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Sample records for project delivering maternal

  1. The MOM Project: delivering maternal health services among internally displaced populations in eastern Burma.

    PubMed

    Mullany, Luke C; Lee, Catherine I; Paw, Palae; Shwe Oo, Eh Kalu; Maung, Cynthia; Kuiper, Heather; Masenior, Nicole; Mansenior, Nicole; Beyrer, Chris; Lee, Thomas J

    2008-05-01

    Alternative strategies to increase access to reproductive health services among internally displaced populations are urgently needed. In eastern Burma, continuing conflict and lack of functioning health systems render the emphasis on facility-based delivery with skilled attendants unfeasible. Along the Thailand-Burma border, local organisations have implemented an innovative pilot, the Mobile Obstetric Maternal Health Workers (MOM) Project, establishing a three-tiered collaborative network of community-based reproductive health workers. Health workers from local organisations received practical training in basic emergency obstetric care plus blood transfusion, antenatal care and family planning at a central facility. After returning to their target communities inside Burma, these first-tier maternal health workers trained a second tier of local health workers and a third tier of traditional birth attendants (TBAs) to provide a limited subset of these interventions, depending on their level of training. In this ongoing project, close communication between health workers and TBAs promotes acceptance and coverage of maternity services throughout the community. We describe the rationale, design and implementation of the project and a parallel monitoring plan for evaluation of the project. This innovative obstetric health care delivery strategy may serve as a model for the delivery of other essential health services in this population and for increasing access to care in other conflict settings. PMID:18513606

  2. Marathon Maternity Oral History Project

    PubMed Central

    Orkin, Aaron; Newbery, Sarah

    2014-01-01

    Abstract Objective To explore how birthing and maternity care are understood and valued in a rural community. Design Oral history research. Setting The rural community of Marathon, Ont, with a population of approximately 3500. Participants A purposive selection of mothers, grandmothers, nurses, physicians, and community leaders in the Marathon medical catchment area. Methods Interviews were conducted with a purposive sample, employing an oral history research methodology. Interviews were conducted non-anonymously in order to preserve the identity and personhood of participants. Interview transcripts were edited into short narratives. Oral histories offer perspectives and information not revealed in other quantitative or qualitative research methodologies. Narratives re-personalize and humanize medical research by offering researchers and practitioners the opportunity to bear witness to the personal stories affected through medical decision making. Main findings Eleven stand-alone narratives, published in this issue of Canadian Family Physician, form the project’s findings. Similar to a literary text or short story, they are intended for personal reflection and interpretation by the reader. Presenting the results of these interviews as narratives requires the reader to participate in the research exercise and take part in listening to these women’s voices. The project’s narratives will be accessible to readers from academic and non-academic backgrounds and will interest readers in medicine and allied health professions, medical humanities, community development, gender studies, social anthropology and history, and literature. Conclusion Sharing personal birthing experiences might inspire others to reevaluate and reconsider birthing practices and services in other communities. Where local maternity services are under threat, Marathon’s stories might contribute to understanding the meaning and challenges of local birthing, and the implications of losing

  3. Afraid of Delivering at the Hospital or Afraid of Delivering at Home: A Qualitative Study of Thai Hmong Families' Decision-Making About Maternity Services.

    PubMed

    Culhane-Pera, Kathleen A; Sriphetcharawut, Sarinya; Thawsirichuchai, Rasamee; Yangyuenkun, Wirachon; Kunstadter, Peter

    2015-11-01

    Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into four categories: no ANC/home birth, ANC/home, no ANC/hospital, ANC/hospital. We conducted life-history case studies of 4 women from each category plus their 12 husbands, and 17 elders. We used grounded theory to guide qualitative analysis. Families not using maternity services considered pregnancy a normal process that only needed traditional home support. In addition, they disliked institutional processes that interfered with cultural birth practices, distrusted discriminatory personnel, and detested invasive, involuntary hospital procedures. Families using services perceived physical needs or potential delivery risks that could benefit from obstetrical assistance not available at home. While they disliked aspects of hospital births, they tolerated these conditions for access to obstetrical care they might need. Families also considered cost, travel distance, and time as structural issues. The families ultimately balanced their fear of delivering at home with their fear of delivering at the hospital. Providing health education about pregnancy risks, and changing healthcare practices to accommodate Hmong people's desires for culturally-appropriate family-centered care, which are consistent with evidence-based obstetrics, might improve Hmong women's use of maternity services. PMID:26138321

  4. Bond to deliver our nuclear projects from bondage

    SciTech Connect

    Subramanian, T.K.

    1985-11-01

    This paper examines the Internal Revenue Service (IRS) ruling that prevents the use of Pollution Control Revenue Bonds (PCRB) as a source of capital to complete nuclear projects, advances arguments that prevention of pollutants should be treated at least in par with the removal, alteration, or disposal of realized pollution, recommends reexamination of the IRS ruling, and emphasizes the need for the nuclear community and ultimately the US Congress to take a fresh look at the applicability of the PCRB tax exemption incentives for the nuclear safety-related structures and systems, at least for the completion of suspended nuclear projects.

  5. The Maternal Adversity, Vulnerability and Neurodevelopment Project: Theory and Methodology

    PubMed Central

    O’Donnell, Katherine A; Gaudreau, Hélène; Colalillo, Sara; Steiner, Meir; Atkinson, Leslie; Moss, Ellen; Goldberg, Susan; Karama, Sherif; Matthews, Stephen G; Lydon, John E; Silveira, Patricia P; Wazana, Ashley D; Levitan, Robert D; Sokolowski, Marla B; Kennedy, James L; Fleming, Alison; Meaney, Michael J

    2014-01-01

    Objective: To describe the theory and methodology of the multi-wave, prospective Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) study. The goal of MAVAN is to examine the pre- and postnatal influences, and their interaction, in determining individual differences in mental health. Method: MAVAN is a community-based, birth cohort study of pregnant Canadian mothers and their offspring. Dyads are assessed longitudinally, with multiple assessments of both mother and child in home and laboratory across the child’s development. Study measures, including assessments of cognitive and emotional function, are described. The study uses a candidate gene approach to examine gene–environment interdependence in specific developmental outcomes. Finally, the study includes measures of both brain-based phenotypes and metabolism to explore comorbidities associated with child obesity. One of the unique features of the MAVAN protocol is the extensive measures of the mother–child interaction. The relation between these measures will be discussed. Results: Evidence from the MAVAN project shows interesting results about maternal care, families, and child outcomes. In our review, preliminary analyses showing the correlations between measures of maternal care are reported. As predicted, early evidence suggests that maternal care measures are positively correlated, over time. Conclusions: This review provides evidence for the feasibility and value of laboratory-based measures embedded within a longitudinal birth cohort study. Though retention of the samples has been a challenge of MAVAN, they are within a comparable range to other studies of this nature. Indeed, the trade-off of somewhat greater participant burden has allowed for a rich database. The results yielded from the MAVAN project will not only describe typical development but also possible targets for intervention. Understanding certain endophenotypes will shed light on the pathogenesis of various mental and

  6. Evaluation of Publicly Financed and Privately Delivered Model of Emergency Referral Services for Maternal and Child Health Care in India

    PubMed Central

    Prinja, Shankar; Bahuguna, Pankaj; Lakshmi, P. V. M.; Mokashi, Tushar; Aggarwal, Arun Kumar; Kaur, Manmeet; Reddy, K. Rahul; Kumar, Rajesh

    2014-01-01

    Background Emergency referral services (ERS) are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost. Methods Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS) standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective. Results On an average, an ambulance transported 3–4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7) per patient transported or INR 21 (USD 0.35) per km travelled. Conclusion Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR) should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system. PMID:25360798

  7. Office of Maternal and Child Health Active Projects FY 1989. An Annotated Listing.

    ERIC Educational Resources Information Center

    National Center for Education in Maternal and Child Health, Washington, DC.

    An annotated listing is presented of projects offering maternal and child health care services. These projects, referred to as special projects of regional and national significance (SPRANS), are supported by the Office of Maternal and Child Health of the Department of Health and Human Services. The first section provides information on services…

  8. Maternal and Child Health Research Program. Completed Projects 1989, 1990, and 1991.

    ERIC Educational Resources Information Center

    National Center for Education in Maternal and Child Health, Arlington, VA.

    This publication describes 33 research projects supported by the federal Maternal and Child Health Bureau and completed in 1989, 1990, and 1991. It is the third edition in a series of collected abstracts of completed maternal and child health research projects. Each project abstract contains the name of the grantee, name and address of the…

  9. Delivering Software Process-Specific Project Courses in Tertiary Education Environment: Challenges and Solution

    ERIC Educational Resources Information Center

    Rong, Guoping; Shao, Dong

    2012-01-01

    The importance of delivering software process courses to software engineering students has been more and more recognized in China in recent years. However, students usually cannot fully appreciate the value of software process courses by only learning methodology and principle in the classroom. Therefore, a process-specific project course was…

  10. Innovative model of delivering quality improvement education for trainees – a pilot project

    PubMed Central

    Ramar, Kannan; Hale, Curt W.; Dankbar, Eugene C.

    2015-01-01

    Background After incorporating quality improvement (QI) education as a required curriculum for our trainees in 2010, a need arose to readdress our didactic sessions as they were too long, difficult to schedule, and resulting in a drop in attendance. A ‘flipped classroom’ (FC) model to deliver QI education was touted to be an effective delivery method as it allows the trainees to view didactic materials on videos, on their own time, and uses the classroom to clarify concepts and employ learned tools on case-based scenarios including workshops. Methods The Mayo Quality Academy prepared 29 videos that incorporated the previously delivered 17 weekly didactic sessions, for a total duration of 135 min. The half-day session clarified questions related to the videos, followed by case examples and a hands-on workshop on how to perform and utilize a few commonly used QI tools and methods. Results Seven trainees participated. There was a significant improvement in knowledge as measured by pre- and post-FC model test results [improvement by 40.34% (SD 16.34), p<0.001]. The survey results were overall positive about the FC model with all trainees strongly agreeing that we should continue with this model to deliver QI education. Conclusions The pilot project of using the FC model to deliver QI education was successful in a small sample of trainees. PMID:26400052

  11. Delivering services and influencing policy: health care professionals join forces to improve maternal, newborn, and child health.

    PubMed

    2009-06-01

    This article reviews the major activities of health care professional organizations (HCPAs), and emphasizes the role they can play in advocating for women and children and influencing maternal, newborn, and child health (MNCH) programs and policies. The ICM/FIGO joint effort to prevent postpartum hemorrhage and the 40-year partnership between the American Academy of Pediatrics (AAP) and the Indian Health Service (IHS) are highlighted as examples of how and why HCPAs should assume a leadership role in advocacy work. The action-oriented multicountry HCPA workshops organized by the Partnership for Maternal, Newborn, and Child Health (PMNCH) and the international HCPAs are also described. These capacity building workshops are aimed at strengthening the ability of HCPAs to organize, coordinate activities, and become more involved in program and policy development. PMID:19339007

  12. Maternal and Child Health Bureau Active Projects FY 1991: An Annotated Listing.

    ERIC Educational Resources Information Center

    National Center for Education in Maternal and Child Health, Washington, DC.

    This annotated listing provides brief descriptions of the 591 projects funded during 1991 by federal set-aside funds of the Maternal and Child Health (MCH) Services Block Grant and identified as special projects of regional and national significance (SPRANS). Preliminary information includes an introduction, an organization chart of the Maternal…

  13. The GHG-CCI Project to Deliver the Essential Climate Variable Greenhouse Gases: Current status

    NASA Astrophysics Data System (ADS)

    Buchwitz, M.; Boesch, H.; Reuter, M.

    2012-04-01

    The GHG-CCI project (http://www.esa-ghg-cci.org) is one of several projects of ESA's Climate Change Initiative (CCI), which will deliver various Essential Climate Variables (ECVs). The goal of GHG-CCI is to deliver global satellite-derived data sets of the two most important anthropogenic greenhouse gases (GHGs) carbon dioxide (CO2) and methane (CH4) suitable to obtain information on regional CO2 and CH4 surface sources and sinks as needed for better climate prediction. The GHG-CCI core ECV data products are column-averaged mole fractions of CO2 and CH4, XCO2 and XCH4, retrieved from SCIAMACHY on ENVISAT and TANSO on GOSAT. Other satellite instruments will be used to provide constraints in upper layers such as IASI, MIPAS, and ACE-FTS. Which of the advanced algorithms, which are under development, will be the best for a given data product still needs to be determined. For each of the 4 GHG-CCI core data products - XCO2 and XCH4 from SCIAMACHY and GOSAT - several algorithms are bing further developed and the corresponding data products are inter-compared to identify which data product is the most appropriate. This includes comparisons with corresponding data products generated elsewhere, most notably with the operational data products of GOSAT generated at NIES and the NASA/ACOS GOSAT XCO2 product. This activity, the so-called "Round Robin exercise", will be performed in the first two years of this project. At the end of the 2 year Round Robin phase (end of August 2012) a decision will be made which of the algorithms performs best. The selected algorithms will be used to generate the first version of the ECV GHG. In the last six months of this 3 year project the resulting data products will be validated and made available to all interested users. In the presentation and overview about this project will be given focussing on the latest results.

  14. A Randomised Controlled Trial of Therapist-Assisted, Internet-Delivered Cognitive Behavior Therapy for Women with Maternal Depression

    PubMed Central

    Pugh, Nicole E.; Hadjistavropoulos, Heather D.; Dirkse, Dale

    2016-01-01

    Postpartum depression impacts up to 15% of Canadian women following childbirth. Remarkably, many women suffering from this disorder do not receive appropriate treatment. The aim of this study was to conduct a parallel-group randomized controlled trial to determine the efficacy of Therapist-Assisted Internet-delivered Cognitive Behavior Therapy (TA-ICBT) for the treatment of postpartum depression. This study was registered with the International Standard Randomized Controlled Trials (ISRCTN: 85456371) and received funding from Canadian Institutes of Health Research (#101526) and the Saskatchewan Health Research Foundation. Fifty women who gave birth to an infant in the past year, who scored above 10 on the Edinburgh Postnatal Depression Scale (EPDS), and who resided in Saskatchewan, Canada were eligible to participate. Participants were randomly assigned to receive either TA-ICBT (n = 25) or waitlist control (n = 25). The efficacy of the treatment was investigated at baseline and at seven- to 10-week follow-up. TA-ICBT participants were also contacted four-weeks following treatment completion. Symptoms of postpartum depression decreased more for participants in the TA-ICBT group (average reduction of 6.24 points on the EPDS; n = 21 included in analyses) compared to those participants in the waitlist control group (average reduction of 2.42 points on the EPDS; n = 20 included in analyses), and these results were clinically significant and maintained at four-week follow-up. TA-ICBT participants demonstrated a reduction in postnatal anxiety, general stress, and parental distress, and an increase in psychological and environmental quality of life when compared to the waitlist control participants. Study implications, limitations, and future research directions are discussed. Trial Registration Controlled-Trials.com ISRCTN85456371 PMID:26930488

  15. The NADI program and the JOICFP integrated project: partners in delivering primary health care.

    PubMed

    Arshat, H; Othman, R; Kuan Lin Chee; Abdullah, M

    1985-10-01

    The NADI program (pulse in Malay) was initially launched as a pilot project in 1980 in Kuala Lumpur, Malaysia. It utilized an integrated approach involving both the government and the private sectors. By sharing resources and expertise, and by working together, the government and the people can achieve national development faster and with better results. The agencies work through a multi-level supportive structure, at the head of which is the steering committee. The NADI teams at the field level are the focal points of services from the various agencies. Members of NADI teams also work with urban poor families as well as health groups, parents-teachers associations, and other similar groups. The policy and planning functions are carried out by the steering committee, the 5 area action committees and the community action committees, while the implementation function is carried out by the area program managers and NADI teams. The chairman of each area action committee is the head of the branch office of city hall. Using intestinal parasite control as the entry point, the NADI Integrated Family Development Program has greatly helped in expanding inter-agency cooperation and exchange of experiences by a coordinated, effective and efficient resource-mobilization. The program was later expanded to other parts of the country including the industrial and estate sectors. Services provided by NADI include: comprehensive health services to promote maternal and child health; adequate water supply, proper waste disposal, construction of latrines and providing electricity; and initiating community and family development such as community education, preschool education, vocational training, family counseling and building special facilities for recreational and educational purposes. PMID:12313881

  16. Effectiveness of Kenya's Community Health Strategy in delivering community-based maternal and newborn health care in Busia County, Kenya: non-randomized pre-test post test study

    PubMed Central

    Wangalwa, Gilbert; Cudjoe, Bennett; Wamalwa, David; Machira, Yvonne; Ofware, Peter; Ndirangu, Meshack; Ilako, Festus

    2012-01-01

    Background Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained unacceptably high in a decade. In 2007, the Ministry of Public Health and Sanitation adopted a community health strategy to reverse the poor health outcomes in order to meet Millennium Development Goals 4 and 5. It aims at strengthening community participation and its ability to take action towards health. The study aimed at evaluating the effectiveness of the strategy in improving maternal and neonatal health outcomes in Kenya. Methods Between 2008 and 2010, the African Medical and Research Foundation implemented a community-based maternal and newborn care intervention package in Busia County using the community health strategy approach. An interventional, non-randomized pre-test post test study design was used to evaluate change in essential maternal and neonatal care practices among mothers with children aged 0 - 23 months. Results There was statistically significant (p < 0.05) increase in attendance of at least four antenatal care visits (39% to 62%), deliveries by skilled birth attendants (31% to 57%), receiving intermittent preventive treatment (23% to 57%), testing for HIV during pregnancy (73% to 90%) and exclusive breastfeeding (20% to 52%). Conclusion The significant increase in essential maternal and neonatal care practices demonstrates that, community health strategy is an appropriate platform to deliver community based interventions. The findings will be used by actors in the child survival community to improve current approaches, policies and practice in maternal and neonatal care. PMID:23467438

  17. Project Pals: A Description of a High School-Based Tutorial Program Using Corrective Reading and Peer-Delivered Instruction

    ERIC Educational Resources Information Center

    Marchand-Martella, Nancy; Martella, Ronald C.; Bettis, Daniel F.; Blakely, Molly Riley

    2004-01-01

    The purpose of this investigation was to assess implementation aspects of a peer-delivered Corrective Reading Program (CRP), entitled "Project PALS" (Peer Assisted Learning System), in six area high schools. Specifically, high schools provided details on the following aspects of their programs: school and teachers, students receiving peer…

  18. Developing a Web-Based System to Create, Deliver and Assess Language Proficiency within the PAULEX Universitas Project

    ERIC Educational Resources Information Center

    de Siqueira, Jose Macario; Martinez-Saez, Antonio; Sevilla-Pavon, Ana; Gimeno-Sanz, Ana

    2011-01-01

    This study aims to examine the feasibility of a number of technical solutions implemented in a web-based system designed for the creation and management of online language exams within PAULEX Universitas, a project for the development of an online platform to design, deliver and assess the foreign language exam within the Spanish national…

  19. The Impact of an Implementation Project on Primary Care Staff Perceptions of Delivering Brief Alcohol Advice

    PubMed Central

    Reinholdz, Hanna; Bendtsen, Preben; Spak, Fredrik

    2016-01-01

    Objective. To explore how the perceptions and experiences of working with risky drinkers change over time among primary health care staff during a systematic implementation project. Methods. Qualitative focus group interviews took place before and after the implementation of the project. Results. The staff displayed a positive change during the implementation period with regard to awareness, knowledge, and confidence that led to a change in routine practice. Throughout the project, staff were committed to engaging with risky drinkers and appeared to have been learning-by-doing. Conclusions. The results indicated a positive attitude to alcohol prevention work but staff lack knowledge and confidence in the area. The more practical experience during the study is, the more confidence seems to have been gained. This adds new knowledge to the science of implementation studies concerning alcohol prevention measures, which have otherwise shown disappointing results, emphasizing the importance of learning in practice. PMID:27446626

  20. DELIVERING TIMELY WATER QUALITY INFORMATION TO YOUR COMMUNITY. THE LAKE ACCESS-MINNEAPOLIS PROJECT

    EPA Science Inventory

    This report is a summary of the near-real-time water quality-monitoring project conducted by a consortium of interested parties in the greater Minneapolis area. It was funded by an EPA program known as EMPACT (Environmental Monitoring, Public Access, and Community Tracking). In 1...

  1. Activation of lateral hypothalamus-projecting parabrachial neurons by intraorally delivered gustatory stimuli.

    PubMed

    Tokita, Kenichi; Armstrong, William E; St John, Steven J; Boughter, John D

    2014-01-01

    The present study investigated a subpopulation of neurons in the mouse parabrachial nucleus (PbN), a gustatory and visceral relay area in the brainstem, that project to the lateral hypothalamus (LH). We made injections of the retrograde tracer Fluorogold (FG) into LH, resulting in fluorescent labeling of neurons located in different regions of the PbN. Mice were stimulated through an intraoral cannula with one of seven different taste stimuli, and PbN sections were processed for immunohistochemical detection of the immediate early gene c-Fos, which labels activated neurons. LH projection neurons were found in all PbN subnuclei, but in greater concentration in lateral subnuclei, including the dorsal lateral subnucleus (dl). Fos-like immunoreactivity (FLI) was observed in the PbN in a stimulus-dependent pattern, with the greatest differentiation between intraoral stimulation with sweet (0.5 M sucrose) and bitter (0.003 M quinine) compounds. In particular, sweet and umami-tasting stimuli evoked robust FLI in cells in the dl, whereas quinine evoked almost no FLI in cells in this subnucleus. Double-labeled cells were also found in the greatest quantity in the dl. Overall, these results support the hypothesis that the dl contains direct a projection to the LH that is activated preferentially by appetitive compounds; this projection may be mediated by taste and/or postingestive mechanisms. PMID:25120438

  2. Activation of lateral hypothalamus-projecting parabrachial neurons by intraorally delivered gustatory stimuli

    PubMed Central

    Tokita, Kenichi; Armstrong, William E.; St. John, Steven J.; Boughter Jr., John D.

    2014-01-01

    The present study investigated a subpopulation of neurons in the mouse parabrachial nucleus (PbN), a gustatory and visceral relay area in the brainstem, that project to the lateral hypothalamus (LH). We made injections of the retrograde tracer Fluorogold (FG) into LH, resulting in fluorescent labeling of neurons located in different regions of the PbN. Mice were stimulated through an intraoral cannula with one of seven different taste stimuli, and PbN sections were processed for immunohistochemical detection of the immediate early gene c-Fos, which labels activated neurons. LH projection neurons were found in all PbN subnuclei, but in greater concentration in lateral subnuclei, including the dorsal lateral subnucleus (dl). Fos-like immunoreactivity (FLI) was observed in the PbN in a stimulus-dependent pattern, with the greatest differentiation between intraoral stimulation with sweet (0.5 M sucrose) and bitter (0.003 M quinine) compounds. In particular, sweet and umami-tasting stimuli evoked robust FLI in cells in the dl, whereas quinine evoked almost no FLI in cells in this subnucleus. Double-labeled cells were also found in the greatest quantity in the dl. Overall, these results support the hypothesis that the dl contains direct a projection to the LH that is activated preferentially by appetitive compounds; this projection may be mediated by taste and/or postingestive mechanisms. PMID:25120438

  3. Stakeholder analysis for a maternal and newborn health project in Eastern Uganda

    PubMed Central

    2013-01-01

    , and improved accessibility of services. Conclusion Most of the stakeholders interviewed were supporters of the proposed maternal and newborn care intervention because of the positive benefits of the intervention. The analysis highlighted stakeholder concerns that will be included in the final project design and that could also be useful in countries of similar setting that are planning to set up programmes geared at increasing access to maternal and new born interventions. Key among these concerns was the need to use both human and financial resources that are locally available in the community, to address supply side barriers that influence access to maternal and child healthcare. Research to policy translation, therefore, will require mutual trust, continued dialogue and engagement of the researchers, implementers and policy makers to enable scale up. PMID:23497057

  4. The INTEGRATE project: Delivering solutions for efficient multi-centric clinical research and trials.

    PubMed

    Kondylakis, Haridimos; Claerhout, Brecht; Keyur, Mehta; Koumakis, Lefteris; van Leeuwen, Jasper; Marias, Kostas; Perez-Rey, David; De Schepper, Kristof; Tsiknakis, Manolis; Bucur, Anca

    2016-08-01

    The objective of the INTEGRATE project (http://www.fp7-integrate.eu/) that has recently concluded successfully was the development of innovative biomedical applications focused on streamlining the execution of clinical research, on enabling multidisciplinary collaboration, on management and large-scale sharing of multi-level heterogeneous datasets, and on the development of new methodologies and of predictive multi-scale models in cancer. In this paper, we present the way the INTEGRATE consortium has approached important challenges such as the integration of multi-scale biomedical data in the context of post-genomic clinical trials, the development of predictive models and the implementation of tools to facilitate the efficient execution of postgenomic multi-centric clinical trials in breast cancer. Furthermore, we provide a number of key "lessons learned" during the process and give directions for further future research and development. PMID:27224847

  5. The EUSTACE project: delivering global, daily information on surface air temperature

    NASA Astrophysics Data System (ADS)

    Morice, C. P.; Rayner, N. A.; Auchmann, R.; Bessembinder, J.; Bronnimann, S.; Brugnara, Y.; Conway, E. A.; Ghent, D.; Good, E.; Herring, K.; Kennedy, J.; Lindgren, F.; Madsen, K. S.; Merchant, C. J.; van der Schrier, G.; Stephens, A.; Tonboe, R. T.; Waterfall, A. M.; Mitchelson, J.; Woolway, I.

    2015-12-01

    Day-to-day variations in surface air temperature affect society in many ways; however, daily surface air temperature measurements are not available everywhere. A global daily analysis cannot be achieved with measurements made in situ alone, so incorporation of satellite retrievals is needed. To achieve this, we must develop an understanding of the relationships between traditional (land and marine) surface air temperature measurements and retrievals of surface skin temperature from satellite measurements, i.e. Land Surface Temperature, Ice Surface Temperature, Sea Surface Temperature and Lake Surface Water Temperature. These relationships can be derived either empirically or with the help of a physical model.Here we discuss the science needed to produce a fully-global daily analysis (or ensemble of analyses) of surface air temperature on the centennial scale, integrating different ground-based and satellite-borne data types. Information contained in the satellite retrievals would be used to create globally-complete fields in the past, using statistical models of how surface air temperature varies in a connected way from place to place. As the data volumes involved are considerable, such work needs to include development of new "Big Data" analysis methods.We will present plans and progress along this road in the EUSTACE project (2015-June 2018), i.e.: • providing new, consistent, multi-component estimates of uncertainty in surface skin temperature retrievals from satellites; • identifying inhomogeneities in daily surface air temperature measurement series from weather stations and correcting for these over Europe; • estimating surface air temperature over all surfaces of Earth from surface skin temperature retrievals; • using new statistical techniques to provide information on higher spatial and temporal scales than currently available, making optimum use of information in data-rich eras.Information will also be given on how interested users can become

  6. The DADDI Project: Delivering a Working Prototype for Arctic Coastal Data

    NASA Astrophysics Data System (ADS)

    Wilson, B. E.; Parsons, M. A.; Palanisamy, G.

    2006-12-01

    A key element for the ultimate success of the International Polar Year (IPY) effort will be our ability to make the volumes of data collected in this work available and usable to researchers, both now and into the future. Ultimately, the IPY data will reside in a number of different repositories and will be accessed by users from a wide variety of disciplines and with a wide variety of needs. It is therefore important that appropriate informatics tools be developed and made available to the IPY community for indexing, searching, retrieving, and managing distributed polar data. Discovery, Access, and Delivery of Data for the IPY (DADDI) is a NASA-funded project involving multiple institutions, targeted at leveraging and evolving Earth Science informatics tools to meet the Informatics challenges of the IPY effort. To test our approaches, we have selected Arctic coastal data as a focus area for developing a working prototype of an IPY Informatics solution. Coastal areas are undergoing some of the most drastic changes within the polar regions and are also the area of most concentrated human activity at high latitudes. Coastal regions are also of interest to a broad range of disciplines and data customers, so this is an area where there is a high need for a robust Informatics infrastructure. In this presentation, I will review the requirements which we have collected for an information system to manage a dispersed collection of Arctic coastal data. I will then present the current version of the prototype which we are developing, discuss the ways in which the underlying tools can be leveraged out to other IPY- related areas, and discuss the lessons learned in developing this prototype information system.

  7. Evaluation of Project Students are Sun Safe (SASS): A University Student-Delivered Skin Cancer Prevention Program for Schools.

    PubMed

    Davis, Raeann; Loescher, Lois J; Rogers, Jillian; Spartonos, Denise; Snyder, Aimee; Koch, Stephanie; Harris, Robin B

    2015-12-01

    Skin cancer is the most common cancer in the USA and is increasing in children and young adults. Adolescents are an important target population for sun-safety interventions with ultraviolet radiation as the strongest risk factor for developing skin cancer. Schools are an ideal setting to intervene with adolescents. A novel Arizona skin cancer prevention in-class education-activity program, Project 'Students are Sun Safe' (SASS), was designed to be delivered by university students for middle school and high school students. Participant students completed the pre- and post-program tests and a satisfaction questionnaire; teachers completed reviews. The evaluation examined the program's influence on participants' sun-safety knowledge, perceptions, and behaviors; satisfaction with the program; and intent to change. After exposure to Project SASS, participants were more likely to perceive a high risk of skin cancer, report negative attitudes toward tanned skin, and answer knowledge-based questions correctly. There were minimal differences in self-reported sun-safety behaviors, though participants did report intent to change. Both participants and teachers were satisfied with the program. Project SASS appears to be an effective sun-safety program for middle school and high school students for knowledge and perceptions, and the results confirm that appropriately tailoring program components to the target population has strong potential to impact adolescent perceived susceptibility, knowledge, and behavioral intent. The strengths and weaknesses of Project SASS have many implications for public health practice, and Project SASS may hold promise to be a model for skin cancer prevention in adolescents. PMID:25417824

  8. Can training non-physician clinicians/associate clinicians (NPCs/ACs) in emergency obstetric, neonatal care and clinical leadership make a difference to practice and help towards reductions in maternal and neonatal mortality in rural Tanzania? The ETATMBA project

    PubMed Central

    Ellard, David R; Shemdoe, Aloisia; Mazuguni, Festo; Mbaruku, Godfrey; Davies, David; Kihaile, Paul; Pemba, Senga; Bergström, Staffan; Nyamtema, Angelo; Mohamed, Hamed-Mahfoudh; O'Hare, Joseph Paul

    2016-01-01

    Objectives During late 2010, 36 trainees including 19 assistant medical officers (AMOs) 1 senior clinical officer (CO) and 16 nurse midwives/nurses were recruited from districts across rural Tanzania and invited to join the Enhancing Human Resources and Use of Appropriate Technologies for Maternal and Perinatal Survival in the sub-Saharan Africa (ETATMBA) training programme. The ETATMBA project was training associate clinicians (ACs) as advanced clinical leaders in emergency obstetric care. The trainees returned to health facilities across the country with the hope of being able to apply their new skills and knowledge. The main aim of this study was to explore the impact of the ETATMBA training on health outcomes including maternal and neonatal morbidity and mortality in their facilities. Secondly, to explore the challenges faced in working in these health facilities. Design The study is a pre-examination/postexamination of maternal and neonatal health indicators and a survey of health facilities in rural Tanzania. The facilities surveyed were those in which ETATMBA trainees were placed post-training. The maternal and neonatal indicators were collected for 2011 and 2013 and the survey of the facilities was in early 2014. Results 16 of 17 facilities were surveyed. Maternal deaths show a non-significant downward trend over the 2 years (282–232 cases/100 000 live births). There were no significant differences in maternal, neonatal and birth complication variables across the time-points. The survey of facilities revealed shortages in key areas and some are a serious concern. Conclusions This study represents a snapshot of rural health facilities providing maternal and neonatal care in Tanzania. Enhancing knowledge, practical skills, and clinical leadership of ACs may have a positive impact on health outcomes. However, any impact may be confounded by the significant challenges in delivering a service in terms of resources. Thus, training may be beneficial, but it

  9. Project Ice Storm: Prenatal Maternal Stress Affects Cognitive and Linguistic Functioning in 5 1/2-Year-Old Children

    ERIC Educational Resources Information Center

    Laplante, David P.; Brunet, Alain; Schmitz, Norbert; Ciampi, Antonio; King, Suzanne

    2008-01-01

    The study used data from Project Ice Storm to determine the extent to which exposure to prenatal maternal stress due to a natural disaster can explain variance in the intellectual and language performance of offspring at age 5 1/2.

  10. From oral traditions to elementary textbooks: a description of the maternal languages project in Niger.

    PubMed

    Stephens, C L

    1983-12-01

    Niger is experimenting with maternal language instruction in grades 1-3, within a broader context of educational reform. In these early grades, some 25 experimental schools distributed throughout the country are using 1 of 5 national languages -- Hausa, Zarma-Songhai, Fulfulde, Tamajaq, or Kanuri -- as the language of instruction and of standardized examinations, as in traditional schools. The curriculum in these experimental schools for the early grades is also innovative and favors an interdisciplinary approach. Lessons in various subjects are linked at any given time by a them selected by teachers and students. Niger's national pedagogical institute, in collaboration with the US Agency for International Development (USAID), designed a testbook project which was built around a recorded collection of oral traditions. Once assembled, this collection served as a resource to draw on for production of readers for grades 1 through 3. These readers provide content appropriate to the curriculum and serve as an archive of oral traditions for future use. The Institute's procedure for producing elementary readers in maternal languages has not only yielded the desired books but has also facilitated institutional development in several organizations committed to producing national language materials. The project has had several phases, including the collection, transcription, and cataloging of oral materials; the preselection, adaptation, final editing, and illustration of tests; the publication of the textbooks; and the evaluation of the textbooks. Over 70 primary school teachers participated in the collection phase during the summer vacation of 1981. The teachers were selected to assure a distribution of regions and dialects for each of the 5 languages. Before returning to their villages, trainees were issued Panasonic RQ 230 9A tape recorders, batteries, and a box of 20 cassettes. Supervisory teams composed of at least 1 linguist and 1 pedagogical advisor visited each

  11. Joint Applications Pilot of the National Climate Predictions and Projections Platform and the North Central Climate Science Center: Delivering climate projections on regional scales to support adaptation planning

    NASA Astrophysics Data System (ADS)

    Ray, A. J.; Ojima, D. S.; Morisette, J. T.

    2012-12-01

    The DOI North Central Climate Science Center (NC CSC) and the NOAA/NCAR National Climate Predictions and Projections (NCPP) Platform and have initiated a joint pilot study to collaboratively explore the "best available climate information" to support key land management questions and how to provide this information. NCPP's mission is to support state of the art approaches to develop and deliver comprehensive regional climate information and facilitate its use in decision making and adaptation planning. This presentation will describe the evolving joint pilot as a tangible, real-world demonstration of linkages between climate science, ecosystem science and resource management. Our joint pilot is developing a deliberate, ongoing interaction to prototype how NCPP will work with CSCs to develop and deliver needed climate information products, including translational information to support climate data understanding and use. This pilot also will build capacity in the North Central CSC by working with NCPP to use climate information used as input to ecological modeling. We will discuss lessons to date on developing and delivering needed climate information products based on this strategic partnership. Four projects have been funded to collaborate to incorporate climate information as part of an ecological modeling project, which in turn will address key DOI stakeholder priorities in the region: Riparian Corridors: Projecting climate change effects on cottonwood and willow seed dispersal phenology, flood timing, and seedling recruitment in western riparian forests. Sage Grouse & Habitats: Integrating climate and biological data into land management decision models to assess species and habitat vulnerability Grasslands & Forests: Projecting future effects of land management, natural disturbance, and CO2 on woody encroachment in the Northern Great Plains The value of climate information: Supporting management decisions in the Plains and Prairie Potholes LCC. NCCSC's role in

  12. Preliminary Effectiveness of Project Impact: A Parent-Mediated Intervention for Children with Autism Spectrum Disorder Delivered in a Community Program

    ERIC Educational Resources Information Center

    Stadnick, Nicole A.; Stahmer, Aubyn; Brookman-Frazee, Lauren

    2015-01-01

    This is a pilot study of the effectiveness of Project ImPACT, a parent-mediated intervention for ASD delivered in a community program. The primary aim was to compare child and parent outcomes between the intervention group and a community comparison for 30 young children with ASD at baseline and 12 weeks. The secondary aim was to identify parent…

  13. Delivering safety

    SciTech Connect

    Baldwin, N.D.; Spooner, K.G.; Walkden, P.

    2007-07-01

    In the United Kingdom there have been significant recent changes to the management of civil nuclear liabilities. With the formation in April 2005 of the Nuclear Decommissioning Authority (NDA), ownership of the civil nuclear licensed sites in the UK, including the Magnox Reactor Stations, passed to this new organisation. The NDAs mission is to seek acceleration of the nuclear clean up programme and deliver increased value for money and, consequently, are driving their contractors to seek more innovative ways of performing work. British Nuclear Group manages the UK Magnox stations under contract to the NDA. This paper summarises the approach being taken within its Reactor Sites business to work with suppliers to enhance working arrangements at sites, improve the delivery of decommissioning programmes and deliver improvements in safety and environmental performance. The UK Magnox stations are 1. generation gas-graphite reactors, constructed in the 1950's and 1960's. Two stations are currently still operating, three are shut-down undergoing defueling and the other five are being decommissioned. Despite the distractions of industry restructuring, an uncompromising policy of demanding improved performance in conjunction with improved safety and environmental standards has been adopted. Over the past 5 years, this policy has resulted in step-changes in performance at Reactor Sites, with increased electrical output and accelerated defueling and decommissioning. The improvements in performance have been mirrored by improvements in safety (DACR of 0 at 5 sites); environmental standards (reductions in energy and water consumption, increased waste recycling) and the overall health of the workforce (20% reduction in sickness absence). These achievements have, in turn, been recognised by external bodies, resulting in several awards, including: the world's first ISRS and IERS level 10 awards (Sizewell, 2006), the NUMEX plant maintenance award (Bradwell, 2006), numerous Ro

  14. DELIVERING TIMELY AIR QUALITY, TRAFFIC, AND WEATHER INFORMATION TO YOUR COMMUNITY/THE PASO DEL NORTE ENVIRONMENTAL MONITORING PROJECT

    EPA Science Inventory

    EPA has developed a technology transfer handbook for the EMPACT Paso del Norte Project. The EMPACT Paso del Norte Environmental Monitoring Project is a mobile vehicle emissions project that involves the international community of El Paso, TX; Sundland Park, NM; and Juarez, Mexico...

  15. 75 FR 51083 - Office of Clinical and Preventive Services Maternal and Child Health Program: Project Choices...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-18

    ... children. This is consistent with the HHS mission to protect and advance the physical and mental health of... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Office of Clinical and Preventive Services Maternal and...

  16. Preliminary Effectiveness of Project ImPACT: A Parent-Mediated Intervention for Children with Autism Spectrum Disorder Delivered in a Community Program

    PubMed Central

    Stadnick, Nicole A.; Stahmer, Aubyn; Brookman-Frazee, Lauren

    2015-01-01

    This is a pilot study of the effectiveness of Project ImPACT, a parent-mediated intervention for ASD delivered in a community program. The primary aim was to compare child and parent outcomes between the intervention group and a community comparison for 30 young children with ASD at baseline and 12 weeks. The secondary aim was to identify parent factors associated with changes in child outcomes. Results indicated significant improvement in child communication skills and a strong trend for parent intervention adherence for the intervention group from baseline to 12 weeks. Higher baseline parenting stress was negatively related to child social gains from baseline to 12 weeks. Findings provide further support for delivering parent-mediated interventions in community settings to children with ASD. PMID:25633920

  17. Preliminary Effectiveness of Project ImPACT: A Parent-Mediated Intervention for Children with Autism Spectrum Disorder Delivered in a Community Program.

    PubMed

    Stadnick, Nicole A; Stahmer, Aubyn; Brookman-Frazee, Lauren

    2015-07-01

    This is a pilot study of the effectiveness of Project ImPACT, a parent-mediated intervention for ASD delivered in a community program. The primary aim was to compare child and parent outcomes between the intervention group and a community comparison for 30 young children with ASD at baseline and 12 weeks. The secondary aim was to identify parent factors associated with changes in child outcomes. Results indicated significant improvement in child communication skills and a strong trend for parent intervention adherence for the intervention group from baseline to 12 weeks. Higher baseline parenting stress was negatively related to child social gains from baseline to 12 weeks. Findings provide further support for delivering parent-mediated interventions in community settings to children with ASD. PMID:25633920

  18. DELIVERING TIMELY WATER QUALITY INFORMATION TO YOUR COMMUNITY: THE CHESAPEAKE BAY/NATIONAL AQUARIUM IN BALTIMORE EMPACT PROJECTS

    EPA Science Inventory

    The TTSD in conjunction with a multi-agency Chesapeake Bay Project team, has developed this handbook to provide state and local governments and others "How-to" steps needed to design, employ, and maintain water quality monitoring, data management/delivery, and communications syst...

  19. Lack of maternal folic acid supplementation is associated with heart defects in Down syndrome: a report from the National Down Syndrome Project

    PubMed Central

    Bean, Lora J. H.; Allen, Emily G.; Tinker, Stuart W.; Hollis, NaTasha D.; Locke, Adam E.; Druschel, Charlotte; Hobbs, Charlotte A.; O’Leary, Leslie; Romitti, Paul A.; Royle, Marjorie H.; Torfs, Claudine P.; Dooley, Kenneth J.; Freeman, Sallie B.; Sherman, Stephanie L.

    2011-01-01

    BACKGROUND Maternal folic acid supplementation has been associated with a reduced risk for neural tube defects, and may be associated with a reduced risk for congenital heart defects, and other birth defects. Individuals with Down syndrome are at high risk for congenital heart defects and have been shown to have abnormal folate metabolism. METHODS As part of the population-based case-control National Down Syndrome Project, 1011 mothers of infants with Down syndrome reported their use of folic acid-containing supplements. These data were used to determine whether lack of periconceptional maternal folic acid supplementation is associated with congenital heart defects in Down syndrome. We used logistic regression to test the relationship between maternal folic acid supplementation and the frequency of specific heart defects correcting for maternal race/ethnicity, proband sex, maternal use of alcohol and cigarettes, and maternal age at conception. RESULTS Lack of maternal folic acid supplementation was more frequent among infants with Down syndrome and atrioventricular septal defects (OR=1.69; 95% CI, 1.08–2.63; P=0.011) or atrial septal defects (OR=1.69; 95% CI, 1.11–2.58; P=0.007) than among infants with Down syndrome and no heart defect. Preliminary evidence suggests that the patterns of association differ by race/ethnicity and sex of the proband. There was no statistically significant association with ventricular septal defects (OR=1.26; 95% CI, 0.85–1.87; P=0.124). CONCLUSIONS Our results suggest that lack of maternal folic acid supplementation is associated with septal defects in infants with Down syndrome. PMID:21987466

  20. The EUSTACE project: combining different components of the observing system to deliver global, daily information on surface air temperature

    NASA Astrophysics Data System (ADS)

    Rayner, Nick

    2016-04-01

    Day-to-day variations in surface air temperature affect society in many ways and are fundamental information for many climate services; however, daily surface air temperature measurements are not available everywhere. A global daily analysis cannot be achieved with measurements made in situ alone, so incorporation of satellite retrievals is needed. To achieve this, we must develop an understanding of the relationships between traditional surface air temperature measurements and retrievals of surface skin temperature from satellite measurements, i.e. Land Surface Temperature, Ice Surface Temperature, Sea Surface Temperature and Lake Surface Water Temperature. Here we reflect on our experience so far within the Horizon 2020 project EUSTACE of using satellite skin temperature retrievals to help us to produce a fully-global daily analysis (or ensemble of analyses) of surface air temperature on the centennial scale, integrating different ground-based and satellite-borne data types and developing new statistical models of how surface air temperature varies in a connected way from place to place. We will present plans and progress along this road in the EUSTACE project (2015-June 2018): - providing new, consistent, multi-component estimation of uncertainty in surface skin temperature retrievals from satellites; - identifying inhomogeneities in daily surface air temperature measurement series from weather stations and correcting for these over Europe; - estimating surface air temperature over all surfaces of Earth from surface skin temperature retrievals; - using new statistical techniques to provide information on higher spatial and temporal scales than currently available, making optimum use of information in data-rich eras. Information will also be given on how interested users can become involved.

  1. The NASA IceBridge Project Quickly Delivers Snow and Ice Elevation Measurements of Dynamic Polar Landscapes

    NASA Astrophysics Data System (ADS)

    Tressel, S. S.; Kaminski, M. L.; Brodzik, M.

    2012-12-01

    NASA's Operation IceBridge was formulated to bridge the gap between the ICESat and ICESat-2 satellite missions. IceBridge data are collected by a wide variety of instrumentation aboard aircraft that trace routes around Greenland, Alaska and Antarctica, concentrating on areas experiencing accelerated change. Data parameters such as ice surface elevation, ice bottom elevation, snow and ice depth, grounding line position, sea ice distribution and freeboard are extracted at resolutions better than what can be expected by satellite. IceBridge provides the continuity of such data until the launch of the ICESat-2 satellite, expected in 2016. NSIDC manages the data distribution and makes the data available quickly and effectively to any and all interested parties. For example, the MCoRDS L1B Geolocated Radar Echo Strength Profiles data represents one of 60 total data products available through the IceBridge project. The MCoRDS L1B data for the Greenland 2012 campaign exhibit ice surface and ice bottom information for areas of Greenland between 27 March 2012 and 17 May 2012. In July of 2012, these data were made available on the NSIDC Web site, allowing users to begin analyzing the data only a couple of months after the data collection. The data are distributed in MATLAB files with associated PDF, TIFF and PNG files. Comparable data are available starting in 2009 for periodic campaigns covering both Greenland and Antarctica. These data can be combined with an array of other parameters to track the state of the most crucial areas of the Earth's cryosphere.

  2. Pilot study of a program delivered within the regular service system in Germany: effect of a short-term attachment-based intervention on maternal sensitivity in mothers at risk for child abuse and neglect.

    PubMed

    Pillhofer, Melanie; Spangler, Gottfried; Bovenschen, Ina; Kuenster, Anne K; Gabler, Sandra; Fallon, Barbara; Fegert, Joerg M; Ziegenhain, Ute

    2015-04-01

    This pilot study examined the effectiveness of a short-term attachment-based intervention, the Ulm Model, in a German population at risk for child abuse and neglect. The intervention used home visits and video feedback to promote maternal sensitivity, and was implemented by trained staff within the health care and youth welfare systems. Mothers in the control group (n=33) received standard services only, while those in the intervention group (n=63) additionally the Ulm Model intervention. The outcomes measured were maternal sensitivity, as assessed by the CARE-Index at pre-intervention, after the last session, and at about 6 and 12 months of age; and infant socio-emotional development, as assessed by the ET6-6 development test at about 6 and 12 months of age. The moderating effects on treatment outcomes of two variables were examined: risk for child abuse (moderate vs. high) and type of maternal attachment representation (secure vs. insecure). Among participants at moderate risk for child abuse, no differences were found between the intervention group and control group in either maternal sensitivity or infant development. Among those considered high risk, mothers in the intervention group showed a significant increase in maternal sensitivity from pre- to post-intervention; however, no group differences were seen at follow-up. There were some indications that infants of mothers in the intervention group showed better emotional development. The variable of maternal attachment representation was not a significant moderator for the intervention effect, but post hoc analysis indicated that the mean sensitivity of secure mothers was significant higher at the 6-month follow-up. PMID:25066526

  3. Prenatal maternal stress predicts autism traits in 6½ year-old children: Project Ice Storm.

    PubMed

    Walder, Deborah J; Laplante, David P; Sousa-Pires, Alexandra; Veru, Franz; Brunet, Alain; King, Suzanne

    2014-10-30

    Research implicates prenatal maternal stress (PNMS) as a risk factor for neurodevelopmental disorders; however few studies report PNMS effects on autism risk in offspring. We examined, prospectively, the degree to which objective and subjective elements of PNMS explained variance in autism-like traits among offspring, and tested moderating effects of sex and PNMS timing in utero. Subjects were 89 (46F/43M) children who were in utero during the 1998 Quebec Ice Storm. Soon after the storm, mothers completed questionnaires on objective exposure and subjective distress, and completed the Autism Spectrum Screening Questionnaire (ASSQ) for their children at age 6½. ASSQ scores were higher among boys than girls. Greater objective and subjective PNMS predicted higher ASSQ independent of potential confounds. An objective-by-subjective interaction suggested that when subjective PNMS was high, objective PNMS had little effect; whereas when subjective PNMS was low, objective PNMS strongly affected ASSQ scores. A timing-by-objective stress interaction suggested objective stress significantly affected ASSQ in first-trimester exposed children, though less so with later exposure. The final regression explained 43% of variance in ASSQ scores; the main effect of sex and the sex-by-PNMS interactions were not significant. Findings may help elucidate neurodevelopmental origins of non-clinical autism-like traits from a dimensional perspective. PMID:24907222

  4. Maternal microchimerism

    PubMed Central

    Ye, Jody; Vives-Pi, Marta; Gillespie, Kathleen M

    2014-01-01

    Increased levels of non-inherited maternal HLA alleles have been detected in the periphery of children with type 1 diabetes and an increased frequency of maternal cells have been identified in type 1 diabetes pancreas. It is now clear that the phenotype of these cells is pancreatic,1 supporting the hypothesis that maternal cells in human pancreas are derived from multipotent maternal progenitors. Here we hypothesize how increased levels of maternal cells could play a role in islet autoimmunity. PMID:25093746

  5. Community-based delivery of maternal care in conflict-affected areas of eastern Burma: perspectives from lay maternal health workers.

    PubMed

    Teela, Katherine C; Mullany, Luke C; Lee, Catherine I; Poh, Eh; Paw, Palae; Masenior, Nicole; Maung, Cynthia; Beyrer, Chris; Lee, Thomas J

    2009-04-01

    In settings where active conflict, resource scarcity, and logistical constraints prevail, provision of maternal health services within health centers and hospitals is unfeasible and alternative community-based strategies are needed. In eastern Burma, such conditions necessitated implementation of the "Mobile Obstetric Maternal Health Worker" (MOM) project, which has employed a community-based approach to increase access to essential maternal health services including emergency obstetric care. Lay Maternal Health Workers (MHWs) are central to the MOM service delivery model and, because they are accessible to both the communities inside Burma and to outside project managers, they serve as key informants for the project. Their insights can facilitate program and policy efforts to overcome critical delays and insufficient management of maternal complications linked to maternal mortality. Focus group discussions (n=9), in-depth interviews (n=18), and detailed case studies (n=14) were collected from MHWs during centralized project management meetings in February and October of 2007. Five case studies are presented to characterize and interpret the realities of reproductive health work in a conflict-affected setting. Findings highlight the process of building supportive networks and staff ownership of the MOM project, accessing and gaining community trust and participation to achieve timely delivery of care, and overcoming challenges to manage and appropriately deliver essential health services. They suggest that some emergency obstetric care services that are conventionally delivered only within healthcare settings might be feasible in community or home-based settings when alternatives are not available. This paper provides an opportunity to hear directly from community-based workers in a conflict setting, perspectives seldom documented in the scientific literature. A rights-based approach to service delivery and its suitability in settings where human rights violations

  6. Maternal Vitamin D Status and Spontaneous Preterm Birth by Placental Histology in the US Collaborative Perinatal Project

    PubMed Central

    Bodnar, Lisa M.; Klebanoff, Mark A.; Gernand, Alison D.; Platt, Robert W.; Parks, W. Tony; Catov, Janet M.; Simhan, Hyagriv N.

    2014-01-01

    The objective of this study was to determine the association between maternal 25-hydroxyvitamin D (25(OH)D) and the risk of spontaneous preterm birth (sPTB) before 35 weeks’ gestation. A random subcohort from the US Collaborative Perinatal Project (1959–1965) was sampled (n = 2,629) and augmented with all remaining cases of sPTB before 35 weeks’ gestation for a total of 767 cases. Banked serum samples collected at 26 weeks’ gestation or earlier were assayed for 25(OH)D. Constructs for vascular histology and inflammatory histology were developed from placental pathology examinations. There was no relationship between 25(OH)D and sPTB among white women. Among nonwhite mothers, serum 25(OH)D levels of 30–<50, 50–<75, and ≥75 nmol/L were associated with reductions of 1.0–1.6 cases of sPTB per 100 live births and 20%–30% reductions in risk of sPTB compared with 25(OH)D levels less than 30 nmol/L after adjustment for prepregnancy body mass index (weight (kg)/height (m)2), season, and other confounders. This association was driven by inflammation-mediated cases of sPTB and sPTB cases without placental lesions. A sensitivity analysis for unmeasured confounding by exercise, fish intake, and skin color suggested some bias away from the null in the conventional results, but conclusions were generally supported. The vitamin D–sPTB relationship should be examined in modern cohorts with detailed data on skin pigmentation and other covariates. PMID:24124195

  7. Maternal Immunization

    PubMed Central

    Chu, Helen Y.; Englund, Janet A.

    2014-01-01

    Maternal immunization has the potential to protect the pregnant woman, fetus, and infant from vaccine-preventable diseases. Maternal immunoglobulin G is actively transported across the placenta, providing passive immunity to the neonate and infant prior to the infant's ability to respond to vaccines. Currently inactivated influenza, tetanus toxoid, and acellular pertussis vaccines are recommended during pregnancy. Several other vaccines have been studied in pregnancy and found to be safe and immunogenic and to provide antibody to infants. These include pneumococcus, group B Streptococcus, Haemophilus influenzae type b, and meningococcus vaccines. Other vaccines in development for potential maternal immunization include respiratory syncytial virus, herpes simplex virus, and cytomegalovirus vaccines. PMID:24799324

  8. Maternal immunization

    PubMed Central

    Moniz, Michelle H; Beigi, Richard H

    2014-01-01

    Maternal immunization holds tremendous promise to improve maternal and neonatal health for a number of infectious conditions. The unique susceptibilities of pregnant women to infectious conditions, as well as the ability of maternally-derived antibody to offer vital neonatal protection (via placental transfer), together have produced the recent increased attention on maternal immunization. The Advisory Committee on Immunization Practices (ACIP) currently recommends 2 immunizations for all pregnant women lacking contraindication, inactivated Influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap). Given ongoing research the number of vaccines recommended during pregnancy is likely to increase. Thus, achieving high vaccination coverage of pregnant women for all recommended immunizations is a key public health enterprise. This review will focus on the present state of vaccine acceptance in pregnancy, with attention to currently identified barriers and determinants of vaccine acceptance. Additionally, opportunities for improvement will be considered. PMID:25483490

  9. Using Technology to Claim Rights to Free Maternal Health Care: Lessons about Impact from the My Health, My Voice Pilot Project in India.

    PubMed

    Dasgupt, Jashodhara; Sandhya, Y K; Lobis, Samantha; Verma, Pravesh; Schaaf, Marta

    2015-01-01

    My Health, My Voice is a human rights-based project that pilots the use of technology to monitor and display online data regarding informal payments for maternal health care in two districts of Uttar Pradesh, India. SAHAYOG, an organization based in Uttar Pradesh, partnered with a grassroots women's forum to inform women about their entitlements, to publicize the project, and to implement a toll-free hotline where women could report health providers' demands for informal payments. Between January 2012 and May 2013, the hotline recorded 873 reports of informal payment demands. Monitoring and evaluation revealed that the project enhanced women's knowledge of their entitlements, as well as their confidence to claim their rights. Anecdotal evidence suggests that health providers' demands for informal payments were reduced in response to the project, although hospital and district officials did not regularly consult the data. The use of technology accorded greater legitimacy among governmental stakeholders. Future research should examine the sustainability of changes, as well as the mechanisms driving health sector responsiveness. PMID:26766855

  10. Metallochaperones: bind and deliver

    SciTech Connect

    Rosenzweig, A.C.

    2010-03-08

    Metallochaperones deliver metal ions directly to target proteins via specific protein-protein interactions. Recent research has led to a molecular picture of how some metallochaperones bind metal ions, recognize their partner proteins, and accomplish metal ion transfer.

  11. Realizing universal health coverage for maternal health services in the Republic of Guinea: the use of workforce projections to design health labor market interventions

    PubMed Central

    Jansen, Christel; Codjia, Laurence; Cometto, Giorgio; Yansané, Mohamed Lamine; Dieleman, Marjolein

    2014-01-01

    Background Universal health coverage requires a health workforce that is available, accessible, and well-performing. This article presents a critical analysis of the health workforce needs for the delivery of maternal and neonatal health services in Guinea, and of feasible and relevant interventions to improve the availability, accessibility, and performance of the health workforce in the country. Methods A needs-based approach was used to project human resources for health (HRH) requirements. This was combined with modeling of future health sector demand and supply. A baseline scenario with disaggregated need and supply data for the targeted health professionals per region and setting (urban or rural) informed the identification of challenges related to the availability and distribution of the workforce between 2014 and 2024. Subsequently, the health labor market framework was used to identify interventions to improve the availability and distribution of the health workforce. These interventions were included in the supply side modeling, in order to create a “policy rich” scenario B which allowed for analysis of their potential impact. Results In the Republic of Guinea, only 44% of the nurses and 18% of the midwives required for maternal and neonatal health services are currently available. If Guinea continues on its current path without scaling up recruitment efforts, the total stock of HRH employed by the public sector will decline by 15% between 2014 and 2024, while HRH needs will grow by 22% due to demographic trends. The high density of HRH in urban areas and the high number of auxiliary nurses who are currently employed pose an opportunity for improving the availability, accessibility, and performance of the health workforce for maternal and neonatal health in Guinea, especially in rural areas. Conclusion Guinea will need to scale up its recruitment efforts in order to improve health workforce availability. Targeted labor market interventions need to be

  12. The Effects of the Coordinated Consumer Education Project on Improving Maternal and Infant Care Practices in Appalachia.

    ERIC Educational Resources Information Center

    Adams, Kay A.; And Others

    Findings from a qualitative evaluation of the Coordinated Consumer Health Education Project in rural Eastern Kentucky are presented. The purpose of the project is to provide health education for pregnant and lactating women and their infants up to one year of age through a coordinated effort with other health care providers. The evaluation…

  13. Maternal mortality in Yazd Province, Iran

    PubMed Central

    Karimi-Zarchi, Mojgan; Ghane-Ezabadi, Marzie; Vafaienasab, Mohammadreza; Dehghan, Ali; Ghasemi, Fateme; Zaidabadi, Mahbube; Zanbagh, Leila; Yazdian-Anari, Pouria; Teimoori, Soraya

    2016-01-01

    Introduction Five hundred thousand maternal deaths occur each year worldwide, many of which are in developing countries. The maternal mortality rate is a measure that demonstrates the degree of adequacy of prenatal care and of economic and social conditions. The aim of this study was to determine the frequency and causes of pregnancy-related mortality rates in Yazd Province. Methods This cross-sectional study examined the maternal deaths related to pregnancy that were recorded in Yazd Province, Iran, from 2002 to 2011. All maternal deaths that occurred during pregnancy, during delivery, and 42 days after birth were analyzed in this study. The data were collected through a questionnaire, and both direct and indirect causes of maternal deaths were determined. Results Forty pregnancy-related deaths occurred in this period, and the maternal mortality rate was 20.8 deaths per 100,000 live births. The mean age of death in the mothers in this study was 29.17. Fifty-five percent of women of the women who died delivered their babies by cesarean section, and only 20% of them delivered their babies vaginally. Bleeding was the most common cause of maternal mortality (30%), and it was associated directly with maternal mortality. Furthermore 20% of the mothers died due to heart disease and cardiac complications, which were associated indirectly with maternal mortality. Conclusion Cesarean section and its complications were the main cause of death in many cases. Thus, providing a strategic plan to reduce the use of this procedure, educate mothers, and ensure adequate access to pre-maternal care and to care during pregnancy are the most important measures that can be taken to decrease the maternal mortality rate. PMID:27054003

  14. Maternity telehealth: ringing the changes.

    PubMed

    Finlay, Dorothy; Brown, Sheona

    2013-12-01

    This article describes NHS Scotland's Maternity telehealth options project and the implementation of the recommendations made. This 17-month project resulted in the development of national documentation for recording telehealth calls; the development of a self-directed eLearning tool on maternity telehealth call structure which was made available to all health boards in Scotland; a comprehensive programme of training on telehealth for student midwives; a programme of 'Train-the-trainer' events for qualified midwives to enable the cascade of learning throughout the service. The project also involved collaboration with Health Scotland, signposting for women to contact the appropriate caregiver at the appropriate time. PMID:24386706

  15. Delivering PrePex Medical Male Circumcision Services Through a Mobile Clinic: The Experience From a Pilot Project in North West Province, South Africa.

    PubMed

    Kufa, Tendesayi; Chetty-Makkan, Candice; Maraisane, Mpho; Charalambous, Salome; Chihota, Violet; Toledo, Carlos

    2016-06-01

    We describe the implementation of a pilot project to demonstrate the safety and feasibility of providing PrePex circumcision from a mobile clinic. We analyzed available project diary entries and staff meeting minutes to identify challenges encountered. The main challenges identified were (1) daily time constraints because of setting up procedures, (2) transportation logistics for clients when the mobile clinic had moved to a different location, (3) integration and coordination of staff responsibilities, and (4) recruitment for PrePex services in the mobile clinic. The provision of PrePex device circumcision through a mobile clinic was feasible but careful planning and review of operational procedures were needed to resolve the implementation challenges. PMID:27331594

  16. Delivering PrePex Medical Male Circumcision Services Through a Mobile Clinic: The Experience From a Pilot Project in North West Province, South Africa

    PubMed Central

    Chetty-Makkan, Candice; Maraisane, Mpho; Charalambous, Salome; Chihota, Violet; Toledo, Carlos

    2016-01-01

    Abstract: We describe the implementation of a pilot project to demonstrate the safety and feasibility of providing PrePex circumcision from a mobile clinic. We analyzed available project diary entries and staff meeting minutes to identify challenges encountered. The main challenges identified were (1) daily time constraints because of setting up procedures, (2) transportation logistics for clients when the mobile clinic had moved to a different location, (3) integration and coordination of staff responsibilities, and (4) recruitment for PrePex services in the mobile clinic. The provision of PrePex device circumcision through a mobile clinic was feasible but careful planning and review of operational procedures were needed to resolve the implementation challenges. PMID:27331594

  17. Maternal Employment

    ERIC Educational Resources Information Center

    Clark, Sam

    1975-01-01

    The overwhelming evidence from years of research is that maternal employment, by itself, has little influence on the behaviors of children. More relevant issues are: mother's reasons for working, family's acceptance of mother's employment, quality of substitute child care, family's social and emotional health, and economic conditions. (Author/AJ)

  18. Financial incentives to influence maternal mortality in a low-income setting: making available ‘money to transport’ – experiences from Amarpatan, India

    PubMed Central

    De Costa, Ayesha; Patil, Rajkumar; Kushwah, Surgiv Singh; Diwan, Vinod Kumar

    2009-01-01

    Objectives Only 40.7% women in India deliver in an institution; leaving many vulnerable to maternal morbidity and mortality (India has 22% of global maternal deaths). While limited accessibility to functioning institutions may account in part, a common reason why women deliver at home is poverty. A lack of readily available financial resources for families to draw upon at the time of labor to transport the mother to an institution, is often observed. This paper reports a yearlong collaborative intervention (between the University and Department of Health) to study if providing readily available and easily accessible funds for emergency transportation would reduce maternal deaths in a rural, low income, and high maternal mortality setting in central India. It aimed to obviate a deterrent to emergency obstetric care; the non-availability of resources with mothers when most needed. Issues in implementation are also discussed. Methods Maternal deaths were actively identified in block Amarpatan (0.2 million population) over a 2-year period. The project, with participation from local government and other groups, trained 482 local health care providers (public and private) to provide antenatal care. Emergency transport money (in cash) was placed with one provider in each village. Maternal mortality in the adjacent block (Maihar) was followed (as a ‘control’ block). Results Maternal deaths in Amarpatan decreased during the project year relative to the previous year, or in the control block the same year. Discussion and conclusions Issues in implementation of the cash incentive scheme are discussed. Although the intervention reduced maternal deaths in this low-income setting, chronic poverty and malnutrition are underlying structural problems that need to be addressed. PMID:20027276

  19. Design Environment for Novel Vertical Lift Vehicles: DELIVER

    NASA Technical Reports Server (NTRS)

    Theodore, Colin

    2016-01-01

    This is a 20 minute presentation discussing the DELIVER vision. DELIVER is part of the ARMD Transformative Aeronautics Concepts Program, particularly the Convergent Aeronautics Solutions Project. The presentation covers the DELIVER vision, transforming markets, conceptual design process, challenges addressed, technical content, and FY2016 key activities.

  20. Managing and delivering of 3D geo data across institutions has a web based solution - intermediate results of the project GeoMol.

    NASA Astrophysics Data System (ADS)

    Gietzel, Jan; Schaeben, Helmut; Gabriel, Paul

    2014-05-01

    The increasing relevance of geological information for policy and economy at transnational level has recently been recognized by the European Commission, who has called for harmonized information related to reserves and resources in the EU Member States. GeoMol's transnational approach responds to that, providing consistent and seamless 3D geological information of the Alpine Foreland Basins based on harmonized data and agreed methodologies. However, until recently no adequate tool existed to ensure full interoperability among the involved GSOs and to distribute the multi-dimensional information of a transnational project facing diverse data policy, data base systems and software solutions. In recent years (open) standards describing 2D spatial data have been developed and implemented in different software systems including production environments for 2D spatial data (like regular 2D-GI-Systems). Easy yet secured access to the data is of upmost importance and thus priority for any spatial data infrastructure. To overcome limitations conditioned by highly sophisticated and platform dependent geo modeling software packages functionalities of a web portals can be utilized. Thus, combining a web portal with a "check-in-check-out" system allows distributed organized editing of data and models but requires standards for the exchange of 3D geological information to ensure interoperability. Another major concern is the management of large models and the ability of 3D tiling into spatially restricted models with refined resolution, especially when creating countrywide models . Using GST ("Geosciences in Space and Time") developed initially at TU Bergakademie Freiberg and continuously extended by the company GiGa infosystems, incorporating these key issues and based on an object-relational data model, it is possible to check out parts or whole models for edits and check in again after modification. GST is the core of GeoMol's web-based collaborative environment designed to

  1. A family planning program based on maternal and child health services.

    PubMed

    Taylor, H C; Rosenfield, A G

    1974-11-15

    A feasibility study for maternity-centered family planning to be located in Indonesia, the Philippines, Turkey, Brazil, Egypt, and Bangladesh is presented. The project will aim at women who are pregnant, recently delivered, or have young children. The objectives of the project are to improve health and reduce fertility. The program will include antepartum care including maternity care and education and motivation for family planning. Delivery will occur routinely at home aided by an indigenous village midwife. Postpartum care will include care for the mother, further motivation and initiation of contraception, immunization, and nutrition for the infant. Health personnel involved in the program will include physicians, trained midwives, field workers, and indigenous midwives. The average annual per capita cost will be U.S. $.97, including evaluation and technical assistance, and for service alone, $.47. PMID:4429081

  2. Time Resolved Contrast Enhanced Intracranial MRA Using a Single Dose Delivered as Sequential Injections and Highly Constrained Projection Reconstruction (HYPR CE)

    PubMed Central

    Wu, Yijing; Johnson, Kevin; Kecskemeti, Steven R.; Wang, Kang; Wieben, Oliver; Aagaard-Kienitz, Beverly L.; Rowley, Howard; Korosec, Frank R.; Mistretta, Charles; Turski, Patrick

    2011-01-01

    Time-resolved contrast-enhanced magnetic resonance angiography of the brain is challenging due to the need for rapid imaging and high spatial resolution. Moreover, the significant dispersion of the intravenous contrast bolus as it passes through the heart and lungs increases the overlap between arterial and venous structures, regardless of the acquisition speed and reconstruction window. An innovative technique is presented that divides a single dose contrast into two injections. Initially a small volume of contrast material (2–3 mL) is used to acquiring time-resolved weighting images with a high frame rate (2 frames/s) during the first pass of the contrast agent. The remaining contrast material is used to obtain a high resolution whole brain contrast-enhanced (CE) magnetic resonance angiography (0.57 × 0.57 × 1 mm3) that is used as the spatial constraint for Local Highly Constrained Projection Reconstruction (HYPR LR) reconstruction. After HYPR reconstruction, the final dynamic images (HYPR CE) have both high temporal and spatial resolution. Furthermore, studies of contrast kinetics demonstrate that the shorter bolus length from the reduced contrast volume used for the first injection significantly improves the arterial and venous separation. PMID:21413059

  3. Delivering Science from Big Data

    NASA Astrophysics Data System (ADS)

    Quinn, Peter Joseph

    2015-08-01

    The SKA will be capable of producing a stream of science data products that are Exa-scale in terms of their storage and processing requirements. This Google-scale enterprise is attracting considerable international interest and excitement from within the industrial and academic communities. In this paper we examine the data flow, storage and processing requirements of a number of key SKA survey science projects to be executed on the baseline SKA1 configuration. Based on a set of conservative assumptions about trends for HPC and storage costs, and the data flow process within the SKA Observatory, it is apparent that survey projects of the scale proposed will potentially drive construction and operations costs beyond the current anticipated SKA1 budget. This implies a sharing of the resources and costs to deliver SKA science between the community and what is contained within the SKA Observatory. A similar situation was apparent to the designers of the LHC more than 10 years ago. We propose that it is time for the SKA project and broader community to consider the effort and process needed to design and implement a distributed science data system that leans on the lessons of other projects and looks to recent developments in Cloud technologies to ensure an affordable, effective and global achievement of science goals.

  4. An Interprofessional Quality Improvement Project to Implement Maternal/Infant Skin-to-Skin Contact During Cesarean Delivery

    PubMed Central

    Brady, Karen; Bulpitt, Denise; Chiarelli, Caren

    2014-01-01

    Immediate skin-to-skin contact between a mother and her newborn has been associated with successful breastfeeding outcomes. One of the challenges nurses face in promoting skin-to-skin occurs in the operating room during a cesarean delivery. Utilizing an interprofessional approach for this quality improvement project, we successfully implemented skin-to-skin contact for all eligible mother/infant couplets after cesarean birth. Exclusive breastfeeding rates for these women increased as a result. PMID:24981767

  5. Maternal mental health: The missing "m" in the global maternal and child health agenda.

    PubMed

    Atif, Najia; Lovell, Karina; Rahman, Atif

    2015-08-01

    While the physical health of women and children is emphasized, the mental aspects of their health are often ignored by maternal and child health programs, especially in low- and middle-income countries. We review the evidence of the magnitude, impact, and interventions for common maternal mental health problems with a focus on depression, the condition with the greatest public health impact. The mean prevalence of maternal depression ranges between 15.6% in the prenatal and 19.8% in the postnatal period. It is associated with preterm birth, low birth weight, and poor infant growth and cognitive development. There is emerging evidence for the effectiveness of interventions, especially those that can be delivered by non-specialists, including community health workers, in low-income settings. Strategies for integrating maternal mental health in the maternal and child health agenda are suggested. PMID:26164538

  6. Infant emotional distress, maternal restriction at a home meal, and child BMI gain through age 6years in the Colorado Adoption Project.

    PubMed

    Hittner, James B; Johnson, Cassandra; Tripicchio, Gina; Faith, Myles S

    2016-04-01

    Infant temperament and parental feeding practices may be risk factors for childhood obesity, however most studies have relied upon parent-report assessments. We tested whether infant emotional distress and maternal restrictive feeding at 12-months of age, assessed observationally at a home feeding interaction, predicted child BMI through age 6years. We conducted a prospective observational study of 86 children (34 girls and 52 boys, from 55 adoptive and 31 non-adoptive families) enrolled in the Colorado Adoption Project. Mother-infant feeding interactions were video-recorded during a home snack or meal at year 1, and child anthropometrics (length or height, and weight) were assessed at years 1 through 6. The main outcome measures were child weight-for-length at year 1 and body mass index (BMI: kg/m(2)) at years 2-6. Results of generalized linear models indicated that greater infant emotional distress at 12-months predicted greater increases in child weight status through age 6years, B=0.62 and odds ratio (OR)=1.87. In separate analyses, restrictive feeding interacted with child sex in predicting weight status trajectories (p=.012). Male infants whose mothers displayed any compared to no restriction at year 1 showed a downward BMI trajectory from 2 to 6years; for female infants, exposure to any compared to no restriction prompts predicted increasing BMI from 4 to 6years. In sum, early obesity prevention strategies should pay greater attention to infant temperament, especially distress and negative affect, and how parents respond to such cues. Additionally, 'responsive feeding' strategies that provide an alternative to restriction warrant greater research during infancy. PMID:26872074

  7. Change in Oregon Maternity Care Workforce after Malpractice Premium Subsidy Implementation

    PubMed Central

    Smits, Ariel K; King, Valerie J; Rdesinski, Rebecca E; Dodson, Lisa G; Saultz, John W

    2009-01-01

    Objectives (1) To determine the proportion of maternity care providers who continue to deliver babies in Oregon; (2) to determine the important factors relating to the decision to discontinue maternity care services; and (3) to examine how the rural liability subsidy is affecting rural maternity care providers' ability to provide maternity care services. Study Design We surveyed all obstetrical care providers in Oregon in 2002 and 2006. Survey data, supplemented with state administrative data, were analyzed for changes in provision of maternity care, reasons for stopping maternity care, and effect of the malpractice premium subsidy on practice. Principal Findings Only 36.6% of responding clinicians qualified to deliver babies were actually providing maternity care in Oregon in 2006, significantly lower than the proportion (47.8%) found in 2002. Cost of malpractice premiums remains the most frequently cited reason for stopping maternity care, followed by lifestyle issues. Receipt of the malpractice subsidy was not associated with continuing any maternity services. Conclusions Oregon continues to lose maternity care providers. A state program subsidizing the liability premiums of rural maternity care providers does not appear effective at keeping rural providers delivering babies. Other policies to encourage continuation of maternity care need to be considered. PMID:19500166

  8. Randomized Controlled Trial of a Paraprofessional-Delivered In-Home Intervention for Young Reservation-Based American Indian Mothers

    ERIC Educational Resources Information Center

    Walkup, John T.; Mullany, Britta C.; Pan, William; Goklish, Novalene; Hasting, Ranelda; Cowboy, Brandii; Fields, Pauline; Baker, Elena Varipatis; Speakman, Kristen; Ginsburg, Golda; Reid, Raymond

    2009-01-01

    The efficacy of the paraprofessional-delivered Family Spirit home-visiting intervention for young American Indian mothers on maternal knowledge and infant behavior outcomes is supported. Participating mothers showed greater knowledge gains compared to non-participating mothers.

  9. Assessing Community Based Improved Maternal Neonatal Child Survival (IMNCS) Program in Rural Bangladesh

    PubMed Central

    Mistry, Sabuj Kanti; Chowdhury, Tridib Roy; Ishaque, Tanveen; Shah, Rasheduzzaman

    2015-01-01

    Objectives A community based approach before, during and after child birth has been proven effective address the burden of maternal, neonatal and child morbidity and mortality in the low and middle income countries. We aimed to examine the overall change in maternal and newborn health outcomes due the “Improved Maternal Newborn and Child Survival” (IMNCS) project, which was implemented by BRAC in rural communities of Bangladesh. Methods The intervention was implemented in four districts for duration of 5-years, while two districts served as comparison areas. The intervention was delivered by community health workers who were trained on essential maternal, neonatal and child health care services. A baseline survey was conducted in 2008 among 7, 200 women with pregnancy outcome in last year or having a currently alive child of 12–59 months. A follow-up survey was administered in 2012–13 among 4, 800 women of similar characteristics in the same villages. Findings We observed significant improvements in maternal and essential newborn care in intervention areas over time, especially in health care seeking behaviors. The proportion of births taking place at home declined in the intervention districts from 84.3% at baseline to 71.2% at end line (P<0.001). Proportion of deliveries with skilled attendant was higher in intervention districts (28%) compared to comparison districts (27.4%). The number of deliveries was almost doubled at public sector facility comparing with baseline (P<0.001). Significant improvement was also observed in healthy cord care practice, delayed bathing of the new-born and reduction of infant mortality in intervention districts compared to that of comparison districts. Conclusions This study demonstrates that community-based efforts offer encouraging evidence and value for combining maternal, neonatal and child health care package. This approach might be considered at larger scale in similar settings with limited resources. PMID:26340672

  10. Delivering bad news to patients.

    PubMed

    Monden, Kimberley R; Gentry, Lonnie; Cox, Thomas R

    2016-01-01

    When physicians lack proper training, breaking bad news can lead to negative consequences for patients, families, and physicians. A questionnaire was used to determine whether a didactic program on delivering bad news was needed at our institution. Results revealed that 91% of respondents perceived delivering bad news as a very important skill, but only 40% felt they had the training to effectively deliver such news. We provide a brief review of different approaches to delivering bad news and advocate for training physicians in a comprehensive, structured model. PMID:26722188

  11. Strategies To Boost Maternal Immunization To Achieve Further Gains In Improved Maternal And Newborn Health.

    PubMed

    Steedman, Mark R; Kampmann, Beate; Schillings, Egbert; Al Kuwari, Hanan; Darzi, Ara

    2016-02-01

    Despite the indisputable successes of the United Nations Millennium Development Goals, which include goals on improving maternal health and reducing child mortality, millions of mothers and newborns still die tragically and unnecessarily each year. Many of these deaths result from vaccine-preventable diseases, since obstacles such as cost and accessibility have hampered efforts to deliver efficacious vaccines to those most in need. Additionally, many vaccines given to mothers and children under age five are not suitable for newborns, since their maturing immune systems do not respond optimally during the first few months of life. Maternal immunization-the process by which a pregnant woman's immune system is fortified against a particular disease and the protection is then transferred to her unborn child-has emerged as a strategy to prevent many unnecessary maternal and newborn deaths. We review vaccines that are already used for maternal immunization, analyze vaccines under development that could be used for maternal immunization strategies in the future, and recommend that policy makers use maternal immunization for improved maternal and newborn health. PMID:26858385

  12. First Steps in Initiating an Effective Maternal, Neonatal, and Child Health Program in Urban Slums: the BRAC Manoshi Project's Experience with Community Engagement, Social Mapping, and Census Taking in Bangladesh.

    PubMed

    Marcil, Lucy; Afsana, Kaosar; Perry, Henry B

    2016-02-01

    The processes for implementing effective programs at scale in low-income countries have not been well-documented in the peer-reviewed literature. This article describes the initial steps taken by one such program--the BRAC Manoshi Project, which now reaches a population of 6.9 million. The project has achieved notable increases in facility births and reductions in maternal and neonatal mortality. The focus of the paper is on the initial steps--community engagement, social mapping, and census taking. Community engagement began with (1) engaging local leaders, (2) creating Maternal, Neonatal, and Child Health Committees for populations of approximately 10,000 people, (3) responding to advice from the community, (4) social mapping of the community, and (5) census taking. Social mapping involved community members working with BRAC staff to map all important physical features that affect how the community carries out its daily functions--such as alleys, lanes and roads, schools, mosques, markets, pharmacies, health facilities, latrine sites, and ponds. As the social mapping progressed, it became possible to conduct household censuses with maps identifying every household and listing family members by household. Again, this was a process of collaboration between BRAC staff and community members. Thus, social mapping and census taking were also instrumental for advancing community engagement. These three processes-community engagement, social mapping, and census taking--can be valuable strategies for strengthening health programs in urban slum settings of low-income countries. PMID:26830423

  13. ALTERATIONS IN MATERNAL-FETAL CELLULAR TRAFFICKING AFTER FETAL SURGERY

    PubMed Central

    Saadai, Payam; Lee, Tzong-Hae; Bautista, Geoanna; Gonzales, Kelly D.; Nijagal, Amar; Busch, Michael P.; Kim, CJ; Romero, Roberto; Lee, Hanmin; Hirose, Shinjiro; Rand, Larry; Miniati, Douglas; Farmer, Diana L.; MacKenzie, Tippi C.

    2012-01-01

    Background/Purpose Bi-directional trafficking of cells between the mother and the fetus is routine in pregnancy and a component of maternal-fetal tolerance. Changes in fetal-to-maternal cellular trafficking have been reported in prenatal complications, but maternal-to-fetal trafficking has never been studied in the context of fetal intervention. We hypothesized that patients undergoing open fetal surgery would have altered maternal-fetal cellular trafficking. Methods Cellular trafficking was analyzed in patients with myelomeningocele (MMC) who underwent open fetal surgical repair (n=5), MMC patients who had routine postnatal repair (n=6), and normal term patients (n=9). As a control for the fetal operation, trafficking was also analyzed in patients who were delivered by an ex utero intrapartum treatment (EXIT) procedure (n=6). Microchimerism in maternal and cord blood was determined using quantitative real-time PCR for non-shared alleles. Results Maternal-to-fetal trafficking was significantly increased in patients who underwent open fetal surgery for MMC compared to normal controls, postnatal MMC repair, and EXIT patients. There were no differences in fetal-to-maternal cell trafficking between groups. Conclusion Patients undergoing open fetal surgery for MMC have elevated levels of maternal microchimerism. These results suggest altered trafficking and/or increased proliferation of maternal cells in fetal blood and may have important implications for preterm labor. PMID:22703775

  14. Community based maternal death review: lessons learned from ten districts in Andhra Pradesh, India.

    PubMed

    Singh, Samiksha; Murthy, Gudlavalleti V S; Thippaiah, Anitha; Upadhyaya, Sanjeev; Krishna, Murali; Shukla, Rajan; Srikrishna, S R

    2015-07-01

    Maternal death is as much a social phenomenon as a medical event. Maternal death review (MDR), a strategy for monitoring maternal deaths, provides information on medical, social and health system factors that should be addressed to redress gaps in service provision or utilisation. To strengthen MDR implementation in the state of Andhra Pradesh, India. The project involved development of state specific guidelines, technical assistance in operationalization and analysing processes and findings of MDR in ten districts. 284 deaths were recorded over 6 months (April-September 2012) of which 193 (75.4 %) could be reviewed. Post-partum haemorrhage (24 %) and hypertensive disorders (27.4 %) followed by puerperal sepsis in the post-partum period (16.8 %) were the leading causes of maternal deaths. 68.3 % deaths occurred at health facilities. 67 % of mothers dying during the natal or post-natal period, delivered at home, though the death occurred in a health facility. Type 1 delay (58.9 %) was the most common underlying cause of death, followed by type 3 delay (33.3 %). Under or nil reporting from the facilities was observed. Program staff could identify broad areas of intervention but lacked capacity to monitor, analyse, interpret and utilize the generated information to develop feasible actionable plans. Information gathered was incomplete and inaccurate in many cases. Challenges observed showed that it will require more time and continuous committed efforts of health staff for implementation of high quality MDR. Successful implementation will improve the response of the health system and contribute to improved maternal health. PMID:25636651

  15. A qualitative process evaluation of training for non-physician clinicians/associate clinicians (NPCs/ACs) in emergency maternal, neonatal care and clinical leadership, impact on clinical services improvements in rural Tanzania: the ETATMBA project

    PubMed Central

    Ellard, David R; Shemdoe, Aloisia; Mazuguni, Festo; Mbaruku, Godfrey; Davies, David; Kihaile, Paul; Pemba, Senga; Bergström, Staffan; Nyamtema, Angelo; Mohamed, Hamed-Mahfoudh; O'Hare, Joseph Paul

    2016-01-01

    Objectives The Enhancing Human Resources and Use of Appropriate Training for Maternal and Perinatal Survival in sub-Saharan Africa (ETATMBA) project is training non-physician clinicians as advanced clinical leaders in emergency maternal and newborn care in Tanzania and Malawi. The main aims of this process evaluation were to explore the implementation of the programme of training in Tanzania, how it was received, how or if the training has been implemented into practice and the challenges faced along the way. Design Qualitative interviews with trainees, trainers, district officers and others exploring the application of the training into practice. Participants During late 2010 and 2011, 36 trainees including 19 assistant medical officers one senior clinical officer and 16 nurse midwives/nurses (anaesthesia) were recruited from districts across rural Tanzania and invited to join the ETATMBA training programme. Results Trainees (n=36) completed the training returning to 17 facilities, two left and one died shortly after training. Of the remaining trainees, 27 were interviewed at their health facility. Training was well received and knowledge and skills were increased. There were a number of challenges faced by trainees, not least that their new skills could not be practised because the facilities they returned to were not upgraded. Nonetheless, there is evidence that the training is having an effect locally on health outcomes, like maternal and neonatal mortality, and the trainees are sharing their new knowledge and skills with others. Conclusions The outcome of this evaluation is encouraging but highlights that there are many ongoing challenges relating to infrastructure (including appropriate facilities, electricity and water) and the availability of basic supplies and drugs. This cadre of workers is a dedicated and valuable resource that can make a difference, which with better support could make a greater contribution to healthcare in the country. PMID:26873045

  16. Social exclusion, infant behavior, social isolation, and maternal expectations independently predict maternal depressive symptoms.

    PubMed

    Eastwood, John; Jalaludin, Bin; Kemp, Lynn; Phung, Hai; Barnett, Bryanne; Tobin, Jacinta

    2013-01-01

    The objective of the study was to identify latent variables that can be used to inform theoretical models of perinatal influences on postnatal depressed mood and maternal-infant attachment. A routine survey of mothers with newborn infants was commenced in South Western Sydney in 2000. The survey included the Edinburgh Postnatal Depression Scale (EPDS) and 46 psychosocial and health-related variables. Mothers (n = 15,389) delivering in 2002 and 2003 were surveyed at 2-3 weeks for depressive symptoms. Nonlinear principal components analysis was undertaken to identify dimensions that might represent latent variables. Correlations between latent variables and EPDS >12 were assessed by logistic regression. A five-dimension solution was identified, which accounted for 51% of the variance among the items studied. The five dimensions identified were maternal responsiveness, social exclusion, infant behavior, migrant social isolation, and family size. In addition, the variable maternal expectation contributed significantly to total variance and was included in the regression analysis. Regression on EPDS >12 was predictive for all variables except for maternal responsiveness, which was considered an outcome variable. The findings are consistent with the proposition that social exclusion, infant behavior, social isolation among migrant mothers, and maternal expectations are determinants of maternal mood. PMID:23408743

  17. The Impact of Official Development Aid on Maternal and Reproductive Health Outcomes: A Systematic Review

    PubMed Central

    Taylor, Emma Michelle; Hayman, Rachel; Crawford, Fay; Jeffery, Patricia; Smith, James

    2013-01-01

    Background Progress toward meeting Millennium Development Goal 5, which aims to improve maternal and reproductive health outcomes, is behind schedule. This is despite ever increasing volumes of official development aid targeting the goal, calling into question the distribution and efficacy of aid. The 2005 Paris Declaration on Aid Effectiveness represented a global commitment to reform aid practices in order to improve development outcomes, encouraging a shift toward collaborative aid arrangements which support the national plans of aid recipient countries (and discouraging unaligned donor projects). Methods and Findings We conducted a systematic review to summarise the evidence of the impact on MDG 5 outcomes of official development aid delivered in line with Paris aid effectiveness principles and to compare this with the impact of aid in general on MDG 5 outcomes. Searches of electronic databases identified 30 studies reporting aid-funded interventions designed to improve maternal and reproductive health outcomes. Aid interventions appear to be associated with small improvements in the MDG indicators, although it is not clear whether changes are happening because of the manner in which aid is delivered. The data do not allow for a meaningful comparison between Paris style and general aid. The review identified discernible gaps in the evidence base on aid interventions targeting MDG 5, notably on indicators MDG 5.4 (adolescent birth rate) and 5.6 (unmet need for family planning). Discussion This review presents the first systematic review of the impact of official development aid delivered according to the Paris principles and aid delivered outside this framework on MDG 5 outcomes. Its findings point to major gaps in the evidence base and should be used to inform new approaches and methodologies aimed at measuring the impact of official development aid. PMID:23468860

  18. DNA methylation mediates the impact of exposure to prenatal maternal stress on BMI and central adiposity in children at age 13½ years: Project Ice Storm

    PubMed Central

    Cao-Lei, Lei; Dancause, Kelsey N; Elgbeili, Guillaume; Massart, Renaud; Szyf, Moshe; Liu, Aihua; Laplante, David P; King, Suzanne

    2015-01-01

    Prenatal maternal stress (PNMS) in animals and humans predicts obesity and metabolic dysfunction in the offspring. Epigenetic modification of gene function is considered one possible mechanism by which PNMS results in poor outcomes in offspring. Our goal was to determine the role of maternal objective exposure and subjective distress on child BMI and central adiposity at 13½ years of age, and to test the hypothesis that DNA methylation mediates the effect of PNMS on growth. Mothers were pregnant during the January 1998 Quebec ice storm. We assessed their objective exposure and subjective distress in June 1998. At age 13½ their children were weighed and measured (n = 66); a subsample provided blood samples for epigenetic studies (n = 31). Objective and subjective PNMS correlated with central adiposity (waist-to-height ratio); only objective PNMS predicted body mass index (BMI). Bootstrapping analyses showed that the methylation level of genes from established Type-1 and -2 diabetes mellitus pathways showed significant mediation of the effect of objective PNMS on both central adiposity and BMI. However, the negative mediating effects indicate that, although greater objective PNMS predicts greater BMI and adiposity, this effect is dampened by the effects of objective PNMS on DNA methylation, suggesting a protective role of the selected genes from Type-1 and -2 diabetes mellitus pathways. We provide data supporting that DNA methylation is a potential mechanism involved in the long-term adaptation and programming of the genome in response to early adverse environmental factors. PMID:26098974

  19. Assessment of maternal mortality in Tanzania.

    PubMed

    Walraven, G E; Mkanje, R J; van Roosmalen, J; van Dongen, P W; Dolmans, W M

    1994-05-01

    The results from a prospective community survey, a sisterhood method survey, and a hospital survey were compared in order to ascertain a reliable and inexpensive method for estimating direct deaths from obstetric complications of pregnancy. The maternal mortality ratio was used to express risk of dying during pregnancy. The surveys were conducted in Kwimba District in Mwanza region of northwestern Tanzania: in August 1989 to March 1991 in the community study within the primary health care area of Sumve Hospital, which supplied data on maternal mortality between 1986 and 1990. The sisterhood survey was conducted in 2 villages in 1990, of which 1 village was included in the community survey. The village study included 447 women, of whom 421 remained in the survey and delivered 427 infants (415 live born); there was 1 maternal death. The sisterhood method engaged 2865 respondents and the lifetime risk of maternal death was estimated at 297 and the proportional maternal mortality rate was 13.9%. There were 82 maternal deaths and 589 deaths from all causes among sisters aged 15 years and older. 7526 women were included in the hospital survey, of which 7335 births were represented; there were 62 maternal deaths. The maternal mortality risk was 845 among hospital admissions. 69% of all maternal deaths were accounted for by direct causes. Most deaths were attributed to the top 5 worldwide causes: obstructed labor, puerperal sepsis, postpartum hemorrhage, complications of abortion, and preeclampsia. There were few reports of abortions and abortion-related mortality. Relapsing fever or Borrelia infection was an indirect cause of death common to the region and particularly hazardous to pregnant women. Many hospital deaths were emergency admissions. The conclusion was that the sisterhood method provided a better indication of the extent of maternal mortality within the community. Other advantages were the small sample and the speed, quickness, and low cost. Hospital data

  20. Maternal mortality in Sirur.

    PubMed

    Shrotri, A; Pratinidhi, A; Shah, U

    1990-01-01

    The research aim was 1) to determine the incidence of maternal mortality in a rural health center area in Sirur, Maharashtra state, India; 2) to determine the relative risk; and 3) to make suggestions about reducing maternal mortality. The data on deliveries was obtained between 1981 and 1984. Medical care at the Rural Training Center was supervised by the Department of Preventive and Social Medicine, the B.J. Medical College in Pune. Deliveries numbered 5994 singleton births over the four years; 5919 births were live births. 15 mothers died: 14 after delivery and 1 predelivery. The maternal mortality rate was 2.5/1000 live births. The maternal causes of death included 9 direct obstetric causes, 3 from postpartum hemorrhage of anemic women, and 3 from puerperal sepsis of anemic women with prolonged labor. 2 deaths were due to eclampsia, and 1 death was unexplained. There were 5 (33.3%) maternal deaths due to indirect causes (3 from hepatitis and 2 from thrombosis). One woman died of undetermined causes. Maternal jaundice during pregnancy was associated with the highest relative risk of maternal death: 106.4. Other relative risk factors were edema, anemia, and prolonged labor. Attributable risk was highest for anemia, followed by jaundice, edema, and maternal age of over 30 years. Maternal mortality at 30 years and older was 3.9/1000 live births. Teenage maternal mortality was 3.3/1000. Maternal mortality among women 20-29 years old was lowest at 2.1/1000. Maternal mortality for women with a parity of 5 or higher was 3.6/1000. Prima gravida women had a maternal mortality rate of 2.9/1000. Parities between 1 and 4 had a maternal mortality rate of 2.3/1000. The lowest maternal mortality was at parity of 3. Only 1 woman who died had received more than 3 prenatal visits. 11 out of 13 women medically examined prenatally were identified with the following risk factors: jaundice, edema, anemia, young or old maternal age, parity, or poor obstetric history. The local

  1. Maternal behavior as a predictor of sibling interactions during mealtimes.

    PubMed

    Mosli, Rana H; Miller, Alison L; Peterson, Karen E; Gearhardt, Ashley N; Lumeng, Julie C

    2016-04-01

    Children who frequently experience encouragement or pressure to eat are more likely to exhibit less favorable eating behaviors and dietary outcomes. Siblings can encourage or pressure each other to eat during mealtimes, but the role of mothers in shaping sibling mealtime interactions is not understood. The objective of this study was to examine the association between the behavior of mothers and siblings during mealtimes. The associations of maternal presence and maternal engagement with children during mealtimes with encouragements to eat delivered by the child to his/her sibling were examined. Children aged 4-8years (n=73) were videotaped while eating a routine evening meal at home with one sibling present. Encouragement to eat delivered by the index child to the sibling, maternal presence, and non-food-related and food-related maternal engagement were coded from the videotapes. Poisson regression showed that maternal presence was associated with fewer encouragements to eat from the index child to the sibling (rate ratio (RR): 0.40, 95% confidence interval (CI): 0.26, 0.62). Each type of maternal engagement was independently associated with the number of encouragements to eat from the index child to the sibling: maternal engagement that was not food-related was associated with fewer encouragements to eat (RR: 0.62, 95% CI: 0.53, 0.73), while maternal engagement that was food-related was associated with more encouragements to eat (RR: 1.49, 95% CI: 1.22, 1.81). Future studies may explore how sibling interactions may mediate links between maternal behavior during mealtimes and children's health-related outcomes. PMID:26765971

  2. Combined Effect of Fetal Sex and Advanced Maternal Age on Pregnancy Outcomes

    PubMed Central

    Weissmann-Brenner, Alina; Simchen, Michal J.; Zilberberg, Eran; Kalter, Anat; Dulitzky, Mordechai

    2015-01-01

    Background Fetal sex and maternal age are each known to affect outcomes of pregnancies. The objective of the present study was to investigate the influence of the combination of maternal age and fetal sex on pregnancy outcomes in term and post-term singleton pregnancies. Material/Methods This was a retrospective study on term singleton pregnancies delivered between 2004 and 2008 at the Chaim Sheba Medical Center. Data collected included maternal age, fetal sex, and maternal and neonatal complications. The combined effect of fetal sex and maternal age on complications of pregnancy was assessed by multivariable logistic regression models. Results The study population comprised 37,327 pregnancies. The risk of operative deliveries increased with maternal age ≥40 and in pregnancies with male fetuses. The risk of maternal diabetes and of longer hospitalization increased as maternal age increased, and in women <40 carrying male fetuses. The risk of hypertensive disorders increased in pregnancies with males as maternal age advanced. The risk of shoulder dystocia and neonatal respiratory complications increased in male neonates born to women<40. The risk of neonatal hypoglycemia increased in males for all maternal ages. Conclusions Risk assessment for fetal sex and advanced maternal age were given for different pregnancy complications. Knowledge of fetal sex adds value to the risk assessment of pregnancies as maternal age increases. PMID:25892459

  3. Improving women's diet quality preconceptionally and during gestation: effects on birth weight and prevalence of low birth weight—a randomized controlled efficacy trial in India (Mumbai Maternal Nutrition Project)12345

    PubMed Central

    Potdar, Ramesh D; Sahariah, Sirazul A; Gandhi, Meera; Kehoe, Sarah H; Brown, Nick; Sane, Harshad; Dayama, Monika; Jha, Swati; Lawande, Ashwin; Coakley, Patsy J; Marley-Zagar, Ella; Chopra, Harsha; Shivshankaran, Devi; Chheda-Gala, Purvi; Muley-Lotankar, Priyadarshini; Subbulakshmi, G; Wills, Andrew K; Cox, Vanessa A; Taskar, Vijaya; Barker, David JP; Jackson, Alan A; Margetts, Barrie M; Fall, Caroline HD

    2014-01-01

    Background: Low birth weight (LBW) is an important public health problem in undernourished populations. Objective: We tested whether improving women's dietary micronutrient quality before conception and throughout pregnancy increases birth weight in a high-risk Indian population. Design: The study was a nonblinded, individually randomized controlled trial. The intervention was a daily snack made from green leafy vegetables, fruit, and milk (treatment group) or low-micronutrient vegetables (potato and onion) (control group) from ≥90 d before pregnancy until delivery in addition to the usual diet. Treatment snacks contained 0.69 MJ of energy (controls: 0.37 MJ) and 10–23% of WHO Reference Nutrient Intakes of β-carotene, riboflavin, folate, vitamin B-12, calcium, and iron (controls: 0–7%). The primary outcome was birth weight. Results: Of 6513 women randomly assigned, 2291 women became pregnant, 1962 women delivered live singleton newborns, and 1360 newborns were measured. In an intention-to-treat analysis, there was no overall increase in birth weight in the treatment group (+26 g; 95% CI: −15, 68 g; P = 0.22). There was an interaction (P < 0.001) between the allocation group and maternal prepregnant body mass index (BMI; in kg/m2) [birth-weight effect: −23, +34, and +96 g in lowest (<18.6), middle (18.6–21.8), and highest (>21.8) thirds of BMI, respectively]. In 1094 newborns whose mothers started supplementation ≥90 d before pregnancy (per-protocol analysis), birth weight was higher in the treatment group (+48 g; 95% CI: 1, 96 g; P = 0.046). Again, the effect increased with maternal BMI (−8, +79, and +113 g; P-interaction = 0.001). There were similar results for LBW (intention-to-treat OR: 0.83; 95% CI: 0.66, 1.05; P = 0.10; per-protocol OR = 0.76; 95% CI: 0.59, 0.98; P = 0.03) but no effect on gestational age in either analysis. Conclusions: A daily snack providing additional green leafy vegetables, fruit, and milk before conception and throughout

  4. Effects of Mother-Infant Separation on Maternal Attachment Behavior

    ERIC Educational Resources Information Center

    Leifer, A. D.; And Others

    1972-01-01

    This project hoped to specify the role of early, mother-infant separation in determining later maternal behavior. Clinically, the results suggest that such a separation should be avoided whenever possible and should be minimized when separation is unavoidable. (Authors)

  5. Pregnancy Risk Assessment Monitoring System and the W.K. Kellogg Foundation joint project to enhance maternal and child health surveillance: focus on collaboration.

    PubMed

    Ahluwalia, Indu B; Harrison, Leslie; Simpson, Patrick; Wako, Etobssie; Helms Shealy, Kristen; Kapaya, Martha; Williams, Tanya; Williams, Letitia; D'Angelo, Denise

    2015-04-01

    Maternal and child health (MCH) surveillance data are important for understanding gaps in services and disparities in burden of disease, access to care, risk behaviors, and health outcomes. However, national and state surveillance systems are not always designed to gather sufficient data for calculating reliable estimates of the health conditions among high-risk or underrepresented population subgroups living in smaller geographic areas. The Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS) has conducted surveillance for over 25 years in collaboration with state and city health departments. In 2012, PRAMS embarked on a multiyear collaboration with the W.K. Kellogg Foundation (WKKF) to include oversampling of minority and low-income women in selected geographic areas in four states (Louisiana, Michigan, Mississippi, and New Mexico) where the WKKF funded extensive place-based initiatives are located. The PRAMS-WKKF collaboration has broad implications for promoting meaningful collaboration between public, private, local, state, and federal organizations to address MCH data gaps on disparities, and for improving the availability of information needed for MCH programs, policy makers, and women. PMID:25860106

  6. Maternal Smoking during Pregnancy and DNA-Methylation in Children at Age 5.5 Years: Epigenome-Wide-Analysis in the European Childhood Obesity Project (CHOP)-Study

    PubMed Central

    Rzehak, Peter; Saffery, Richard; Reischl, Eva; Covic, Marcela; Wahl, Simone; Grote, Veit; Xhonneux, Annick; Langhendries, Jean-Paul; Ferre, Natalia; Closa-Monasterolo, Ricardo; Verduci, Elvira; Riva, Enrica; Socha, Piotr; Gruszfeld, Dariusz; Koletzko, Berthold

    2016-01-01

    Mounting evidence links prenatal exposure to maternal tobacco smoking with disruption of DNA methylation (DNAm) profile in the blood of infants. However, data on the postnatal stability of such DNAm signatures in childhood, as assessed by Epigenome Wide Association Studies (EWAS), are scarce. Objectives of this study were to investigate DNAm signatures associated with in utero tobacco smoke exposure beyond the 12th week of gestation in whole blood of children at age 5.5 years, to replicate previous findings in young European and American children and to assess their biological role by exploring databases and enrichment analysis. DNA methylation was measured in blood of 366 children of the multicentre European Childhood Obesity Project Study using the Illumina Infinium HM450 Beadchip (HM450K). An EWAS was conducted using linear regression of methylation values at each CpG site against in utero smoke exposure, adjusted for study characteristics, biological and technical effects. Methylation levels at five HM450K probes in MYO1G (cg12803068, cg22132788, cg19089201), CNTNAP2 (cg25949550), and FRMD4A (cg11813497) showed differential methylation that reached epigenome-wide significance according to the false-discovery-rate (FDR) criteria (q-value<0.05). Whereas cg25949550 showed decreased methylation (-2% DNAm ß-value), increased methylation was observed for the other probes (9%: cg12803068; 5%: cg22132788; 4%: cg19089201 and 4%: cg11813497) in exposed relative to non-exposed subjects. This study thus replicates previous findings in children ages 3 to 5, 7 and 17 and confirms the postnatal stability of MYO1G, CNTNAP2 and FRMD4A differential methylation. The role of this differential methylation in mediating childhood phenotypes, previously associated with maternal smoking, requires further investigation. PMID:27171005

  7. Maternal mortality in Cameroon: a university teaching hospital report.

    PubMed

    Tebeu, Pierre-Marie; Pierre-Marie, Tebeu; Halle-Ekane, Gregory; Gregory, Halle-Ekane; Da Itambi, Maxwell; Maxwell, Da Itambi; Enow Mbu, Robinson; Robinson, Enow Mbu; Mawamba, Yvette; Yvette, Mawamba; Fomulu, Joseph Nelson; Nelson, Fomulu Joseph

    2015-01-01

    More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon. PMID:26401210

  8. Women, poverty and adverse maternal outcomes in Nairobi, Kenya

    PubMed Central

    2010-01-01

    Background The link between poverty and adverse maternal outcomes has been studied largely by means of quantitative data. We explore poor urban Kenyan women's views and lived experiences of the relationship between economic disadvantage and unpleasant maternal outcomes. Method Secondary analysis of focus group discussions and in-depth individual interviews data with women in two slums in Nairobi, Kenya. Results Urban poor women in Nairobi associate poverty with adverse maternal outcomes. However, their accounts and lived experiences of the impact of poverty on maternal outcomes underscore dynamics other than those typically stressed in the extant literature. To them, poverty primarily generates adverse maternal outcomes by exposing women to exceedingly hard and heavy workloads during pregnancy and the period surrounding it; to intimate partner violence; as well as to inhospitable and unpleasant treatment by service providers. Conclusions Poverty has wider and more intricate implications for maternal outcomes than are acknowledged in extant research. To deliver their expected impact, current efforts to promote better maternal outcomes must be guided by a more thorough perspective of the link between women's livelihoods and their health and wellbeing. PMID:21122118

  9. Pump for delivering heated fluids

    NASA Technical Reports Server (NTRS)

    Sabelman, E. E. (Inventor)

    1973-01-01

    A thermomechanical pump particularly suited for use in pumping a warming fluid obtained from an RTG (Radioisotope Thermal Generator) through science and flight instrumentation aboard operative spacecraft is described. The invention is characterized by a pair of operatively related cylinders, each including a reciprocating piston head dividing the cylinder into a pressure chamber confining therein a vaporizable fluid, and a pumping chamber for propelling the warming fluid, and a fluid delivery circuit for alternately delivering the warming fluid from the RTG through the pressure chamber of one cylinder to the pumping chamber of the other cylinder, whereby the vaporizable fluid within the pair of pressure chambers alternately is vaporized and condensed for driving the associated pistons in pumping and intake strokes.

  10. 'Big push' to reduce maternal mortality in Uganda and Zambia enhanced health systems but lacked a sustainability plan.

    PubMed

    Kruk, Margaret E; Rabkin, Miriam; Grépin, Karen Ann; Austin-Evelyn, Katherine; Greeson, Dana; Masvawure, Tsitsi Beatrice; Sacks, Emma Rose; Vail, Daniel; Galea, Sandro

    2014-06-01

    In the past decade, "big push" global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. We evaluated the first six to twelve months of the program's implementation, its ownership by national ministries of health, and its effects on health systems. The project's impact on maternal mortality is not reported here. We found that the Saving Mothers, Giving Life initiative delivered a large "dose" of intervention quickly by capitalizing on existing US international health assistance platforms, such as the President's Emergency Plan for AIDS Relief. Early benefits to the broader health system included greater policy attention to maternal and child health, new health care infrastructure, and new models for collaborating with the private sector and communities. However, the rapid pace, external design, and lack of a long-term financing plan hindered integration into the health system and local ownership. Sustaining and scaling up early gains of similar big push initiatives requires longer-term commitments and a clear plan for transition to national control. PMID:24889956

  11. Maternal Polybrominated Diphenyl Ether (PBDE) Exposure and Thyroid Hormones in Maternal and Cord Sera: The HOME Study, Cincinnati, USA

    PubMed Central

    Vuong, Ann M.; Webster, Glenys M.; Romano, Megan E.; Braun, Joseph M.; Zoeller, R. Thomas; Hoofnagle, Andrew N.; Sjödin, Andreas; Yolton, Kimberly; Lanphear, Bruce P.

    2015-01-01

    Background Polybrominated diphenyl ethers (PBDEs) reduce blood concentrations of thyroid hormones in laboratory animals, but it is unclear whether PBDEs disrupt thyroid hormones in pregnant women or newborn infants. Objectives We investigated the relationship between maternal PBDE levels and thyroid hormone concentrations in maternal and cord sera. Methods We used data from the Health Outcomes and Measures of the Environment (HOME)Study, a prospective birth cohort of 389 pregnant women in Cincinnati, Ohio, who were enrolled from 2003 through 2006 and delivered singleton infants. Maternal serum PBDE concentrations were measured at enrollment (16 ± 3 weeks of gestation). Thyroid hormone concentrations were measured in maternal serum at enrollment (n = 187) and in cord serum samples (n = 256). Results Median maternal serum concentrations of BDEs 28 and 47 were 1.0 and 19.1 ng/g lipid, respectively. A 10-fold increase in BDEs 28 and 47 concentrations was associated with a 0.85-μg/dL [95% confidence interval (CI): 0.05, 1.64] and 0.82-μg/dL (95% CI: 0.12, 1.51) increase in maternal total thyroxine concentrations (TT4), respectively. Both congeners were also positively associated with maternal free thyroxine (FT4). We also observed positive associations between BDE-47 and maternal total and free triiodothyronine (TT3 and FT3). A 10-fold increase in BDE-28 was associated with elevated FT3 concentrations (β = 0.14 pg/mL; 95% CI: 0.02, 0.26). In contrast, maternal PBDE levels were not associated with thyroid hormone concentrations in cord serum. Conclusions These findings suggest that maternal PBDE exposure, particularly BDEs 28 and 47, are associated with maternal concentrations of T4 and T3 during pregnancy. Citation Vuong AM, Webster GM, Romano ME, Braun JM, Zoeller RT, Hoofnagle AN, Sjödin A, Yolton K, Lanphear BP, Chen A. 2015. Maternal polybrominated diphenyl ether (PBDE) exposure and thyroid hormones in maternal and cord sera: the HOME Study, Cincinnati, USA

  12. Maternal and Fetal Lipid and Adipokine Profiles and Their Association with Obesity.

    PubMed

    Solis-Paredes, Mario; Espino Y Sosa, Salvador; Estrada-Gutierrez, Guadalupe; Nava-Salazar, Sonia; Ortega-Castillo, Veronica; Rodriguez-Bosch, Mario; Bravo-Flores, Eyerahi; Espejel-Nuñez, Aurora; Tolentino-Dolores, Maricruz; Gaona-Estudillo, Rubí; Martinez-Bautista, Nancy; Perichart-Perera, Otilia

    2016-01-01

    Background. Maternal metabolic changes impact fetal metabolism resulting in a higher risk for developing chronic diseases later in life. The aim of this study was to assess the association between maternal and fetal adipokine and lipid profiles, as well as the influence of maternal weight on this association. Methods. Healthy pregnant women at term who delivered by C-section were enrolled. Maternal and fetal glucose, lipid profile, adiponectin, leptin, and resistin levels were analyzed by obesity and maternal weight gain. Statistics included descriptives, correlations, and mean differences (SPSS v20.0). Results. Adiponectin and resistin concentrations were higher in fetal blood, while leptin was lower (p < 0.05). A significant inverse association between maternal resistin and fetal LDL-cholesterol (LDL-C) (r = -0.327; p = 0.022) was observed. A positive correlation was found between maternal and fetal resistin (r = 0.358; p = 0.013). Women with excessive weight gain had higher leptin levels and their fetuses showed higher LDL-C levels (p < 0.05). Conclusions. Maternal resistin showed an inverse association with fetal LDL-C, suggesting that maternal adiposity status may play an active role in the regulation of fetal lipid profile and consequently, in fetal programming. Excessive maternal weight gain during pregnancy may exert an effect over metabolic mediators in both mother and newborn. PMID:27190514

  13. Maternal and Fetal Lipid and Adipokine Profiles and Their Association with Obesity

    PubMed Central

    Solis-Paredes, Mario; Espino y Sosa, Salvador; Estrada-Gutierrez, Guadalupe; Nava-Salazar, Sonia; Ortega-Castillo, Veronica; Rodriguez-Bosch, Mario; Bravo-Flores, Eyerahi; Espejel-Nuñez, Aurora; Tolentino-Dolores, Maricruz; Gaona-Estudillo, Rubí; Martinez-Bautista, Nancy; Perichart-Perera, Otilia

    2016-01-01

    Background. Maternal metabolic changes impact fetal metabolism resulting in a higher risk for developing chronic diseases later in life. The aim of this study was to assess the association between maternal and fetal adipokine and lipid profiles, as well as the influence of maternal weight on this association. Methods. Healthy pregnant women at term who delivered by C-section were enrolled. Maternal and fetal glucose, lipid profile, adiponectin, leptin, and resistin levels were analyzed by obesity and maternal weight gain. Statistics included descriptives, correlations, and mean differences (SPSS v20.0). Results. Adiponectin and resistin concentrations were higher in fetal blood, while leptin was lower (p < 0.05). A significant inverse association between maternal resistin and fetal LDL-cholesterol (LDL-C) (r = −0.327; p = 0.022) was observed. A positive correlation was found between maternal and fetal resistin (r = 0.358; p = 0.013). Women with excessive weight gain had higher leptin levels and their fetuses showed higher LDL-C levels (p < 0.05). Conclusions. Maternal resistin showed an inverse association with fetal LDL-C, suggesting that maternal adiposity status may play an active role in the regulation of fetal lipid profile and consequently, in fetal programming. Excessive maternal weight gain during pregnancy may exert an effect over metabolic mediators in both mother and newborn. PMID:27190514

  14. A Fetus with Iniencephaly Delivered at the Third Trimester

    PubMed Central

    Tanriverdi, Esra Cinar; Delibas, Ilhan Bahri; Kamalak, Zeynep; Kadioglu, Berrin Goktug; Bender, Rukiye Ada

    2015-01-01

    Iniencephaly is an uncommon neural tube defect, having retroflexion of the head without a neck and severe distortion of the spine. Iniencephaly is classified into two groups, iniencephaly apertus (with encephalocele) and iniencephaly clausus (without encephalocele). Incidence ranges from 0.1 to 10 in 10.000 pregnancies and it is seen more frequently in girls. Most of the fetuses with this defect die before birth or soon after birth, while those with the milder forms may live through childhood. Recurrence risk is around 1–5%. Family should be offered termination to reduce maternal risks and counseled for folic acid supplementation before the next planned pregnancy. Here we present a rare case of iniencephaly clausus which was diagnosed at 18th week of gestation by ultrasonography and delivered in the third trimester of pregnancy due to rejection of termination. PMID:26345271

  15. A Fetus with Iniencephaly Delivered at the Third Trimester.

    PubMed

    Tanriverdi, Esra Cinar; Delibas, Ilhan Bahri; Kamalak, Zeynep; Kadioglu, Berrin Goktug; Bender, Rukiye Ada

    2015-01-01

    Iniencephaly is an uncommon neural tube defect, having retroflexion of the head without a neck and severe distortion of the spine. Iniencephaly is classified into two groups, iniencephaly apertus (with encephalocele) and iniencephaly clausus (without encephalocele). Incidence ranges from 0.1 to 10 in 10.000 pregnancies and it is seen more frequently in girls. Most of the fetuses with this defect die before birth or soon after birth, while those with the milder forms may live through childhood. Recurrence risk is around 1-5%. Family should be offered termination to reduce maternal risks and counseled for folic acid supplementation before the next planned pregnancy. Here we present a rare case of iniencephaly clausus which was diagnosed at 18th week of gestation by ultrasonography and delivered in the third trimester of pregnancy due to rejection of termination. PMID:26345271

  16. Rural maternity care: can we learn from Wal-Mart?

    PubMed

    van Teijlingen, E R; Pitchforth, E

    2010-03-01

    In many countries rural maternity care is under threat. Consequently rural pregnant women will have to travel further to attend larger maternity units to receive care and deliver their babies. This trend is not dissimilar from the disappearance of other rural services, such as village shops, banks, post offices and bus services. We use a comparative approach to draw an analogy with large-scale supermarkets, such as the Wal-Mart and Tesco and their effect on the viability of smaller rural shops, depersonalisation of service and the wider community. The closure of a community-maternity unit leads to women attending a different type of hospital with a different approach to maternity care. Thus small community-midwifery units are being replaced, not by a very similar unit that happens to be further away, but by a larger obstetric unit that operates on different models, philosophy and notions of risk. Comparative analysis allows a fresh perspective on the provision of rural maternity services. We argue that previous discussions focusing on medicalisation and change in maternity services can be enhanced by drawing on experience in other sectors and taking a wider societal lens. PMID:20004606

  17. Flavor mediation delivers natural SUSY

    NASA Astrophysics Data System (ADS)

    Craig, Nathaniel; McCullough, Matthew; Thaler, Jesse

    2012-06-01

    If supersymmetry (SUSY) solves the hierarchy problem, then naturalness considerations coupled with recent LHC bounds require non-trivial superpartner flavor structures. Such "Natural SUSY" models exhibit a large mass hierarchy between scalars of the third and first two generations as well as degeneracy (or alignment) among the first two generations. In this work, we show how this specific beyond the standard model (SM) flavor structure can be tied directly to SM flavor via "Flavor Mediation". The SM contains an anomaly-free SU(3) flavor symmetry, broken only by Yukawa couplings. By gauging this flavor symmetry in addition to SM gauge symmetries, we can mediate SUSY breaking via (Higgsed) gauge mediation. This automatically delivers a natural SUSY spectrum. Third-generation scalar masses are suppressed due to the dominant breaking of the flavor gauge symmetry in the top direction. More subtly, the first-two-generation scalars remain highly degenerate due to a custodial U(2) symmetry, where the SU(2) factor arises because SU(3) is rank two. This custodial symmetry is broken only at order ( m c /m t )2. SUSY gauge coupling unification predictions are preserved, since no new charged matter is introduced, the SM gauge structure is unaltered, and the flavor symmetry treats all matter multiplets equally. Moreover, the uniqueness of the anomaly-free SU(3) flavor group makes possible a number of concrete predictions for the superpartner spectrum.

  18. Maternal Separation Anxiety and Child Care: Effects on Maternal Behavior.

    ERIC Educational Resources Information Center

    Storm, Heidi A.; Ridley-Johnson, Robyn

    Maternal separation anxiety influences maternal behavior, attitudes about employment, and employment decisions made by mothers. This study examined the relationship between maternal separation anxiety and the number of hours a child was in substitute care. The sample consisted of 44 mothers and their children who ranged in age from 12 to 41 months…

  19. Maternal and Handicapped Child Characteristics Associated with Maternal Involvement Behavior.

    ERIC Educational Resources Information Center

    Huntington, Gail S.

    Eighty-six mother-infant pairs were studied to determine the extent to which maternal and child variables predicted maternal involvement. The infants, ranging in age from 3-36 months, were examined on temperament and developmental status. Maternal characteristics studied were temperament, locus of control, and socioeconomic status. Criterion…

  20. Maternal and neonatal tetanus.

    PubMed

    Thwaites, C Louise; Beeching, Nicholas J; Newton, Charles R

    2015-01-24

    Maternal and neonatal tetanus is still a substantial but preventable cause of mortality in many developing countries. Case fatality from these diseases remains high and treatment is limited by scarcity of resources and effective drug treatments. The Maternal and Neonatal Tetanus Elimination Initiative, launched by WHO and its partners, has made substantial progress in eliminating maternal and neonatal tetanus. Sustained emphasis on improvement of vaccination coverage, birth hygiene, and surveillance, with specific approaches in high-risk areas, has meant that the incidence of the disease continues to fall. Despite this progress, an estimated 58,000 neonates and an unknown number of mothers die every year from tetanus. As of June, 2014, 24 countries are still to eliminate the disease. Maintenance of elimination needs ongoing vaccination programmes and improved public health infrastructure. PMID:25149223

  1. Gastroschisis and maternal intake of phytoestrogens.

    PubMed

    Wadhwa, Elizabeth L; Ma, Chen; Shaw, Gary M; Carmichael, Suzan L

    2016-08-01

    The prevalence of gastroschisis has increased significantly in the past few decades. The strongest risks have been observed for women <25 years old or of low body mass index, and maternal diet also been proposed to be associated with risk. The objective of this study was to evaluate whether the risk of gastroschisis is associated with maternal dietary intake of phytoestrogens. The analysis includes data on mothers of 409 gastroschisis cases and 3,007 controls who delivered their infants from 2005 to 2010 and participated in the National Birth Defects Prevention Study, a multistate, population-based, case-control study. Detailed information was obtained from maternal telephone interviews that included a validated food frequency questionnaire. We conducted logistic regression analyses that included each phytoestrogen in its continuous form (to test for linearity) and quadratic form (to test for non-linearity), adjusted for maternal energy intake, age, BMI, race-ethnicity, and smoking in 1st trimester. Logistic regression analysis indicated that biochanin A, formonoetin, and coumestrol had a significant non-linear association with gastroschisis (P-value <0.05 for quadratic term). Lower intakes were associated with increased risk, with somewhat stronger but relatively modest associations at the lower end of the distribution; for example, the ORs for the 10th versus 50th percentiles ranged from 1.1 to 1.2. Associations were not significant for the other phytoestrogens. This study provides some evidence for association with certain phytoestrogens, after adjusting for covariates. The implications of our findings for clinical practice are uncertain pending other studies examining this association. © 2016 Wiley Periodicals, Inc. PMID:27232448

  2. Maternal and neonatal outcomes of macrosomic pregnancies

    PubMed Central

    Weissmann-Brenner, Alina; Simchen, Michal J.; Zilberberg, Eran; Kalter, Anat; Weisz, Boaz; Achiron, Reuven; Dulitzky, Mordechai

    2012-01-01

    Summary Background To compare maternal and neonatal outcomes of term macrosomic and adequate for gestational age (AGA) pregnancies. Material/Methods A retrospective analysis was performed on all term singleton macrosomic (birth weight ≥4000 g) and AGA (birth weight >10th percentile and <4000 g) pregnancies delivered at our hospital between 2004 and 2008. Data collected included maternal age, gestational age at delivery, mode of delivery, birth weight, fetal gender, maternal and neonatal complications. Comparisons were made between macrosomic and AGA pregnancies and between different severities of macrosomia (4000–4250 g, 4250–4500 g and ≥4500 g). Results The study population comprised of 34,685 pregnancies. 2077 neonates had birth weight ≥4000 g. Maternal age and gestational age at delivery were significantly higher for macrosomic neonates. Significantly more macrosomic neonates were born by cesarean section, and were complicated with shoulder dystocia, neonatal hypoglycemia, and had longer hospitalization period (both in vaginal and cesarean deliveries). Specifically, the odds ratio (OR) relative to AGA pregnancies for each macrosomic category (4000–4250 g, 4250–4500 g and ≥4500 g) of shoulder dystocia was 2.37, 2.24, 7.61, respectively, and for neonatal hypoglycemia 4.24, 4.41, 4.15, respectively. The risk of post partum hemorrhage was statistically increased when birth weight was >4500 g (OR=5.23) but not for birth weight between 4000–4500 g. No differences were found in the rates of extensive perineal lacerations between AGA and the different macrosomic groups. Conclusions Macrosomia is associated with increased rate of cesarean section, shoulder dystocia, neonatal hypoglycemia, and longer hospitalization, but not associated with excessive perineal tears. Increased risk of PPH was found in the >4500g group. PMID:22936200

  3. Maternal Sexuality and Breastfeeding

    ERIC Educational Resources Information Center

    Bartlett, Alison

    2005-01-01

    In this paper I consider the ways in which lactation has been discussed as a form of maternal sexuality, and the implications this carries for our understanding of breastfeeding practices and sexuality. Drawing on knowledge constructed in the western world during the last half of the twentieth century, the paper identifies a shift between the…

  4. Maternity Leave in Taiwan

    ERIC Educational Resources Information Center

    Feng, Joyce Yen; Han, Wen-Jui

    2010-01-01

    Using the first nationally representative birth cohort study in Taiwan, this paper examines the role that maternity leave policy in Taiwan plays in the timing of mothers returning to work after giving birth, as well as the extent to which this timing is linked to the amount of time mothers spend with their children and their use of breast milk…

  5. Maternal Attitudes. Progress Report.

    ERIC Educational Resources Information Center

    Harnischfeger, Annegret; Wiley, David E.

    This paper discusses ways in which maternal attitudes may serve as mediating variables linking social class characteristics of the family to the socialization of children. Reference is made to the Family Problem Scale (Ernhart and Loevinger) which provides a psychological characterization of social class levels on five dimensions or subscales:…

  6. [Social inequalities in maternal health].

    PubMed

    Azria, E; Stewart, Z; Gonthier, C; Estellat, C; Deneux-Tharaux, C

    2015-10-01

    Although medical literature on social inequalities in perinatal health is qualitatively heterogeneous, it is quantitatively important and reveals the existence of a social gradient in terms of perinatal risk. However, published data regarding maternal health, if also qualitatively heterogeneous, are relatively less numerous. Nevertheless, it appears that social inequalities also exist concerning severe maternal morbidity as well as maternal mortality. Analyses are still insufficient to understand the mechanisms involved and explain how the various dimensions of the women social condition interact with maternal health indicators. Inadequate prenatal care and suboptimal obstetric care may be intermediary factors, as they are related to both social status and maternal outcomes, in terms of maternal morbidity, its worsening or progression, and maternal mortality. PMID:26433316

  7. The 2016 Hughes Lecture: What's new in maternal morbidity and mortality?

    PubMed

    Arendt, K W

    2016-05-01

    Each year, the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review a given year's published obstetric anesthesiology literature. This individual then produces a syllabus of the year's most influential publications, delivers the Ostheimer Lecture at the Society's annual meeting, the Hughes Lecture at the following year's Sol Shnider meeting, and writes corresponding review articles. This 2016 Hughes Lecture review article focuses specifically on the 2014 publications that relate to maternal morbidity and mortality. It begins by discussing the 2014 research that was published on severe maternal morbidity and maternal mortality in developed countries. This is followed by a discussion of specific coexisting diseases and specific causes of severe maternal mortality. The review ends with a discussion of worldwide maternal mortality and the 2014 publications that examined the successes and the shortfalls in the work to make childbirth safe for women throughout the entire world. PMID:26847944

  8. Maternal collapse: Challenging the four-minute rule

    PubMed Central

    Benson, M.D.; Padovano, A.; Bourjeily, G.; Zhou, Y.

    2016-01-01

    Introduction The current approach to, cardiopulmonary resuscitation of pregnant women in the third trimester has been to adhere to the “four-minute rule”: If pulses have not returned within 4 min of the start of resuscitation, perform a cesarean birth so that birth occurs in the next minute. This investigation sought to re-examine the evidence for the four-minute rule. Methods A literature review focused on perimortem cesarean birth was performed using the same key words that were used in formulating the “four-minute rule.” Maternal and neonatal injury free survival rates as a function of arrest to birth intervals were determined, as well as actual incision to birth intervals. Results Both maternal and neonatal injury free survival rates diminished steadily as the time interval from maternal arrest to birth increased. There was no evidence for any specific survival threshold at 4 min. Skin incision to birth intervals of 1 min occurred in only 10% of women. Conclusion Once a decision to deliver is made, care providers should proceed directly to Cesarean birth during maternal cardiac arrest in the third trimester rather than waiting for 4 min for restoration of the maternal pulse. Birth within 1 min from the start of the incision is uncommon in these circumstances. PMID:27211568

  9. Delivering Online Examinations: A Case Study

    ERIC Educational Resources Information Center

    Howarth, Jason; Messing, John; Altas, Irfan

    2004-01-01

    This paper represents a brief case study of delivering online examinations to a worldwide audience. These examinations are delivered in partnership with a commercial online testing company as part of the Industry Master's degree at Charles Sturt University (CSU). The Industry Master's degree is an academic program for students currently employed…

  10. Using natural disasters to study prenatal maternal stress in humans.

    PubMed

    King, Suzanne; Laplante, David P

    2015-01-01

    Animal studies of prenatal maternal stress permit random assignment of pregnant animals to stress and no-stress groups, and allow total control of the type, severity, and timing of the stressor in utero. Human studies have obvious constraints that make the use of experimental methods nearly impossible. Studying pregnant women who experience natural disasters during pregnancy, however, approximates the random assignment to groups enjoyed by animal studies, and can characterize the timing of the stressor in utero with great precision. In this chapter, we briefly describe our three ongoing prospective longitudinal studies of children exposed to prenatal maternal stress from natural disasters. We present results from Project Ice Storm in detail, showing effects of prenatal maternal stress on cognitive and neurodevelopment. We contrast these results with preliminary findings from the Iowa Flood Study and introduce the QF2011 Queensland Flood Project. In the "Discussion" section, we present conclusions to date and discuss the relative effects of the severity of maternal objective disaster exposure and maternal subjective distress levels, the moderating effects of fetal sex and the timing of the stressor in utero, and the longevity of the effects. Finally, we discuss some possible mechanisms that may mediate the effects of prenatal maternal stress on the neurodevelopment of children. PMID:25287546

  11. Maternal obesity and pregnancy.

    PubMed

    Johnson, S R; Kolberg, B H; Varner, M W; Railsback, L D

    1987-05-01

    We examined the risk of maternal obesity in 588 pregnant women weighing at least 113.6 kilograms (250 pounds) during pregnancy. Compared with a control group matched for age and parity, we found a significantly increased risk in the obese patient for gestational diabetes, hypertension, therapeutic induction, prolonged second stage of labor, oxytocin stimulation of labor, shoulder dystocia, infants weighing more than 4,000 grams and delivery after 42 weeks gestation. Certain operative complications were also more common in obese women undergoing cesarean section including estimated blood loss of more than 1,000 milliliters, operating time of more than two hours and wound infection postoperatively. These differences remained significant after controlling for appropriate confounding variables. We conclude that maternal obesity should be considered a high risk factor. PMID:3576419

  12. Maternal Hartnup disorder.

    PubMed

    Mahon, B E; Levy, H L

    1986-07-01

    We describe childbearing in two unrelated women with Hartnup disorder, an inborn error of neutral amino acid transport. Two living, unaffected offspring born after untreated and uneventful pregnancies, one from each woman, have had normal growth and development. The older one had an IQ of 92 at 4 years while the younger one at 4 months had a Development Quotient of 107 on the Mental Scale and 102 on the Motor Scale. A third offspring had a neural tube defect complicated by hydrocephalus and died at 3 months. This mother had a family history of major congenital anomalies. We think that this experience supports the view that Hartnup disorder in the mother, unlike phenylketonuria, does not have an adverse effect on the fetus. The presence of normal ratios of the amino acid concentrations between maternal and umbilical veins in one mother also suggests that placental transport of free amino acids, unlike renal transport, may not be reduced in maternal Hartnup disorder. PMID:3728570

  13. Improving adolescent maternal health.

    PubMed

    Baxter, C; Moodley, D

    2015-11-01

    Each year thousands of adolescent girls and young women in South Africa (SA) become pregnant and many die from complications related to pregnancy and childbirth. Although women of all ages are susceptible, girls<15 years of age are five times as likely, and those aged 15-19 years twice as likely, to die from complications related to childbirth than women in their 20s. In SA, non-pregnancy-related infections (e.g. HIV), obstetric haemorrhage and hypertension contributed to almost 70% of avoidable maternal deaths. In addition to the implementation of standardized preventive interventions to reduce obstetric haemorrhage and hypertension, better reproductive health services for adolescents, access to HIV care and treatment for women infected with HIV, and improved access to and uptake of long-acting reversible contraception are important ingredients for reducing maternal mortality among adolescents. PMID:26937508

  14. Maternal filicide theoretical framework.

    PubMed

    Mugavin, Marie

    2008-01-01

    The maternal filicide theoretical framework (MFTF) was developed to enrich the understanding of how traumatic experiences during formative years can affect a woman's relationship with her own child. Exposure to a known set of vulnerabilities can foster triggers that predispose a woman to respond impulsively and violently toward her child. Comprehensive assessment of vulnerable families is essential for the prevention of fatal and nonfatal abuse. The MFTF may be applied to both crimes. PMID:18522605

  15. Maternal-fetal conflict.

    PubMed

    Fasouliotis, S J; Schenker, J G

    2000-03-01

    Advances in prenatal care have brought about a greater understanding as to the special status of the fetus to the point that it is considered a patient in its own regard. Pregnant women generally follow the medical recommendations of their physicians that are intended for the benefit of their baby. Any situation where maternal well-being or wishes contradict fetal benefit constitutes a maternal-fetal conflict. Such situations include a broad range of possible interventions, non-interventions, and coercive influences. In such cases, the attending physician is expected to attain an attitude that involves either the respect of the woman's autonomy and right to privacy, which precludes any approach other than to accept her decision, or to modify this absolute for the beneficence of the fetus. Current ethical viewpoints range from absolute respect for maternal autonomy with no persuasion allowed, to gentle persuasion and to others which permit intervention and overriding of the woman's autonomy. Court-ordered decisions enforcing the pregnant woman to undergo a procedure in order to improve fetal outcome have been criticized as an invasion of a woman's privacy, limitation of her autonomy, and taking away of her right to informed consent. PMID:10733034

  16. A Geometric Capacity-Demand Analysis of Maternal Levator Muscle Stretch Required for Vaginal Delivery.

    PubMed

    Tracy, Paige V; DeLancey, John O; Ashton-Miller, James A

    2016-02-01

    Because levator ani (LA) muscle injuries occur in approximately 13% of all vaginal births, insights are needed to better prevent them. In Part I of this paper, we conducted an analysis of the bony and soft tissue factors contributing to the geometric "capacity" of the maternal pelvis and pelvic floor to deliver a fetal head without incurring stretch injury of the maternal soft tissue. In Part II, we quantified the range in demand, represented by the variation in fetal head size and shape, placed on the maternal pelvic floor. In Part III, we analyzed the capacity-to-demand geometric ratio, g, in order to determine whether a mother can deliver a head of given size without stretch injury. The results of a Part I sensitivity analysis showed that initial soft tissue loop length (SL) had the greatest effect on maternal capacity, followed by the length of the soft tissue loop above the inferior pubic rami at ultimate crowning, then subpubic arch angle (SPAA) and head size, and finally the levator origin separation distance. We found the more caudal origin of the puborectal portion of the levator muscle helps to protect it from the stretch injuries commonly observed in the pubovisceral portion. Part II fetal head molding index (MI) and fetal head size revealed fetal head circumference values ranging from 253 to 351 mm, which would increase up to 11 mm upon face presentation. The Part III capacity-demand analysis of g revealed that, based on geometry alone, the 10th percentile maternal capacity predicted injury for all head sizes, the 25th percentile maternal capacity could deliver half of all head sizes, while the 50th percentile maternal capacity could deliver a head of any size without injury. If ultrasound imaging could be operationalized to make measurements of ratio g, it might be used to usefully inform women on their level of risk for levator injury during vaginal birth. PMID:26746116

  17. PUERTO RICAN MATERNAL AND INFANT HEALTH PROJECT

    EPA Science Inventory

    The high neonatal and post neonatal mortality rates of Puerto Rican infants have led to the identification of this subgroup as a target for special attention by the Public Health Service. This survey will provide the rich data necessary to examine this important health issue. Vit...

  18. Maternal and perinatal mortality.

    PubMed

    Krishna Menon, M K

    1972-01-01

    A brief analysis of data from the records of the Government Hospital for Women and Children in Madras for a 36-year period (1929-1964) is presented. India with a population of over 550 million has only 1 doctor for each 6000 population. For the 80% of the population which is rural, the doctor ratio is only 88/1 million. There is also a shortage of paramedical personnel. During the earlier years of this study period, abortions, puerperal infections; hemorrhage, and toxemia accounted for nearly 75% of all meternal deaths, while in later years deaths from these causes were 40%. Among associated factors in maternal mortality, anemia was the most frequent, it still accounts for 20% and is a contributory factor in another 20%. The mortality from postpartum hemorrhage was 9.3% but has now decreased to 2.8%. Eclampsia is a preventable disease and a marked reduction in maternal and perinatal mortality from this cause has been achieved. Maternal deaths from puerperal infections have dropped from 25% of all maternal deaths to 7%. Uterine rupture has been reduced from 75% to 9.3% due to modern facilities. Operative deliveries still have an incidence of 2.1% and a mortality rate of 1.4% of all deliveries. These rates would be further reduced by more efficient antenatal and intranatal care. Reported perinatal mortality of infants has been reduced from 182/1000 births to an average of 78/1000 in all areas, but is 60.6/1000 in the city of Madras. Socioeconomic standards play an important role in perinatal mortality, 70% of such deaths occurring in the lowest economic groups. Improvement has been noted in the past 25 years but in rural areas little progress has been made. Prematurity and low birth weights are still larger factors in India than in other countries, with acute infectious diseases, anemia, and general malnutrition among mothers the frequent causes. Problems requiring further efforts to reduce maternal and infant mortality are correct vital statistics, improved

  19. More Soil Delivered to Phoenix Lab

    NASA Technical Reports Server (NTRS)

    2008-01-01

    This image, taken by NASA's Phoenix Mars Lander's Surface Stereo Imager, documents the delivery of a soil sample from the 'Snow White' trench to the Wet Chemistry Laboratory. A small pile of soil is visible on the lower edge of the second cell from the top.This deck-mounted lab is part of Phoenix's Microscopy, Electrochemistry and Conductivity Analyzer (MECA).

    The delivery was made on Sept. 12, 2008, which was Sol 107 (the 107th Martian day) of the mission, which landed on May 25, 2008.

    The Wet Chemistry Laboratory mixes Martian soil with an aqueous solution from Earth as part of a process to identify soluble nutrients and other chemicals in the soil. Preliminary analysis of this soil confirms that it is alkaline, and composed of salts and other chemicals such as perchlorate, sodium, magnesium, chloride and potassium. This data validates prior results from that same location, said JPL's Michael Hecht, the lead scientist for MECA.

    In the coming days, the Phoenix team will also fill the final four of eight single-use ovens on another soil-analysis instrument, the Thermal and Evolved Gas Analyzer, or TEGA. The team's strategy is to deliver as many samples as possible before the power produced by Phoenix's solar panels declines due to the end of the Martian summer.

    The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.

  20. Maternal cardiac metabolism in pregnancy.

    PubMed

    Liu, Laura X; Arany, Zolt

    2014-03-15

    Pregnancy causes dramatic physiological changes in the expectant mother. The placenta, mostly foetal in origin, invades maternal uterine tissue early in pregnancy and unleashes a barrage of hormones and other factors. This foetal 'invasion' profoundly reprogrammes maternal physiology, affecting nearly every organ, including the heart and its metabolism. We briefly review here maternal systemic metabolic changes during pregnancy and cardiac metabolism in general. We then discuss changes in cardiac haemodynamic during pregnancy and review what is known about maternal cardiac metabolism during pregnancy. Lastly, we discuss cardiac diseases during pregnancy, including peripartum cardiomyopathy, and the potential contribution of aberrant cardiac metabolism to disease aetiology. PMID:24448314

  1. Drones Could Deliver Vaccines in Developing Countries

    MedlinePlus

    ... nlm.nih.gov/medlineplus/news/fullstory_159549.html Drones Could Deliver Vaccines in Developing Countries Machines might ... Right now, people often associate the use of drones with warfare. But in the future they could ...

  2. Drones Could Deliver Vaccines in Developing Countries

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_159549.html Drones Could Deliver Vaccines in Developing Countries Machines might ... Right now, people often associate the use of drones with warfare. But in the future they could ...

  3. Maternal ethanol ingestion: effect on maternal and neonatal glucose balance

    SciTech Connect

    Witek-Janusek, L.

    1986-08-01

    Liver glycogen availability in the newborn is of major importance for the maintenance of postnatal blood glucose levels. This study examined the effect of maternal ethanol ingestion on maternal and neonatal glucose balance in the rate. Female rats were placed on 1) the Lieber-DeCarli liquid ethanol diet, 2) an isocaloric liquid pair-diet, or 3) an ad libitum rat chow diet at 3 wk before mating and throughout gestation. Blood and livers were obtained from dams and rat pups on gestational days 21 and 22. The pups were studied up to 6 h in the fasted state and up to 24 h in the fed state. Maternal ethanol ingestion significantly decreased litter size, birth weight, and growth. A significantly higher mortality during the early postnatal period was seen in the prenatal ethanol exposed pups. Ethanol significantly decreased fed maternal liver glycogen stores but not maternal plasma glucose levels. The newborn rats from ethanol ingesting dams also had significantly decreased liver glycogen stores. Despite mobilizing their available glycogen, these prenatal ethanol exposed pups became hypoglycemic by 6 h postnatal. This was more marked in the fasted pups. Ethanol did not affect maternal nor neonatal plasma insulin levels. Thus maternal ethanol ingestion reduces maternal and neonatal liver glycogen stores and leads to postnatal hypoglycemia in the newborn rat.

  4. Child Health, Maternal Marital and Socioeconomic Factors, and Maternal Health

    ERIC Educational Resources Information Center

    Garbarski, Dana; Witt, Whitney P.

    2013-01-01

    Although maternal socioeconomic status and health predict in part children's future health and socioeconomic prospects, it is possible that the intergenerational association flows in the other direction such that child health affects maternal outcomes. Previous research demonstrates that poor child health increases the risk of adverse…

  5. Maternal Depression, Maternal Expressed Emotion, and Youth Psychopathology

    ERIC Educational Resources Information Center

    Tompson, Martha C.; Pierre, Claudette B.; Boger, Kathryn Dingman; McKowen, James W.; Chan, Priscilla T.; Freed, Rachel D.

    2010-01-01

    Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two…

  6. Finance and faith at the Catholic Maternity Institute, Santa Fe, New Mexico, 1944-1969.

    PubMed

    Cockerham, Anne Z; Keeling, Arlene W

    2010-01-01

    In 1944, the Medical Mission Sisters opened the Catholic Maternity Institute in Santa Fe, New Mexico, primarily to serve patients of Spanish American descent. The Maternity Institute offered nurse-midwifery care and functioned as a school to train nurse-midwifery students. Originally planned as a home birth service, the Catholic Maternity Institute soon evolved into a service in which patients chose whether to deliver in their own homes or in a small freestanding building called La Casita. In fact, despite their idealism about home birth and strong feelings that home birth was best, the sisters experienced significant ambivalence concerning La Casita. Births there met many of the institute's pragmatic needs for a larger number of student experiences, quick and safe transfers to a nearby hospital, and more efficient use of the midwives' time. Importantly, as the sisters realized that many of their patients preferred to deliver at La Casita, they came to see that this option permitted these impoverished patients an opportunity to exercise some choice. However, the choice of many patients to deliver at La Casita--which was significantly more expensive for the Maternity Institute than home birth--eventually led to the demise of the Maternity Institute. PMID:20067097

  7. Maternal nutrition, health, and survival.

    PubMed

    Christian, Parul

    2002-05-01

    The burden of maternal morbidity and mortality in developing countries is high. Each year, 600,000 women die from pregnancy-related causes and 62 million women suffer from morbidity and complications of pregnancy. The extent to which maternal nutrition can improve maternal health and survival is not well understood. Excluding deaths due to induced abortions, the other four main causes of maternal mortality (preeclampsia, hemorrhage, obstructed labor, and infection) may be amenable to nutrition interventions. The role of calcium in reducing the incidence of preeclampsia and hypertension is promising, but more research in deficient populations is urgently needed. Antenatal iron supplementation, although frequently recommended to prevent anemia during pregnancy, has had little program success. Severe anemia may be an important cause of maternal mortality, but convincing evidence is lacking on the health consequences of mild-to-moderate maternal anemia. Knowledge of the etiology of anemia is important in identifying effective strategies for combating it. Other vitamins such as folate, B12, and vitamin A may enhance the effect of iron supplementation in populations where multiple nutrition deficiencies exist. Maternal night blindness is widespread in South Asian women. In Nepal, this condition is associated with markedly increased risks of vitamin A deficiency, anemia, morbidity, and maternal and infant mortality. These findings need to be replicated elsewhere in South Asia. One study has shown vitamin A and beta carotene supplementation to reduce maternal mortality and morbidity. These findings need testing in different settings with emphasis on investigating the mechanisms of the effect. The area of prepregnancy nutrition and its influence on prolonged and obstructed labor is wide open for investigation. The scope for research in the area of maternal nutrition and health is large and the onus is on nutritionists to bring to the forefront the role of nutrition in

  8. Toll free mobile communication: overcoming barriers in maternal and neonatal emergencies in Rural Bangladesh

    PubMed Central

    2014-01-01

    Background Toll free mobile telephone intervention to support mothers in pregnancy and delivery period was tested in one sub district of Bangladesh. Qualitative research was conducted to measure the changes of mobile phone use in increasing communication for maternal and neonatal complications. Methods In-depth interviews were conducted among twelve Community Skilled Birth Attendants and fourteen mothers along with their husbands prior to intervention. At intervention end, six Community Skilled Birth Attendants were purposively selected for in-depth interview. Semi structured interviews were conducted among all 27 Community Skilled Birth Attendants engaged in the intervention. One Focus Group Discussion was conducted with 10 recently delivered mothers. Thematic analysis and triangulation of different responses were conducted. Results Prior to intervention, Community Skilled Birth Attendants reported that mobile communication was not a norm. It was also revealed that poor mothers had poor accessibility to mobile services. Mothers, who communicated through mobile phone with providers noted irritability from Community Skilled Birth Attendants and sometimes found phones switched off. At the end of the project, 85% of mothers who had attended orientation sessions of the intervention communicated with Community Skilled Birth Attendants through mobile phones during maternal health complications. Once a complication is reported or anticipated over phone, Community Skilled Birth Attendants either made a prompt visit to mothers or advised for direct referral. More than 80% Community Skilled Birth Attendants communicated with Solution Linked Group for guidance on maternal health management. Prior to intervention, Solution Linked Group was not used to receive phone call from Community Skilled Birth Attendants. Community Skilled Birth Attendants were valued by the mothers. Mothers viewed that Community Skilled Birth Attendants are becoming confident in managing complication due

  9. Disabled women׳s maternal and newborn health care in rural Nepal: A qualitative study

    PubMed Central

    Morrison, Joanna; Basnet, Machhindra; Budhathoki, Bharat; Adhikari, Dhruba; Tumbahangphe, Kirti; Manandhar, Dharma; Costello, Anthony; Groce, Nora

    2014-01-01

    Objective there is little evidence about disabled women׳s access to maternal and newborn health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and care seeking. Our study explores disabled women׳s experiences of maternal and newborn care in rural Nepal. Design we used a qualitative methodology, using semi-structured interviews. Setting rural Makwanpur District of central Nepal. Participants we purposively sampled married women with different impairments who had delivered a baby in the past 10 years from different topographical areas of the district. We also interviewed maternal health workers. We compared our findings with a recent qualitative study of non-disabled women in the same district to explore the differences between disabled and non-disabled women. Findings married disabled women considered pregnancy and childbirth to be normal and preferred to deliver at home. Issues of quality, cost and lack of family support were as pertinent for disabled women as they were for their non-disabled peers. Health workers felt unprepared to meet the maternal health needs of disabled women. Key conclusions and implications for practice integration of disability into existing Skilled Birth Attendant training curricula may improve maternal health care for disabled women. There is a need to monitor progress of interventions that encourage institutional delivery through the use of disaggregated data, to check that disabled women are benefiting equally in efforts to improve access to maternal health care. PMID:24768318

  10. Designing, Implementing and Evaluating Preclinical Simulation Lab for Maternity Nursing Course

    ERIC Educational Resources Information Center

    ALFozan, Haya; El Sayed, Yousria; Habib, Farida

    2015-01-01

    Background: The opportunity for students to deliver care safely in today's, complex health care environment is limited. Simulation allows students to practice skills in a safe environment. Purpose: to assess the students' perception, satisfaction, and learning outcomes after a simulation based maternity course. Method: a quasi experimental design…

  11. Ethnic/racial diversity, maternal stress, lactation and very low birthweight infants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study compared maternal characteristics and psychological stress profile among African-American, Caucasian, and Hispanic mothers who delivered very low birthweight infants. Our intention was to investigate associations between psychosocial factors, frequency of milk expression, skin-to-skin hol...

  12. Evolution of maternal effect senescence.

    PubMed

    Moorad, Jacob A; Nussey, Daniel H

    2016-01-12

    Increased maternal age at reproduction is often associated with decreased offspring performance in numerous species of plants and animals (including humans). Current evolutionary theory considers such maternal effect senescence as part of a unified process of reproductive senescence, which is under identical age-specific selective pressures to fertility. We offer a novel theoretical perspective by combining William Hamilton's evolutionary model for aging with a quantitative genetic model of indirect genetic effects. We demonstrate that fertility and maternal effect senescence are likely to experience different patterns of age-specific selection and thus can evolve to take divergent forms. Applied to neonatal survival, we find that selection for maternal effects is the product of age-specific fertility and Hamilton's age-specific force of selection for fertility. Population genetic models show that senescence for these maternal effects can evolve in the absence of reproductive or actuarial senescence; this implies that maternal effect aging is a fundamentally distinct demographic manifestation of the evolution of aging. However, brief periods of increasingly beneficial maternal effects can evolve when fertility increases with age faster than cumulative survival declines. This is most likely to occur early in life. Our integration of theory provides a general framework with which to model, measure, and compare the evolutionary determinants of the social manifestations of aging. Extension of our maternal effects model to other ecological and social contexts could provide important insights into the drivers of the astonishing diversity of lifespans and aging patterns observed among species. PMID:26715745

  13. Maternal Gatekeeping: Antecedents and Consequences

    ERIC Educational Resources Information Center

    Gaunt, Ruth

    2008-01-01

    This study examined maternal gatekeeping, its background and psychological antecedents, and its consequences for paternal and maternal involvement in child care. In sum, 209 couples with 6- to 36-month-old children completed extensive questionnaires. Analyses revealed that various dimensions of gate-keeping were differentially associated with the…

  14. Evolution of maternal effect senescence

    PubMed Central

    Moorad, Jacob A.; Nussey, Daniel H.

    2016-01-01

    Increased maternal age at reproduction is often associated with decreased offspring performance in numerous species of plants and animals (including humans). Current evolutionary theory considers such maternal effect senescence as part of a unified process of reproductive senescence, which is under identical age-specific selective pressures to fertility. We offer a novel theoretical perspective by combining William Hamilton’s evolutionary model for aging with a quantitative genetic model of indirect genetic effects. We demonstrate that fertility and maternal effect senescence are likely to experience different patterns of age-specific selection and thus can evolve to take divergent forms. Applied to neonatal survival, we find that selection for maternal effects is the product of age-specific fertility and Hamilton’s age-specific force of selection for fertility. Population genetic models show that senescence for these maternal effects can evolve in the absence of reproductive or actuarial senescence; this implies that maternal effect aging is a fundamentally distinct demographic manifestation of the evolution of aging. However, brief periods of increasingly beneficial maternal effects can evolve when fertility increases with age faster than cumulative survival declines. This is most likely to occur early in life. Our integration of theory provides a general framework with which to model, measure, and compare the evolutionary determinants of the social manifestations of aging. Extension of our maternal effects model to other ecological and social contexts could provide important insights into the drivers of the astonishing diversity of lifespans and aging patterns observed among species. PMID:26715745

  15. Effect of maternal ethanol intake on fetal rabbit gastrointestinal development.

    PubMed

    Guo, W; Gregg, J P; Fonkalsrud, E W

    1994-08-01

    Maternal ingestion of alcohol is believed to be one factor that greatly influences the development of intrauterine growth retardation (IUGR) and postnatal growth failure. The present study was undertaken to determine whether maternally ingested alcohol adversely affects fetal growth and intestinal mucosal function. Five time-mated New Zealand white rabbit does were given ethanol intravenously (ETH group) (30% vol/vol; 1.0 g/kg/d) on gestational days (GD) 15 through 29 (term, 31 days). Two other rabbits received the same dose of ethanol. Maternal, fetal, and amniotic fluid alcohol levels were measured on GD 24. Four control rabbits (SH group) received normal saline (25 mL, intravenously). At term, the animals were delivered by cesarean section and killed. Seventeen of the 42 ETH fetuses survived the study period (43%); all 24 SH fetuses survived. On GD 24, within 60 minutes after maternal ethanol infusion, the fetal blood alcohol concentration (BAC) increased to 153 +/- 1.97 mg/dL (v maternal, 179 +/- 1.75 mg/dL); the amniotic ethanol level increased to 46 +/- 1.32 mg/dL. Birth weight was lower in the ETH group (46.88 +/- 2.21 g) than in the SH group (55.78 +/- 1.80 g) (P < .01). Disaccharidase activity, an indicator of intestinal mucosal function, showed that lactase activity (per milligram of protein) was significantly lower in ETH fetuses (2.60 x 10(-2) +/- 0.22 UE/mg) than in SH fetuses (3.50 x 10(-2) +/- 0.25 UE/mg) (P = .01); maltase activity and protein content were not affected significantly. This report provides the first description of the adverse effects of maternal alcohol ingestion on the small intestinal mucosal function of the fetal rabbit. PMID:7965501

  16. The Effect of Maternal Thrombophilia on Placental Abruption: Histologic Correlates

    PubMed Central

    Kinzler, Wendy L.; Prasad, Vinay; Ananth, Cande V.

    2011-01-01

    Objective To determine if the histology of placental abruption differs by maternal thrombophilia status. Study design This was a multicenter, case-control study of women with abruption and delivering at ≥20 weeks’ gestation, collected as part of the ongoing New Jersey-Placental Abruption Study. Women were identified by clinical criteria of abruption. Maternal blood was collected postpartum and tested for anticardiolipin antibodies, and mutations in the Factor V Leiden and prothrombin genes. Cases were comprised of women with an abruption and a positive thrombophilia screen. Controls were comprised of women with an abruption and a negative thrombophilia screen. All placental histology was systematically reviewed by two perinatal pathologists, blinded to the abruption status. Results A total of 135 women with placental abruption were identified, of which 63.0% (n=85) had at least one diagnosed maternal thrombophilia. There were increases in the rates of meconium-stained membranes (7.9% versus 2.1%, P=0.015) and decidual necrosis (4.5% versus 2.1%, P=0.023) when a maternal thrombophilia was diagnosed. Although there was no difference in the overall presence of infarcts between the 2 groups (27.0% versus 38.3%, P=0.064), the presence of an old infarct was more common among women with a positive thrombophilia screen (83.3% versus 44.4%, P=0.003). Conclusion Placental abruption with a positive maternal thrombophilia screen is associated with higher rates of old placental infarcts and decidual necrosis compared with abruption when thrombophilia is not diagnosed. These lesions suggest a chronic etiology of placental abruption in the presence of a maternal thrombophilia. PMID:19330709

  17. Maternal filicide in Turkey.

    PubMed

    Eke, Salih Murat; Basoglu, Saba; Bakar, Bulent; Oral, Gokhan

    2015-01-01

    Filicide occurs in every socioeconomic stratum around the world. This study was conducted to evaluate motives, psychopathological aspects, and socio-demographic factors of 74 filicide cases of women in Turkey. Mean age of mothers, most of whom committed infanticide, was 26 years, and breakdown of criminal offenses are as follows: "to get rid of unwanted babies" (24.3%), "acute psychotic-type filicide" (21.6%), "fatal child abuse and neglect" (17.6%), "to get revenge" (12.2%), "protect the lonely child from the harm and badness after suicide" (10.8%), and "pity" (9.5%) motives. Results showed that maternal filicide cannot be reduced to only mental instability or environmental factors and indicates deficiencies in the capacity of the mothers' role in connecting with their child and with parenting skills. Finally, with regard to defendants' motives, similar factors that contribute to committing maternal filicide should be considered while making an assessment of the data and determining employee risk groups. PMID:25066272

  18. The effect of maternal healthcare on the probability of child survival in Azerbaijan.

    PubMed

    Habibov, Nazim; Fan, Lida

    2014-01-01

    This study assesses the effects of maternal healthcare on child survival by using nonrandomized data from a cross-sectional survey in Azerbaijan. Using 2SLS and simultaneous equation bivariate probit models, we estimate the effects of delivering in healthcare facility on probability of child survival taking into account self-selection into the treatment. For women who delivered at healthcare facilities, the probability of child survival increases by approximately 18%. Furthermore, if every woman had the opportunity to deliver in healthcare facility, then the probability of child survival in Azerbaijan as a whole would have increased by approximately 16%. PMID:25110673

  19. Effect of Maternal Depression on Child Behavior: A Sensitive Period?

    ERIC Educational Resources Information Center

    Bagner, Daniel M.; Pettit, Jeremy W.; Lewinsohn, Peter M.; Seeley, John R.

    2010-01-01

    Objective: The purpose of this study was to examine the effect of maternal depression during the child's first year of life (i.e., sensitive period) on subsequent behavior problems. Method: Participants were 175 mothers participating in the Oregon Adolescent Depression Project (OADP) who met lifetime diagnostic criteria for major depressive…

  20. Transparency in Maternity Care: Empowering Women to Make Educated Choices

    PubMed Central

    McAllister, Elan

    2008-01-01

    The author of this guest editorial calls for a higher level of transparency in maternity care. The public should have access to information about hospital and provider policies and practices so that women and their families can determine where and with whom to birth. Currently, many grassroots-level projects, including The Birth Survey, are addressing this need. PMID:19436532

  1. Can a community-based maternal care package in rural Ethiopia increase the use of health facilities for childbirth and reduce the stillbirth rate?

    PubMed Central

    Atnafu, Habtamu; Belete, Zelalem; Kinfu, Hirut; Tadesse, Mebkyou; Amin, Mohammed; Ballard, Karen D

    2016-01-01

    Objective To measure the impact of a maternal health package on health facility delivery and stillbirth rates. Methods This is a cross-sectional study in Ethiopia where a maternal package was integrated into eight health centers across three regions. The package included trained midwives with a mentoring program, transport for referral, and equipment and accommodation for the midwives. Ten health centers without the package but in the same districts as the intervention centers and eight without the package in different districts were randomly selected as the comparison groups. Women living in the catchment areas of the 26 health centers, who delivered a baby in the past 12 months, were randomly selected to complete a face-to-face survey about maternal health experiences. Results The maternal package did not significantly affect the stillbirth or facility delivery rates. Women were positively influenced to deliver in a health facility if their husbands were involved in the decision concerning the place of birth and if they had prior maternal experience in the health center. Barriers to delivering in a health facility included distance and ability to read and write. Conclusion Women served by health centers with a maternal health package did not have significantly fewer stillbirths and were not more likely to deliver their babies in a health facility. Husbands played an important role in influencing the decisions to deliver in a health facility. PMID:27574471

  2. Maternal mortality in the developed world: lessons from the UK confidential enquiry

    PubMed Central

    de Swiet, Michael

    2008-01-01

    The UK confidential maternal mortality enquiry shows that not only has maternal mortality decreased since 1952, the year of the first enquiry, but also the pattern of maternal mortality has changed markedly. Major surgical causes of death, such as post-partum haemorrhage and ruptured uterus, are no longer as important as medical causes such as heart disease. The ‘Top Ten’ recommendations in the current report for the years 2003–2005 emphasise the need for health care practitioners to be aware of the risks that medical conditions, both pre-existing and those arising de novo in pregnancy, impose on the expectant and newly delivered mother. Training and further education programmes should emphasise the importance of medical problems in pregnancy without omitting the knowledge and skills in basic obstetrics that have made such an impact on maternal mortality in the past.

  3. Evidence for action on improving the maternal and newborn health workforce: The basis for quality care.

    PubMed

    Campbell, Jim; Sochas, Laura; Cometto, Giorgio; Matthews, Zoë

    2016-01-01

    Ambitious new goals to end preventable maternal and newborn deaths will not only require increased coverage but also improved quality of care. Unfortunately, current levels of quality in the delivery of maternal and newborn care are low in high-burden countries, for reasons that are intimately linked with inadequate planning and management of the maternal and newborn health workforce. The Global Strategy on Human Resources for Health is a key opportunity to strengthen global and country-level accountability frameworks for the health workforce and its capacity to deliver quality care. In order to succeed, maternal and newborn health specialists must embrace this strategy and its linkages with the new Global Strategy for Women's, Children's, and Adolescents' Health; action is needed across high- and low-income countries; and any accountability framework must be underpinned by ambitious, measurable indicators and strengthened data collection on human resources for health. PMID:26725857

  4. Maternal Fatty Acids and Their Association with Birth Outcome: A Prospective Study

    PubMed Central

    Meher, Akshaya; Randhir, Karuna; Mehendale, Savita; Wagh, Girija; Joshi, Sadhana

    2016-01-01

    Maternal nutrition, especially LCPUFA, is an important factor in determining fetal growth and development. Our earlier cross sectional study reports lower docosahexanoic acid (DHA) levels at the time of delivery in mothers delivering low birth weight (LBW) babies. This study was undertaken to examine the role of the maternal omega-3 and omega-6 fatty acid profile across the gestation in fetal growth. This is a hospital based study where women were recruited in early gestation. Maternal blood was collected at 3 time points, i.e., T1 = 16th–20th week, T2 = 26th–30th week and T3 = at delivery. Cord blood was collected at delivery. At delivery, these women were divided into 2 groups: those delivering at term a baby weighing >2.5kg [Normal birth weight (NBW) group] and those delivering at term a baby weighing <2.5kg [LBW group]. The study reports data on 111 women recruited at T1, out of which 60 women delivered an NBW baby at term and 51 women delivered an LBW baby at term. Fatty acids were analysed using gas chromatography. At T1 of gestation, maternal erythrocyte DHA levels were positively (p<0.05) associated with baby weight. Maternal plasma and erythrocyte arachidonic acid and total erythrocyte omega-6 fatty acid levels at T2 were higher (p<0.05 for both) in the LBW group. Total erythrocyte omega-3 fatty acid levels were lower (p<0.05) while total erythrocyte omega-6 fatty acid levels were higher (p<0.05) in the LBW group at delivery. Our data demonstrates the possible role of LCPUFA in the etiology of LBW babies right from early pregnancy. PMID:26815428

  5. The Impact of Maternal Obesity on Maternal and Fetal Health

    PubMed Central

    Leddy, Meaghan A; Power, Michael L; Schulkin, Jay

    2008-01-01

    The increasing rate of maternal obesity provides a major challenge to obstetric practice. Maternal obesity can result in negative outcomes for both women and fetuses. The maternal risks during pregnancy include gestational diabetes and preeclampsia. The fetus is at risk for stillbirth and congenital anomalies. Obesity in pregnancy can also affect health later in life for both mother and child. For women, these risks include heart disease and hypertension. Children have a risk of future obesity and heart disease. Women and their offspring are at increased risk for diabetes. Obstetrician-gynecologists are well positioned to prevent and treat this epidemic. PMID:19173021

  6. Using food to soothe: Maternal attachment anxiety is associated with child emotional eating.

    PubMed

    Hardman, Charlotte A; Christiansen, Paul; Wilkinson, Laura L

    2016-04-01

    Attachment anxiety (fear of abandonment) is associated with disinhibited eating in adults. Both maternal disinhibited eating and use of emotional feedings strategies are associated with emotional eating in children. On this basis, the current study sought to determine whether attachment anxiety is an underlying maternal characteristic that predicts parental reports of child emotional over-eating via its effects on maternal disinhibited eating and emotional feeding. Mothers of a preadolescent child (N = 116) completed an internet-delivered questionnaire. Maternal attachment anxiety and dietary disinhibition were assessed by the Experiences in Close Relationships questionnaire and the Three Factor Eating Questionnaire, respectively. The Parental Feeding Strategies Questionnaire and the Child Eating Behaviour Questionnaire were used to quantify emotional feeding and child emotional over-eating, respectively. Bias-corrected bootstrapping indicated a significant direct effect of maternal attachment anxiety on child emotional over-eating (i.e., controlling for maternal disinhibited eating and emotional feeding). There was also a significant indirect effect of maternal attachment anxiety on child emotional over-eating via emotional feeding strategies. In a subsequent model to investigate bi-directional relationships, the direct effect of maternal attachment anxiety on emotional feeding strategies was not statistically significant after controlling for child emotional over-eating. There was, however, a significant indirect effect of maternal attachment anxiety on emotional feeding strategies via child emotional over-eating. These findings highlight the influence of maternal attachment anxiety on parental reports of aberrant eating behaviour in children. While this may be partly due to use of emotional feeding strategies, there is stronger evidence for a "child-responsive" model whereby anxiously-attached mothers use these feeding practices in response to perceived

  7. Perimortem cesarean delivery: its role in maternal mortality.

    PubMed

    Katz, Vern L

    2012-02-01

    Since Roman times, physicians have been instructed to perform postmortem cesarean deliveries to aid in funeral rites, baptism, and in the very slim chance that a live fetus might still be within the deceased mother's womb. This procedure was disliked by physicians being called to a dying mother's bedside. As births moved to hospitals, and modern obstetrics evolved, the causes of maternal death changed from sepsis, hemorrhage, and dehydration to a greater incidence of sudden cardiac arrest from medication errors or embolism. Thus, the likelihood of delivering a viable neonate at the time of a mother's death increased. Additionally, as cardiopulmonary resuscitation (CPR) became widespread, physicians realized that during pregnancy, with the term gravid woman lying on her back, chest compressions cannot deliver sufficient cardiac output to accomplish resuscitation. Paradoxically, after a postmortem cesarean delivery is performed, effective CPR was seen to occur. Mothers were revived. Thus, the procedure was renamed the perimortem cesarean. Because brain damage begins at 5 minutes of anoxia, the procedure should be initiated at 4 minutes (the 4-minute rule) to deliver the healthiest fetus. If a mother has a resuscitatable cause of death, then her life may be saved as well by a prompt and timely cesarean delivery during CPR. Sadly, too often, we are paralyzed by the horror of the maternal cardiac arrest, and instinctively, we try CPR for too long before turning to the perimortem delivery. The quick procedure though may actually improve the situation for the mother, and certainly will save the child. PMID:22280869

  8. Lucile Jones to Deliver Public Lecture at 2013 Fall Meeting

    NASA Astrophysics Data System (ADS)

    Adamec, Bethany Holm

    2013-07-01

    Lucile Jones, science advisor for risk reduction with the U.S. Geological Survey, will deliver the annual public lecture at the 2013 AGU Fall Meeting. A familiar face to many in California, Jones is frequently interviewed on television after major earthquakes in the southern part of the state. Her work, which has resulted in more than 90 publications on research seismology, focuses on foreshocks and earthquake physics. Her current Multi-Hazards Demonstration Project aims to demonstrate to the public how science can improve society's resiliency to earthquakes.

  9. Color View of 'Rosy Red' Delivered to TEGA

    NASA Technical Reports Server (NTRS)

    2008-01-01

    NASA's Phoenix Mars Lander's Surface Stereo Imager took this false color image on Sol 72 (August 7, 2008), the 72nd Martian day after landing. It shows a soil sample from a trench informally called 'Rosy Red' after being delivered to a gap between partially opened doors on the lander's Thermal and Evolved-Gas Analyzer, or TEGA.

    The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.

  10. Maternal Phenylketonuria (MPKU)

    PubMed Central

    Schoonheyt, W.E.; Hanley, W.B.; Clarke, J.T.R.; Austin, V.; Howe, D.A.

    1986-01-01

    Untreated maternal phenylketonuria (MPKU) is a major cause of microcephaly, congenital heart disease, intrauterine growth retardation and mental retardation in the offspring of mothers who have the disease. There is evidence, however, that dietary restriction of phenylalanine in the mother before conception and throughout the pregnancy will reduce the risk of these congenital anomalies in the fetus. It is important to be alert to this preventable cause of developmental retardation and congenital abnormalities in all pregnancies until the stage is reached where every woman of child-bearing age has been through the neonatal PKU-screening program. Family physicians are advised to consider prenatal or premarital screening for PKU of all female patients of child-bearing age for the next generation. PMID:21267327

  11. Neuroendocrine Regulation of Maternal Behavior

    PubMed Central

    Bridges, Robert S.

    2015-01-01

    The expression of maternal behavior in mammals is regulated by the developmental and experiential events over a female’s lifetime. In this review the relationships between the endocrine and neural systems that play key roles in these developmental and experiential that affect both the establishment and maintenance of maternal care are presented. The involvement of the hormones estrogen, progesterone, and lactogens are discussed in the context of ligand, receptor, and gene activity in rodents and to a lesser extent in higher mammals. The roles of neuroendocrine factors, including oxytocin, vasopressin, classical neurotransmitters, and other neural gene products that regulate aspects of maternal care are set forth, and the interactions of hormones with central nervous system mediators of maternal behavior are discussed. The impact of prior developmental factors, including epigenetic events, and maternal experience on subsequent maternal care are assessed over the course of the female’s lifespan. It is proposed that common neuroendocrine mechanisms underlie the regulation of maternal care in mammals. PMID:25500107

  12. [Enflurane and fluorconcentrations in maternal and fetal blood during anaesthesia for for caesarean Section (authors transl)].

    PubMed

    Weiss, V; de Carlini, C; Engelhorn, A

    1977-10-01

    During anaesthesia for caesarean sections, the placental transfer and metabolism of Enflurane were investigated in 14 cases. In 3 cases, the administered concentration of 0.4 vol.% Enflurane showed too slight anaesthesia. In 11 cases, 0.6 vol.% Enflurane were delivered to the maternal respiratory mixture. A gaschromatographic method was used to measure the maternal and fetal blood concentrations of Enflurane. The calculated maternal mean value of Enflurane showed a concentration of 330 mumol/l which corresponds to 6.07 mg/100ml; the fetal mean value was 148 mumol/l or 2.72 mg/100 ml. This means that during operating time about 44.8% from the maternal Enflurane concentration has crossed to the fetus. The metabolic break down of Enflurane could be demonstrated by the measurement of inorganic fluorides in the maternal and fetal blood. The fluor concentration in the maternal blood increased during the operation and reached a mean value of 15.5 mumol/l at the time of birth; the mean value in the cord vein was at the same time 9.28 mumol/l which corresponds to 61% of the maternal concentration. PMID:917976

  13. Association between Short Maternal Height and Low Birth Weight: a Hospital-based Study in Japan

    PubMed Central

    2016-01-01

    Anthropometry measurements, such as height and weight, have recently been used to predict poorer birth outcomes. However, the relationship between maternal height and birth outcomes remains unclear. We examined the effect of shorter maternal height on low birth weight (LBW) among 17,150 pairs of Japanese mothers and newborns. Data for this analysis were collected from newborns who were delivered at a large hospital in Japan. Maternal height was the exposure variable, and LBW and admission to the neonatal intensive care unit were the outcome variables. Logistic regression models were used to estimate the associations. The shortest maternal height quartile (131.0–151.9 cm) was related to LBW (OR 1.91 [95% CI 1.64, 2.22]). The groups with the second (152.0–157.9 cm) and the third shortest maternal height quartiles (158.0–160.9 cm) were also related to LBW. A P trend with one quartile change also showed a significant relationship. The relationship between maternal height and NICU admission disappeared when the statistical model was adjusted for LBW. A newborn’s small size was one factor in the relationship between shorter maternal height and NICU admission. In developed countries, shorter mothers provide a useful prenatal target to anticipate and plan for LBW newborns and NICU admission. PMID:26955234

  14. Fetal growth in early pregnancy and risk of delivering low birth weight infant: prospective cohort study

    PubMed Central

    Smith, Gordon C S; Malone, Fergal D; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Hankins, Gary D V; Berkowitz, Richard L; Gross, Susan J; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E

    2007-01-01

    Objective To determine if first trimester fetal growth is associated with birth weight, duration of pregnancy, and the risk of delivering a small for gestational age infant. Design Prospective cohort study of 38 033 pregnancies between 1999 and 2003. Setting 15 centres representing major regions of the United States. Participants 976 women from the original cohort who conceived as the result of assisted reproductive technology, had a first trimester ultrasound measurement of fetal crown-rump length, and delivered live singleton infants without evidence of chromosomal or congenital abnormalities. First trimester growth was expressed as the difference between the observed and expected size of the fetus, expressed as equivalence to days of gestational age. Main outcome measures Birth weight, duration of pregnancy, and risk of delivering a small for gestational age infant. Results For each one day increase in the observed size of the fetus, birth weight increased by 28.2 (95% confidence interval 14.6 to 41.2) g. The association was substantially attenuated by adjustment for duration of pregnancy (adjusted coefficient 17.1 (6.6 to 27.5) g). Further adjustments for maternal characteristics and complications of pregnancy did not have a significant effect. The risk of delivering a small for gestational age infant decreased with increasing size in the first trimester (odds ratio for a one day increase 0.87, 0.81 to 0.94). The association was not materially affected by adjustment for maternal characteristics or complications of pregnancy. Conclusion Variation in birth weight may be determined, at least in part, by fetal growth in the first 12 weeks after conception through effects on timing of delivery and fetal growth velocity. PMID:17355993

  15. Delivering Multimedia Teaching Modules via the Internet.

    ERIC Educational Resources Information Center

    Mudge, Stephen M.

    1999-01-01

    Discusses advantages and disadvantages of using the Internet for delivering teaching modules and makes recommendations for successful use of the Internet. Highlights include the availability of information at all times and from remote locations, multimedia capabilities, infrastructure needed, security issues, updating, needed skills, and…

  16. Delivering Images for Mars Rover Science Planning

    NASA Technical Reports Server (NTRS)

    Edmonds, Karina

    2008-01-01

    A methodology has been developed for delivering, via the Internet, images transmitted to Earth from cameras on the Mars Explorer Rovers, the Phoenix Mars Lander, the Mars Science Laboratory, and the Mars Reconnaissance Orbiter spacecraft. The images in question are used by geographically dispersed scientists and engineers in planning Rover scientific activities and Rover maneuvers pertinent thereto.

  17. Is International Accounting Education Delivering Pedagogical Value?

    ERIC Educational Resources Information Center

    Patel, Chris; Millanta, Brian; Tweedie, Dale

    2016-01-01

    This paper examines whether universities are delivering pedagogical value to international accounting students commensurate with the costs of studying abroad. The paper uses survey and interview methods to explore the extent to which Chinese Learners (CLs) in an Australian postgraduate accounting subject have distinct learning needs. The paper…

  18. Potential pathways by which maternal second-hand smoke exposure during pregnancy causes full-term low birth weight.

    PubMed

    Niu, Zhongzheng; Xie, Chuanbo; Wen, Xiaozhong; Tian, Fuying; Yuan, Shixin; Jia, Deqin; Chen, Wei-Qing

    2016-01-01

    It is well documented that maternal exposure to second-hand smoke (SHS) during pregnancy causes low birth weight (LBW), but its mechanism remains unknown. This study explored the potential pathways. We enrolled 195 pregnant women who delivered full-term LBW newborns, and 195 who delivered full-term normal birth weight newborns as the controls. After controlling for maternal age, education level, family income, pre-pregnant body mass index, newborn gender and gestational age, logistic regression analysis revealed that LBW was significantly and positively associated with maternal exposure to SHS during pregnancy, lower placental weight, TNF-α and IL-1β, and that SHS exposure was significantly associated with lower placental weight, TNF-α and IL-1β. Structural equation modelling identified two plausible pathways by which maternal exposure to SHS during pregnancy might cause LBW. First, SHS exposure induced the elevation of TNF-α, which might directly increase the risk of LBW by transmission across the placenta. Second, SHS exposure first increased maternal secretion of IL-1β and TNF-α, which then triggered the secretion of VCAM-1; both TNF-α and VCAM-1 were significantly associated with lower placental weight, thus increasing the risk of LBW. In conclusion, maternal exposure to SHS during pregnancy may lead to LBW through the potential pathways of maternal inflammation and lower placental weight. PMID:27126191

  19. Potential pathways by which maternal second-hand smoke exposure during pregnancy causes full-term low birth weight

    PubMed Central

    Niu, Zhongzheng; Xie, Chuanbo; Wen, Xiaozhong; Tian, Fuying; Yuan, Shixin; Jia, Deqin; Chen, Wei-Qing

    2016-01-01

    It is well documented that maternal exposure to second-hand smoke (SHS) during pregnancy causes low birth weight (LBW), but its mechanism remains unknown. This study explored the potential pathways. We enrolled 195 pregnant women who delivered full-term LBW newborns, and 195 who delivered full-term normal birth weight newborns as the controls. After controlling for maternal age, education level, family income, pre-pregnant body mass index, newborn gender and gestational age, logistic regression analysis revealed that LBW was significantly and positively associated with maternal exposure to SHS during pregnancy, lower placental weight, TNF-α and IL-1β, and that SHS exposure was significantly associated with lower placental weight, TNF-α and IL-1β. Structural equation modelling identified two plausible pathways by which maternal exposure to SHS during pregnancy might cause LBW. First, SHS exposure induced the elevation of TNF-α, which might directly increase the risk of LBW by transmission across the placenta. Second, SHS exposure first increased maternal secretion of IL-1β and TNF-α, which then triggered the secretion of VCAM-1; both TNF-α and VCAM-1 were significantly associated with lower placental weight, thus increasing the risk of LBW. In conclusion, maternal exposure to SHS during pregnancy may lead to LBW through the potential pathways of maternal inflammation and lower placental weight. PMID:27126191

  20. Investigating financial incentives for maternal health: an introduction.

    PubMed

    Stanton, Mary Ellen; Higgs, Elizabeth S; Koblinsky, Marge

    2013-12-01

    Projection of current trends in maternal and neonatal mortality reduction shows that many countries will fall short of the UN Millennium Development Goal 4 and 5. Underutilization of maternal health services contributes to this poor progress toward reducing maternal and neonatal morbidity and mortality. Moreover, the quality of services continues to lag in many countries, with a negative effect on the health of women and their babies, including deterring women from seeking care. To enhance the use and provision of quality maternal care, countries and donors are increasingly using financial incentives. This paper introduces the JHPN Supplement, in which each paper reviews the evidence of the effectiveness of a specific financial incentive instrument with the aim of improving the use and quality of maternal healthcare and impact. The US Agency for International Development and the US National Institutes of Health convened a US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives on 24-25 April 2012 in Washington, DC. The Summit brought together leading global experts in finance, maternal health, and health systems from governments, academia, development organizations, and foundations to assess the evidence on whether financial incentives significantly and substantially increase provision, use and quality of maternal health services, and the contextual factors that impact the effectiveness of these incentives. Evidence review teams evaluated the multidisciplinary evidence of various financial mechanisms, including supply-side incentives (e.g. performance-based financing, user fees, and various insurance mechanisms) and demand-side incentives (e.g. conditional cash transfers, vouchers, user fee exemptions, and subsidies for care-seeking). At the Summit, the teams presented a synthesis of evidence and initial recommendations on practice, policy, and research for discussion. The Summit enabled structured

  1. Investigating Financial Incentives for Maternal Health: An Introduction

    PubMed Central

    Higgs, Elizabeth S.; Koblinsky, Marge

    2013-01-01

    Projection of current trends in maternal and neonatal mortality reduction shows that many countries will fall short of the UN Millennium Development Goal 4 and 5. Underutilization of maternal health services contributes to this poor progress toward reducing maternal and neonatal morbidity and mortality. Moreover, the quality of services continues to lag in many countries, with a negative effect on the health of women and their babies, including deterring women from seeking care. To enhance the use and provision of quality maternal care, countries and donors are increasingly using financial incentives. This paper introduces the JHPN Supplement, in which each paper reviews the evidence of the effectiveness of a specific financial incentive instrument with the aim of improving the use and quality of maternal healthcare and impact. The US Agency for International Development and the US National Institutes of Health convened a US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives on 24-25 April 2012 in Washington, DC. The Summit brought together leading global experts in finance, maternal health, and health systems from governments, academia, development organizations, and foundations to assess the evidence on whether financial incentives significantly and substantially increase provision, use and quality of maternal health services, and the contextual factors that impact the effectiveness of these incentives. Evidence review teams evaluated the multidisciplinary evidence of various financial mechanisms, including supply-side incentives (e.g. performance-based financing, user fees, and various insurance mechanisms) and demand-side incentives (e.g. conditional cash transfers, vouchers, user fee exemptions, and subsidies for care-seeking). At the Summit, the teams presented a synthesis of evidence and initial recommendations on practice, policy, and research for discussion. The Summit enabled structured

  2. Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors.

    PubMed Central

    Southwick, K. L.; Blanco, S.; Santander, A.; Estenssoro, M.; Torrico, F.; Seoane, G.; Brady, W.; Fears, M.; Lewis, J.; Pope, V.; Guarner, J.; Levine, W. C.

    2001-01-01

    OBJECTIVES: The present study was carried out in seven maternity hospitals to determine the prevalence of maternal syphilis at the time of delivery and the associated risk factors, to conduct a pilot project of rapid syphilis testing in hospital laboratories, to assure the quality of syphilis testing, and to determine the rate of congenital syphilis in infants born to women with syphilis at the time of delivery--all of which would provide baseline data for a national prevention programme in Bolivia. METHODS: All women delivering either live-born or stillborn infants in the seven participating hospitals in and around La Paz, El Alto, and Cochabamba between June and November 1996 were eligible for enrolment in the study. FINDINGS: A total of 61 out of 1428 mothers (4.3%) of live-born infants and 11 out of 43 mothers (26%) of stillborn infants were found to have syphilis at delivery. Multivariate analysis showed that women with live-born infants who had less than secondary-level education, who did not watch television during the week before delivery (this was used as an indicator of socioeconomic status), who had a previous history of syphilis, or who had more than one partner during the pregnancy were at increased risk of syphilis. While 76% of the study population had received prenatal care, only 17% had syphilis testing carried out during the pregnancy; 91% of serum samples that were reactive to rapid plasma reagin (RPR) tests were also reactive to fluorescent treponemal antibody-absorption (FTA-ABS) testing. There was 96% agreement between the results from local hospital laboratories and national reference laboratories in their testing of RPR reactivity of serum samples. Congenital syphilis infection was confirmed by laboratory tests in 15% of 66 infants born to women with positive RPR and FTA-ABS testing. CONCLUSION: These results indicate that a congenital syphilis prevention programme in Bolivia could substantially reduce adverse infant outcomes due to this

  3. Maternal Care Determinant of Longevity?

    PubMed

    Giorgio, Marco; Renzi, Chiara; Oliveri, Serena; Pravettoni, Gabriella

    2016-04-01

    Maternal care is an essential early environment in mammals that ensures emotional regulation and adaptive fitness of progeny. Longevity and healthy aging are associated with favorable environmental factors including fitting social and behavioral features. In the present review, we discuss the findings that link rearing conditions and early maternal care with life span and aging from an evolutionary, psychological, and molecular perspective. The quality of maternal care may influence internal adaptation through a variety of parallel mechanisms including emotional regulation, stress sensitivity, coping and other behavioral strategies in response to events requiring adaptation. From a biological perspective, it regulates physiological pathways that may persist in adulthood through epigenetic mechanisms, influencing disease susceptibility and, potentially, longevity. Abnormal maternal care induces maladaptation that persists over the life span, may accelerate the onset of aging associated diseases, and shorten life span. This may have important implications in the development of preventive approaches and early interventions. PMID:27548096

  4. Partnership Transitions and Maternal Parenting

    PubMed Central

    Beck, Audrey N.; Cooper, Carey E.; McLanahan, Sara; Brooks-Gunn, Jeanne

    2011-01-01

    We use data from the Fragile Families and Child Wellbeing Study (N = 1,975) to examine the association between mothers’ partnership changes and parenting behavior during the first five years of their children’s lives. We compare coresidential with dating transitions, and recent with more distal transitions. We also examine interactions between transitions and race/ethnicity, maternal education and family structure at birth. Findings indicate that both coresidential and dating transitions were associated with higher levels of maternal stress and harsh parenting; recent transitions had stronger associations than distal transitions. Maternal education significantly moderates these associations, with less educated mothers responding more negatively to instability in terms of maternal stress, and more educated mothers responding more negatively in terms of literacy activities. PMID:21423848

  5. Oxytocin and Maternal Brain Plasticity.

    PubMed

    Kim, Sohye; Strathearn, Lane

    2016-09-01

    Although dramatic postnatal changes in maternal behavior have long been noted, we are only now beginning to understand the neurobiological mechanisms that support this transition. The present paper synthesizes growing insights from both animal and human research to provide an overview of the plasticity of the mother's brain, with a particular emphasis on the oxytocin system. We examine plasticity observed within the oxytocin system and discuss how these changes mediate an array of other adaptations observed within the maternal brain. We outline factors that affect the oxytocin-mediated plasticity of the maternal brain and review evidence linking disruptions in oxytocin functions to challenges in maternal adaptation. We conclude by suggesting a strategy for intervention with mothers who may be at risk for maladjustment during this transition to motherhood, while highlighting areas where further research is needed. PMID:27589498

  6. Maternal Competence, Expectation, and Involvement

    ERIC Educational Resources Information Center

    Heath, Douglas H.

    1977-01-01

    Presents a study of maternal competence, expectations and involvement in child rearing decisions in relation to paternal personality and marital characteristics. Subjects were 45 thirty-year-old mothers. (BD)

  7. A service model for delivering care closer to home.

    PubMed

    Dodd, Joanna; Taylor, Charlotte Elizabeth; Bunyan, Paul; White, Philippa Mary; Thomas, Siân Myra; Upton, Dominic

    2011-04-01

    Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient.This is a practical example of early implementation of the principles underlying the Department of Health's (DH) recent Best Practice Guidance, 'Delivering Care Closer to Home' (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the 'Customer Care' award by 'Management in Practice'. The Surgery was also awarded the 'Practice of the Year' award for this and a number of other customer-focussed projects. PMID:21457595

  8. Development and implementation of a novel online breastfeeding support resource: the Maternal Virtual Infant Nutrition Support Clinic.

    PubMed

    Geoghegan-Morphet, Nicola; Yuen, Doris; Rai, Esther; Angelini, Michelle; Christmas, Melissa; da Silva, Orlando

    2014-12-01

    Exclusive breastfeeding is the optimal method of infant feeding for the first 6 months of life for both term and preterm infants. This recommendation is based on indisputable evidence that breastfeeding offers numerous infant and maternal health benefits. Several trials have shown the beneficial effect of peer and/or professional support on the duration of any breastfeeding up to 6 months. Although many well-established programs exist that provide this support in-person or via telephone, the Internet is a relatively new means to deliver breastfeeding help. Yet, mothers have a vast presence online and a clear desire to seek healthcare information on the Internet. The availability and accessibility of interactive communication technologies via the internet provide the opportunity for developing new methods of healthcare delivery. Our project uses information technology to deliver an innovative and cost-effective way to support breastfeeding mothers. Our new online breastfeeding support clinic has the potential to improve access to specialized professional breastfeeding support in combination with interactive peer support. This new online clinic can be readily implemented to all regions in Canada with reliable Internet access, with the potential to significantly impact the health of all Canadian infants and their families. PMID:25244066

  9. Neurotensin inversely modulates maternal aggression.

    PubMed

    Gammie, S C; D'Anna, K L; Gerstein, H; Stevenson, S A

    2009-02-18

    Neurotensin (NT) is a versatile neuropeptide involved in analgesia, hypothermia, and schizophrenia. Although NT is released from and acts upon brain regions involved in social behaviors, it has not been linked to a social behavior. We previously selected mice for high maternal aggression (maternal defense), an important social behavior that protects offspring, and found significantly lower NT expression in the CNS of highly protective females. Our current study directly tested NT's role in maternal defense. Intracerebroventricular (i.c.v.) injections of NT significantly impaired defense in terms of time aggressive and number of attacks at all doses tested (0.05, 0.1, 1.0, and 3.0 microg). Other maternal behaviors, including pup retrieval, were unaltered following NT injections (0.05 microg) relative to vehicle, suggesting specificity of NT action on defense. Further, i.c.v. injections of the NT receptor 1 (NT1) antagonist, SR 48692 (30 microg), significantly elevated maternal aggression in terms of time aggressive and attack number. To understand where NT may regulate aggression, we examined Fos following injection of either 0.1 microg NT or vehicle. Thirteen of 26 brain regions examined exhibited significant Fos increases with NT, including regions expressing NT1 and previously implicated in maternal aggression, such as lateral septum, bed nucleus of stria terminalis, paraventricular nucleus, and central amygdala. Together, our results indicate that NT inversely regulates maternal aggression and provide the first direct evidence that lowering of NT signaling can be a mechanism for maternal aggression. To our knowledge, this is the first study to directly link NT to a social behavior. PMID:19118604

  10. Maternal health phone line: saving women in papua new Guinea.

    PubMed

    Watson, Amanda H A; Sabumei, Gaius; Mola, Glen; Iedema, Rick

    2015-01-01

    This paper presents the findings of a research project which has involved the establishment of a maternal health phone line in Milne Bay Province of Papua New Guinea (PNG). Mobile phones and landline phones are key information and communication technologies (ICTs). This research study uses the "ICTs for healthcare development" model to ascertain benefits and barriers to the successful implementation of the Childbirth Emergency Phone. PNG has a very high maternal mortality rate. The "three stages of delay" typology was developed by Thaddeus and Maine to determine factors that might delay provision of appropriate medical treatment and hence increase risk of maternal death. The "three stages of delay" typology has been utilised in various developing countries and also in the present study. Research undertaken has involved semi-structured interviews with health workers, both in rural settings and in the labour ward in Alotau. Additional data has been gathered through focus groups with health workers, analysis of notes made during phone calls, interviews with women and community leaders, observations and field visits. One hundred percent of interviewees (n = 42) said the project helped to solve communication barriers between rural health workers and Alotau Provincial Hospital. Specific examples in which the phone line has helped to create positive health outcomes will be outlined in the paper, drawn from research interviews. The Childbirth Emergency Phone project has shown itself to play a critical role in enabling healthcare workers to address life-threatening childbirth complications. The project shows potential for rollout across PNG; potentially reducing maternal morbidity and maternal mortality rates by overcoming communication challenges. PMID:25923199

  11. Maternal Health Phone Line: Saving Women in Papua New Guinea

    PubMed Central

    Watson, Amanda H.A.; Sabumei, Gaius; Mola, Glen; Iedema, Rick

    2015-01-01

    This paper presents the findings of a research project which has involved the establishment of a maternal health phone line in Milne Bay Province of Papua New Guinea (PNG). Mobile phones and landline phones are key information and communication technologies (ICTs). This research study uses the “ICTs for healthcare development” model to ascertain benefits and barriers to the successful implementation of the Childbirth Emergency Phone. PNG has a very high maternal mortality rate. The “three stages of delay” typology was developed by Thaddeus and Maine to determine factors that might delay provision of appropriate medical treatment and hence increase risk of maternal death. The “three stages of delay” typology has been utilised in various developing countries and also in the present study. Research undertaken has involved semi-structured interviews with health workers, both in rural settings and in the labour ward in Alotau. Additional data has been gathered through focus groups with health workers, analysis of notes made during phone calls, interviews with women and community leaders, observations and field visits. One hundred percent of interviewees (n = 42) said the project helped to solve communication barriers between rural health workers and Alotau Provincial Hospital. Specific examples in which the phone line has helped to create positive health outcomes will be outlined in the paper, drawn from research interviews. The Childbirth Emergency Phone project has shown itself to play a critical role in enabling healthcare workers to address life-threatening childbirth complications. The project shows potential for rollout across PNG; potentially reducing maternal morbidity and maternal mortality rates by overcoming communication challenges. PMID:25923199

  12. Preconception maternal nutrition: a multi-site randomized controlled trial

    PubMed Central

    2014-01-01

    Background Research directed to optimizing maternal nutrition commencing prior to conception remains very limited, despite suggestive evidence of its importance in addition to ensuring an optimal nutrition environment in the periconceptional period and throughout the first trimester of pregnancy. Methods/Study design This is an individually randomized controlled trial of the impact on birth length (primary outcome) of the time at which a maternal nutrition intervention is commenced: Arm 1: ≥ 3 mo preconception vs. Arm 2: 12-14 wk gestation vs. Arm 3: none. 192 (derived from 480) randomized mothers and living offspring in each arm in each of four research sites (Guatemala, India, Pakistan, Democratic Republic of the Congo). The intervention is a daily 20 g lipid-based (118 kcal) multi-micronutient (MMN) supplement. Women randomized to receive this intervention with body mass index (BMI) <20 or whose gestational weight gain is low will receive an additional 300 kcal/d as a balanced energy-protein supplement. Researchers will visit homes biweekly to deliver intervention and monitor compliance, pregnancy status and morbidity; ensure prenatal and delivery care; and promote breast feeding. The primary outcome is birth length. Secondary outcomes include: fetal length at 12 and 34 wk; incidence of low birth weight (LBW); neonatal/infant anthropometry 0-6 mo of age; infectious disease morbidity; maternal, fetal, newborn, and infant epigenetics; maternal and infant nutritional status; maternal and infant microbiome; gut inflammatory biomarkers and bioactive and nutritive compounds in breast milk. The primary analysis will compare birth Length-for-Age Z-score (LAZ) among trial arms (independently for each site, estimated effect size: 0.35). Additional statistical analyses will examine the secondary outcomes and a pooled analysis of data from all sites. Discussion Positive results of this trial will support a paradigm shift in attention to nutrition of all females of

  13. Maternity Leave in Taiwan

    PubMed Central

    Feng, Joyce Yen; Han, Wen-Jui

    2011-01-01

    Using the first nationally representative birth cohort study in Taiwan, this paper examines the role that maternity leave policy in Taiwan plays in the timing of mothers returning to work after giving birth, as well as the extent to which this timing is linked to the amount of time mothers spend with their children and their use of breast milk versus formula. We found that the time when mothers returned to work coincided with the duration of guaranteed leave. In particular, mothers with a labor pension plan resumed work significantly earlier than mothers with no pension plan, and mothers with no pension plan returned to work significantly later than those with pension plans. The short leave of absence guaranteed under existing policies translated into mothers spending less time with their children and being more likely to exclusively use formula by 6 months after birth. In contrast, mothers who resumed work later than 6 months after birth were more likely to have not worked before birth or to have quit their jobs during pregnancy. Implications and recommendations for parental leave policy in Taiwan are discussed. PMID:21603074

  14. Delivering difficult news in psychiatric settings.

    PubMed

    Cleary, Michelle; Hunt, Glenn E; Horsfall, Jan

    2009-01-01

    Communication research and investigations into the delivery of bad news are uncommon in psychiatry versus other medical specialties. The question of delivering "bad" diagnostic news in psychiatry has been focused on dementia rather than actual psychiatric disorders and their sequelae. Common problems are that psychiatrists avoid dealing with patients' emotional reactions to bad news and that they avoid providing a clear diagnosis for fear that patients or carers will be distressed. This article aims to provide an overview of key elements of the "breaking bad news" literature, teasing out factors that are relevant to psychiatric practice. Topics explored include: definitions; clinical considerations for delivering difficult news within medical and psychiatric settings; protocols and guidelines; evidence about patient information needs and communication preferences; research into actual delivery of such news; and areas for future education and research. PMID:19832045

  15. TMS delivered for A-3 Test Stand

    NASA Technical Reports Server (NTRS)

    2010-01-01

    A state-of-the-art thrust measurement system for the A-3 Test Stand under construction at NASA's John C. Stennis Space Center was delivered March 17. Once completed, the A-3 stand (seen in background) will allow simulated high-altitude testing on the next generation of rocket engines for America's space program. Work on the stand began in 2007, with activation scheduled for 2012. The stand is the first major test structure to be built at Stennis since the 1960s. The recently delivered TMS was fabricated by Thrust Measurement Systems in Illinois. It is an advanced calibration system capable of measuring vertical and horizontal thrust loads with an accuracy within 0.15 percent at 225,000 pounds.

  16. Major Placenta Previa: Rate, Maternal and Neonatal Outcomes Experience at a Tertiary Maternity Hospital, Sohag, Egypt: A Prospective Study

    PubMed Central

    Ahmed, Salah Roshdy; Aitallah, Abdusaeed; Abdelghafar, Hazem M.

    2015-01-01

    Introduction Major degree placenta is a serious health issue and is associated with high fetal-maternal morbidity and mortality. Literature from developing countries is scant. Aim To determine the prevalence and maternal and neonatal outcomes among women with major placenta previa (PP). Materials and Methods A prospective descriptive study of 52 singleton pregnancies with PP was evaluated in this study. The study was conducted at Sohag University Hospital, Egypt from January through June 2014. Outcome measures, including the prevalence of PP, maternal and neonatal outcomes, and case-fatality rate. Results The total number of deliveries performed during the study period was 3841, of them, 52 cases were placenta previa. Thus, the prevalence of PP was 1.3%. The mean of previous cesarean scars was 2.2±1.4. Of women with PP, 26.4% (n=14) had placenta accreta. In total, 15.1% (n=8) of women underwent an obstetric hysterectomy. From the total no. of babies, 13.2% (n=7) were delivered fresh stillborn babies. Of the surviving babies (n=45), 20% (n=9) required admission to NICU. The frequencies of bowel and bladder injuries were 3.8% (n=2) and 13.2% (n=7) respectively. There was no maternal death in this study. Conclusion The rate of PP is comparable to previous studies, however, the rate of placenta accreta is high. Also, there are high rates of neonatal mortality and intraoperative complications which can be explained by accreta. The study highlights the need to revise maternity and child health services. PMID:26674539

  17. Magnetic Fluids Deliver Better Speaker Sound Quality

    NASA Technical Reports Server (NTRS)

    2015-01-01

    In the 1960s, Glenn Research Center developed a magnetized fluid to draw rocket fuel into spacecraft engines while in space. Sony has incorporated the technology into its line of slim speakers by using the fluid as a liquid stand-in for the speaker's dampers, which prevent the speaker from blowing out while adding stability. The fluid helps to deliver more volume and hi-fidelity sound while reducing distortion.

  18. Maternal Weight Gain as a Predictor of Litter Size in Swiss Webster, C57BL/6J, and BALB/cJ mice

    PubMed Central

    Finlay, James B; Liu, Xueli; Ermel, Richard W; Adamson, Trinka W

    2015-01-01

    An important task facing both researchers and animal core facilities is producing sufficient mice for a given project. The inherent biologic variability of mouse reproduction and litter size further challenges effective research planning. A lack of precision in project planning contributes to the high cost of animal research, overproduction (thus waste) of animals, and inappropriate allocation of facility resources. To examine the extent daily prepartum maternal weight gain predicts litter size in 2 commonly used mouse strains (BALB/cJ and C57BL/6J) and one mouse stock (Swiss Webster), we weighed ≥ 25 pregnant dams of each strain or stock daily from the morning on which a vaginal plug (day 0) was present. On the morning when dams delivered their pups, we recorded the weight of the dam, the weight of the litter itself, and the number of pups. Litter sizes ranged from 1 to 7 pups for BALB/cJ, 2 to 13 for Swiss Webster, and 5 to 11 for C57BL/6J mice. Linear regression models (based on weight change from day 0) demonstrated that maternal weight gain at day 9 (BALB/cJ), day 11 (Swiss Webster), or day 14 (C57BL/6J) was a significant predictor of litter size. When tested prospectively, the linear regression model for each strain or stock was found to be accurate. These data indicate that the number of pups that will be born can be estimated accurately by using maternal weight gain at specific or stock-specific time points. PMID:26632778

  19. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy

    PubMed Central

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  20. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy.

    PubMed

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  1. Where to deliver? Analysis of choice of delivery location from a national survey in India

    PubMed Central

    Thind, Amardeep; Mohani, Amir; Banerjee, Kaberi; Hagigi, Fred

    2008-01-01

    Background In order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. We assess the determinants of home, private and public sector utilization for a delivery in a Western state. Methods Cross sectional analyses of the National Family Health Survey – 2 dataset. Setting Maharashtra state. The dataset had a sample size of 5391 ever-married females between the ages of 15 to 49 years. Data were abstracted for the most recent birth (n = 1510) and these were used in the analyses. Conceptual framework was the Andersen Behavioral Model. Multinomial logistic regression analyses was conducted to assess the association of predisposing, enabling and need factors on use of home, public or private sector for delivery. Results A majority delivered at home (n = 559, 37%); with private and public facility deliveries accounting for 32% (n = 493) and 31% (n = 454) respectively. For the choice set of home delivery versus public facility, women with higher birth order and those living in rural areas had greater odds of delivering at home, while increasing maternal age, greater media exposure, and more then three antenatal visits were associated with greater odds of delivery in a public facility. Maternal and paternal education, scheduled caste/tribe status, and media exposure were statistically significant predictors of the choice of public versus private facility delivery. Conclusion As India's economy continues to grow, the private sector will continue to expand. Given the high household expenditures on health, the government needs to facilitate insurance schemes or provide grants to prevent impoverishment. It also needs to strengthen the public sector so that it can return to its mission of being the safety net. PMID:18218093

  2. Maternal scaffolding behavior: links with parenting style and maternal education.

    PubMed

    Carr, Amanda; Pike, Alison

    2012-03-01

    The purpose of this study was to specify the relationship between positive and harsh parenting and maternal scaffolding behavior. A 2nd aim was to disentangle the effects of maternal education and parenting quality, and a 3rd aim was to test whether parenting quality mediated the association between maternal education and scaffolding practices. We examined associations between positive and harsh parenting practices and contingent and noncontingent tutoring strategies. Ninety-six mother-child dyads (49 boys, 47 girls) from working- and middle-class English families participated. Mothers reported on parenting quality at Time 1 when children were 5 years old and again approximately 5 years later at Time 2. Mother-child pairs were observed working together on a block design task at Time 2, and interactions were coded for contingent (contingent shifting) and noncontingent (fixed failure feedback) dimensions of maternal scaffolding behavior. Positive and harsh parenting accounted for variance in contingent behavior over and above maternal education, whereas only harsh parenting accounted for unique variance in noncontingent scaffolding practices. Our findings provide new evidence for a more differentiated model of the relation between general parenting quality and specific scaffolding behaviors. PMID:22004338

  3. Reproductive health for refugees by refugees in Guinea III: maternal health

    PubMed Central

    2011-01-01

    Background Maternal mortality can be particularly high in conflict and chronic emergency settings, partly due to inaccessible maternal care. This paper examines associations of refugee-led health education, formal education, age, and parity on maternal knowledge, attitudes, and practices among reproductive-age women in refugee camps in Guinea. Methods Data comes from a 1999 cross-sectional survey of 444 female refugees in 23 camps. Associations of reported maternal health outcomes with exposure to health education (exposed versus unexposed), formal education (none versus some), age (adolescent versus adult), or parity (nulliparous, parous, grand multiparous), were analysed using logistic regression. Results No significant differences were found in maternal knowledge or attitudes. Virtually all respondents said pregnant women should attend antenatal care and knew the importance of tetanus vaccination. Most recognised abdominal pain (75%) and headaches (24%) as maternal danger signs and recommended facility attendance for danger signs. Most had last delivered at a facility (67%), mainly for safety reasons (99%). Higher odds of facility delivery were found for those exposed to RHG health education (adjusted odds ratio 2.03, 95%CI 1.23-3.01), formally educated (adjusted OR 1.93, 95%CI 1.05-3.92), or grand multipara (adjusted OR 2.13, 95%CI 1.21-3.75). Main reasons for delivering at home were distance to a facility (94%) and privacy (55%). Conclusions Refugee-led maternal health education appeared to increase facility delivery for these refugee women. Improved knowledge of danger signs and the importance of skilled birth attendance, while vital, may be less important in chronic emergency settings than improving facility access where quality of care is acceptable. PMID:21486433

  4. Maternal mortality in a district hospital in West Bengal.

    PubMed

    Gun, K M

    1970-06-01

    To ascertain the causes of high maternal mortality in West Bengal, the author examined maternal mortality between 1964-68. It was intended that measures to improve the situation in rural areas could be suggested. Women in labor often arrive at the hospital very late and few antenatal care facilities are available in rural areas. High risk cases often are delivered at home, a situation which often results in fetal complications. Maternal deaths have declined, but not dramatically. Of the 24,265 deliveries at the Burdwan district hospital, there were 333 maternal deaths for an incidence of 13.7/1000, along with another 42 cases where death was due to pregnancy-associated causes. In contrast, the maternal mortality rate in a district hospital in Calcutta was 4/1000 in 1968. Eclampsia accounted for 42.34% (141) of maternal deaths making it the major cause of death. In Calcutta this cause of death is receding gradually but in the districts it still accounts for a heavy loss of life (an incidence of 1 in 38). Adequate antenatal care would reduce this high mortality. 2 factors which have contributed to the high mortality are the hours lost in transporting a patient from a rural area and inadequate hospital staff. Postpartum hemorrhage and/or retained placenta was responsible for 39 deaths and none of the cases admitted from outside had received antenatal care. A shortage of blood was also a contributory factor. Severe anemia was responsible for 34 deaths and abortions resulted in another 29 deaths (16 because of severe sepsis; 13 due to hemorrhage or shock). An emergency service would help reduce the number of deaths but at present such a service does not even exist in the urban areas. Ruptured uterus resulted in 29 deaths and obstructed labor in 27 deaths. Placenta previa brought about 14 deaths and the remaining 20 deaths were due to such causes as accidental hemorrhage (10), hydatidiform mole (4), puerperal sepsis (3), ectopic pregnancy (2), and uterine inversion (1

  5. Human resources for maternal health: multi-purpose or specialists?

    PubMed Central

    Fauveau, Vincent; Sherratt, Della R; de Bernis, Luc

    2008-01-01

    A crucial question in the aim to attain MDG5 is whether it can be achieved faster with the scaling up of multi-purpose health workers operating in the community or with the scaling up of professional skilled birth attendants working in health facilities. Most advisers concerned with maternal mortality reduction concur to promote births in facilities with professional attendants as the ultimate strategy. The evidence, however, is scarce on what it takes to progress in this path, and on the 'interim solutions' for situations where the majority of women still deliver at home. These questions are particularly relevant as we have reached the twentieth anniversary of the safe motherhood initiative without much progress made. In this paper we review the current situation of human resources for maternal health as well as the problems that they face. We propose seven key areas of work that must be addressed when planning for scaling up human resources for maternal health in light of MDG5, and finally we indicate some advances recently made in selected countries and the lessons learned from these experiences. Whilst the focus of this paper is on maternal health, it is acknowledged that the interventions to reduce maternal mortality will also contribute to significantly reducing newborn mortality. Addressing each of the seven key areas of work – recommended by the first International Forum on 'Midwifery in the Community', Tunis, December 2006 – is essential for the success of any MDG5 programme. We hypothesize that a great deal of the stagnation of maternal health programmes has been the result of confusion and careless choices in scaling up between a limited number of truly skilled birth attendants and large quantities of multi-purpose workers with short training, fewer skills, limited authority and no career pathways. We conclude from the lessons learnt that no significant progress in maternal mortality reduction can be achieved without a strong political decision to

  6. Maternal nutrition and perinatal survival.

    PubMed

    Rush, D

    2001-09-01

    This review addresses the relationship between maternal nutrition and the survival of the foetus and infant. This survey was undertaken because wide-scale programmes on maternal feeding are in process, based, not on a critical synthesis of currently-available empirical research, but on a series of nested and, at times, weakly supported, assumptions. It is concluded that: (i) maternal weight and weight gain are remarkably resistant to either dietary advice or supplementation; (ii) nutritionally-induced increased birth-weight does not universally increase the chance of survival of the offspring, since pre-pregnancy weight, at least in affluent, industrialized societies-while associated with increased birth-weight-is also associated with higher perinatal mortality; (iii) while dietary supplements during pregnancy do have a modest effect on birth-weight, in contrast to a large effect in famine or near-famine conditions, this is not mediated by maternal energy deposition; and (iv) declining peripheral fat stores in late pregnancy are associated with accelerated foetal growth, and improved nutrition can lead to lower fat stores. Rather, the component of maternal weight gain associated with accelerated foetal growth is water, and, presumably, plasma volume. In the few studies, large and thorough enough to adequately address the issues, maternal feeding--both in famine and non-famine conditions--has led to lower perinatal, primarily foetal, mortality; the mechanisms are not likely to have been due only to the acceleration of foetal growth. It is concluded that there is currently an inadequate base of secure knowledge to foster improvement in the health and nutrition of poor mothers and children. The public and policy-makers alike must be informed that greater knowledge relating maternal nutrition to perinatal outcome is urgently needed to create sound health advice and to mount effective programmes. PMID:11761778

  7. Verbal autopsy of maternal deaths in two districts of Pakistan--filling information gaps.

    PubMed

    Jafarey, Sadiqua N; Rizvi, Talat; Koblinsky, Marge; Kureshy, Nazo

    2009-04-01

    In Pakistan, the vital registration system is weak, and population-based data on the maternal mortality ratio are limited. This study was carried out to collect information on maternal deaths from different existing sources during the current year-2007 (prospective) and the past two years--2005 and 2006-(retrospective), identify gaps in information, and critically analyze maternal deaths at the community and health-facility levels in two districts in Pakistan. The verbal autopsy questionnaire was administered to households where a maternal death had occurred. No single source had complete data on maternal deaths. Risk factors identified among 128 deceased women were low socioeconomic status, illiteracy, low-earning jobs, parity, and bad obstetric history. These were similar to the findings of earlier studies. Half of the women did seek antenatal care, 34% having made more than four visits. Of the 104 women who died during or after delivery, 38% had delivered in a private facility and 18% in a government facility. The quality of services in both private and public sectors was inadequate. Sixty-nine percent of deaths occurred in the postpartum period, and 51% took place within 24 hours of delivery. The study identified gaps in reporting of maternal deaths and also provided profile of the dead women and the causes of death. PMID:19489414

  8. Maternal fructose drives placental uric acid production leading to adverse fetal outcomes.

    PubMed

    Asghar, Zeenat A; Thompson, Alysha; Chi, Maggie; Cusumano, Andrew; Scheaffer, Suzanne; Al-Hammadi, Noor; Saben, Jessica L; Moley, Kelle H

    2016-01-01

    Maternal metabolic diseases increase offspring risk for low birth weight and cardiometabolic diseases in adulthood. Excess fructose consumption may confer metabolic risks for both women and their offspring. However, the direct consequences of fructose intake per se are unknown. We assessed the impact of a maternal high-fructose diet on the fetal-placental unit in mice in the absence of metabolic syndrome and determined the association between maternal serum fructose and placental uric acid levels in humans. In mice, maternal fructose consumption led to placental inefficiency, fetal growth restriction, elevated fetal serum glucose and triglyceride levels. In the placenta, fructose induced de novo uric acid synthesis by activating the activities of the enzymes AMP deaminase and xanthine oxidase. Moreover, the placentas had increased lipids and altered expression of genes that control oxidative stress. Treatment of mothers with the xanthine oxidase inhibitor allopurinol reduced placental uric acid levels, prevented placental inefficiency, and improved fetal weights and serum triglycerides. Finally, in 18 women delivering at term, maternal serum fructose levels significantly correlated with placental uric acid levels. These findings suggest that in mice, excess maternal fructose consumption impairs placental function via a xanthine oxidase/uric acid-dependent mechanism, and similar effects may occur in humans. PMID:27125896

  9. Maternal fructose drives placental uric acid production leading to adverse fetal outcomes

    PubMed Central

    Asghar, Zeenat A.; Thompson, Alysha; Chi, Maggie; Cusumano, Andrew; Scheaffer, Suzanne; Al-Hammadi, Noor; Saben, Jessica L.; Moley, Kelle H.

    2016-01-01

    Maternal metabolic diseases increase offspring risk for low birth weight and cardiometabolic diseases in adulthood. Excess fructose consumption may confer metabolic risks for both women and their offspring. However, the direct consequences of fructose intake per se are unknown. We assessed the impact of a maternal high-fructose diet on the fetal-placental unit in mice in the absence of metabolic syndrome and determined the association between maternal serum fructose and placental uric acid levels in humans. In mice, maternal fructose consumption led to placental inefficiency, fetal growth restriction, elevated fetal serum glucose and triglyceride levels. In the placenta, fructose induced de novo uric acid synthesis by activating the activities of the enzymes AMP deaminase and xanthine oxidase. Moreover, the placentas had increased lipids and altered expression of genes that control oxidative stress. Treatment of mothers with the xanthine oxidase inhibitor allopurinol reduced placental uric acid levels, prevented placental inefficiency, and improved fetal weights and serum triglycerides. Finally, in 18 women delivering at term, maternal serum fructose levels significantly correlated with placental uric acid levels. These findings suggest that in mice, excess maternal fructose consumption impairs placental function via a xanthine oxidase/uric acid-dependent mechanism, and similar effects may occur in humans. PMID:27125896

  10. Maternal health care focus in Bolivian campaign.

    PubMed

    1995-02-01

    Maternal health care is one of the focuses of Bolivia's new reproductive health campaign. The campaign, which uses television, radio and print media to get its message across, has the slogan "Your health is in your hands." Prenatal and postnatal care, as well as safe delivery, form one of the campaign's target areas. Others are family planning, breast-feeding, and the prevention of illegal abortions. The Bolivian campaign, which has a logo showing a child's tiny hand grasping a parent's finger, is supported by the Population Communication Services project of the Johns Hopkins School of Public Health, Baltimore, US. Bolivia has the highest maternal mortality in the western hemisphere. "The need to create an awareness of reproductive health is vital, with the risk of a Bolivian woman dying during pregnancy or childbirth 60 times that for a woman in Europe or the US," according to Dr. Phyllis Piotrow, director of Johns Hopkins' Center for Communication Programs. Further, Bolivia has the second highest infant mortality rate in the western hemisphere after Haiti. PMID:12319470

  11. Maternal persistent vegetative state with successful fetal outcome.

    PubMed Central

    Sim, K. B.

    2001-01-01

    A woman suffered from massive blunt injuries in a motor vehicle accident at a presumed 4 weeks' gestation, but she successfully carried the fetus for an additional 29 weeks. Premature labor began at 33 weeks' gestation and a live 1,890 g male was delivered. His development was normal for the 12-months postnatal follow-up period. The patient remained in a persistent vegetative state. Only 12 cases of severely brain-injured pregnant patients who delivered babies have been reported in English literature. Such patients need special maternal and fetal monitoring. As shown in our patient, successful fetal outcome could be obtained in a mother who suffered from hypovolemic shock and diffuse axonal injury, was treated with numerous medications from 4 weeks' gestation, and survived premature labor at 33 weeks' gestation in a persistent vegetative state. This report represents the longest interval from maternal vegetative state to obstetric delivery. From our case, it would seem that no clear limit exists that restricts the physician's ability to support a severely injured pregnant patient. PMID:11641542

  12. Epidemic Profile of Maternal Syphilis in China in 2013

    PubMed Central

    Dou, Lixia; Wang, Xiaoyan; Wang, Fang; Wang, Qian; Qiao, Yaping; Su, Min; Jin, Xi; Qiu, Jie; Song, Li; Wang, Ailing

    2016-01-01

    Objective. The aim of this study was to investigate the epidemiological characteristics and adverse pregnancy outcomes of pregnant women with syphilis infection in China. Methods. Data were from China's Information System of Prevention of Mother-to-Child Transmission of Syphilis Management. Women who were registered in the system and delivered in 2013 were included in the analysis. Results. A total of 15884 pregnant women with syphilis infection delivered in China in 2013. 79.1% of infected women attended antenatal care at or before 37 gestational weeks; however, 55.4% received no treatment or initiated the treatment after 37 gestational weeks. 14.0% of women suffered serious adverse pregnancy outcomes including stillbirth/neonatal death, preterm delivery/low birth weight, or congenital syphilis in newborns. High maternal titer (≥1 : 64) and late treatment (>37 gestational weeks)/nontreatment were significantly associated with increased risk of congenital syphilis and the adjusted ORs were 1.88 (95% CI 1.27 to 2.80) and 3.70 (95% CI 2.36 to 5.80), respectively. Conclusion. Syphilis affects a great number of pregnant women in China. Large proportions of women are not detected and treated at an early pregnancy stage. Burden of adverse pregnancy outcomes is high among infected women. Comprehensive interventions still need to be strengthened to improve uptake of screening and treatment for maternal syphilis. PMID:26981537

  13. Improving maternal care reduces mortality.

    PubMed

    1987-01-01

    Reduction of maternal mortality in developing countries by community-based action is complex but possible. Deaths related to pregnancy are primarily due to bleeding, infection, toxemia and illegal abortion. The excess maternal deaths in developing countries are also related to high numbers of high-risk pregnancies, total lack of prenatal and obstetric care in some areas, poor nutrition and overwork. The basic interventions available to communities include prenatal care, improved alarm and transport systems, referral centers and improved community-based care. Prenatal care can include nutritional supplements and exams and referrals by traditional birth attendants, targeting women suffering from toxemia, bleeding and infections. Local ambulances with life-support equipment, and maternity waiting houses are examples of ways of dealing with transport problems. Referral centers should be capable of providing sterile conditions and blood transfusions. Nurses can be trained to do caesarean sections. Birth attendants can use checklists to administer antibiotics and oxytocic drugs, for example. PMID:12281272

  14. Strategies for reducing maternal mortality.

    PubMed

    Clark, Steven L

    2012-02-01

    The maternal death rate in the United States has shown no improvement in several decades and may be increasing. On the other hand, hospital systems that have instituted comprehensive programs directed at the prevention of maternal mortality have demonstrated rates that are half of the national average. These programs have emphasized the reduction of variability in the provision of care through the use of standard protocols, reliance on checklists instead of memory for critical processes, and an approach to peer review that emphasizes systems change. In addition, elimination of a small number of repetitive errors in the management of hypertension, postpartum hemorrhage, pulmonary embolism, and cardiac disease will contribute significantly to a reduction in maternal mortality. Attention to these general principles and specific error reduction strategies will be of benefit to every practitioner and more importantly to the patients we serve. PMID:22280865

  15. Maternal Employment and Adolescent Development

    PubMed Central

    Ruhm, Christopher J.

    2009-01-01

    This study investigates how maternal employment is related to the cognitive development and body weight of 10 and 11 year olds, controlling for a wide variety of child, mother and family characteristics. The results suggest that limited market work benefits youths who are relatively “disadvantaged” and even long hours, which occur infrequently, are unlikely to leave them much worse off. By contrast, maternal labor supply is estimated to have more uniformly harmful consequences for “advantaged” adolescents. The negative cognitive effects for these youths probably partly occur because maternal labor supply reduces the time spent in enriching home environments. Some of the growth in obesity may be related to determinants of excess weight common to the child and mother. PMID:19830269

  16. [Wawared Peru: reducing health inequities and improving maternal health by improving information systems in health].

    PubMed

    Pérez-Lu, José E; Iguiñiz Romero, Ruth; Bayer, Angela M; García, Patricia J

    2015-01-01

    In developing countries, there are no high quality data to support decision-making and governance due to inadequate information collection and transmission processes. Our project WawaRed-Peru: "Reducing health inequities and improving maternal health by improving health information systems" aims to improve maternal health processes and indicators through the implementation of interoperability standards for maternal health information systems in order for decision makers to have timely, high quality information. Through this project, we hope to support the development of better health policies and to also contribute to reducing problems of health equity among Peruvian women and potentially women in other developing countries. The aim of this article is to present the current state of information systems for maternal health in Peru. PMID:26338401

  17. Relationships between Maternal Adult Attachment Security, Child Perceptions of Maternal Support, and Maternal Perceptions of Child Responses to Sexual Abuse.

    ERIC Educational Resources Information Center

    Leifer, Myra; Kilbane, Teresa; Skolnick, Linda I.

    2002-01-01

    Study assessed the relationships between maternal adult attachment style, children's perceptions of maternal support following disclosure of sexual abuse, and maternal perceptions of children's behavioral and emotional responses to sexual abuse. Findings indicate that fostering parent-child attachment is important in order to decrease the risk for…

  18. Reduction in maternal mortality due to sepsis.

    PubMed

    Chhabra, S; Kaipa, A; Kakani, A

    2005-02-01

    The present study was undertaken at a rural medical institute in India to analyse the trends in maternal mortality due to sepsis and the factors associated with change, if any. During the study period of 20 years, a total of 37,155 women delivered, 192 deaths occurred and forty deaths (20.83%) were due to sepsis and it's sequlae. It was revealed that there is a definite decrease in the proportion of deaths due to sepsis, to 10% in the last five years from 35% in earlier years. The change seems to be due to the advocacy of clean deliveries and reduction in case fatality because of alterations in medication and earlier surgical intervention. However the percentage contribution of septic abortion has remained the same. Septic abortion continues to exist inspite of all the current laws and discussion about the availability of a liberal law, which permits abortion almost on request. Most of the women who had died due to septic abortion were married (65%). Deaths due to septic abortion, are persisting even in married women and it is a matter of concern for health providers, policy makers and governments. PMID:15814392

  19. Hypospadias and Maternal Intake of Phytoestrogens

    PubMed Central

    Carmichael, Suzan L.; Cogswell, Mary E.; Ma, Chen; Gonzalez-Feliciano, Amparo; Olney, Richard S.; Correa, Adolfo; Shaw, Gary M.

    2013-01-01

    Experimental data indicate that gestational exposures to estrogenic compounds impact risk of hypospadias. We examined whether risk of hypospadias (i.e., a congenital malformation in which the opening of the penile urethra occurs on the ventral side of the penis) was associated with maternal intake of phytoestrogens, given their potential impact on estrogen metabolism. The analysis included data on mothers of 1,250 hypospadias cases and 3,118 controls who delivered their infants from 1997 to 2005 and participated in the National Birth Defects Prevention Study, a multistate, population-based, case-control study. After adjustment for several covariates, high intakes of daidzein, genistein, glycetin, secoisolariciresinol, total isoflavones, total lignans, and total phytoestrogens were associated with reduced risks; odds ratios comparing intakes ≥90th percentile with intakes between the 11th and 89th percentiles ranged from 0.6 to 0.8. For example, the odds ratio for total phytoestrogen intake was 0.7 (95% confidence interval: 0.5, 1.0). This study represents the first large-scale analysis of phytoestrogen intake and hypospadias. The observed associations merit investigation in additional populations before firm conclusions can be reached. PMID:23752918

  20. [Psychiatry at the maternal clinic].

    PubMed

    Ammälä, Antti-Jussi

    2015-01-01

    Various mental disorders are encountered at the maternal clinic. Pregnancy predisposes to some mental disorders, most commonly depressive and anxiety disorders. The recognition of substance use disorders during pregnancy is very important, but difficult owing to the associated disgrace. An eating disorder with an onset preceding the pregnancy may cause problems for growth and development of the fetus and should thus be identified early enough. The rare but severe postpartum psychosis may often break out only after discharge from the maternity hospital. Drug therapy during pregnancy requires careful consideration and clear-cut reasoning. PMID:26237899

  1. Alternative medicine in maternity care.

    PubMed

    Petrie, K A; Peck, M R

    2000-03-01

    Primary care physicians are confronted daily with questions from their patients about alternative medicine. When maternity care patients seek information about such therapies, careful attention must be paid to issues of safety and efficacy for both the mother and her unborn child. This article clarifies the role of alternative medicine in maternity care by looking at the definitions and history of common alternative therapies, documenting the evidence for alternative therapies in prenatal, intrapartum, and postpartum care, and suggesting ways to incorporate alternative medicine into primary care practice. PMID:10739460

  2. Delivering Data Reduction Pipelines to Science Users

    NASA Astrophysics Data System (ADS)

    Freudling, Wolfram

    2015-12-01

    Producing science data products that can be used to extract science is the ultimate objective of astronomical observation. The complexity of modern instruments require highly specialized algorithms for data organization and data reduction. Data visualization and user interaction, both to fine tune individual algorithms and to modify the data flow itself, are essential for the production of science grade products that fully exploits the potential of the raw data. ESO has a long history of providing specialized algorithms called recipes for each of its instruments. ESOREFLEX is an environment to deliver complete data reduction workflows that include these recipes to the users. These workflows encapsulate the best practise data reduction for the data from a particular instrument, and at the same can easily be modified by the user. ESOREFLEX includes systems for automatic data organization and visualization, interaction with recipes, and the exploration of the provenance tree of intermediate and final data products. ESOREFLEX allows ESO to deliver recipes that are used in its unsupervised operational pipelines to [...

  3. Delivering New Ultrasound System to International Space Station

    NASA Technical Reports Server (NTRS)

    Sugita, Yoshino

    2011-01-01

    Ultrasound has been used for medical purposes and experiments. The previous ultrasound, HDI 5000, was delivered to the ISS in 2001 and had expected its service life in February, 2012. Due to on-orbit ultrasound failure in February 2011, the delivery date of new ultrasound was moved to July 8, 2011, which is 7 months earlier than original delivery date. This report shows how the Ultrasound 2 team including myself worked to make new delivery date. Four-step approach, (1) understanding the project (literature search), (2) learning different documents, (3) performing certification tests and (4) participating crew trainings, were used to succeed my internship at NASA JSC. In addition, the participation in Summer Institution and other contributions are explained. i

  4. Delivering Sound Energy along an Arbitrary Convex Trajectory

    PubMed Central

    Zhao, Sipei; Hu, Yuxiang; Lu, Jing; Qiu, Xiaojun; Cheng, Jianchun; Burnett, Ian

    2014-01-01

    Accelerating beams have attracted considerable research interest due to their peculiar properties and various applications. Although there have been numerous research on the generation and application of accelerating light beams, few results have been published on the generation of accelerating acoustic beams. Here we report on the experimental observation of accelerating acoustic beams along arbitrary convex trajectories. The desired trajectory is projected to the spatial phase profile on the boundary which is discretized and sampled spatially. The sound field distribution is formulated with the Green function and the integral equation method. Both the paraxial and the non-paraxial regimes are examined and observed in the experiments. The effect of obstacle scattering in the sound field is also investigated and the results demonstrate that the approach is robust against obstacle scattering. The realization of accelerating acoustic beams will have an impact on various applications where acoustic information and energy are required to be delivered along an arbitrary convex trajectory. PMID:25316353

  5. Preterm Labor and Maternal Hypoxia in Patients With Community-Acquired Pneumonia

    PubMed Central

    Pinell, Phillip; Martens, Mark G.; Faro, Sebastian

    1996-01-01

    Objective: We sought to determine if preterm labor is associated with the degree of maternal hypoxia in pregnant women with community-acquired pneumonia but no other maternal diseases. Methods: We retrospectively reviewed the medical records of all antepartum patients admitted with a diagnosis of community-acquired pneumonia to an inner-city university hospital between 1983 and 1987. Included in this review were only the patients with radiologically confirmed diagnose of pneumonia and documented arterial blood gases on room air at the time of admission, but no other maternal diseases. Results: A total of 22 cases were identified. There was no maternal mortality, but there were 2 patients (9%) who developed respiratory failure requiring mechanical ventilation. Bacteremia with Streptococcus pneumoniae was documented in 1 patient (5%). Preterm labor complicated 5 cases (23%) and led to preterm delivery in 3 patients (14%). Terbutaline tocolysis was instituted in 3 patients, but was discontinued in 1 patient who was allowed to deliver because of her worsening condition. Preterm labor was associated with the WBC count on admission, usually > 18,000/mm3, but no statistically significant correlation with the severity of maternal hypoxia was noted. Five patients (23%) were incorrectly diagnosed at the time of admission, 4 with an initial diagnosis of pyelonephritis and 1 with an initial diagnosis of cholecystitis. Conclusions: Community-acquired pneumonia in the antepartum period is responsible for significant maternal and fetal complications even in the absence of other maternal diseases. Preterm labor and delivery remain frequent, and tocolysis should be used cautiously. At the time of admission, the diagnosis may be difficult. The degree of maternal hypoxia on admission does not correlate with the presence of preterm labor. PMID:18476096

  6. Prenatal Maternal Stress Programs Infant Stress Regulation

    ERIC Educational Resources Information Center

    Davis, Elysia Poggi; Glynn, Laura M.; Waffarn, Feizal; Sandman, Curt A.

    2011-01-01

    Objective: Prenatal exposure to inappropriate levels of glucocorticoids (GCs) and maternal stress are putative mechanisms for the fetal programming of later health outcomes. The current investigation examined the influence of prenatal maternal cortisol and maternal psychosocial stress on infant physiological and behavioral responses to stress.…

  7. Commentary on “Moniz and Beigi's maternal immunization clinical experiences, challenges, and opportunities in vaccine acceptance”

    PubMed Central

    Frew, Paula M

    2014-01-01

    Maternal immunization faces an array of structural, sociocultural, and individual challenges that must be effectively addressed to realize widespread improvements in vaccination uptake. As Moniz and Beigi correctly detail in their review, immunization during this period offers unique opportunity to make substantial improvements in maternal and neonatal health. Moving beyond the existing Health Belief Model, we learn that immunization uptake can be significantly improved by shaping messages, addressing logistical challenges such as out-of-pocket (i.e., “copay”) barriers, and delivering provider education on maternal immunization to encourage future provider recommendations and facilitate the patient convenience of in-office vaccine administration. The resulting approach of “Educate, Recommend, Normalize, Maximize Convenience” is consistent with the evidence on maternal immunization. In its systematic application, such a model may usher in unprecedented opportunity to improve immunization uptake in decades ahead. PMID:25483456

  8. Assessment of an Internet-Delivered Interactive Approach to Introductory Astronomy for Non-Science Majors

    ERIC Educational Resources Information Center

    Slater, Timothy F.; Jones, Lauren V.

    2004-01-01

    This project explores the effectiveness of learner-centered education (LCE) principles and practices on student learning and attitudes in an online interactive introductory astronomy course for non-science majors by comparing a high-quality Internet-delivered course with a high-quality on-campus course, both of which are based on the principles of…

  9. Increasing Customer Service Behaviors Using Manager-Delivered Task Clarification and Social Praise

    ERIC Educational Resources Information Center

    Rice, Anna; Austin, John; Gravina, Nicole

    2009-01-01

    This project assessed an intervention to improve employee customer service behaviors (correct greetings and closing behaviors). A combination of task clarification and manager-delivered social praise resulted in increased correct greeting from 11.5% to 66% and correct closing from 8% to 70%. The effect was maintained at a 48-week follow-up for…

  10. Internet-Delivered Indicated Prevention for Anxiety Disorders: Six-Month Follow-Up

    ERIC Educational Resources Information Center

    Kenardy, Justin; McCafferty, Kelly; Rosa, Virginia

    2006-01-01

    This project aims to conduct a medium-term follow-up to assess the efficacy of a preventive cognitive behavioural intervention delivered via the Internet to individuals at risk of developing anxiety disorders. Previous work on immediate outcome indicated that the program was effective in reducing depression and anxiety-related cognitions.…

  11. Workshops the Wired Way: More Tips and Tools for Developing and Delivering an Online Workshop.

    ERIC Educational Resources Information Center

    Trottier, Vicki

    This document, which was developed during a project to expand professional development opportunities for adult literacy practitioners affiliated with member agencies of Community Literacy of Ontario (CLO), presents tips and tools for developing and delivering an online workshop for literacy practitioners. The document begins with an overview of…

  12. 43 CFR 418.10 - Determining the amount of water duty to be delivered.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Determining the amount of water duty to be delivered. 418.10 Section 418.10 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR OPERATING CRITERIA AND PROCEDURES FOR THE NEWLANDS RECLAMATION PROJECT, NEVADA Conditions of...

  13. Antecedents of Maternal Separation Anxiety.

    ERIC Educational Resources Information Center

    Fein, Greta G.; And Others

    1993-01-01

    Examined antecedents of maternal separation anxiety in 83 Italian mothers prior to their infants or toddlers entering group care. Mothers' anxiety did not vary with the child's age. Anxious mothers were younger and less educated, received less support, had temperamentally negative infants, and provided less varied stimulation in the home. (MM)

  14. Plotting Maternity in Three Persons

    ERIC Educational Resources Information Center

    Kinser, Amber E.

    2012-01-01

    This performance text examines complexities of personal and maternal identity in family life. Speaking in first, second, and third person voices, the author offers autoethnographic accounts of the tensions between separateness and connectedness, normative and subjective motherhood, and novice and seasoned perspectives. The piece functions as a…

  15. Androgyny and the Maternal Principle

    ERIC Educational Resources Information Center

    Johnson, Miriam M.

    1977-01-01

    Discusses the movement toward androgyny based upon and fostered by an increasing societal emphasis upon "femininity" in its maternal (as opposed to its heterosexual) aspects. Argues that the masculine paradigm promotes differentiation between the sexes, especially the sex objectification of women. (Author/RK)

  16. Scientific Publishing: Adding Value, Delivering Impact

    NASA Astrophysics Data System (ADS)

    Mayes, Beth

    2015-08-01

    Publishers are developing new services and applying new technologies to improve publication and reading experiences for the scholarly community. This needs to be implemented with care to avoid adding technology-driven complexity. Our publishing processes need to be widely accessible to both authors and readers and to maintain the scientific record. Beth Mayes will outline new developments at IOP Publishing delivering (1) improvements to the presentation of articles and their commitment to formats that go beyond the PDF, improving the understanding of research. (2) How IOP Publishing is responding to the growing calls for metadata and linking that involve being central to the shared information ecosystem for astronomy. (3) After publication, discuss how publishers invest in metrics and new initiatives for discovery that improve the impact of published research.

  17. Delivering Hubble Discoveries to the Classroom

    NASA Astrophysics Data System (ADS)

    Eisenhamer, B.; Villard, R.; Weaver, D.; Cordes, K.; Knisely, L.

    2013-04-01

    Today's classrooms are significantly influenced by current news events, delivered instantly into the classroom via the Internet. Educators are challenged daily to transform these events into student learning opportunities. In the case of space science, current news events may be the only chance for educators and students to explore the marvels of the Universe. Inspired by these circumstances, the education and news teams developed the Star Witness News science content reading series. These online news stories (also available in downloadable PDF format) mirror the content of Hubble press releases and are designed for upper elementary and middle school level readers to enjoy. Educators can use Star Witness News stories to reinforce students' reading skills while exposing students to the latest Hubble discoveries.

  18. Empathic engineering: helping deliver dignity through design

    PubMed Central

    Hosking, Ian; Cornish, Katie; Bradley, Mike; Clarkson, P. John

    2015-01-01

    Abstract Dignity is a key value within healthcare. Technology is also recognized as being a fundamental part of healthcare delivery, but also a potential cause of dehumanization of the patient. Therefore, understanding how medical devices can be designed to help deliver dignity is important. This paper explores the role of empathy tools as a way of engendering empathy in engineers and designers to enable them to design for dignity. A framework is proposed that makes the link between empathy tools and outcomes of feelings of dignity. It represents a broad systems view that provides a structure for reviewing the evidence for the efficacy of empathy tools and also how dignity can be systematically understood for particular medical devices. PMID:26453036

  19. Delivering Astronomy Software with Minimal user Maintenance

    NASA Astrophysics Data System (ADS)

    Fabbro, S.; Goliath, S.

    2013-10-01

    We present an approach to deliver astronomy processing software using virtualization and a network file system. User-requested astronomy software applications are built and tested on a dedicated server, and distributed on-demand to cloud-based worker clients using a fast HTTP read-only cache file system. The worker clients are light virtual machines which keep overheads to processing resources very small, while still ensuring the portability of all software applications. The goal is to limit the need for astronomers to carry out software maintenance tasks and to keep consistency between batch processing and interactive analysis sessions. We describe the design and infrastructure of the system, the software building process on the server, and show an application with a multi-frame automated transient detection on a wide field survey, with a batch processing on a cloud infrastructure.

  20. LNG carrier using membrane tank system delivered

    SciTech Connect

    Not Available

    1993-12-06

    The world's first LNG carrier that incorporates the Technigaz Mark 3 membrane tank system was delivered in October to its owner, Asia LNG Transport Sdn. Bhd., a joint venture between Nippon Yusen K.K. and Perbadanan Nasional Shipping Line Berhad of Malaysia. NKK built the 18,800 cu m, fully double-hull carrier Aman Bintulu at its Tsu works. Construction was completed in September with more than 2 months of sea trials and gas tests using [minus]190 C. Liquid nitrogen and final gas trails with LNG. The orthogonally corrugated stainless membrane primary barrier and the triplex (aluminum foil/fiber glass cloth) composite-material secondary barrier prevent LNG from leaking in the event of an accident.

  1. Adiponectin supplementation in pregnant mice prevents the adverse effects of maternal obesity on placental function and fetal growth.

    PubMed

    Aye, Irving L M H; Rosario, Fredrick J; Powell, Theresa L; Jansson, Thomas

    2015-10-13

    Mothers with obesity or gestational diabetes mellitus have low circulating levels of adiponectin (ADN) and frequently deliver large babies with increased fat mass, who are susceptible to perinatal complications and to development of metabolic syndrome later in life. It is currently unknown if the inverse correlation between maternal ADN and fetal growth reflects a cause-and-effect relationship. We tested the hypothesis that ADN supplementation in obese pregnant dams improves maternal insulin sensitivity, restores normal placental insulin/mechanistic target of rapamycin complex 1 (mTORC1) signaling and nutrient transport, and prevents fetal overgrowth. Compared with dams on a control diet, female C57BL/6J mice fed an obesogenic diet before mating and throughout gestation had increased fasting serum leptin, insulin, and C-peptide, and reduced high-molecular-weight ADN at embryonic day (E) 18.5. Placental insulin and mTORC1 signaling was activated, peroxisome proliferator-activated receptor-α (PPARα) phosphorylation was reduced, placental transport of glucose and amino acids in vivo was increased, and fetal weights were 29% higher in obese dams. Maternal ADN infusion in obese dams from E14.5 to E18.5 normalized maternal insulin sensitivity, placental insulin/mTORC1 and PPARα signaling, nutrient transport, and fetal growth without affecting maternal fat mass. Using a mouse model with striking similarities to obese pregnant women, we demonstrate that ADN functions as an endocrine link between maternal adipose tissue and fetal growth by regulating placental function. Importantly, maternal ADN supplementation reversed the adverse effects of maternal obesity on placental function and fetal growth. Improving maternal ADN levels may serve as an effective intervention strategy to prevent fetal overgrowth caused by maternal obesity. PMID:26417088

  2. Adiponectin supplementation in pregnant mice prevents the adverse effects of maternal obesity on placental function and fetal growth

    PubMed Central

    Aye, Irving L. M. H.; Rosario, Fredrick J.; Powell, Theresa L.; Jansson, Thomas

    2015-01-01

    Mothers with obesity or gestational diabetes mellitus have low circulating levels of adiponectin (ADN) and frequently deliver large babies with increased fat mass, who are susceptible to perinatal complications and to development of metabolic syndrome later in life. It is currently unknown if the inverse correlation between maternal ADN and fetal growth reflects a cause-and-effect relationship. We tested the hypothesis that ADN supplementation in obese pregnant dams improves maternal insulin sensitivity, restores normal placental insulin/mechanistic target of rapamycin complex 1 (mTORC1) signaling and nutrient transport, and prevents fetal overgrowth. Compared with dams on a control diet, female C57BL/6J mice fed an obesogenic diet before mating and throughout gestation had increased fasting serum leptin, insulin, and C-peptide, and reduced high-molecular-weight ADN at embryonic day (E) 18.5. Placental insulin and mTORC1 signaling was activated, peroxisome proliferator-activated receptor-α (PPARα) phosphorylation was reduced, placental transport of glucose and amino acids in vivo was increased, and fetal weights were 29% higher in obese dams. Maternal ADN infusion in obese dams from E14.5 to E18.5 normalized maternal insulin sensitivity, placental insulin/mTORC1 and PPARα signaling, nutrient transport, and fetal growth without affecting maternal fat mass. Using a mouse model with striking similarities to obese pregnant women, we demonstrate that ADN functions as an endocrine link between maternal adipose tissue and fetal growth by regulating placental function. Importantly, maternal ADN supplementation reversed the adverse effects of maternal obesity on placental function and fetal growth. Improving maternal ADN levels may serve as an effective intervention strategy to prevent fetal overgrowth caused by maternal obesity. PMID:26417088

  3. Recommended Feeding and Dietary Practices To Improve Infant and Maternal Nutrition.

    ERIC Educational Resources Information Center

    Academy for Educational Development, Washington, DC.

    The LINKAGES Project is intended to improve breastfeeding and related complementary feeding and maternal dietary practices. The project, in consultation with technical experts and program managers, identified a set of recommended feeding and dietary practices intended to break the cycle of poor health and nutrition that passes from generation to…

  4. The importance of cardiovascular pathology contributing to maternal death: Confidential Enquiry into Maternal Deaths in South Africa, 2011–2013

    PubMed Central

    Soma-Pillay, Priya; Seabe, Joseph; Soma-Pillay, Priya; Seabe, Joseph; Sliwa, Karen

    2016-01-01

    many CVD deaths that were not reported, such as late maternal mortality (up to one year postpartum). Infrastructural changes, use of appropriate referral algorithm and training of primary, secondary and tertiary staff in CVD complicating pregnancy is likely to improve the outcome. The use of simple screening equipment and point-of-care testing for early-onset heart failure should be explored via research projects. PMID:26895406

  5. Associations between maternal anthropometric characteristics and infant birth weight in Iranian population

    PubMed Central

    Nourbakhsh, Sormeh; Ashrafzadeh, Sepideh; Hafizi, Ali; Naseh, Ali

    2016-01-01

    Objective: To examine the (1) normal ranges of anthropometric and insulin resistance/sensitivity indices (homeostatic model assessment for insulin resistance, homeostatic model assessment for insulin sensitivity, and quantitative insulin sensitivity check index) for Iranian pregnant women and their newborns and (2) associations between maternal anthropometric and metabolic values and infants’ birth weights among Iranian women. Methods: Anthropometric and metabolic values of 163 singleton non-diabetic pregnant women in Tehran, Iran (2014) were collected before and during pregnancy and at delivery. Linear regression, multivariable regression, and Student t tests were used to evaluate correlations between birth weight and maternal variables. Results: Linear regression modeling suggested that maternal serum glucose (p = 0.2777) and age (p = 0.6752) were not associated with birth weight. Meanwhile, maternal weight and body mass index before pregnancy (p = 0.0006 and 0.0204, respectively), weight at delivery (p = 0.0036), maternal height (p = 0.0118), and gestational age (p = 0.0016) were positively associated with birth weight, while serum insulin (p = 0.0300) and homeostatic model assessment for insulin resistance (p = 0.0334) were negatively associated with infant’s birth weight. Using multivariate modeling, we identified severalconfounders: parity (multipara mothers delivered heavier babies compared to first-time mothers) explained as much as 24% of variation in birth weight (p = 0.005), maternal height explained 20.7% (p = 0.014), gestational age accounted for 19.7% (p = 0.027), and maternal body mass index explained 19.1% (p = 0.023) of the variation in the infant’s birth weight. Maternal serum insulin and infant’s sex were not observed to be associated with birth weight (p = 0.342 and 0.669, respectively) in the overall model. Conclusion: Overweight/obese women may experience higher incidence of

  6. Maternal control of early embryogenesis in mammals

    PubMed Central

    Zhang, Kun; Smith, George W.

    2015-01-01

    Oocyte quality is a critical factor limiting the efficiency of assisted reproductive technologies (ART) and pregnancy success in farm animals and humans. ART success is diminished with increased maternal age, suggesting a close link between poor oocyte quality and ovarian-aging. However, the regulation of oocyte quality remains poorly understood. Oocyte quality is functionally linked to ART success because the maternal-to-embryonic transition is dependent on stored maternal factors, which are accumulated in oocytes during oocyte development and growth. The maternal-to-embryonic transition consists of critical developmental processes including maternal RNA depletion and embryonic genome activation. In recent years, key maternal proteins encoded by maternal-effect genes have been determined, primarily using genetically modified mouse models. These proteins are implicated in various aspects of early embryonic development including maternal mRNA degradation, epigenetic reprogramming, signal transduction, protein translation and initiation of embryonic genome activation. Species differences exist in number of cell divisions encompassing the maternal-to-embryonic transition and maternal-effect genes controlling this developmental window. Perturbations of maternal control result in decreased oocyte quality, some of which are associated with ovarian aging. PMID:25695370

  7. Maternal Characteristics Predicting Young Girls’ Disruptive Behavior

    PubMed Central

    van der Molen, Elsa; Hipwell, Alison E.; Vermeiren, Robert; Loeber, Rolf

    2011-01-01

    Little is known about the relative predictive utility of maternal characteristics and parenting skills on the development of girls’ disruptive behavior. The current study used five waves of parent and child-report data from the ongoing Pittsburgh Girls Study to examine these relationships in a sample of 1,942 girls from age 7 to 12 years. Multivariate Generalized Estimating Equation (GEE) analyses indicated that European American race, mother’s prenatal nicotine use, maternal depression, maternal conduct problems prior to age 15, and low maternal warmth explained unique variance. Maladaptive parenting partly mediated the effects of maternal depression and maternal conduct problems. Both current and early maternal risk factors have an impact on young girls’ disruptive behavior, providing support for the timing and focus of the prevention of girls’ disruptive behavior. PMID:21391016

  8. The Evolution of Multivariate Maternal Effects

    PubMed Central

    Kuijper, Bram; Johnstone, Rufus A.; Townley, Stuart

    2014-01-01

    There is a growing interest in predicting the social and ecological contexts that favor the evolution of maternal effects. Most predictions focus, however, on maternal effects that affect only a single character, whereas the evolution of maternal effects is poorly understood in the presence of suites of interacting traits. To overcome this, we simulate the evolution of multivariate maternal effects (captured by the matrix M) in a fluctuating environment. We find that the rate of environmental fluctuations has a substantial effect on the properties of M: in slowly changing environments, offspring are selected to have a multivariate phenotype roughly similar to the maternal phenotype, so that M is characterized by positive dominant eigenvalues; by contrast, rapidly changing environments favor Ms with dominant eigenvalues that are negative, as offspring favor a phenotype which substantially differs from the maternal phenotype. Moreover, when fluctuating selection on one maternal character is temporally delayed relative to selection on other traits, we find a striking pattern of cross-trait maternal effects in which maternal characters influence not only the same character in offspring, but also other offspring characters. Additionally, when selection on one character contains more stochastic noise relative to selection on other traits, large cross-trait maternal effects evolve from those maternal traits that experience the smallest amounts of noise. The presence of these cross-trait maternal effects shows that individual maternal effects cannot be studied in isolation, and that their study in a multivariate context may provide important insights about the nature of past selection. Our results call for more studies that measure multivariate maternal effects in wild populations. PMID:24722346

  9. Maternal vitamin D status and infant anthropometry in a US multi-centre cohort study

    PubMed Central

    Eckhardt, Cara L.; Gernand, Alison D.; Roth, Daniel E.; Bodnar, Lisa M.

    2015-01-01

    Background Maternal vitamin D status in pregnancy is linked to foetal growth and may impact infant growth. Aim This study examined the association between maternal vitamin D status and infant anthropometry. Subjects and methods Data came from n = 2473 mother–child pairs from the 12-site US Collaborative Perinatal Project (1959–1965). Maternal serum 25-hydroxyvitamin D (25(OH)D) was measured at ≤26 weeks gestation. Multivariate-adjusted linear mixed models were used to relate maternal vitamin D status to infant z-scores for length (LAZ), head circumference (HCZ), weight (WAZ) and BMI (BMIZ), measured at birth and 4, 8 and 12 months. Results Infants with maternal 25(OH)D ≥30 nmol/L vs <30 nmol/L had LAZ and HCZ measures 0.13 (95% CI = 0.03–0.23) and 0.20 (95% CI = 0.11–0.28) units higher, respectively, across the first year of life. Similar differences in WAZ and BMIZ at birth were resolved by 12 months of age due to interactions indicating steeper age slopes in infants with maternal 25(OH)D <30 nmol/L. Conclusion Low maternal vitamin D status was associated with deficits at birth in infant weight and BMI that were recouped across the first year of life; associations with reduced measures of linear and skeletal growth were sustained from birth to 12 months. PMID:25268792

  10. Current Concepts of Maternal Nutrition

    PubMed Central

    Lowensohn, Richard I.; Stadler, Diane D.; Naze, Christie

    2016-01-01

    Background A nutrient-rich maternal diet before and during pregnancy is associated with improved fetal health, more appropriate birth weight, and increased rates of maternal and infant survival. Physicians need a better understanding of the role of diet in shaping fetal outcomes. Given this background, we reviewed and summarized articles on maternal nutrition found in MEDLINE since 1981, written in English, and limited to human subjects. For the Offspring Maternal diets high in sugar and fat lead to an increased incidence of metabolic syndrome, diabetes, and cardiovascular disease later in life. Folic acid should be supplemented prior to conception and continued through at least the first 28 days of fetal life to prevent neural tube defects, and vitamin C should be given to women who smoke to lower the incidence of asthma and wheezing in the children. Iodine deficiency is increasing, and iodine should be included in prenatal supplements. If the maternal hemoglobin is 7 g/dL or more, there is no evidence that iron supplementation is needed. Fish intake during pregnancy is protective against atopic outcomes, whereas high-meat diets contribute to elevated adult blood pressure and hypersecretion of cortisol. For the Mother Calcium supplementation lowers the risk of preeclampsia and hypertensive disease in pregnancy. Conclusions Given the limits of our current knowledge, a diet rich in whole grains, fruits, vegetables, and selected fish is desirable for the best outcomes. Diets high in sugar and fat lead to higher rates of diabetes, metabolic syndrome, and cardiovascular disease. Folic acid, iodine, and calcium in all pregnant women and vitamin C in smokers are the only supplements so far shown to be of value for routine use. The physician treating a pregnant woman should be ready to advise a healthy diet for the benefit of the fetus. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After participating in this activity, the

  11. Point-of-Care Diagnostics for Improving Maternal Health in South Africa.

    PubMed

    Mashamba-Thompson, Tivani P; Sartorius, Benn; Drain, Paul K

    2016-01-01

    Improving maternal health is a global priority, particularly in high HIV-endemic, resource-limited settings. Failure to use health care facilities due to poor access is one of the main causes of maternal deaths in South Africa. "Point-of-care" (POC) diagnostics are an innovative healthcare approach to improve healthcare access and health outcomes in remote and resource-limited settings. In this review, POC testing is defined as a diagnostic test that is carried out near patients and leads to rapid clinical decisions. We review the current and emerging POC diagnostics for maternal health, with a specific focus on the World Health Organization (WHO) quality-ASSURED (Affordability, Sensitivity, Specificity, User friendly, Rapid and robust, Equipment free and Delivered) criteria for an ideal point-of-care test in resource-limited settings. The performance of POC diagnostics, barriers and challenges related to implementing POC diagnostics for maternal health in rural and resource-limited settings are reviewed. Innovative strategies for overcoming these barriers are recommended to achieve substantial progress on improving maternal health outcomes in these settings. PMID:27589808

  12. Boston's Lewenberg Middle School Delivers Success.

    ERIC Educational Resources Information Center

    O'Donnell, Mark D.

    1997-01-01

    Describes how a neglected Boston middle school transformed itself into an inviting, tree-lined campus with comfortable reading and study areas and an exemplary physical education program. Project Adventure is an intense six-week physical training course that teaches advanced rock-climbing skills. With classmates' encouragement, participants…

  13. Evaluation of Drug Concentrations Delivered by Microiontophoresis.

    PubMed

    Kirkpatrick, Douglas C; Wightman, R Mark

    2016-06-21

    Microiontophoresis uses an electric current to eject a drug solution from a glass capillary and is often utilized for targeted delivery in neurochemical investigations. The amount of drug ejected, and its effective concentration at the tip, has historically been difficult to determine, which has precluded its use in quantitative studies. To address this, a method called controlled iontophoresis was developed which employs a carbon-fiber microelectrode incorporated into a multibarreled iontophoretic probe to detect the ejection of electroactive species. Here, we evaluate the accuracy of this method. To do this, we eject different concentrations of quinpirole, a D2 receptor agonist, into a brain slice containing the dorsal striatum, a brain region with a high density of dopamine terminals. Local electrical stimulation was used to evoke dopamine release, and inhibitory actions of quinpirole on this release were examined. The amount of drug ejected was estimated by detection of a coejected electrochemical marker. Dose response curves generated in this manner were compared to curves generated by conventional perfusion of quinpirole through the slice. We find several experimental conditions must be optimized for accurate results. First, selection of a marker with an identical charge was necessary to mimic the ejection of the cationic agonist. Next, evoked responses were more precise following longer periods between the end of the ejection and stimulation. Lastly, the accuracy of concentration evaluations was improved by longer ejections. Incorporation of these factors into existing protocols allows for greater certainty of concentrations delivered by controlled iontophoresis. PMID:27212615

  14. Changing Maternal Behavior in an Urban Low Birthweight Intervention.

    ERIC Educational Resources Information Center

    Coates, Deborah L.; Maxwell, Joan P.

    The Better Babies Project is attempting to intervene with inner city pregnant women, many of whom are poor, to change their behavior in order to reduce the many behavioral risks associated with delivering a low birthweight infant. The research objective of this intervention is to offer and document the provision of consistent and comprehensive…

  15. Addressing disparities in maternal health care in Pakistan: gender, class and exclusion

    PubMed Central

    2012-01-01

    Background After more than two decades of the Safe Motherhood Initiative and Millennium Development Goals aimed at reducing maternal mortality, women continue to die in childbirth at unacceptably high rates in Pakistan. While an extensive literature describes various programmatic strategies, it neglects the rigorous analysis of the reasons these strategies have been unsuccessful, especially for women living at the economic and social margins of society. A critical gap in current knowledge is a detailed understanding of the root causes of disparities in maternal health care, and in particular, how gender and class influence policy formulation and the design and delivery of maternal health care services. Taking Pakistan as a case study, this research builds upon two distinct yet interlinked conceptual approaches to understanding the phenomenon of inequity in access to maternal health care: social exclusion and health systems as social institutions. Methods/Design This four year project consists of two interrelated modules that focus on two distinct groups of participants: (1) poor, disadvantaged women and men and (2) policy makers, program managers and health service providers. Module one will employ critical ethnography to understand the key axes of social exclusion as related to gender, class and zaat and how they affect women’s experiences of using maternal health care. Through health care setting observations, interviews and document review, Module two will assess policy design and delivery of maternal health services. Discussion This research will provide theoretical advances to enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems in Pakistan. It will also provide empirical evidence to support formulation of maternal health care policies and health care system practices aimed at reducing disparities in maternal health care in Pakistan. Lastly, it will enhance inter

  16. Delivering labeled teaching images over the Web.

    PubMed Central

    Lehmann, H. P.; Nguyen, B.; Freedman, J.

    1998-01-01

    The Web provides educators with the best opportunity to date for distributing teaching images across the educational enterprise and within the clinical environment. Experience in the pre-Web era showed that labels and information linked to parts of the image are crucial to student learning. Standard Web technology does not enable the delivery of labeled images. We have developed an environment called OverLayer that succeeds in the authoring and delivering of such images in a variety of formats. OverLayer has a number of functional specifications, based on the literature and on our experience, among them, the following: Users should be able to find components by name or by image; to receive feedback about their choice to test themselves. The image should be of arbitrary size; should be reusable; should be linked to further information; should be stand-alone files. The labels should not obscure the image; should be linked to further information. Images should be stand-alone files that can be transferred among faculty members. Implemented in Java, OverLayer (http:/(/)omie.med.jhmi.edu/overlayer) has at its heart a set of object classes that have been reused in a number of applets for different teaching purposes and a file format for creating OverLayer images. We have created a 350-image histology library and a 500-image pathology library, and are working on a 400-image GI endoscopy library. We hope that the OverLayer suite of classes and implementations will help to further the gains made by previous image-based hyperlinked technologies. Images Figure 3 PMID:9929253

  17. Effect on mortality of community-based maternity-care programme in rural Bangladesh.

    PubMed

    Fauveau, V; Stewart, K; Khan, S A; Chakraborty, J

    1991-11-01

    Various community-based interventions have been proposed to improve maternity care, but hardly any studies have reported the effect of these measures on maternal mortality. In this study, the efficacy of a maternity-care programme to reduce maternal mortality has been evaluated in the context of a primary health-care project in rural Bangladesh. Trained midwives were posted in villages, and asked to attend as many home-deliveries as possible, detect and manage obstetric complications at onset, and accompany patients requiring referral for higher-level care to the project central maternity clinic. The effect of the programme was evaluated by comparison of direct obstetric maternal mortality ratios between the programme area and a neighbouring control area without midwives. Random assignment of the intervention was not possible but potentially confounding characteristics, including coverage and use of other health and family planning services, were similar in both areas. Maternal mortality ratios due to obstetric complications were similar in both areas during the 3 years preceding the start of the programme. By contrast, during the following 3 years, the ratio was significantly lower in the programme than in the control area (1.4 vs 3.8 per 1000 live births, p = 0.02). The findings suggest that maternal survival can be improved by the posting of midwives at village level, if they are given proper training, means, supervision, and back-up. The inputs for such a programme to succeed and the constraints of its replication on a large scale should not be underestimated. PMID:1682600

  18. Maternal and child health in Yushu, Qinghai Province, China

    PubMed Central

    2011-01-01

    Introduction Surmang, Qinghai Province is a rural nomadic Tibetan region in western China recently devastated by the 2010 Yushu earthquake; little information is available on access and coverage of maternal and child health services. Methods A cross-sectional household survey was conducted in August 2004. 402 women of reproductive age (15-50) were interviewed regarding their pregnancy history, access to and utilization of health care, and infant and child health care practices. Results Women's access to education was low at 15% for any formal schooling; adult female literacy was <20%. One third of women received any antenatal care during their last pregnancy. Institutional delivery and skilled birth attendance were <1%, and there were no reported cesarean deliveries. Birth was commonly attended by a female relative, and 8% of women delivered alone. Use of unsterilized instrument to cut the umbilical cord was nearly universal (94%), while coverage for tetanus toxoid immunization was only 14%. Traditional Tibetan healers were frequently sought for problems during pregnancy (70%), the postpartum period (87%), and for childhood illnesses (74%). Western medicine (61%) was preferred over Tibetan medicine (9%) for preventive antenatal care. The average time to reach a health facility was 4.3 hours. Postpartum infectious morbidity appeared to be high, but only 3% of women with postpartum problems received western medical care. 64% of recently pregnant women reported that they were very worried about dying in childbirth. The community reported 3 maternal deaths and 103 live births in the 19 months prior to the survey. Conclusions While China is on track to achieve national Millennium Development Goal targets for maternal and child health, women and children in Surmang suffer from substantial health inequities in access to antenatal, skilled birth and postpartum care. Institutional delivery, skilled attendance and cesarean delivery are virtually inaccessible, and

  19. Abnormal maternal serum alpha fetoprotein and pregnancy outcome.

    PubMed

    Zarzour, S J; Gabert, H A; Diket, A L; St Amant, M; Miller, J M

    1998-01-01

    The objective was to assess the occurrence of miscarriages, low birth weight, and karyotype abnormalities found with low and elevated maternal serum alpha-fetoprotein (MSAFP) among women who had genetic amniocentesis performed. A retrospective study of 2,159 women who had MSAFP analysis prior to amniocentesis was conducted. Pregnancy outcomes were obtained from record review and physicians follow-up. Limits of MSAFP used in analysis were <0.5 adjusted multiples of the median (MOM) (lower levels) and >2.0 MOM (upper levels). Autosomal trisomy was found in 1.6% with low, 0.9% normal, and 0.6% with elevated MSAFP values. Sex chromosome abnormalities were present only in patients with normal MSAFP, [45X (n = 6), 47XXY (n = 2), 69XXX]. Of five open neural tube defects, four had elevated MSAFP and one had a normal value. Omphalocele was identified in four patients, two with normal and two with elevated MSAFP. Gastroschisis was found in one low and one elevated MSAFP. Amniotic fluid alpha-fetoprotein (AFAFP) values did not correlate with MSAFP values. Patients with low MSAFP levels had a greater prevalence of abnormal karyotype (19 of 249, prevalence = 0.076) than patients with an elevated MSAFP level (2 or 166, prevalence = 0.012 OR (odds ratio) = 0.20 (P value = 0.024) when unadjusted for maternal age, and OR = 0.09 (P value = 0.001) when adjusted for maternal age. Spontaneous abortion occurred more often in patients with elevated (4 of 166, or 4%) than normal or low (20 of 1948, or 1%) values of MSAFP (odds ratio 4.32, P = 0.020 when adjusted for maternal age). Birth weight below 2,500 g was present less frequently with low or normal MSAFP (136 of 1,760, or 7.7%) than in elevated MSAFP (21 of 144 or 14.6%) (odds ratio 2.04, P = 0.005, unadjusted; and odds ratio = 2.32, P = 0.003, adjusted for maternal age). Female fetuses were present more often with low MSAFP (136 of 249, or 55%) than elevated levels 43% (71 of 164, or 43%; P = 0.024). We conclude that patients

  20. Risk Factors for Maternal Mortality in Rural Tigray, Northern Ethiopia: A Case-Control Study

    PubMed Central

    Godefay, Hagos; Byass, Peter; Graham, Wendy J.; Kinsman, John; Mulugeta, Afework

    2015-01-01

    Background Maternal mortality continues to have devastating impacts in many societies, where it constitutes a leading cause of death, and thus remains a core issue in international development. Nevertheless, individual determinants of maternal mortality are often unclear and subject to local variation. This study aims to characterise individual risk factors for maternal mortality in Tigray, Ethiopia. Methods A community-based case-control study was conducted, with 62 cases and 248 controls from six randomly-selected rural districts. All maternal deaths between May 2012 and September 2013 were recruited as cases and a random sample of mothers who delivered in the same communities within the same time period were taken as controls. Multiple logistic regression was used to identify independent determinants of maternal mortality. Results Four independent individual risk factors, significantly associated with maternal death, emerged. Women who were not members of the voluntary Women’s Development Army were more likely to experience maternal death (OR 2.07, 95% CI 1.04–4.11), as were women whose husbands or partners had below-median scores for involvement during pregnancy (OR 2.19, 95% CI 1.14–4.18). Women with a pre-existing history of other illness were also at increased risk (OR 5.58, 95% CI 2.17–14.30), as were those who had never used contraceptives (OR 2.58, 95% CI 1.37–4.85). Previous pregnancy complications, a below-median number of antenatal care visits and a woman’s lack of involvement in health care decision making were significant bivariable risks that were not significant in the multivariable model. Conclusions The findings suggest that interventions aimed at reducing maternal mortality need to focus on encouraging membership of the Women’s Development Army, enhancing husbands’ involvement in maternal health services, improving linkages between maternity care and other disease-specific programmes and ensuring that women with previous

  1. Using vouchers to increase access to maternal healthcare in Bangladesh.

    PubMed

    Rob, Ubaidur; Rahman, Moshiur; Bellows, Benjamin

    The maternal mortality ratio (322) is comparatively high in Bangladesh. The utilization of maternity care provided by trained professionals during and after delivery is alarmingly low, primarily due to lack of knowledge and money. The overall objective of this operations research project was to test the feasibility and effectiveness of introducing financial support (voucher scheme) for poor rural women to improve utilization of antenatal care (ANC), delivery and postnatal check-up (PNC) from trained service providers. A pretest-posttest design was utilized. A total of 436 women were interviewed before and 414 after the intervention to evaluate the impact of interventions. In-depth interviews were conducted with users and non-users of vouchers. Findings show that institutional deliveries have increased from 2% to 18%. Utilization of ANC from trained providers has increased from 42% to 89%. Similarly, utilization of PNC from trained providers has increased from 10% to 60%. PMID:21273164

  2. Critical maternal health knowledge gaps in low- and middle-income countries for the post-2015 era.

    PubMed

    Kendall, Tamil; Langer, Ana

    2015-01-01

    Effective interventions to promote maternal health and address obstetric complications exist, however 800 women die every day during pregnancy and childbirth from largely preventable causes and more than 90% of these deaths occur in low and middle income countries (LMIC). In 2014, the Maternal Health Task Force consulted 26 global maternal health researchers to identify persistent and critical knowledge gaps to be filled to reduce maternal morbidity and mortality and improve maternal health. The vision of maternal health articulated was comprehensive and priorities for knowledge generation encompassed improving the availability, accessibility, acceptability, and quality of institutional labor and delivery services and other effective interventions, such as contraception and safe abortion services. Respondents emphasized the need for health systems research to identify models that can deliver what is known to be effective to prevent and treat the main causes of maternal death at scale in different contexts and to sustain coverage and quality over time. Researchers also emphasized the development of tools to measure quality of care and promote ongoing quality improvement at the facility, district, and national level. Knowledge generation to improve distribution and retention of healthcare workers, facilitate task shifting, develop and evaluate training models to improve "hands-on" skills and promote evidence-based practice, and increase managerial capacity at different levels of the health system were also prioritized. Interviewees noted that attitudes, behavior, and power relationships between health professionals and within institutions must be transformed to achieve coverage of high-quality maternal health services in LMIC. The increasing burden of non-communicable diseases, urbanization, and the persistence of social and economic inequality were identified as emerging challenges that require knowledge generation to improve health system responses and evaluate

  3. The use of smart technology to deliver efficient and effective pressure-damage education.

    PubMed

    Rajpaul, Kumal; Acton, Claire

    2015-11-11

    This article outlines an innovative joint working strategy, as well as a partnership project, between two NHS Foundation Trusts-a community trust and industry partner-to develop a mobile training app to deliver pressure ulcer prevention and management for clinical staff. The aim of the innovation was to enable a new way of delivering education to large numbers of staff by moving away from traditional classroom-based training. The process included development of the app, along with testing and implementation, followed by a review of the qualitative data after the app's implementation. The review takes into account the key outcomes that have had an impact on this method of delivering education, its challenges and how it has been received by clinical staff and patients. PMID:26559237

  4. Maternal Depression and Parent Management Training Outcomes.

    PubMed

    Dempsey, Jack; McQuillin, Samuel; Butler, Ashley M; Axelrad, Marni E

    2016-09-01

    This study examines the impact of maternal depression on reductions in children's behavior problems severity following implementation of the Brief Behavioral Intervention-a brief, manualized parent management training treatment. The parents of 87 children aged 2-6 years of age received parent management training at a metropolitan hospital. Parents of participants completed measures of externalizing behavior and maternal depression. The association between pre-post treatment change in externalizing behavior and maternal depression was examined using an autoregressive cross-lagged model. Results showed that self-reported maternal depressive symptoms at pre-treatment negatively influenced the overall magnitude of reduction of reported externalizing behaviors in children following treatment. Results indicate that aspects of family functioning not specifically targeted by parent management training, such as maternal depression, significantly affect treatment outcomes. Clinicians providing parent management training may benefit from assessing for maternal depression and modifying treatment as indicated. PMID:27448152

  5. Adoption, ART, and a re-conception of the maternal body: toward embodied maternity.

    PubMed

    Brakman, Sarah-Vaughan; Scholz, Sally J

    2006-01-01

    We criticize a view of maternity that equates the natural with the genetic and biological and show how such a practice overdetermines the maternal body and the maternal experience for women who are mothers through adoption and ART (Assisted Reproductive Technologies). As an alternative, we propose a new framework designed to rethink maternal bodies through the lens of feminist embodiment. Feminist embodied maternity, as we call it, stresses the particularity of experience through subjective embodiment. A feminist embodied maternity emphasizes the physical relations of the subjective lived-body rather than the genetic or biological connections. Instead of universalizing claims about the maternal body, embodied maternity looks to communicable experiences and empathetic understanding. PMID:17111556

  6. Maternal deaths in eastern Indonesia: 20 years and still walking: an ethnographic study

    PubMed Central

    2014-01-01

    Background The delays in receiving adequate emergency maternal care described by Thaddeus and Maine twenty years ago are still occurring, as exemplified in this study of cases of maternal deaths in a subdistrict in rural eastern Indonesia. Methods An ethnographic design was conducted, recruiting eleven families who reported on cases of maternal deaths in one sub-district of Indonesia, as well as assessing the geographical and cultural context of the villages. Traditional birth attendants and village leaders provided information to the research team which was thematically and contextually analysed. Results Two stages to the first and second delays have been differentiated in this study. First, delays in the decision to seek care comprised time taken to recognise (if at all) that an emergency situation existed, followed by time taken to reach a decision to request care. The decision to request care resided variously with the family or cadre. Second, delays in reaching care comprised time taken to deliver the request for help and then time for help to arrive. A phone was not available to request care in many cases and so the request was delivered by walking or motorbike. In two cases where the decision to seek care and the delivery of the request happened in a timely way, help was delayed because the midwife and ambulance respectively were unavailable. Conclusions This study, although a small sample, confirmed that either a single delay or a sequence of delays can prove fatal. Delays were determined by both social and geographic factors, any of which alone could be limiting. Initiatives to improve maternal health outcomes need to address multiple factors: increased awareness of equitable access to maternal health care, village preparedness for emergency response, improved access to telecommunications and geographic access. PMID:24447873

  7. The Neuroendocrinology of Primate Maternal Behavior

    PubMed Central

    Saltzman, Wendy; Maestripieri, Dario

    2010-01-01

    In nonhuman primates and humans, similar to other mammals, hormones are not strictly necessary for the expression of maternal behavior, but nevertheless influence variation in maternal responsiveness and parental behavior both within and between individuals. A growing number of correlational and experimental studies have indicated that high circulating estrogen concentrations during pregnancy increase maternal motivation and responsiveness to infant stimuli, while effects of prepartum or postpartum estrogens and progestogens on maternal behavior are less clear. Prolactin is thought to play a role in promoting paternal and alloparental care in primates, but little is known about the relationship between this hormone and maternal behavior. High circulating cortisol levels appear to enhance arousal and responsiveness to infant stimuli in young, relatively inexperienced female primates, but interfere with the expression of maternal behavior in older and more experienced mothers. Among neuropeptides and neurotransmitters, preliminary evidence indicates that oxytocin and endogenous opioids affect maternal attachment to infants, including maintenance of contact, grooming, and responses to separation. Brain serotonin affects anxiety and impulsivity, which in turn may affect maternal behaviors such as infant retrieval or rejection of infants’ attempts to make contact with the mother. Although our understanding of the neuroendocrine correlates of primate maternal behavior has grown substantially in the last two decades, very little is known about the mechanisms underlying these effects, e.g., the extent to which these mechanisms may involve changes in perception, emotion, or cognition. PMID:20888383

  8. Neonatal insulin action impairs hypothalamic neurocircuit formation in response to maternal high-fat feeding.

    PubMed

    Vogt, Merly C; Paeger, Lars; Hess, Simon; Steculorum, Sophie M; Awazawa, Motoharu; Hampel, Brigitte; Neupert, Susanne; Nicholls, Hayley T; Mauer, Jan; Hausen, A Christine; Predel, Reinhard; Kloppenburg, Peter; Horvath, Tamas L; Brüning, Jens C

    2014-01-30

    Maternal metabolic homeostasis exerts long-term effects on the offspring's health outcomes. Here, we demonstrate that maternal high-fat diet (HFD) feeding during lactation predisposes the offspring for obesity and impaired glucose homeostasis in mice, which is associated with an impairment of the hypothalamic melanocortin circuitry. Whereas the number and neuropeptide expression of anorexigenic proopiomelanocortin (POMC) and orexigenic agouti-related peptide (AgRP) neurons, electrophysiological properties of POMC neurons, and posttranslational processing of POMC remain unaffected in response to maternal HFD feeding during lactation, the formation of POMC and AgRP projections to hypothalamic target sites is severely impaired. Abrogating insulin action in POMC neurons of the offspring prevents altered POMC projections to the preautonomic paraventricular nucleus of the hypothalamus (PVH), pancreatic parasympathetic innervation, and impaired glucose-stimulated insulin secretion in response to maternal overnutrition. These experiments reveal a critical timing, when altered maternal metabolism disrupts metabolic homeostasis in the offspring via impairing neuronal projections, and show that abnormal insulin signaling contributes to this effect. PMID:24462248

  9. Neonatal insulin action impairs hypothalamic neurocircuit formation in response to maternal high fat feeding

    PubMed Central

    Vogt, Merly C.; Paeger, Lars; Hess, Simon; Steculorum, Sophie M.; Awazawa, Motoharu; Hampel, Brigitte; Neupert, Susanne; Nicholls, Hayley T.; Mauer, Jan; Hausen, A. Christine; Predel, Reinhard; Kloppenburg, Peter; Horvath, Tamas L.; Brüning, Jens C.

    2014-01-01

    Summary Maternal metabolic homeostasis exerts long-term effects on the offspring's health outcomes. Here, we demonstrate that maternal high fat diet (HFD)-feeding during lactation predisposes the offspring for obesity and impaired glucose homeostasis in mice, which is associated with an impairment of the hypothalamic melanocortin circuitry. Whereas the number and neuropeptide expression of anorexigenic proopiomelanocortin-(POMC) and orexigenic agoui-related peptide (AgRP)-neurons, electrophysiological properties of POMC-neurons and posttranslational processing of POMC remain unaffected in response to maternal HFD-feeding during lactation, the formation of POMC- and AgRP-projections to hypothalamic target sites is severely impaired. Abrogating insulin action in POMC-neurons of the offspring prevents altered POMC-projections to the preautonomic paraventricular nucleus of the hypothalamus (PVH), pancreatic parasympathetic innervation and impaired glucose-stimulated insulin-secretion in response to maternal overnutrition. These experiments reveal a critical timing, when altered maternal metabolism disrupts metabolic homeostasis in the offspring via impairing neuronal projections and that abnormal insulin signaling contributes to this effect. PMID:24462248

  10. Evidence from Maternity Leave Expansions of the Impact of Maternal Care on Early Child Development

    ERIC Educational Resources Information Center

    Baker, Michael; Milligan, Kevin

    2010-01-01

    We study the impact of maternal care on early child development using an expansion in Canadian maternity leave entitlements. Following the leave expansion, mothers who took leave spent 48-58 percent more time not working in their children's first year of life. This extra maternal care primarily crowded out home-based care by unlicensed…