programs, and more integration of doula services in health-care settings are recommended. PMID:24453465

  7. State infants after perinatal complications prevention by mother with the association of HIV and herpes virus infection

    Directory of Open Access Journals (Sweden)

    Zhdanovich O.I.

    2016-12-01

    Full Text Available Relevance. Complicated and little studied issue is the perinatal complications prevention in pregnant women with HIV and herpes virus infections (GI The goal — to evaluate the effectiveness of the system of perinatal complications prevention during the association of HIV and herpes infection. Materials and methods. Selected 60 HIV-infected pregnant women with the GI, which divided into 2 groups: primary — 30 pregnant women with the use of recommended prophylaxis complex (specific immunoglobulins, interferon α-2β, flavonoids, probiotics, arginine glutamat, the comparison group — 30 pregnant women with the knowledge of the pregnancy according to the Ministry of Health reports. Results. After recommended treatment course significantly improving the condition of children at birth: in satisfactory condition (without asphyxia was born 60.0 against 37.9% of children (p<0.05. Relatively better and during the period of early neonatal adaptation: 1.5–2 times lower than the frequency of jaundice, hemorrhagic syndrome, and gastrointestinal. Significantly reduces the incidence of life-threatening syndromes and further development of the child as neurological (up 23.3% vs. 44.8%, p<0.05 and RDS (up 16.7% vs. 37.9%, p<0.05. Conclusions. Security and high efficiency of the proposed complex of perinatal complications prevention for HIV-infected pregnant women with herpes infection can be recommended for implementation in antenatal clinics and maternity homes.

  8. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. preventive services task force recommendation statement.

    Science.gov (United States)

    Moyer, Virginia A

    2013-08-06

    Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening and behavioral counseling interventions in primary care to reduce alcohol misuse. The USPSTF reviewed new evidence on the effectiveness of screening for alcohol misuse for improving health outcomes, the accuracy of various screening approaches, the effectiveness of various behavioral counseling interventions for improving intermediate or long-term health outcomes, the harms of screening and behavioral counseling interventions, and influences from the health care system that promote or detract from effective screening and counseling interventions for alcohol misuse. These recommendations apply to adolescents aged 12 to 17 years and adults aged 18 years or older. These recommendations do not apply to persons who are actively seeking evaluation or treatment of alcohol misuse. The USPSTF recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. (Grade B recommendation)The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse in adolescents. (I statement)

  9. Neonatal encephalopathic cerebral injury in South India assessed by perinatal magnetic resonance biomarkers and early childhood neurodevelopmental outcome.

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    Peter J Lally

    Full Text Available Although brain injury after neonatal encephalopathy has been characterised well in high-income countries, little is known about such injury in low- and middle-income countries. Such injury accounts for an estimated 1 million neonatal deaths per year. We used magnetic resonance (MR biomarkers to characterise perinatal brain injury, and examined early childhood outcomes in South India.We recruited consecutive term or near term infants with evidence of perinatal asphyxia and a Thompson encephalopathy score ≥6 within 6 h of birth, over 6 months. We performed conventional MR imaging, diffusion tensor MR imaging and thalamic proton MR spectroscopy within 3 weeks of birth. We computed group-wise differences in white matter fractional anisotropy (FA using tract based spatial statistics. We allocated Sarnat encephalopathy stage aged 3 days, and evaluated neurodevelopmental outcomes aged 3½ years using Bayley III.Of the 54 neonates recruited, Sarnat staging was mild in 30 (56%; moderate in 15 (28% and severe in 6 (11%, with no encephalopathy in 3 (6%. Six infants died. Of the 48 survivors, 44 had images available for analysis. In these infants, imaging indicated perinatal rather than established antenatal origins to injury. Abnormalities were frequently observed in white matter (n = 40, 91% and cortex (n = 31, 70% while only 12 (27% had abnormal basal ganglia/thalami. Reduced white matter FA was associated with Sarnat stage, deep grey nuclear injury, and MR spectroscopy N-acetylaspartate/choline, but not early Thompson scores. Outcome data were obtained in 44 infants (81% with 38 (79% survivors examined aged 3½ years; of these, 16 (42% had adverse neurodevelopmental outcomes.No infants had evidence for established brain lesions, suggesting potentially treatable perinatal origins. White matter injury was more common than deep brain nuclei injury. Our results support the need for rigorous evaluation of the efficacy of rescue hypothermic

  10. The analysis of perinatal morbidity and mortality in conditions of perinatal center and the ways of its decrease

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    Нана Мерабівна Пасієшвілі

    2016-01-01

    Full Text Available Aim of research. The analysis of perinatal morbidity and mortality in the condition of one perinatal center of Ukraine and optimization of the possible ways of its decrease.Methods of research. There was analyze the work of Kharkiv regional center in 2011–2015 years taking into account the rates of perinatal morbidity and mortality and factors that have influence on it. There were studied the next parameters: the number of newborns, its apportionment on the weight category, survival, general morbidity, mortality structure of the full-term and premature children. Statistical processing of the received results was carried out using Statistica 6.0 program.Results of research. The frequency of normal delivery in perinatal center is in average 58,9 %. The rates of neonatal mortality decreased– 4,11 ‰ (in 2011 year – 8,23 ‰ and early neonatal one – 3,34 ‰ (in 2011 year – 6,44 ‰. The survival of newborns with extremely low body weight (500- 999 g in first 0-168 hours was 62,50 %; with body weight 1000 – 1499 g – 82,35 %; with body weight at delivery 1500-2499 g was 98,17 %, survival of newborns with body weight > 2500 g in the first 0-6 days was 99,75 % .The morbidity structure of full-term children still almost unchangeable during the last 5 years: asphyxia, congenital defects of development, arrest of foetus growth, cerebral ischemia, intrauterine infection, birth trauma. The morbidity structure of premature ones: respiratory disorder syndrome, intrauterine infection; asphyxia, congenital defects of development, arrest of foetus growth.Among the mortality causes the main ones were congenial defects of development (prevailed in full-term children and intrauterine infection (on the first place in premature children. The perinatal mortality rate in 2015 year was 18,22 %о, in 2011year – 26,65 %о . The maternal foetus infection is the very frequent cause of stillbirth and pre-term birth and as the result the birth of small

  11. Borderline Personality Disorder in the perinatal period: early infant and maternal outcomes.

    Science.gov (United States)

    Blankley, Gaynor; Galbally, Megan; Snellen, Martien; Power, Josephine; Lewis, Andrew J

    2015-12-01

    This study examines pregnancy and early infant outcomes of pregnant women with a clinical diagnosis of Borderline Personality Disorder presenting for obstetric services to a major metropolitan maternity hospital in Victoria, Australia. A retrospective case review of pregnancy and early infant outcomes on 42 women who had been diagnosed with Borderline Personality Disorder via psychiatric assessment using DSM-IV-R criteria was undertaken. Outcomes were compared with a control group of 14,313 consisting of women and infants of non-affected women from the same hospital over the same period of time. Women presenting for obstetric services with a clinical diagnosis of Borderline Personality Disorder experienced considerable psychosocial impairment. They anticipated birth as traumatic and frequently requested early delivery. High comorbidity with substance abuse was found and high rates of referral to child protective services. Mothers with Borderline Personality Disorder were significantly more likely to have negative birth outcomes such as lowered Apgar scores, prematurity and special care nursery referral when compared with controls. These findings offer preliminary evidence to be considered by clinicians in developing treatments and services for the perinatal care of women with Borderline Personality Disorder and their infants. Further research is required in order to develop evidence informed clinical guidelines for the management of women with Borderline Personality Disorder and their infants. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  12. Causes of perinatal death at a tertiary care hospital in Northern Tanzania 2000–2010: a registry based study

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    Mmbaga Blandina T

    2012-12-01

    Full Text Available Abstract Background Perinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. This study aimed at classifying causes of perinatal death in order to identify categories of potentially preventable deaths. Methods We studied a total of 1958 stillbirths and early neonatal deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC in Northern Tanzania. The deaths were classified according to the Neonatal and Intrauterine deaths Classification according to Etiology (NICE. Results Overall perinatal mortality was 57.7/1000 (1958 out of 33 929, of which 1219 (35.9/1000 were stillbirths and 739 (21.8/1000 were early neonatal deaths. Major causes of perinatal mortality were unexplained asphyxia (n=425, 12.5/1000, obstetric complications (n=303, 8.9/1000, maternal disease (n=287, 8.5/1000, unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000, and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000. Obstructed/prolonged labour was the leading condition (251/303, 82.8% among the obstetric complications. Preeclampsia/eclampsia was the leading cause (253/287, 88.2% among the maternal conditions. When we excluded women who were referred for delivery at KCMC due to medical reasons (19.1% of all births and 36.0% of all deaths, perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer deaths from obstetric complications (from 8.9 to 2.1/1000 and maternal conditions (from 8.5 to 5.5/1000. Conclusion The distribution of causes of death in this population suggests a great potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care

  13. Perinatal mortality--a suitable index of health worldwide?

    Science.gov (United States)

    Savage, A

    1986-11-22

    As a result of cultural factors, perinatal mortality may not be the most appropriate measure of health. Comparisons of the health of different countries should not be based on only 1 criterion unless general attitudes are the same. In developed countries, where abortion is widely available, unwanted pregnancies are handled before delivery. In some developing countries in Africa, however, population control may take the form of allowing a newborn to die of starvation, for example. Given this cultural difference, Third World countries rank lowest in perinatal health. It is suggested that mortality and morbidity should be calculated decade by decade before an index is derived. A 20-year old from a developing country, where there is no drug problem and attempted suicide is rare, might receive a higher health rating than his counterpart in developed countries.

  14. Perinatal outcome of pregnancies complicated by threatened abortion.

    Science.gov (United States)

    Verma, S K; Premi, H K; Gupta, T V; Thakur, S; Gupta, K B; Randhawa, I

    1994-11-01

    One hundred and two cases of viable pregnancies with threatened abortion were studied in the department of obstetrics and gynaecology, Kamla Nehru Hospital, IG Medical College, Shimla between November 1987 and February 1989 and their perinatal outcome was evaluated. The pregnancies continued beyond 28 weeks in 61.7% of the cases. The incidence of prematurity was 19.0%. The incidence of low birth weight (LBW) babies was 23.8%. Apgar score was less than 7 in 22.3%. The incidence of neonatal complications was 25.3%. There was no perinatal mortality. In a control group of 50 cases, the incidence of prematurity and LBW was 8% and 4% respectively. Apgar score less than 7 was noted in 4% and neonatal complications were observed only in 4% of newborns.

  15. Prenatal diagnosis and perinatal management of congenital hydrocephalus using MRI

    International Nuclear Information System (INIS)

    Hamada, Hiromi; Koresawa, Mitsuhiko; Kubo, Takeshi

    1990-01-01

    We studied congenital hydrocephalus in 14 patients who were diagnosed prenatally. As a result, we obtained the following insights concerning the prenatal diagnosis by MRI (magnetic resonance imaging) and perinatal management of congenital hydrocephalus. Accurate diagnosis of congenital hydrocephalus was impossible prenatally by two-dimensional ultrasonography or computed tomography alone in some patients. MRI was useful for accurate prenatal diagnosis. Problem of MRI in prenatal diagnosis included deterioration of the image by fetal movements and safety concern over the fetus. The cause of hydrocephalus, complicated anomaly, cerebral cortical thickness, and gestational age must be considered in the perinatal management of congenital hydrocephalus. There appeared to be a chance of recovery to a certain extent from thinning of cerebral cortex by decompression in a patient in whom dilation of cerebral ventricles progressed rapidly. (author)

  16. Perinatal Depression and Patterns of Attachment: A Critical Risk Factor?

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    Valentina Meuti

    2015-01-01

    Full Text Available Background. This study aims to verify if the presence and severity of perinatal depression are related to any particular pattern of attachment. Methods. The study started with a screening of a sample of 453 women in their third trimester of pregnancy, who were administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS and the Experience in Close Relationship (ECR. A clinical group of subjects with perinatal depression (PND, 89 subjects was selected and compared with a control group (C, regarding psychopathological variables and attachment patterns. Results. The ECR showed a prevalence of “Fearful-Avoidant” attachment style in PND group (29.2% versus 1.1%, p<0.001; additionally, the EPDS average score increases with the increasing of ECR dimensions (Avoidance and Anxiety. Conclusion. The severity of depression increases proportionally to attachment disorganization; therefore, we consider attachment as both an important risk factor as well as a focus for early psychotherapeutic intervention.

  17. Perinatal and Early Childhood Environmental Factors Influencing Allergic Asthma Immunopathogenesis

    Science.gov (United States)

    Gaffin, Jonathan M.; Kanchongkittiphon, Watcharoot; Phipatanakul, Wanda

    2014-01-01

    Background The prevalence of asthma has increased dramatically over the past several decades. While hereditary factors are highly important, the rapid rise outstrips the pace of genomic variation. Great emphasis has been placed on potential modifiable early life exposures leading to childhood asthma. Methods We reviewed the recent medical literature for important studies discussing the role of the perinatal and early childhood exposures and the inception of childhood asthma. Results and Discussion Early life exposure to allergens (House dust mite (HDM), furred pets, cockroach, rodent and mold)air pollution (nitrogen dioxide (NO2), ozone (O3), volatile organic compounds (VOCs), and particulate matter (PM)) and viral respiratory tract infections (Respiratory syncytial virus (RSV) and human rhinovirus (hRV)) have been implicated in the development of asthma in high risk children. Conversely, exposure to microbial diversity in the perinatal period may diminish the development of atopy and asthma symptoms. PMID:24952205

  18. Suicide During Perinatal Period: Epidemiology, Risk Factors and Clinical Correlates

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    Laura Orsolini

    2016-08-01

    Full Text Available Perinatal period may pose a great challenge for the clinical management and treatment of psychiatric disorders in women. In fact, several mental illnesses can arise during pregnancy and/or following childbirth. Suicide and infanticide have been considered relatively rare events during the perinatal period. However, in some mental disorders (i.e. postpartum depression, bipolar disorder, postpartum psychosis, etc. have been reported a higher risk of suicidal ideation, suicide attempt or suicide. Therefore, a complete screening of mothers’ mental health should also take into account thoughts of suicide and thoughts about harming infants as well. Clinicians should carefully monitor and early identify related clinical manifestations, potential risk factors and alarm symptoms related to suicide. The present paper aims at providing a focused review about epidemiological data, risk and protective factors and an overview about the main clinical correlates associated with the suicidal behaviour during the pregnancy and postpartum period.

  19. Obstetric interventions and perinatal asphyxia in growth retarded term infants

    DEFF Research Database (Denmark)

    Langhoff-Roos, J; Lindmark, G

    1997-01-01

    BACKGROUND: The monitoring of fetal growth during pregnancy is usually justified because of the increased perinatal risk of these babies. METHODS: In 1552 infants from the Scandinavian Small for Gestational Age Study the need for obstetric interventions, risk of fetal asphyxia and immediate...... neonatal outcome at term have been studied in relation to different types of fetal growth retardation, including sub-groups with low ponderal index or low amount of subcutaneous fat. RESULTS: The need for obstetric intervention indicated by suspected fetal asphyxia before or during labor was increased 3......-fold (6-8%) for growth retarded infants both in SGA infants in general and infants with asymmetric body proportions. The immediate perinatal outcome, however, was favorable with Apgar below 8 at 5 min in only 2% irrespective of the type of growth retardation, in spite of the fact that less than 25...

  20. Perinatal exposure to music protects spatial memory against callosal lesions.

    Science.gov (United States)

    Amagdei, Anca; Balteş, Felicia Rodica; Avram, Julia; Miu, Andrei C

    2010-02-01

    Several studies have indicated that the exposure of rodents to music modulates brain development and neuroplasticity, by mechanisms that involve facilitated hippocampal neurogenesis, neurotrophin synthesis and glutamatergic signaling. This study focused on the potential protection that the perinatal exposure to music, between postnatal days 2 and 32, could offer against functional deficits induced by neonatal callosotomy in rats. The spontaneous alternation and marble-burying behaviors were longitudinally measured in callosotomized and control rats that had been exposed to music or not. The results indicated that the neonatal callosotomy-induced spontaneous alternation deficits that became apparent only after postnatal day 45, about the time when the rat corpus callosum reaches its maximal levels of myelination. The perinatal exposure to music efficiently protected the spontaneous alternation performance against the deficits induced by callosotomy. The present findings may offer important insights into music-induced neuroplasticity, relevant to brain development and neurorehabilitation. Copyright 2009 ISDN. Published by Elsevier Ltd. All rights reserved.

  1. Asymptomatic bacteriuria in pregnancy and its relation to perinatal outcome

    OpenAIRE

    Anjana Verma; Smita Baheti; Medhavi Sharma

    2016-01-01

    Background: Asymptomatic bacteriuria is one of the cause for adverse perinatal outcome. Pregnant women are at high risk for UTIs. Women exposed to antepartum urinary tract infection had increased incidence of delivering infants with low birth weights, premature infants, preterm infants with low birth weights, than those who were not exposed. Women exposed to antepartum urinary tract infection were also more likely to experience premature labor, hypertension or preeclampsia and anemia. Meth...

  2. Management of Gestational Diabetes Mellitus: Selfefficacy and Perinatal Outcomes

    OpenAIRE

    Emine Gerçek; Hakan Şen

    2015-01-01

    The purpose of this review is to give knowledge about effects on perinatal outcomes of self-efficacy in management of gestational diabetes. Gestational diabetes mellitus (GDM) is a significant health concern due to the potentially adverse outcomes for the mother and the fetus/infant. Close monitoring and treatment of GDM are important to the long-term health of a pregnant woman and her baby. More over, maternal metabolic control during pregnancy may positively impact women’s...

  3. [Perinatal complications in patients with chronic renal insufficiency on hemodialysis].

    Science.gov (United States)

    Vázquez-Rodríguez, Juan Gustavo; del Angel-García, Guadalupe

    2010-09-01

    Pregnant patients with chronic renal insufficiency treated with hemodialysis experience adverse perinatal results. To compare perinatal complications of patients with chronic renal insufficiency undergoing hemodialysis who become pregnant vs. the complications of women with chronic renal insufficiency not undergoing dialysis but who then require dialysis during gestation. Transversal and retrospective study that included three patients with chronic renal insufficiency on chronic hemodialysis who became pregnant (group A) and three patients with chronic renal insufficiency without hemodialysis at the time of conception but who required dialysis during gestation (group B). Perinatal results were compared. Statistical analysis was performed with measures of central tendency and dispersion and Student t-test. Group A had 25 sessions vs. group B with 29 hemodialysis sessions (p = 0.88). Maternal complications were anemia 100% (six cases), Cesarean delivery 83.3% (group A 2 cases vs. group B 2 cases), preeclampsia 50% (group A 2 cases vs. group B 1 case), uncontrolled hypertension 50% (group A 2 cases vs. group B 1 case), preterm delivery 50% (group A 2 cases vs. group B 1 case), transfusion 33.3% (group A 2 cases), polyhydramnios 33.3% (group A 1 case vs. group B 1 case) and abortion 16.6% (group A 1 case). Fetal complications included fetal loss 16.6% (group A 1 case), neonatal mortality 33.3% (group A 1 cases vs. group B 1 case), prematurity 50% (group A2 cases vs. group B 1 case), fetal distress 50% (group A 1 case vs. group B 2 cases), respiratory failure 33.3% (group A 2 cases) and fetal growth restriction 16.6% (group A 1 case). Frequency of perinatal complications is elevated in both groups.

  4. Perinatal asphyxia: CNS development and deficits with delayed onset

    Directory of Open Access Journals (Sweden)

    Mario eHerrera-Marschitz

    2014-03-01

    Full Text Available Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified.In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by over expression of sentinel proteins, such as poly(ADP-ribose polymerase-1 (PARP-1, competing for NAD+ during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat foetuses into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that it constitutes a lead for exploring compounds with similar or better pharmacological profiles.

  5. Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia

    Directory of Open Access Journals (Sweden)

    P. Benson Ham

    2015-05-01

    Full Text Available Perinatal asphyxia is a common cause of morbidity and mortality in the newborn and is associated with myocardial injury in a significant proportion of cases. Biomarkers, echocardiography, and rhythm disturbances are sensitive indicators of myocardial ischemia and may predict mortality. We present a case of severe myocardial dysfunction immediately after delivery managed with extracorporeal membrane oxygenation (ECMO and discuss the role of cardiac biomarkers, echocardiography, electrocardiography, and ECMO in the asphyxiated newborn.

  6. Pregnancy, obstetric, and perinatal health outcomes in eating disorders.

    Science.gov (United States)

    Linna, Milla S; Raevuori, Anu; Haukka, Jari; Suvisaari, Jaana M; Suokas, Jaana T; Gissler, Mika

    2014-10-01

    The purpose of this study was to assess pregnancy, obstetric, and perinatal health outcomes and complications in women with lifetime eating disorders. Female patients (n = 2257) who were treated at the Eating Disorder Clinic of Helsinki University Central Hospital from 1995-2010 were compared with unexposed women from the population (n = 9028). Register-based information on pregnancy, obstetric, and perinatal health outcomes and complications were acquired for all singleton births during the follow-up period among women with broad anorexia nervosa (AN; n = 302 births), broad bulimia nervosa (BN; n = 724), binge eating disorder (BED; n = 52), and unexposed women (n = 6319). Women with AN and BN gave birth to babies with lower birthweight compared with unexposed women, but the opposite was observed in women with BED. Maternal AN was related to anemia, slow fetal growth, premature contractions, short duration of the first stage of labor, very premature birth, small for gestational age, low birthweight, and perinatal death. Increased odds of premature contractions, resuscitation of the neonate, and very low Apgar score at 1 minute were observed in mothers with BN. BED was associated positively with maternal hypertension, long duration of the first and second stage of labor, and birth of large-for-gestational-age infants. Eating disorders appear to be associated with several adverse perinatal outcomes, particularly in offspring. We recommend close monitoring of pregnant women with either a past or current eating disorder. Attention should be paid to children who are born to these mothers. Copyright © 2014. Published by Elsevier Inc.

  7. Tei index in neonatal respiratory distress and perinatal asphyxia

    Directory of Open Access Journals (Sweden)

    Ahmed Anwer Attia Khattab

    2015-09-01

    Full Text Available Cardiovascular compromise is a common complication of neonatal respiratory distress and perinatal asphyxia. Tei index is a Doppler-derived index for the assessment of overall left ventricular function that combines systolic and diastolic time intervals. Aim: Assess the role of MPI versus cardiac troponin I as early indicator of hypoxic cardiac damage in neonates with respiratory distress or perinatal asphyxia. The present work was conducted on forty neonates, 15 with neonatal respiratory distress (group I, 15 with perinatal asphyxia (group II, and 10 apparently healthy neonates as a control (group III. All have: Detailed history-thorough clinical examination-Plain X-ray-ECG-Two dimensional, M-mode and Doppler echocardiographic examination with the measurement of both myocardial performance index (MPI of the right and left ventricle-Serum cardiac troponin I. Results: There was statistically significant increase in serum cardiac troponin I in groups I and II than group III. Left and right ventricular myocardial performance index (MPI were increased in group I and II than the control group. No correlation between Tei index and each of postnatal age, apgar score at 5-min, heart rate, serum cardiac troponin I, ejection fraction and fractional shortening, but there was direct relationship between MPI and LVEDD and inverse relationship between MPI and each of EF% and FS%. But there was significant correlation between L.V. MPI and gestational age. Conclusion: Tei index was higher in neonates with respiratory distress and neonates with perinatal asphyxia than in normal neonates despite normal or even increased ejection fraction which indicates that these patients may have subclinical ventricular dysfunction which should be followed up carefully.

  8. The Effect of Childbirth Self-Efficacy on Perinatal Outcomes

    Science.gov (United States)

    Tilden, Ellen L.; Caughey, Aaron B.; Lee, Christopher S.; Emeis, Cathy

    2016-01-01

    Objective To synthesize and critique the quantitative literature on measuring childbirth self-efficacy and the effect of childbirth self-efficacy on perinatal outcomes. Data Sources Eligible studies were identified through searching MEDLINE, CINAHL, Scopus, and Google Scholar databases. Study Selection Published research using a tool explicitly intended to measure childbirth self-efficacy and also examining outcomes within the perinatal period were included. All manuscripts were in English and published in peer-reviewed journals. Data Extraction First author, country, year of publication, reference and definition of childbirth self-efficacy, measurement of childbirth self-efficacy, sample recruitment and retention, sample characteristics, study design, interventions (with experimental and quasi-experimental studies), and perinatal outcomes were extracted and summarized. Data Synthesis Of 619 publications, 23 studies published between 1983 and 2015 met inclusion criteria and were critiqued and synthesized in this review. Conclusions There is overall consistency in how childbirth self-efficacy is defined and measured among studies, facilitating comparison and synthesis. Our findings suggest that increased childbirth self-efficacy is associated with a wide variety of improved perinatal outcomes. Moreover, there is evidence that childbirth self-efficacy is a psychosocial factor that can be modified through various efficacy-enhancing interventions. Future researchers will be able to build knowledge in this area through: (a) utilization of experimental and quasi-experimental design; (b) recruitment and retention of more diverse samples; (c) explicit reporting of definitions of terms (e.g. ‘high risk’); (d) investigation of interventions that increase childbirth self-efficacy during pregnancy; and, (e) investigation regarding how childbirth self-efficacy enhancing interventions might lead to decreased active labor pain and suffering. Exploratory research should

  9. Parental decision making around perinatal autopsy: a qualitative investigation.

    Science.gov (United States)

    Meaney, Sarah; Gallagher, Stephen; Lutomski, Jennifer E; O'Donoghue, Keelin

    2015-12-01

    Decades of decline in uptake rates of perinatal autopsies has limited investigation into the causes and risk factors for stillbirth. This study aimed to qualitatively explore perinatal autopsy decision-making processes in parents who experienced antepartum and intrapartum stillbirths. A qualitative semi-structured interview format was utilized. The line of questioning centred on how parents came to decide on consenting or declining to have a perinatal autopsy undertaken. Interpretative phenomenological analysis was employed as the analytic strategy. Purposive sampling was used to recruit 10 parents who either consented or declined autopsy from a large tertiary maternity hospital in Cork Ireland, where there were 30 stillbirths in 2011. Findings revealed four superordinate themes influencing parents' decision-making which varied with type of stillbirth experienced. Those parents who experienced antepartum stillbirths were more likely to consent; thus, knowing that the child was stillborn prior to delivery rather than on the day of delivery was associated with consent. In fact, these parents had more time for meaning-making; those consenting wanted to rule out self-blame and were fearful about future pregnancies. Parents who declined autopsy wanted to protect their infant from further harm. Interestingly, parents' knowledge and understanding of the autopsy itself were acquired primarily from public discourse. Parents' decision-making regarding autopsy is profoundly affected by their emotional response to stillbirth; clinicians and other health professionals may play a key role, especially if they can address parental concerns regarding the invasiveness of the autopsy procedure. © 2014 John Wiley & Sons Ltd.

  10. Neuroimmunological Disturbance Features in Premature Infants with Perinatal Infections

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    Nailya J. Rahimova

    2018-01-01

    Full Text Available Infectious diseases in newborns are commonly intrauterine infections which affect greatly on the morbidity and mortality rates in neonates.Background: The purpose of this study was to analyse the neurological status, taking into account the neuroimmunological indicators (neuron-specific enolase (NSE, interleukin-1β (IL1β, Interleukin-6 (IL6 in the serum of neonates with perinatal infections.Metods: We conducted a complex clinical, laboratory, and instrumental examination of 433 infants with perinatal infections with a gestation period of 27–37 weeks. Determination of the level of NSE, IL1β, IL6 was performed with the standard method of the immune-enzyme analysis.Results. Hypoxic ischemic, hemorrhagic, infectious lesion of the central nervous system (CNS were more common in newborns with mixed infection and sepsis. High levels of NSE, IL6, IL1β in the serum of the examined newborns reflect a combined, deeper character of the CNS damage.Conclusion: Significant diagnostic value of neuroimmunological indicators in the blood serum of newborns with perinatal infections makes it possible to use them as a markers for assessing the severity of the CNS lesions.

  11. Perinatal taurine exposure affects adult arterial pressure control

    Science.gov (United States)

    Roysommuti, Sanya; Wyss, J. Michael

    2012-01-01

    Taurine is an abundant free amino acid found in mammalian cells that contributes to many physiologic functions from that of a simple cell osmolyte to a programmer of adult health and disease. Taurine’s contribution extends from conception throughout life, but its most critical exposure period is during perinatal life. In adults, taurine supplementation prevents or alleviates cardiovascular disease and related complications. In contrast, low taurine consumption coincides with increased risk of cardiovascular disease, obesity and type II diabetes. This review focuses on the effects that altered perinatal taurine exposure has on long-term mechanisms that control adult arterial blood pressure and could thereby contribute to arterial hypertension through its ability to program these cardiovascular regulatory mechanisms very early in life. The modifications of these mechanisms can last a lifetime and transfer to the next generation, suggesting that epigenetic mechanisms underlie the changes. The ability of perinatal taurine exposure to influence arterial pressure control mechanisms and hypertension in adult life appears to involve the regulation of growth and development, the central and autonomic nervous system, the renin-angiotensin system, glucose-insulin interaction and changes to heart, blood vessels and kidney function. PMID:23070226

  12. Infertility and Perinatal Loss: When the Bough Breaks

    Science.gov (United States)

    Byatt, Nancy

    2016-01-01

    Infertility and perinatal loss are common, and associated with lower quality of life, marital discord, complicated grief, major depressive disorder, anxiety disorders, and posttraumatic stress disorder. Young women, who lack social supports, have experienced recurrent pregnancy loss or a history of trauma and / or preexisting psychiatric illness are at a higher risk of experiencing psychiatric illnesses or symptoms after a perinatal loss or during infertility. It is especially important to detect, assess, and treat depression, anxiety, or other psychiatric symptoms because infertility or perinatal loss may be caused or perpetuated by such symptoms. Screening, psychoeducation, provision of resources and referrals, and an opportunity to discuss their loss and plan for future pregnancies can facilitate addressing mental health concerns that arise. Women at risk of or who are currently experiencing psychiatric symptoms should receive a comprehensive treatment plan that includes the following: (1) proactive clinical monitoring, (2) evidence-based approaches to psychotherapy, and (3) discussion of risks, benefits, and alternatives of medication treatment during preconception and pregnancy. PMID:26847216

  13. 42 CFR 405.2448 - Preventive primary services.

    Science.gov (United States)

    2010-10-01

    ... centers are the following: (1) Medical social services. (2) Nutritional assessment and referral. (3) Preventive health education. (4) Children's eye and ear examinations. (5) Prenatal and post-partum care. (6) Perinatal services. (7) Well child care, including periodic screening. (8) Immunizations, including tetanus...

  14. The City MISS: development of a scale to measure stigma of perinatal mental illness

    OpenAIRE

    Moore, D.; Ayers, S.; Drey, N.

    2017-01-01

    Objective: This study aimed to develop and validate a scale to measure perceived stigma for perinatal mental illness in women. \\ud \\ud Background: Stigma is one of the most frequently cited barriers to seeking treatment and many women with perinatal mental illness fail to get the treatment they need. However, there is no psychometric scale that measures how women may experience the unique aspects of perinatal mental illness stigma.\\ud \\ud Method: A draft scale of 30 items was developed from a...

  15. Perinatal characteristics and breast cancer risk in daughters: a Scandinavian population-based study

    OpenAIRE

    Troisi, R.; Grotmol, T.; Jacobsen, J.; Tretli, S.; Toft-Sørensen, H.; Gissler, M.; Kaaja, R.; Potischman, N.; Ekbom, A.; N. Hoover, R.; Stephansson, O.

    2013-01-01

    The in utero origins of breast cancer are an increasing focus of research. However, the long time period between exposure and disease diagnosis, and the lack of standardized perinatal data collection makes this research challenging. We assessed perinatal factors, as proxies for in utero exposures, and breast cancer risk using pooled, population-based birth and cancer registry data. Birth registries provided information on perinatal exposures. Cases were females born in Norway, Sweden or Denma...

  16. Tobacco control policies and perinatal and child health: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Timor Faber

    2018-03-01

    Full Text Available Background Tobacco smoking and smoke exposure during pregnancy and childhood cause considerable childhood morbidity and mortality. We aimed to determine whether implementation of the World Health Organization's recommended tobacco control policies (MPOWER were of benefit to perinatal and child health. Methods We searched 19 electronic databases, hand-searched references and citations, and consulted experts to identify (quasi-experimental studies assessing the association between implementation of MPOWER policies and child health. Our primary outcomes of interest were: perinatal mortality, preterm birth, hospital attendance for asthma exacerbations, and hospital attendance for respiratory tract infections (RTIs. Where possible and appropriate, we combined data from different studies in random-effects meta-analyses. Results We identified 41 eligible studies that assessed (combinations of MPOWER policies: smoke-free legislation (n=35, tobacco taxation (n=11, and smoking cessation services (n=3. Following implementation of smoke-free legislation, rates of preterm birth decreased by -3.77% (10 studies, 27,530,183 individuals; 95%CI -6.37 to -1.16, hospital attendance for asthma exacerbations decreased by -9.83% (five studies, 684,826 events; 95%CI -16.62 to -3.04, and hospital attendance for RTIs decreased by -3.45% (two studies, 1,681,020 events; 95%CI -4.64, -2.25 for all RTIs, and by -18.48% (three studies, 887,414 events; 95%CI -32.79 to -4.17 for lower RTIs. Associations appeared to be stronger when comprehensive smoke-free laws were implemented. Among two studies assessing the association between smoke-free legislation and perinatal mortality, one demonstrated significant reductions in stillbirth and neonatal mortality. Meta-analysis of studies on other MPOWER policies was not possible; all four studies on increasing tobacco taxation and one of two on offering disadvantaged pregnant women help to quit smoking that reported on our primary

  17. Collaborative survey of perinatal loss in planned and unplanned home births. Northern Region Perinatal Mortality Survey Coordinating Group.

    OpenAIRE

    1996-01-01

    OBJECTIVE: To document the outcome of planned and unplanned births outside hospital. DESIGN: Confidential review of every pregnancy ending in stillbirth or neonatal death in which plans had been made for home delivery, irrespective of where delivery eventually occurred. The review was part of a sustained collaborative survey of all perinatal deaths. SETTING: Northern Regional Health Authority area. SUBJECTS: All 558,691 registered births to women normally resident in the former Northern Regio...

  18. Perinatal risks of planned home births in the United States.

    Science.gov (United States)

    Grünebaum, Amos; McCullough, Laurence B; Brent, Robert L; Arabin, Birgit; Levene, Malcolm I; Chervenak, Frank A

    2015-03-01

    We analyzed the perinatal risks of midwife-attended planned home births in the United States from 2010 through 2012 and compared them with recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) for planned home births. Data from the US Centers for Disease Control and Prevention's National Center for Health Statistics birth certificate data files from 2010 through 2012 were utilized to analyze the frequency of certain perinatal risk factors that were associated with planned midwife-attended home births in the United States and compare them with deliveries performed in the hospital by certified nurse midwives. Home birth deliveries attended by others were excluded; only planned home births attended by midwives were included. Hospital deliveries attended by certified nurse midwives served as the reference. Perinatal risk factors were those established by ACOG and AAP. Midwife-attended planned home births in the United States had the following risk factors: breech presentation, 0.74% (odds ratio [OR], 3.19; 95% confidence interval [CI], 2.87-3.56); prior cesarean delivery, 4.4% (OR, 2.08; 95% CI, 2.0-2.17); twins, 0.64% (OR, 2.06; 95% CI, 1.84-2.31); and gestational age 41 weeks or longer, 28.19% (OR, 1.71; 95% CI, 1.68-1.74). All 4 perinatal risk factors were significantly higher among midwife-attended planned home births when compared with certified nurse midwives-attended hospital births, and 3 of 4 perinatal risk factors were significantly higher in planned home births attended by non-American Midwifery Certification Board (AMCB)-certified midwives (other midwives) when compared with home births attended by certified nurse midwives. Among midwife-attended planned home births, 65.7% of midwives did not meet the ACOG and AAP recommendations for certification by the American Midwifery Certification Board. At least 30% of midwife-attended planned home births are not low risk and not within

  19. Birth weight discordance and perinatal mortality among triplets

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    Egić Amira

    2005-01-01

    Full Text Available INTRODUCTION. The incidence of multiple births has increased in the last decade. Perinatal mortality in triplets is significantly greater than in twin and singleton births. OBJECTIVE. The objective of this study was to describe the extent of birth weight discordance among triplets and to identify its association with an increased risk of perinatal mortality. METHOD A retrospective analysis of triplet births, for the period 1993-2003, was conducted at the Gynaecological-Obstetric Clinic "Narodni Front" in Belgrade. Birth weight discordance was defined as the difference in birth weight between the largest and the smallest triplet's weight of more than 20%. RESULTS. The rate of triplets has increased by almost 75% between the first (7.7% and the last (29.6% 5-year period of the last decade. Triplets are becoming more common because of the frequent use of assisted reproductive technology as a treatment for infertility. In the period 1993-2003, there were a total of 40 triplet live births (24 weeks and greater with incidence of 0.06%. There was no clear association between maternal age, parity, method of conception, birth gestational age, and disorders complicating pregnancy with birth discordance more than 20%. Regarding birth weight groups, statistical significance occurred only in the <999 grams group for discordant and in the 2000-2499 grams group for concordant triplets. Overall, the perinatal mortality rate in the group was 10.8%, the foetal mortality rate was 1.7% (2/120, and the neonatal (0-28 days mortality rate was 9.1% (11/120. An odds ratio of 95% confidence interval shows 3 times greater risk for adverse perinatal outcome in the discordant group. However, the difference was not significant. CONCLUSION. Increasing birth weight discordance may increase the risk of adverse perinatal outcome. Triplet pregnancies, being high risk, require intensive antenatal care in order to prevent preterm delivery and ultrasound in order to diagnose foetal

  20. Immunity peculiarities of neonates in case of perinatal pathology

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    О. S. Godovanets

    2018-02-01

    Full Text Available The immune system as one of the regulating systems of the body determined peculiarities of child adaptation after birth stipulating physiology of adaptation or perinatal pathology formation. Objective: to study peculiarities of immunological indices in case of neonates’ perinatal pathology to detect their role in pathogenesis and formation of diseases severity. Materials and methods. The group of term infants with clinical signs of perinatal pathology (173 individuals was examined. They were divided into two groups: group A included those with diagnosed severe forms of diseases (121 individuals, and group B included 52 infants with general moderate severity of perinatal pathology. The group of comparison included 82 newborns without substantial adaptive deviations after birth. IL1 and IL6 levels were examined by means of immunofluorescence method “Clonospectr” using the reagents produced by “ProCon”. Absolute and relative amount of СD2+-associated Т and NK-lymphocytes, СD14+-associated monocytes, СD15+-associated neutrophils, СD19+-associated В-lymphocytes and СD54+-associated ІСАМ-1 cells were determined by means of immunofluorescence method “Status” using the set of monoclonal and polyclonal antibodies produced by “Sorbent”. The data obtained were statistically processed with the application of applied programs package used for medical-biological studies “Statgraphics Centurion XVI.I” [2011] on the personal computer Pentium MMX CPU. Results. The results obtained were indicative of considerable changes in the immune system indices in newborns under conditions of birth stress and hypoxia. It has been found that a term newborn has a special different from that of adults biologically mediated state of immune system, that can determine both the development of physiological adaptation and under certain circumstances excessive reactions of systemic inflammation, autoimmune processes and destruction of tissues. One

  1. Cost-effectiveness of antiviral therapy during late pregnancy to prevent perinatal transmission of hepatitis B virus

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    Wenjun Wang

    2016-03-01

    Full Text Available Background. Hepatitis B virus (HBV infections are perinatally transmitted from chronically infected mothers. Supplemental antiviral therapy during late pregnancy with lamivudine (LAM, telbivudine (LdT, or tenofovir (TDF can substantially reduce perinatal HBV transmission compared to postnatal immunoprophylaxis (IP alone. However, the cost-effectiveness of these measures is not clear. Aim. This study evaluated the cost-effectiveness from a societal perspective of supplemental antiviral agents for preventing perinatal HBV transmission in mothers with high viral load (>6 log10 copies/mL. Methods. A systematic review and network meta-analysis were performed for the risk of perinatal HBV transmission with antiviral therapies. A decision analysis was conducted to evaluate the clinical and economic outcomes in China of four competing strategies: postnatal IP alone (strategy IP, or in combination with perinatal LAM (strategy LAM + IP, LdT (strategy LdT + IP, or TDF (strategy TDF + IP. Antiviral treatments were administered from week 28 of gestation to 4 weeks after birth. Outcomes included treatment-related costs, number of infections, and quality-adjusted life years (QALYs. One- and two-way sensitivity analyses were performed to identify influential clinical and cost-related variables. Probabilistic sensitivity analyses were used to estimate the probabilities of being cost-effective for each strategy. Results. LdT + IP and TDF + IP averted the most infections and HBV-related deaths, and gained the most QALYs. IP and TDF + IP were dominated as they resulted in less or equal QALYs with higher associated costs. LdT + IP had an incremental $2,891 per QALY gained (95% CI [$932–$20,372] compared to LAM + IP (GDP per capita for China in 2013 was $6,800. One-way sensitivity analyses showed that the cost-effectiveness of LdT + IP was only sensitive to the relative risk of HBV transmission comparing LdT + IP with LAM + IP. Probabilistic sensitivity analyses

  2. Characteristics of pregnancy with human immuno-deficiency virus (HIV) and perinatal transmission in Nakornping Hospital.

    Science.gov (United States)

    Gomutbutra, Vorapin

    2008-02-01

    The HIV infected pregnancy delivered at Nakornping Hospital was common. To reduce and prevent HIV infection in pregnancy and perinatal transmission, the understanding of characteristics of HIV pregnancy and neonatal infective outcome were needed for proper strategy and policy making. To study the characteristics of HIV pregnancy and neonatal infective outcome in a hospital in the northern part of Thailand. This retrospective descriptive study was conducted at the Department of Obstetrics and Gynecology Unit, Nakornping Hospital, Chiang Mai Province, Thailand. Medical records of HIV infected pregnancy from the labor unit during October 2002 and September 2005 was scrutinized. The relevant data of the characteristics of HIV infected mother, pregnancy and neonatal infective outcome were collected and analyzed. There were 172 HIV infected mothers among 7,872 parturients (2.2%). The mean age was 28.2 years (range 14-44 years). Most of the cases were between 25-29 years (40%). 45 pregnancies (26%) delivered before 37 weeks. About half (50.6%) delivered via cesarean section. 22% of their newborn weighted below 2,500 grams. With antiviral regimen of Navirapine and Zidovudine for both mothers and their neonate the overall perinatal transmission rate was 4%. In mothers having ANC group the transmission rate was 3.2% compared to 11.7% in no ANC group. (X2 = 1.092 p = 0.296 Cl 0.04-1.4) RR of ANC group = 0.274 compare to no ANC. Many of HIV infected mothers were in the young age group. High preterm labor rate was observed. The no ANC group had about 4 folds infective neonate compared to the ANC group. No antiviral drug during pregnancy in no ANC group may be a factor. This information was vital for strategic ANC planning to prevent and reduce this problem.

  3. Factors affecting implementation of perinatal mental health screening in women of refugee background

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    Nishani Nithianandan

    2016-11-01

    Full Text Available Abstract Background For women of refugee background, the increased risk of mental illness associated with pregnancy is compounded by pre- and post-settlement stressors. In Australia, antenatal screening for depression and anxiety symptoms using the Edinburgh Postnatal Depression Scale is recommended for all women. Despite this, screening is not routinely implemented and little is known about barriers and enablers to implementation for women of refugee background. Methods Semi-structured interviews were conducted with a range of health professionals (n = 28: midwives, obstetricians, perinatal mental health and refugee health experts, interpreters and women of refugee background (n = 9. Themes generated from thematic analysis were examined in relation to the Theoretical Domains Framework and Cultural Competence Conceptual Framework, followed by identification of effective behaviour change techniques to address the barriers and enablers identified by participants. These techniques formed the basis of recommendations to inform sustainable implementation of screening and referral. Results Almost all participants perceived perinatal mental health screening to be necessary and most recognised the importance of post-traumatic stress disorder (PTSD screening. Barriers and enablers were identified and related to eight domains: knowledge, skills, professional roles, beliefs about capabilities and consequences, environmental context, social influences and behavioural regulation. Conclusions This research clarifies how mental health screening may be integrated into routine antenatal care for women of refugee background, in order to improve provision of recommended care. These theory-informed recommendations include an inter-disciplinary approach, coordinating care within and across services, addition of PTSD screening, and effective communication with women.

  4. The Perinatal Guidelines Evaluation Project HIV and Pregnancy Study: overview and cohort description.

    Science.gov (United States)

    Ethier, Kathleen A.; Ickovics, Jeannette R.; Fernandez, M. Isabel; Wilson, Tracey E.; Royce, Rachel A.; Koenig, Linda J.

    2002-01-01

    OBJECTIVE: The HIV and Pregnancy Study of the Perinatal Guidelines Evaluation Project is a prospective, longitudinal, multisite study established to: (a) assess the implementation of Public Health Service guidelines regarding the prevention of perinatal HIV transmission and (b) evaluate the psychosocial consequences of HIV infection among pregnant women. A distinctive aspect of the study is the use of an HIV-negative comparison group. This article describes the methodology of the study and baseline characteristics of the study sample. Methods and Results. HIV-infected (n = 336) and uninfected (n = 298) pregnant women were enrolled from four geographic areas: Connecticut, North Carolina, Brooklyn, NY, and Miami, FL. The study included three structured face-to-face interviews from late pregnancy to six months postpartum for HIV-infected and uninfected women. Additional self-reports of medication adherence were collected for the HIV-infected participants, and the medical records of infected mothers and their infants were reviewed. Electronic monitoring of medication adherence was conducted for a subset of the infected women. The groups were successfully matched on self-reported characteristics, including HIV-risk behaviors. More than half of the uninfected women reported a high-risk sexual partner. Baseline comparisons indicated that both the HIV-infected and uninfected women had high levels of depressive symptoms, stress, and recent negative life events. CONCLUSIONS: This study provides a unique description of the psychosocial and behavioral characteristics of a population of low-income women. The results of this study suggest that HIV infection is one of many stressors faced by the women in this study. PMID:12356998

  5. The addition of a goal-based motivational interview to standardised treatment as usual to reduce dropouts in a service for patients with personality disorder: a feasibility study

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    Whitham Diane

    2010-10-01

    Full Text Available Abstract Background Rates of non-completion of treatments for personality disorder are high and there are indications that those who do not complete treatment have worse outcomes than those who do. Improving both cost-efficiency and client welfare require attention to engaging people with personality disorder in treatment. A motivational interview, based on the Personal Concerns Inventory, may have the ability to enhance engagement and retention in therapy. Here, we report the protocol for a feasibility study for a randomised controlled trial (RCT. Methods All referrals accepted to the psychological service of Nottinghamshire Healthcare NHS Trust's outpatient service for people with personality disorder are eligible for inclusion. Consenting participants are randomised to receive the Personal Concerns Inventory interview plus treatment as usual or treatment as usual only. We aim to recruit 100 participants over 11/2 years. A randomised controlled trial will be considered feasible if 1 the recruitment rate to the project is 54% of all referrals (95% CI 54-64, 2 80% of clients find the intervention acceptable in terms of its practicability and usefulness (95% CI 80-91, and 3 80% of therapists report finding the intervention helpful (95% CI 80-100. In a full-scale randomised controlled trial, the primary outcome measure will be completion of treatment i.e., entry into and completion of ≥ 75% of sessions offered. Therefore, information will be collected on recruitment rates, attendance at therapy sessions, and completion of treatment. The feasibility of examining the processes of engagement will be tested by assessing the value, coherence, and attainability of goals pre-treatment, and engagement in treatment. The costs associated with the intervention will be calculated, and the feasibility of calculating the cost-benefits of the intervention will be tested. The views of clients and therapists on the intervention, collected using semi

  6. The addition of a goal-based motivational interview to standardised treatment as usual to reduce dropouts in a service for patients with personality disorder: a feasibility study.

    Science.gov (United States)

    McMurran, Mary; Cox, W Miles; Coupe, Stephen; Whitham, Diane; Hedges, Lucy

    2010-10-14

    Rates of non-completion of treatments for personality disorder are high and there are indications that those who do not complete treatment have worse outcomes than those who do. Improving both cost-efficiency and client welfare require attention to engaging people with personality disorder in treatment. A motivational interview, based on the Personal Concerns Inventory, may have the ability to enhance engagement and retention in therapy. Here, we report the protocol for a feasibility study for a randomised controlled trial (RCT). All referrals accepted to the psychological service of Nottinghamshire Healthcare NHS Trust's outpatient service for people with personality disorder are eligible for inclusion. Consenting participants are randomised to receive the Personal Concerns Inventory interview plus treatment as usual or treatment as usual only. We aim to recruit 100 participants over 11/2 years. A randomised controlled trial will be considered feasible if 1 the recruitment rate to the project is 54% of all referrals (95% CI 54-64), 2 80% of clients find the intervention acceptable in terms of its practicability and usefulness (95% CI 80-91), and 3 80% of therapists report finding the intervention helpful (95% CI 80-100). In a full-scale randomised controlled trial, the primary outcome measure will be completion of treatment i.e., entry into and completion of ≥ 75% of sessions offered. Therefore, information will be collected on recruitment rates, attendance at therapy sessions, and completion of treatment. The feasibility of examining the processes of engagement will be tested by assessing the value, coherence, and attainability of goals pre-treatment, and engagement in treatment. The costs associated with the intervention will be calculated, and the feasibility of calculating the cost-benefits of the intervention will be tested. The views of clients and therapists on the intervention, collected using semi-structured interviews, will be analysed using thematic

  7. Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes.

    Science.gov (United States)

    Cunningham, Shayna D; Lewis, Jessica B; Thomas, Jordan L; Grilo, Stephanie A; Ickovics, Jeannette R

    2017-05-18

    Despite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent. Evidence suggests that group prenatal care can reduce these risks, with implications for maternal and child health as well as substantial cost savings. However, widespread dissemination presents challenges, in part because training and health systems have not been designed to deliver care in a group setting. This manuscript describes the design and evaluation of Expect With Me, an innovative model of group prenatal care with a strong integrated information technology (IT) platform designed to be scalable nationally. Expect With Me follows clinical guidelines from the American Congress of Obstetricians and Gynecologists. Expect With Me incorporates the best evidence-based features of existing models of group care with a novel integrated IT platform designed to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. A multisite prospective longitudinal cohort study is being conducted to examine the impact of Expect With Me on perinatal and postpartum outcomes, and to identify and address barriers to national scalability. Process and outcome evaluation will include quantitative and qualitative data collection at patient, provider, and organizational levels. Mixed-method data collection includes patient surveys, medical record reviews, patient focus groups; provider surveys, session evaluations, provider focus groups and in-depth interviews; an online tracking system; and clinical site visits. A two-to-one matched cohort of women receiving individual care from each site will provide a comparison group (n = 1,000 Expect With Me patients; n = 2,000 individual care patients) for outcome and cost analyses. By bundling prevention and care services into a high-touch, high-tech group prenatal care model

  8. Unique aspects of the perinatal immune system.

    Science.gov (United States)

    Zhang, Xiaoming; Zhivaki, Dania; Lo-Man, Richard

    2017-08-01

    The early stages of life are associated with increased susceptibility to infection, which is in part due to an ineffective immune system. In the context of infection, the immune system must be stimulated to provide efficient protection while avoiding insufficient or excessive activation. Yet, in early life, age-dependent immune regulation at molecular and cellular levels contributes to a reduced immunological fitness in terms of pathogen clearance and response to vaccines. To enable microbial colonization to be tolerated at birth, epigenetic immune cell programming and early life-specific immune regulatory and effector mechanisms ensure that vital functions and organ development are supported and that tissue damage is avoided. Advancement in our understanding of age-related remodelling of immune networks and the consequent tuning of immune responsiveness will open up new possibilities for immune intervention and vaccine strategies that are designed specifically for early life.

  9. Angiogenic proteins, placental weight and perinatal outcomes among pregnant women in Tanzania.

    Science.gov (United States)

    McDonald, Chloe R; Darling, Anne M; Liu, Enju; Tran, Vanessa; Cabrera, Ana; Aboud, Said; Urassa, Willy; Kain, Kevin C; Fawzi, Wafaie W

    2016-01-01

    Placental vascular development, and ultimately placental weight, is essential to healthy fetal development. Here, we examined placental weight in a cohort of Tanzanian women in association with angiogenic proteins known to regulate placental vascular development and perinatal outcomes. A total of n = 6579 women with recorded placental weight were included in this study. The relative risk of adverse perinatal outcomes (Apgar score, death, asphyxia, respiratory distress, seizures, pneumonia and sepsis) was compared between placental weight in the bottom and top 10th percentiles. We quantified angiogenic mediators (Ang-1, Ang-2, VEGF, PGF and sFlt-1) in plasma samples (n = 901) collected between 12 to 27 weeks of pregnancy using ELISA and assessed the relative risk of placental weight in the bottom and top 10th percentiles by protein levels in quartiles. Women with Ang-2 levels in the highest quartile had an increased relative risk of placental weight in the bottom 10th percentile (RR = 1.45 (1.10, 1.91), p = 0.01). Women with VEGF-A (RR = 0.73 (0.56, 0.96), p = 0.05) and PGF (RR = 0.58 (0.44, 0.72), p = 0.002) in the highest quartile had a reduced relative risk of placental weight in the bottom 10th percentile. Low placental weight (in bottom 10th percentile) was associated with an increased relative risk of Apgar score of <7 at 1 minute (RR = 2.31 (1.70, 3.13), p = 0.001), at 5 minutes (RR = 3.53 (2.34, 5.33), p = 0.001), neonatal death (RR = 5.02 (3.61, 7.00), p = 0.001), respiratory distress (RR = 4.80(1.71, 13.45), p = 0.001), and seizures (RR = 4.18 (1.16, 15.02), p = 0.03). The association between low placental weight and risk of adverse perinatal outcomes in this cohort suggests that placental weight could serve as a useful indicator, providing additional insight into high-risk pregnancies and identifying neonates that may require additional monitoring and follow-up.

  10. Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda.

    Directory of Open Access Journals (Sweden)

    Scholastic Ashaba

    Full Text Available The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28-35], a median of 3 living children [IQR: 2-5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member

  11. Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda.

    Science.gov (United States)

    Ashaba, Scholastic; Kaida, Angela; Coleman, Jessica N; Burns, Bridget F; Dunkley, Emma; O'Neil, Kasey; Kastner, Jasmine; Sanyu, Naomi; Akatukwasa, Cecilia; Bangsberg, David R; Matthews, Lynn T; Psaros, Christina

    2017-01-01

    The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28-35], a median of 3 living children [IQR: 2-5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy

  12. Reducing hospital admissions and improving the diagnosis of COPD in Southampton City: methods and results of a 12-month service improvement project.

    Science.gov (United States)

    Wilkinson, Tom; North, Mal; Bourne, Simon C

    2014-08-21

    The British Lung Foundation highlighted Southampton City as a hotspot for patients at future risk of chronic obstructive pulmonary disease (COPD) exacerbations due to severe deprivation levels and a high undiagnosed level of disease based on health economic modelling. We developed a strategy spanning primary and secondary care to reduce emergency admissions of patients with acute exacerbations of COPD and increase the diagnosed prevalence of COPD on general practitioner (GP) registers closer to that predicted from local modelling. A comprehensive 3-year audit of admissions was performed. Patients who had been admitted with an exacerbation to University Hospital Southampton three or more times in the previous 12 months were cohorted and cared for in a consultant-led, but community based, COPD service. Within primary care, a programme of education and case-based finding was delivered to most practices within the city. Thirty-four patients were found to be responsible for 176 admissions (22% of total COPD admissions) to the hospital. These 34 patients required 185 active interventions during the 12-month period but only 39 hospital admissions. The 30-day readmission rate dropped from 13.4 to 1.9% (Pmodel.

  13. Maternal perinatal mental health and offspring academic achievement at age 16: the mediating role of childhood executive function.

    Science.gov (United States)

    Pearson, Rebecca M; Bornstein, Marc H; Cordero, Miguel; Scerif, Gaia; Mahedy, Liam; Evans, Jonathan; Abioye, Abu; Stein, Alan

    2016-04-01

    Elucidating risk pathways for under-achieving at school can inform strategies to reduce the number of adolescents leaving school without passing grades in core subjects. Maternal depression can compromise the quality of parental care and is associated with multiple negative child outcomes. However, only a few small studies have investigated the association between perinatal maternal depression and poor academic achievement in adolescence. The pathways to explain the risks are also unclear. Prospective observational data from 5,801 parents and adolescents taking part in a large UK population cohort (Avon-Longitudinal-Study-of-Parents-and-Children) were used to test associations between maternal and paternal depression and anxiety in the perinatal period, executive function (EF) at age 8, and academic achievement at the end of compulsory school at age 16. Adolescents of postnatally depressed mothers were 1.5 times (1.19, 1.94, p = .001) as likely as adolescents of nondepressed mothers to fail to achieve a 'pass' grade in math; antenatal anxiety was also an independent predictor of poor math. Disruption in different components of EF explained small but significant proportions of these associations: attentional control explained 16% (4%, 27%, p working memory explained 17% (13%, 30%, p = .003) of the association with antenatal anxiety. A similar pattern was seen for language grades, but associations were confounded by maternal education. There was no evidence that paternal factors were independently associated with impaired child EF or adolescent exams. Maternal postnatal depression and antenatal anxiety are risk factors for adolescents underachieving in math. Preventing, identifying, and treating maternal mental health in the perinatal period could, therefore, potentially increase adolescents' academic achievement. Different aspects of EF partially mediated these associations. Further work is needed, but if these pathways are causal, improving EF could reduce

  14. Xenon and sevoflurane provide analgesia during labor and fetal brain protection in a perinatal rat model of hypoxia-ischemia.

    Directory of Open Access Journals (Sweden)

    Ting Yang

    Full Text Available It is not possible to identify all pregnancies at risk of neonatal hypoxic-ischemic encephalopathy (HIE. Many women use some form of analgesia during childbirth and some anesthetic agents have been shown to be neuroprotective when used as analgesics at subanesthetic concentrations. In this study we sought to understand the effects of two anesthetic agents with presumptive analgesic activity and known preconditioning-neuroprotective properties (sevoflurane or xenon, in reducing hypoxia-induced brain damage in a model of intrauterine perinatal asphyxia. The analgesic and neuroprotective effects at subanesthetic levels of sevoflurane (0.35% or xenon (35% were tested in a rat model of intrauterine perinatal asphyxia. Analgesic effects were measured by assessing maternal behavior and spinal cord dorsal horn neuronal activation using c-Fos. In separate experiments, intrauterine fetal asphyxia was induced four hours after gas exposure; on post-insult day 3 apoptotic cell death was measured by caspase-3 immunostaining in hippocampal neurons and correlated with the number of viable neurons on postnatal day (PND 7. A separate cohort of pups was nurtured by a surrogate mother for 50 days when cognitive testing with Morris water maze was performed. Both anesthetic agents provided analgesia as reflected by a reduction in the number of stretching movements and decreased c-Fos expression in the dorsal horn of the spinal cord. Both agents also reduced the number of caspase-3 positive (apoptotic neurons and increased cell viability in the hippocampus at PND7. These acute histological changes were mirrored by improved cognitive function measured remotely after birth on PND 50 compared to control group. Subanesthetic doses of sevoflurane or xenon provided both analgesia and neuroprotection in this model of intrauterine perinatal asphyxia. These data suggest that anesthetic agents with neuroprotective properties may be effective in preventing HIE and should be

  15. Perinatal respiratory infections and long term consequences

    Directory of Open Access Journals (Sweden)

    Luciana Indinnimeo

    2015-10-01

    Full Text Available Respiratory syncytial virus (RSV is the most important pathogen in the etiology of respiratory infections in early life. 50% of children are affected by RSV within the first year of age, and almost all children become infected within two years. Numerous retrospective and prospective studies linking RSV and chronic respiratory morbidity show that RSV bronchiolitis in infancy is followed by recurrent wheezing after the acute episod. According to some authors a greater risk of wheezing in children with a history of RSV bronchiolitis would be limited to childhood, while according to others this risk would be extended into adolescence and adulthood. To explain the relationship between RSV infection and the development of bronchial asthma or the clinical pathogenetic patterns related to a state of bronchial hyperreactivity, it has been suggested that RSV may cause alterations in the response of the immune system (immunogenic hypothesis, activating directly mast cells and basophils and changing the pattern of differentiation of immune cells present in the bronchial tree as receptors and inflammatory cytokines. It was also suggested that RSV infection can cause bronchial hyperreactivity altering nervous airway modulation, acting on nerve fibers present in the airways (neurogenic hypothesis.The benefits of passive immunoprophylaxis with palivizumab, which seems to represent an effective approach in reducing the sequelae of RSV infection in the short- and long-term period, strengthen the implementation of prevention programs with this drug, as recommended by the national guidelines of the Italian Society of Neonatology. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the

  16. Stimulation of functional vision in children with perinatal brain damage.

    Science.gov (United States)

    Alimović, Sonja; Mejaski-Bosnjak, Vlatka

    2011-01-01

    Cerebral visual impairment (CVI) is one of the most common causes of bilateral visual loss, which frequently occurs due to perinatal brain injury. Vision in early life has great impact on acquisition of basic comprehensions which are fundamental for further development. Therefore, early detection of visual problems and early intervention is necessary. The aim of the present study is to determine specific visual functioning of children with perinatal brain damage and the influence of visual stimulation on development of functional vision at early age of life. We initially assessed 30 children with perinatal brain damage up to 3 years of age, who were reffered to our pediatric low vision cabinet in "Little house" from child neurologists, ophthalmologists Type and degree of visual impairment was determined according to functional vision assessment of each child. On the bases of those assessments different kind of visual stimulations were carried out with children who have been identified to have a certain visual impairment. Through visual stimulation program some of the children were stimulated with light stimulus, some with different materials under the ultraviolet (UV) light, and some with bright color and high contrast materials. Children were also involved in program of early stimulation of overall sensory motor development. Goals and methods of therapy were determined individually, based on observation of child's possibilities and need. After one year of program, reassessment was done. Results for visual functions and functional vision were compared to evaluate the improvement of the vision development. These results have shown that there was significant improvement in functional vision, especially in visual attention and visual communication.

  17. Tackling perinatal loss, a participatory action research approach: research protocol.

    Science.gov (United States)

    Pastor-Montero, Sonia María; Romero-Sánchez, José Manuel; Paramio-Cuevas, Juan Carlos; Hueso-Montoro, César; Paloma-Castro, Olga; Lillo-Crespo, Manuel; Castro-Yuste, Cristina; Toledano-Losa, Ana Cristina; Carnicer-Fuentes, Concepción; Ortegón-Gallego, José Alejo; Frandsen, Anna J

    2012-11-01

      The aim of this study was to promote changes to improve the care provided to parents who have experienced a perinatal loss through participatory action research.   The birth of a child is a joyful event for most families, however, unfortunately some pregnancies end in loss. Perinatal loss creates a heavy emotional impact not only on parents but also on health professionals, where in most cases there is an evident lack of skills, strategies and resources to cope with these kinds of situations.   Participatory action research is the methodology proposed to achieve the purpose of this study.   Participatory action research consists of five stages: outreach and awareness, induction, interaction, implementation and systematization. The working group will include professionals from the Mother and Child Unit for patients at a tertiary level public hospital in Spain. The duration of the study will be 3 years since the approval of the protocol in January 2011. The qualitative techniques used will include group dynamics such as the SWOT analysis the nominal group technique, focus groups and brainstorming, among others that will be recorded and transcribed, generating reports throughout the evolution of the group sessions and about the consensus reached. Content analysis will be conducted on the field diaries kept by the participants and researchers. This project has been funded by the Andalusian Regional Ministry of Health.   Participatory action research is a methodological strategy that allows changes in clinical practice to conduct a comprehensive transformative action in the care process for perinatal loss. © 2012 Blackwell Publishing Ltd.

  18. Prognostic value of correlation analysis of perinatal anamnesis

    Directory of Open Access Journals (Sweden)

    V. V. Sofronov

    2017-01-01

    Full Text Available Objective research: is to establish the prognostic value of the analysis of correlative relationships of qualitative indicators of the perinatal history. Correlative groups of interactions of the investigated qualitative indicators in the antenatal, intranatal and postnatal periods are constructed. It was shown that in antenatal history for newborns 22–37 weeks. gestation (group 1 the most important parameters are the «gestational age», «chronic respiratory diseases in the mother,» «premature birth in an anamnesis,» and «exacerbation of chronic infections during pregnancy»; for newborns 38–41 weeks. gestation (2nd group – «cervical erosion», «ovarian cyst», «fibromyoma» and «colpitis ». In the intranatal history for children of the 1st group, the most important parameters are «anhydrous period» and «prolonged labor»; for children of the second group – only «prolonged labor». In the postnatal history for the first group, the two most important parameters are the «gestational age» and the «zonal elevation of the brain echogenicity,» and for the 2 nd group only the parameter «degree of asphyxia» is as important. The obtained results confirm the main known interrelationships of parameters of the perinatal history. At the same time, nontrivial connections between the parameters of the perinatal history: «allergic diseases in the mother» – «threatened miscarriage » – «ovarian cyst»; «chronic respiratory diseases in the mother» – «allergic diseases of the mother» – «diseases of the digestive system in the father.»

  19. Perinatal alcohol exposure enhances nocistatin levels in adulthood.

    Science.gov (United States)

    Tekes, Kornélia; Hantos, Mónika; Gyenge, Melinda; Csaba, Gyorgy

    2007-06-01

    In earlier experiments perinatal hormonal imprinting by alcohol decreased the hormone content of immune cells for life. In the present study, both a single day (15% on the third postnatal day) and a long-term treatment schedule of alcohol exposure (3% for 21 days) of dams during lactation significantly (P < 0.01) enhanced endogenous levels of nocistatin in the blood plasma as well as in the cerebrospinal fluid of the offspring, measured in 3-month-old rats. Our data suggest that alcohol consumption during lactation can cause a life-long influence on nocistatin levels in the offspring and most likely modify nocistatin-related functions such as pain tolerance.

  20. Mortalidad perinatal en el Hospital Nacional Edgardo Rebagliati Martins

    Directory of Open Access Journals (Sweden)

    Lizeth Diaz Ledesma

    2003-07-01

    Full Text Available Objetivo: Conocer la tasa de mortalidad perinatal en el Hospital Nacional Edgardo Rebagliati Martins y sus características. Materiales y Métodos: El estudio comprendió la revisión de todas las historias clínicas de gestantes portadoras de óbito fetal (mayor de 28 semanas de gestación o mayor de 1000gramos, de recién nacidos que fallecieron dentro de los primeros 7 días de vida y de sus madres durante el año 2000. Resultados: La tasa de mortalidad perinatal fue de 10.5 por mil nacidos vivos. La edad promedio materna fue de 31.6 años, + 5.9 y un rango entre 14 y 44 años. El 30.1% de partos correspondió a nulíparas, el 61.6% a multíparas y el 8.3% a gran multíparas. El promedio de visitas al control prenatal fue de 4.8 + 2.7. El 53.4% de las madres tuvo algún antecedente relacionado a mala historia obstétrica, siendo los más frecuentes historia de aborto previo (27.4%, cesárea anterior (13.7% y pre eclampsia (12.3%. Las causas asociadas a mortalidad perinatal fueron madres con pre eclampsia severa (38.4% y hemorragia en el tercer trimestre (15.1% y fetos con malformaciones congénitas severas (27.4%. La vía de parto fue abdominal en 68.5% y vaginal en 31.5%. Se tuvo 83.6% de gestaciones únicas y 16.4% de gestaciones múltiples. El peso de los productos fue 1985.2 + 945.8 gramos. El 61.6% de muertes perinatales correspondieron a prematuros. Conclusiones:La tasa de mortalidad neonatal en el HNERM durante el año 2000 fue de 10.5 por mil nacidos vivos y los factores relacionados a mortalidad perinatal fueron pre-eclampsia severa, malformaciones congénitas severas y hemorragias del tercer trimestre. ( Rev Med Hered 2003; 14: 117-121.

  1. The future of pediatric and perinatal postmortem imaging

    International Nuclear Information System (INIS)

    Gorincour, Guillaume; Sarda-Quarello, Laure; Laurent, Pierre-Eloi; Brough, Alison; Rutty, Guy N.

    2015-01-01

    The field and applications of postmortem imaging are exponentially growing. Its potential to identify the cause of death in trauma and ballistic cases is now properly documented, as well as its use in drug mule identification. In pediatric and perinatal practice, large significant series are less available, except for MRI and central nervous system analysis where scientific evidence is now robust. In this review, after a short historical review and analysis of current problems and challenges, we will try to depict the way we see the future of this subspecialty of postmortem cross-sectional imaging, including all specific situations: terminations of pregnancy, intrauterine death, sudden unexpected infant death and identification issues. (orig.)

  2. The future of pediatric and perinatal postmortem imaging

    Energy Technology Data Exchange (ETDEWEB)

    Gorincour, Guillaume [Assistance Publique des Hopitaux de Marseille - Aix-Marseille University, Pediatric and Prenatal Imaging Department, La Timone Children Hospital, Marseille, Marseille Cedex 5 (France); CERIMED, Aix-Marseille University, Experimental and Interventional Imaging Laboratory, Marseille (France); Sarda-Quarello, Laure [La Timone Hospital, Department of Fetopathology, Marseille (France); Laurent, Pierre-Eloi [CERIMED, Aix-Marseille University, Experimental and Interventional Imaging Laboratory, Marseille (France); Brough, Alison; Rutty, Guy N. [University of Leicester, East Midlands Forensic Pathology Unit, Leicester (United Kingdom)

    2015-04-01

    The field and applications of postmortem imaging are exponentially growing. Its potential to identify the cause of death in trauma and ballistic cases is now properly documented, as well as its use in drug mule identification. In pediatric and perinatal practice, large significant series are less available, except for MRI and central nervous system analysis where scientific evidence is now robust. In this review, after a short historical review and analysis of current problems and challenges, we will try to depict the way we see the future of this subspecialty of postmortem cross-sectional imaging, including all specific situations: terminations of pregnancy, intrauterine death, sudden unexpected infant death and identification issues. (orig.)

  3. Breastfeeding and risk of schizophrenia in the Copenhagen Perinatal Cohort

    DEFF Research Database (Denmark)

    Sørensen, Holger Jelling; Mortensen, Erik Lykke; Reinisch, J M

    2005-01-01

    OBJECTIVE: The aim was to study whether early weaning from breastfeeding may be associated with increased risk of schizophrenia. METHOD: The current sample comprises 6841 individuals from the Copenhagen Perinatal Cohort of whom 1671 (24%) had been breastfed for 2 weeks or less (early weaning...... odds ratio 1.73 with 95% CI: 1.13-2.67). CONCLUSION: No or breastfeeding was associated with elevated risk of schizophrenia. The hypothesis of some protective effect of breastfeeding against the risk of later schizophrenia is supported by our data....

  4. Role of Perinatal Inflammation in Neonatal Arterial Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Antoine Giraud

    2017-11-01

    Full Text Available Based on the review of the literature, perinatal inflammation often induced by infection is the only consistent independent risk factor of neonatal arterial ischemic stroke (NAIS. Preclinical studies show that acute inflammatory processes take place in placenta, cerebral arterial wall of NAIS-susceptible arteries and neonatal brain. A top research priority in NAIS is to further characterize the nature and spatiotemporal features of the inflammatory processes involved in multiple levels of the pathophysiology of NAIS, to adequately design randomized control trials using targeted anti-inflammatory vasculo- and neuroprotective agents.

  5. [Perinatal HIV transmission prophylaxis in the Liege region].

    Science.gov (United States)

    Jacquet, Y; Hoyoux, C; Dresse, M F

    1998-08-01

    In Liège, since February 1994, Protocole ACTG 076 has been followed for prevention of perinatal transmission of VIH. The pregnant women are treated by AZT during pregnancy and delivery. The newborn is also treated during 6 weeks. Following this treatment strategy, vertical transmission rate of VIH has dropped from 25.6% to 8.7%. The PCR is particulary promising for the early detection of infection in newborn, but definitive conclusion about infective status of the newborn can't be done during the first week of life. The potential role of intrapartum transmission is now under evaluation in the hope to establish the safest mode of delivery.

  6. Perinatal stroke in Saudi children: clinical features and risk factors

    International Nuclear Information System (INIS)

    Salih, Mustafa A.; Al-Jarallah, Ahmed A.; Kentab, Anal Y.; Al-Nasser, Mohammad N.; Abdel-Gader, Abdel-Galil M.; Alorainy, Ibrahim A.; Hassan, Hamdy H.

    2006-01-01

    To describe the clinical features and presentations of perinatal stroke in a prospective and retrospective cohort of Saudi children and ascertain the risk factors. Patients with perinatal stroke were identified from within a cohort of 104 Saudi children who were evaluated at the Division of Pediatric Neurology at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia from July 1992 to February 2001 (retrospective study) and February 2001 to March 2003 (prospective study). Neuroimaging for suspected cases of stroke consisted of cranial CT, MRI, or both. During the study period, 23 (22%) of 104 children (aged one months to 12 years) were diagnosed to have had perinatal stroke. The male: female ratio was 1.6:1. Ten (67%) of the 15 children who had unilateral ischemic involvement had their lesion in the left hemisphere. The presentation of the ischemic result was within 24-72 hours of life in 13 (57%) patients, and in 6 children (26%), motor impairment was recognized at or after the age of 4 months. Nine children (39%) had seizures at presentation. Pregnancy, labor, and delivery risk factors were ascertained in 18 (78%) cases. The most common of these included emergency cesarean section in 5 cases, and instrumental delivery in other 5. Screening for prothrombotic risk factors detected abnormalities in 6 (26%) patients on at least one test carried out between 2 months and 9 years of age. Four children (17%) had low protein C, which was associated low protein S and raised anticardiolipin antibodies (ACA) in one patient, and low antithrombin III in another. Low proteins S was detected in a 42-month-old boy. The abnormality in the sixth child was confined to raised ACA. The present study highlights the non-specific features by which stroke presents during the neonatal period. The data are in keeping with the potential role for inherited and acquired thrombophilia as being the underlying cause. However, the high prevalence of

  7. Maternal conditions and perinatal characteristics associated with autism spectrum disorder and intellectual disability.

    Science.gov (United States)

    Langridge, Amanda T; Glasson, Emma J; Nassar, Natasha; Jacoby, Peter; Pennell, Craig; Hagan, Ronald; Bourke, Jenny; Leonard, Helen; Stanley, Fiona J

    2013-01-01

    As well as being highly comorbid conditions, autism spectrum disorders (ASD) and intellectual disability (ID) share a number of clinically-relevant phenomena. This raises questions about similarities and overlap in diagnosis and aetiological pathways that may exist for both conditions. To examine maternal conditions and perinatal factors for children diagnosed with an ASD, with or without ID, and children with ID of unknown cause, compared with unaffected children. The study population comprised all live singleton births in Western Australia (WA) between January 1984 and December 1999 (N = 383,153). Univariate and multivariate multinomial logistic regression models were applied using a blocked modelling approach to assess the effect of maternal conditions, sociodemographic factors, labour and delivery characteristics and neonatal outcomes. In univariate analyses mild-moderate ID was associated with pregnancy hypertension, asthma, urinary tract infection, some types of ante-partum haemorrhage, any type of preterm birth, elective C-sections, breech presentation, poor fetal growth and need for resuscitation at birth, with all factors showing an increased risk. Severe ID was positively associated with poor fetal growth and need for resuscitation, as well as any labour or delivery complication. In the multivariate analysis no maternal conditions or perinatal factors were associated with an increased risk of ASD without ID. However, pregnancy hypertension and small head circumference were associated with a reduced risk (OR = 0.64, 95% CI: 0.43, 0.94; OR = 0.58, 95% CI: 0.34, 0.96, respectively). For ASD with ID, threatened abortion before 20 weeks gestation and poor fetal growth were associated with an increased risk. Findings show that indicators of a poor intrauterine environment are associated with an elevated risk of ID, while for ASD, and particularly ASD without ID, the associations are much weaker. As such, these findings highlight the importance of accounting for

  8. Association of missing paternal demographics on infant birth certificates with perinatal risk factors for childhood obesity

    Directory of Open Access Journals (Sweden)

    Erika R. Cheng

    2016-07-01

    Full Text Available Abstract Background The role of fathers in the development of obesity in their offspring remains poorly understood. We evaluated associations of missing paternal demographic information on birth certificates with perinatal risk factors for childhood obesity. Methods Data were from the Linked CENTURY Study, a database linking birth certificate and well-child visit data for 200,258 Massachusetts children from 1980–2008. We categorized participants based on the availability of paternal age, education, or race/ethnicity and maternal marital status on the birth certificate: (1 pregnancies missing paternal data; (2 pregnancies involving unmarried women with paternal data; and (3 pregnancies involving married women with paternal data. Using linear and logistic regression, we compared differences in smoking during pregnancy, gestational diabetes, birthweight, breastfeeding initiation, and ever recording a weight for length (WFL ≥ the 95th percentile or crossing upwards ≥2 WFL percentiles between 0–24 months among the study groups. Results 11,989 (6.0 % birth certificates were missing paternal data; 31,323 (15.6 % mothers were unmarried. In adjusted analyses, missing paternal data was associated with lower birthweight (β -0.07 kg; 95 % CI: −0.08, −0.05, smoking during pregnancy (AOR 4.40; 95 % CI: 3.97, 4.87, non-initiation of breastfeeding (AOR 0.39; 95 % CI: 0.36, 0.42, and with ever having a WFL ≥ 95th percentile (AOR 1.10; 95 % CI: 1.01, 1.20. Similar associations were noted for pregnancies involving unmarried women with paternal data, but differences were less pronounced. Conclusions Missing paternal data on the birth certificate is associated with perinatal risk factors for childhood obesity. Efforts to understand and reduce obesity risk factors in early life may need to consider paternal factors.

  9. A paediatric and perinatal HIV/AIDS leadership initiative in Kingston, Jamaica.

    Science.gov (United States)

    Christie, C D C

    2004-10-01

    In Jamaica 1-2% of pregnant women are HIV-positive; 876 HIV-positive pregnant women will deliver and at least 283 newly infected HIV-infected infants will be born in 2003; HIV/AIDS is the leading cause of death in children aged one to four years. We describe a collaborative "Town and Gown" programme to address the paediatric and perinatal HIV epidemic in Kingston. A team of academic and government healthcare personnel, comprising paediatricians, obstetricians, public health practitioners, nurses, microbiologists, data management and information technology personnel collaborated to address this public health emergency. A five-point plan was implemented This comprised leadership and training of a core group of paediatric/perinatal HIVprofessionals to serve Greater Kingston and St Catherine and be a model for the rest of Jamaica. Mother-to-child transmission of HIV/AIDS is prevented by counselling and HIV-testing women in the antenatal clinics, giving azidothymidine (AZT) to HIV pregnant women beginning at 28 weeks gestation, throughout labour and to the HIV-exposed infants for the first six weeks of life. A unified parallel programme for identifying the HIV-infected infant and delivering paediatric HIV care at the major paediatric centres was implemented In three years, over 30,000 pregnant women are being tested for HIV; 600 HIV-exposed babies are being identified and about 140 paediatric HIV infections will be prevented The team is building research capacity which emphasizes a strong outcomes-based research agenda and implementation of clinical trials. We are collaborating, locally, regionally and internationally. Collaboratively, the mission of reducing mother-to-child transmission of HIV/AIDS and improving the quality of life for those already living and affected by HIV/AIDS can be achieved.

  10. Perinatal outcome in singletons after modified natural cycle IVF and standard IVF with ovarian stimulation

    NARCIS (Netherlands)

    Pelinck, Marie-Jose; Keizer, Marjan H.; Hoek, Annemieke; Simons, Arnold H. M.; Schelling, Karin; Middelburg, Karin; Heineman, Maas Jan

    Objective: Singletons born after IVF treatment are at risk for adverse pregnancy outcome, the cause of which is unknown. The aim of the present study was to investigate the influence of ovarian stimulation on perinatal outcome. Study design: In this single-centre retrospective study, perinatal

  11. Perinatal outcome in singletons after modified natural cycle IVF and standard IVF with ovarian stimulation

    NARCIS (Netherlands)

    Pelinck, Marie-José; Keizer, Marjan H.; Hoek, Annemieke; Simons, Arnold H. M.; Schelling, Karin; Middelburg, Karin; Heineman, Maas Jan

    2010-01-01

    Objective: Singletons born after IVF treatment are at risk for adverse pregnancy outcome, the cause of which is unknown. The aim of the present study was to investigate the influence of ovarian stimulation on peri