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Sample records for project delivering maternal

  1. An intercellular heme trafficking protein delivers maternal heme to the embryo during development in C. elegans

    PubMed Central

    Chen, Caiyong; Samuel, Tamika K.; Sinclair, Jason; Dailey, Harry A.; Hamza, Iqbal

    2011-01-01

    Summary Heme is a cytotoxic, hydrophobic tetrapyrrole that crosses multiple biological membranes for incorporation into proteins critical for numerous biological processes. Thus, a prima facie argument can be made that heme trafficking within the aqueous cellular milieu must be mediated by specific intra- and intercellular pathways. Embryonic development in Caenorhabditis elegans, a heme auxotroph, is inextricably dependent on maternal heme acquisition. Here we show that HRG-3 is required to deliver maternal heme to oocytes for zygotic development. HRG-3 binds heme and is exclusively secreted by the intestine during heme insufficiency into the interstitial fluid for transport of maternal heme to extra-intestinal cells. HRG-3 deficiency results either in death during embryogenesis or in developmental arrest immediately post hatching – phenotypes that are fully suppressed by maternal but not zygotic hrg-3 expression. Our results establish an unprecedented role for HRG-3 as an intercellular heme chaperone in zygotic development and maternal-embryonic nutrition in C. elegans. PMID:21620137

  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. Influence of maternal dexamethasone administration on thermoregulation in lambs delivered by caesarean section.

    PubMed

    Clarke, I; Heasman, L; Symonds, M E

    1998-02-01

    We have previously shown that lambs delivered by caesarean section 1 week prematurely become hypothermic due to reduced brown adipose tissue function in conjunction with low plasma concentrations of cortisol and thyroid hormones. The present study therefore aimed to determine whether maternal dexamethasone (a synthetic corticosteroid) administration could improve thermoregulation in premature lambs to the extent that they become similar to term lambs. Lambs were either delivered by caesarean section into a warm (30 degrees C; WD) or cool (15 degrees C; CD) ambient temperature at 140 days of gestation, 2 days after maternal dexamethasone treatment, or at 146 days for controls. During the first 30 min of life the decline in colonic temperature was greater in dexamethasone treated lambs compared with controls delivered into the same ambient temperature. All lambs then restored colonic temperature although this adaptation took longest in dexamethasone treated lambs CD but these subsequently attained highest plateau colonic temperatures. Oxygen consumption, breathing frequency and plasma free fatty acid concentrations were highest in dexamethasone treated lambs CD. There were no differences in plasma thyroid hormones between groups, but cortisol concentrations were lower in dexamethasone treated lambs irrespective of delivery temperature. Analysis of brown adipose tissue samples at 6 h of life demonstrated that dexamethasone treated lambs WD had more uncoupling protein and, in both dexamethasone treated and control lambs, uncoupling protein content was higher in lambs CD compared with those WD. An effect of ambient temperature on thermogenic activity was only observed in the dexamethasone treated group. It is concluded that maternal dexamethasone treatment can significantly improve thermoregulation after birth following premature delivery by caesarean section. As a consequence, dexamethasone treated lambs delivered 1 week prematurely do not remain hypothermic and have

  4. Infants delivered in maternity homes run by traditional birth attendants in urban Nigeria: a community-based study.

    PubMed

    Olusanya, Bolajoko O; Inem, Victor A; Abosede, Olayinka A

    2011-06-01

    We explored factors associated with traditional maternity/herbal homes (TMHs) run by traditional birth attendants (TBAs) compared with hospital or home delivery in Lagos, Nigeria, and found that infants delivered at TMHs were less likely to have severe hyperbilirubinemia compared with infants delivered in hospitals or residential homes. These infants were also less likely to be preterm compared with those delivered in hospitals or undernourished compared with infants delivered in residential homes. We concluded that infants delivered at TMHs who survive are unlikely to be at greater risks of some adverse perinatal outcomes than those delivered in hospitals or family homes.

  5. Maternal and child health project in Nigeria.

    PubMed

    Okafor, Chinyelu B

    2003-12-01

    Maternal deaths in developing countries are rooted in womens powerlessness and their unequal access to employment, finance, education, basic health care, and other resources. Nigeria is Africa's most populous country, and it is an oil producing country, but Nigeria has one of the worst maternal mortality rates in Africa. These deaths were linked to deficiencies in access to health care including poor quality of health services, socio-cultural factors, and access issues related to the poor status of women. To address these problems, a participatory approach was used to bring Christian women from various denominations in Eastern Nigeria together. With technical assistance from a research unit in a university in Eastern Nigeria, the women were able to implement a Safe Motherhood project starting from needs assessment to program evaluation. Lessons learned from this program approach are discussed.

  6. The Supplemental Instruction Project: peer-devised and delivered tutorials.

    PubMed

    Hurley, Katrina F; McKay, Donald W; Scott, Thomas M; James, Bonnie M

    2003-07-01

    The purpose of this study was to determine whether student devised and delivered supplemental instruction is beneficial and acceptable to first-year medical students. A student-run Supplemental Instruction Project (SIP) was developed and delivered by second-year medical students and offered free of charge to all first-year medical students at Memorial University of Newfoundland taking the Integrated Study of Disease I course in 1999 and again in 2000. Small-group tutorials focused on subject material that second-year medical students identified as 'difficult'. Five 60- to 90-minute sessions covering topics in cardiology, nephrology and respirology were offered. Student and tutor perceptions about the project were collected using anonymous questionnaires. Students were quizzed before and after each tutorial session. Post-tutorial quiz scores were significantly greater than pre-tutorial scores. Student and tutor perceptions of SIP were positive. It is concluded that the SIP is an acceptable, practical and effective method to supplement delivery of challenging material to first-year medical students.

  7. “Someone like us”: Delivering maternal mental health through peers in two South Asian contexts

    PubMed Central

    Singla, Daisy; Lazarus, Anisha; Atif, Najia; Sikander, Siham; Bhatia, Urvita; Ahmad, Ikhlaq; Nisar, Anum; Khan, Sonia; Fuhr, Daniela; Patel, Vikram; Rahman, Atif

    2014-01-01

    BACKGROUND Peer-led psychosocial interventions are one solution to address the great paucity of skilled mental health human resources in South Asia. The aim of this study was to explore peer-delivered care for maternal depression in two diverse contexts in South Asia. METHODS The study was carried out in the urban setting of Goa, India and a rural setting in Rawalpindi, Pakistan. In total, 61 in-depth interviews (IDIs) and 3 focus group discussions (FGDs), and 38 IDIs and 10 FGDs, were conducted with multiple stakeholders in urban Goa and rural Rawalpindi respectively. We used the framework approach to analyze data. RESULTS Peers, from the same community were the most preferred delivery agents of a community-based psychosocial intervention in both sites. There were contextual similarities and differences between the two sites. Preferred characteristics among peers included local, middle-aged, educated mothers with similar experiences, good communication skills and a good character. Key differences between the two contexts included a greater emphasis on the peer's family social standing in rural Rawalpindi and financial incentives as motivators for individual peers in urban Goa. LIMITATIONS Generalizability of our findings is limited to two specific contexts in a vast and diverse region. DISCUSSION Our study demonstrates that peers have the potential to deliver maternal psychosocial interventions in low-income settings. There are contextual differences in the preferred characteristics and motivators between the sites, and these should be carefully considered in program implementation. PMID:25113958

  8. 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.

  9. Comparison of maternal and newborn outcomes of Tibetan and Han Chinese delivering in Lhasa, Tibet

    PubMed Central

    Miller, Suellen; Tudor, Carrie; Thorsten, Vanessa; Nyima; Sonam; Droyoung; Wright, Linda; Varner, Michael

    2009-01-01

    Aim To compare maternal and neonatal outcomes of Tibetan and Han Chinese women delivering vaginally at high altitude (3650 meters) in Lhasa, Tibet Autonomous Region, People’s Republic of China. Method Comparative analysis of data from a prospective observational study of Tibetan (n = 938) and Han Chinese (n = 146) women delivering at three hospitals between January 2004 and May 2005. Results Han Chinese women had higher rates of pre-eclampsia/gestational hypertension than Tibetan women, (10.3% vs 5.9%, P = 0.04). There was no difference in rates of postpartum hemorrhage between Tibetan and Han women (12.8% vs 17.1%, P = 0.15). Han newborns weighed significantly less than Tibetan newborns (P < 0.01), and were twice as likely to be small for gestational age, (24.5% vs 11.6%, P < 0.01). Tibetan newborns were less likely to have poor neonatal outcomes than Han newborns (P < 0.01). Conclusion In high altitude deliveries in Tibet, adverse outcomes were significantly more common among Han Chinese. PMID:19012697

  10. Has the Starkey Project delivered on its commitments?

    Treesearch

    Jack Ward Thomas; Michael J. Wisdom

    2004-01-01

    The Starkey Project was conceived from intense debate about how best to manage habitats and populations of mule deer (Odocoileus hemionus) and elk (Cervus elaphus) in western North America (Rowland et al. 1997). Founders of the research effort promised to provide definitive knowledge about effects of the dominant public land...

  11. Ethnic variation in maternity care: a comparison of Polish and Scottish women delivering in Scotland 2004-2009.

    PubMed

    Gorman, D R; Katikireddi, S V; Morris, C; Chalmers, J W T; Sim, J; Szamotulska, K; Mierzejewska, E; Hughes, R G

    2014-03-01

    Birth outcomes in migrants vary, but the relative explanatory influence of obstetric practice in origin and destination countries has been under-investigated. To explore this, birth outcomes of Scots and Polish migrants to Scotland were compared with Polish obstetric data. Poles are the largest group of migrants to Scotland, and Poland has significantly more medicalized maternity care than Scotland. A population-based epidemiological study of linked maternal country of birth, maternity and birth outcomes. Scottish maternity and neonatal records linked to birth registrations were analysed for differences in modes of delivery and pregnancy outcomes between Polish migrants and Scots, and compared with Polish Health Fund and survey data. 119,698 Scottish and 3105 Polish births to primiparous women in Scotland 2004-9 were analysed. Poles were less likely than Scots to have a Caesarean section and more likely to have a spontaneous vaginal or instrumental delivery. The Caesarean section rate in Poland is significantly higher and instrumental delivery rate lower than for either group of women in Scotland. Methodologically, comparing a large group of migrants from one country with the host population has advantages over grouping migrants from several countries into a single category, and allows more informed analysis of the effect of health services. Polish mothers' being slightly healthier explains some of their lower Caesarean section rate compared to Scots in Scotland. However, dominant models of obstetrics in the two countries seem likely to influence the differences between Poles delivering in Poland and Scotland. Further investigation of both is required. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  12. Maternal stressors and social support as risks for delivering babies with structural birth defects.

    PubMed

    Carmichael, Suzan L; Ma, Chen; Tinker, Sarah; Rasmussen, Sonia A; Shaw, Gary M

    2014-07-01

    We examined the association of maternal stressful life events and social support with risks of birth defects using National Birth Defects Prevention Study data, a population-based case-control study. We examined seven stressful life events and three social support questions applicable to the periconceptional period, among mothers of 552 cases with neural tube defects (NTDs), 413 cleft palate (CP), 797 cleft lip ± cleft palate (CLP), 189 d-transposition of the great arteries (dTGA), 311 tetralogy of Fallot (TOF), and 2974 non-malformed controls. A stressful life events index equalled the sum of 'yes' responses to the seven questions. Social support questions were also summed to form an index. Data were analyzed using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), adjusted for maternal race-ethnicity, age, education, body mass index, smoking, drinking, and intake of vitamin supplements. Associations with the stress index tended to be higher with higher scores, but few 95% CIs excluded one. A four-point increase in the index was moderately associated with NTDs (OR 1.5, [95% CI 1.1, 2.0]) and CLP (OR 1.3, [95% CI 1.0, 1.7]). The social support index tended to be associated with reduced risk but most 95% CIs included one, with the exception of dTGA (OR for a score of 3 vs 0 was 0.5 [95% CI 0.3, 0.8]). Maternal periconceptional stressful life events, social support, and the two factors in combination were at most modestly, if at all, associated with risks of the studied birth defects. © 2014 John Wiley & Sons Ltd.

  13. Maternal stressors and social support as risks for delivering babies with structural birth defects

    PubMed Central

    Carmichael, Suzan L.; Ma, Chen; Tinker, Sarah; Rasmussen, Sonia A.; Shaw, Gary M.

    2014-01-01

    Background We examined the association of maternal stressful life events and social support with risks of birth defects using National Birth Defects Prevention Study data, a population-based case-control study. Methods We examined 7 stressful life events and 3 social support questions applicable to the periconceptional period, among mothers of 552 cases with neural tube defects (NTDs), 413 cleft palate (CP), 797 cleft lip +/− cleft palate (CLP), 189 d-transposition of the great arteries (dTGA), 311 tetralogy of Fallot (TOF), and 2,974 non-malformed controls. A stressful life events index equaled the sum of “yes” responses to the 7 questions. Social support questions were also summed to form an index. Data were analyzed using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), adjusted for maternal race-ethnicity, age, education, body mass index, smoking, drinking, and intake of vitamin supplements. Results Associations with the stress index tended to be higher with higher scores, but few 95% CIs excluded one. A 4-point increase in the index was moderately associated with NTDs (OR 1.5, 95% CI 1.1, 2.0) and CLP (OR 1.3, 95% CI 1.0–1.7). The social support index tended to be associated with reduced risk but most 95% CIs included one, with the exception of dTGA (OR for a score of three versus zero was 0.5, 95% CI 0.3–0.8). Conclusions Maternal periconceptional stressful life events, social support, and the two factors in combination were at most modestly, if at all, associated with risks of the studied birth defects. PMID:24697924

  14. 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…

  15. 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…

  16. A new vision for maternity records in Scotland: the Scottish Woman-Held Maternity Record (SWHMR) project and the electronic Scottish Woman-Held Maternity Record (eSWHMR) project.

    PubMed

    Bedford, Helen; Chalmers, Jim

    2003-06-01

    This article outlines current developments in maternity records in Scotland. It describes the impetus for a unified woman-held paper maternity record and a complementary electronic record. Details of both these ongoing projects are provided.

  17. Birth setting, transfer and maternal sense of control: results from the DELIVER study

    PubMed Central

    2014-01-01

    Background In the Netherlands, low risk women receive midwife-led care and can choose to give birth at home or in hospital. There is concern that transfer of care during labour from midwife-led care to an obstetrician-led unit leads to negative birth experiences, in particular among those with planned home birth. In this study we compared sense of control, which is a major attribute of the childbirth experience, for women planning home compared to women planning hospital birth under midwife-led care. In particular, we studied sense of control among women who were transferred to obstetric-led care during labour according to planned place of birth: home versus hospital. Methods We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Sense of control during labour was assessed 6 weeks after birth, using the short version of the Labour Agentry Scale (LAS-11). A higher LAS-11 score indicates a higher feeling of control. We considered a difference of a minimum of 5.5 points as clinically relevant. Results Nulliparous- and parous women who planned a home birth had a 2.6 (95% CI 1.0, 4.3) and a 3.0 (1.6, 4.4) higher LAS score during first stage of labour respectively and during second stage a higher score of 2.8 (0.9, 4.7) and 2.3 (0.6, 4.0), compared with women who planned a hospital birth. Overall, women who were transferred experienced a lower sense of control than women who were not transferred. Parous women who planned a home birth and who were transferred had a 4.3 (0.2, 8.4) higher LAS score in 2nd stage, compared to those who planned a hospital birth and who were transferred. Conclusion We found no clinically relevant differences in feelings of control among women who planned a home or hospital birth. Transfer of care during labour lowered feelings of control, but feelings of control were similar for transferred women who planned a home or hospital birth. As far as their

  18. Building on community outreach for childhood vaccination to deliver maternal and child health services in Laos: a feasibility assessment.

    PubMed

    Jacobs, Bart; Lindelow, Magnus; Xayyavong, Phoxay; Sackett, Philippa

    2012-12-01

    Outreach services for vaccination present a useful vehicle to deliver maternal and child health (MCH) care to hard-to-reach women and children. In Laos, uptake of MCH services inversely correlates with distance from a health facility; hence, the concurrent delivery of MCH services during community vaccination outreach has been promoted. Here we assess factors affecting delivery of MCH services during vaccination outreach in six districts of three provinces. We conducted 58 in-depth interviews with representatives of district and provincial health offices, health centre staff and village health volunteers. Vaccination outreach sessions by health centre staff were observed in eight villages, and 12 focus group discussions were held with 120 mothers on their perceptions of these sessions. The regularity and frequency of outreach sessions and the number of integrated vaccination/MCH services varied widely between sites. Availability of external financial and technical support was the major determinant of optimal delivery of integrated services, with implications for future policy. To enable concurrent delivery of a range of MCH services during vaccination outreach, the number of these services should gradually be increased in tandem with additional financial and technical support. At the same time, ways need to be found to ensure remote villages are reached and coverage of children and women receiving services increased, to reduce inequity. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  19. Economic evaluation of a Child Health Days strategy to deliver multiple maternal and child health interventions in Somalia.

    PubMed

    Vijayaraghavan, Maya; Wallace, Aaron; Mirza, Imran Raza; Kamadjeu, Raoul; Nandy, Robin; Durry, Elias; Everard, Marthe

    2012-03-01

    Child Health Days (CHDs) are increasingly used by countries to periodically deliver multiple maternal and child health interventions as time-limited events, particularly to populations not reached by routine health services. In countries with a weak health infrastructure, this strategy could be used to reach many underserved populations with an integrated package of services. In this study, we estimate the incremental costs, impact, cost-effectiveness, and return on investment of 2 rounds of CHDs that were conducted in Somalia in 2009 and 2010. We use program costs and population estimates reported by the World Health Organization and United Nations Children's Fund to estimate the average cost per beneficiary for each of 9 interventions delivered during 2 rounds of CHDs implemented during the periods of December 2008 to May 2009 and August 2009 to April 2010. Because unstable areas were unreachable, we calculated costs for targeted and accessible beneficiaries. We model the impact of the CHDs on child mortality using the Lives Saved Tool, convert these estimates of mortality reduction to life years saved, and derive the cost-effectiveness ratio and the return on investment. The estimated average incremental cost per intervention for each targeted beneficiary was $0.63, with the cost increasing to $0.77 per accessible beneficiary. The CHDs were estimated to save the lives of at least 10,000, or 500,000 life years for both rounds combined. The CHDs were cost-effective at $34.00/life year saved. For every $1 million invested in the strategy, an estimated 615 children's lives, or 29,500 life years, were saved. If the pentavalent vaccine had been delivered during the CHDs instead of diphtheria-pertussis-tetanus vaccine, an additional 5000 children's lives could have been saved. Despite high operational costs, CHDs are a very cost-effective service delivery strategy for addressing the leading causes of child mortality in a conflict setting like Somalia and compare

  20. 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…

  1. 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…

  2. Innovative model of delivering quality improvement education for trainees--a pilot project.

    PubMed

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

    2015-01-01

    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. 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. 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. The pilot project of using the FC model to deliver QI education was successful in a small sample of trainees.

  3. 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

  4. Pilot project and evaluation of delivering diabetes work-based education using video conferencing.

    PubMed

    Maltinsky, W; Hall, S; Grant, L; Simpson, K; MacRury, S

    2013-01-01

    Diabetes is a chronic long-term disease with an increasing incidence. There is a need to increase access to effective care and to ensure such care is delivered as locally as possible. The geographical spread of NHS Highland Scotland presents additional challenges to ensuring a skilled workforce given education is normally work-based tuition and assessment. The aim of this pilot project was to deliver teleconferenced diabetes training to healthcare and allied healthcare professionals who provide basic level care for, and management of, people with diabetes and to evaluate this training. Work-based diabetes education was designed to be delivered by a diabetes educator through videoconferencing or face to face (F2F) for healthcare professionals in peripheral settings in the Scottish Highlands region over two half-days. The education covered theoretical and practical training in diabetes. The evaluation of the project was through post-course questionnaires and assessment instruments to capture views of the content and delivery mode, as well as student performance. Feedback from participants indicated that the educational content was relevant and that the use of videoconferencing (VC) could provide accessibility to training where distance, cost and other issues may make access difficult. Student performance on the assessment instruments did not differ between those who received the training through video conferencing and those who received the training through F2F delivery. Video conferencing can counteract the difficulties of accessing training for clinical peripherally based professionals. Training through VC did not compromise student acquisition of learning outcomes. Feedback indicates that VC can reduce the interactive nature of the learning and teaching experience.

  5. 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.

  6. Providing maternal and child health-family planning services to a large rural population: results of the Bohol Project, Philippines.

    PubMed Central

    Williamson, N E; Parado, J P; Maturan, E G

    1983-01-01

    The Bohol Project (1975-1979) sought to improve maternal and child health and to increase the use of family planning among a rural Philippine population of 400,000. Research indicated that maternal and child health (MCH) services did become more available during the Project period and coverage of the priority populations improved. Family planning (FP) use, particularly of less effective methods, increased and fertility declined although some change could have been expected even without the Project. Deaths due to neonatal tetanus were almost eliminated by mortality rates did not decline for a number of reasons, including the fact that services were probably not tailored closely enough to local health problems, especially respiratory diseases. The Project showed that it was possible to increase health and family planning services by using low-cost strategies (such as setting up community drug stores) and by employing paramedical workers, in this case, midwives. Preventive MCH-FP services were not overwhelmed by curative services as had been feared. Perhaps the most significant contributions of the Project were the lessons learned about delivering health and family planning services and conducting evaluation research. In general, if developing countries could maintain well-evaluated field laboratories for working out health and family planning delivery approaches before going nationwide, it is likely that time and money would be saved in the long run. PMID:6848001

  7. Maternal health care seeking by rural Tibetan women: characteristics of women delivering at a newly-constructed birth center in western China.

    PubMed

    Gyaltsen, Kunchok; Gipson, Jessica D; Gyal, Lhusham; Kyi, Tsering; Hicks, Andrew L; Pebley, Anne R

    2015-09-22

    Increasing skilled birth attendance at delivery is key to reducing maternal mortality, particularly among marginalized populations. Despite China's successful rollout of a national policy to promote facility deliveries, challenges remain among rural and ethnic minority populations. In response, a Tibetan Birth and Training Center (TBTC) was constructed in 2010 to provide high-quality obstetric care in a home-like environment to a predominantly Tibetan population in Tso-ngon (Qinghai) province in western China to improve maternal care in the region. This study examines if and how first users of the TBTC differ from women in the broader community, and how this information may inform subsequent maternal health care interventions in this area. Trained, Tibetan interviewers administered a face-to-face, quantitative questionnaire to two groups of married, Tibetan women: women who had delivered at the TBTC between June 2011-June 2012 (n = 114) and a non-equivalent comparison group of women from the same communities who had delivered in the last two years, but not at the TBTC (n = 108). Chi-squared and ANOVA tests were conducted to detect differences between the samples. There were no significant differences between the samples in education or income; however, women from the TBTC sample were significantly younger (25.55 vs. 28.16 years; p < 0.001) and had fewer children (1.54 vs. 1.70; p = 0.05). Items measuring maternity health care-seeking and perceived importance of health facility amenities indicated minimal differences between the samples. However, as compared to the community sample, the TBTC sample had a greater proportion of women who reported having the final say regarding where to deliver (26% vs. 14%; p = 0.02) and having a friend or family member who delivered at home (50% vs. 28%; p < 0.001). Findings did not support the hypothesis that the TBTC attracts lower-income, less-educated women. Minimal differences in women's characteristics

  8. Delivering Climate Projections at Regional Scales to Support Decisionmakers: a new NOAA effort

    NASA Astrophysics Data System (ADS)

    Anderson, D. E.; Ray, A. J.; MacDonald, A. E.; Rood, R. B.; Schneider, J. P.

    2010-12-01

    NOAA is developing a pilot effort for a capability to deliver climate projections at regional scales across the nation, in order to support a wide range of public policy and planning decisionmaking, from urban planning to ecosystems sustainability and management. The initial pilot effort will utilize model output and analyses from previous IPCC studies, such as those available from the DOE LLNL PCMDI archive and the NARCCAP datasets. New global model datasets applicable to US decision support will be generated through access to IPCC-vetted, publically available and documented models. Application of downscaling approaches will be evaluated through community interaction in order to support decisions at regional scales. Over the longer-term, this effort will evolve into a capability to support state-of-the-art approaches and applications of downscaled climate projection information to support regional decision making, including facilitating better connectivity of high resolution data with decision processes and models. This effort addresses the need articulated by the White House Interagency Climate Change Adaptation Task Force for science inputs to adaptation decisions and policy. The effort has considerable science challenges as well as challenges in meeting the needs of the end user community. This talk will discuss plans for addressing near-term and longer-term needs for regional climate information, defined for this effort as decision-scale climate projections over time scales ranging from seasonal to inter-annual out to a century or so. Initially, this effort will engage three key user communities through collaborative efforts: the Regional Integrated Science and Assessment network and other NOAA regional networks, the National Assessment, and the Department of Interior (DOI) via a recently signed DOI-Department of Commerce (DOC) Memorandum of Understanding to cooperate on climate-related activities. In summary, this effort is envisioned as an intellectual

  9. 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.

  10. 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…

  11. 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…

  12. Trends of preeclampsia/eclampsia and maternal and neonatal outcomes among women delivering in addis ababa selected government hospitals, Ethiopia: a retrospective cross-sectional study

    PubMed Central

    Wagnew, Maereg; Dessalegn, Muluken; Worku, Alemayehu; Nyagero, Josephat

    2016-01-01

    Introduction The burden of preeclampsia has been a major concern worldwide, particularly in developing countries such as Ethiopia. Preeclampsia is associated with substantial maternal complications, both acute and long-term. The aim of this research was to determine the magnitude and trends of preeclampsia/ eclampsia, maternal complications, and neonatal complications among women delivering babies at selected government hospitals in Ethiopia. Methods Data were collected retrospectively by reviewing the five-year medical records for 2009 to 2013, using data abstraction tools, to identify mothers with preeclampsia/eclampsia. A total of 1,809 cases were reviewed for general characteristics of the mother, delivery details, and any complications. Descriptive analyses were employed. In addition, extended Mantel Haenszel chi square for linear trend was used to check for significance of the trends. Results The five year average proportion of preeclampsia/eclampsia was 4.2% (95%CI 4.02%, 4.4%). The proportion of women with preeclampsia was 2.2% in 2009 and increased to 5.58% in 2013 (p<0.001), which was a 154% increase. Of the 1,809 mothers with preeclampsia/eclampsia, 36% (95%CI 33.85%, 38.28%) experienced at least one maternal complication; there was an increase of 26.5% (p<0.01) over the five year period. The main complications were HELLP (variant of preeclampsia with hemolysis, elevated liver enzymes, and low platelet count) syndrome, 257 (39.5%); aspiration pneumonia, 114 (17.5%); pulmonary edema, 114 (17.5%); and abruption placentae, 100 (15.3%). At least one neonatal complication occurred in 66.4% (95%CI 64.24%, 68.59%) of deliveries during the five-year study. A decreasing trend in neonatal complications was observed from 2009 (76%) to 2013 (66%), which showed a percentage change over time of negative 13.2%. The most common neonatal complications were stillbirths, which accounted for 363 (30.2%); prematurity, with 395 (32.8%); respiratory distress syndrome, with 456

  13. Trends of preeclampsia/eclampsia and maternal and neonatal outcomes among women delivering in addis ababa selected government hospitals, Ethiopia: a retrospective cross-sectional study.

    PubMed

    Wagnew, Maereg; Dessalegn, Muluken; Worku, Alemayehu; Nyagero, Josephat

    2016-01-01

    The burden of preeclampsia has been a major concern worldwide, particularly in developing countries such as Ethiopia. Preeclampsia is associated with substantial maternal complications, both acute and long-term. The aim of this research was to determine the magnitude and trends of preeclampsia/ eclampsia, maternal complications, and neonatal complications among women delivering babies at selected government hospitals in Ethiopia. Data were collected retrospectively by reviewing the five-year medical records for 2009 to 2013, using data abstraction tools, to identify mothers with preeclampsia/eclampsia. A total of 1,809 cases were reviewed for general characteristics of the mother, delivery details, and any complications. Descriptive analyses were employed. In addition, extended Mantel Haenszel chi square for linear trend was used to check for significance of the trends. The five year average proportion of preeclampsia/eclampsia was 4.2% (95%CI 4.02%, 4.4%). The proportion of women with preeclampsia was 2.2% in 2009 and increased to 5.58% in 2013 (p<0.001), which was a 154% increase. Of the 1,809 mothers with preeclampsia/eclampsia, 36% (95%CI 33.85%, 38.28%) experienced at least one maternal complication; there was an increase of 26.5% (p<0.01) over the five year period. The main complications were HELLP (variant of preeclampsia with hemolysis, elevated liver enzymes, and low platelet count) syndrome, 257 (39.5%); aspiration pneumonia, 114 (17.5%); pulmonary edema, 114 (17.5%); and abruption placentae, 100 (15.3%). At least one neonatal complication occurred in 66.4% (95%CI 64.24%, 68.59%) of deliveries during the five-year study. A decreasing trend in neonatal complications was observed from 2009 (76%) to 2013 (66%), which showed a percentage change over time of negative 13.2%. The most common neonatal complications were stillbirths, which accounted for 363 (30.2%); prematurity, with 395 (32.8%); respiratory distress syndrome, with 456 (37.9%); and low birth

  14. The effect of maternal body condition on in vivo production of zygotes and behavior of delivered offspring in mice.

    PubMed

    Fabian, Dušan; Kubandová, Janka; Čikoš, Štefan; Burkuš, Ján; Fabianová, Kamila; Račeková, Enikö; Czikková, Soňa; Koppel, Juraj

    2015-03-01

    This study investigated the effects of maternal body condition on oocyte quality and zygote production. Additionally, we examined the possible consequences on somatic parameters and behavior of naturally delivered offspring. We used an experimental model based on overfeeding of outbred mice during intrauterine and early postnatal development to produce the following four types of females: physiological (7%-8%), slightly increased (8%-11%), highly increased (>11%), and low (<7%) body fat content (Echo Magnetic Resonance Imaging). The fertilized females with slightly increased body fat showed increased numbers of spontaneously ovulated oocytes and an increased fertilization index compared with control animals. On the contrary, mice with slightly and highly increased body fat showed increased numbers of isolated immature oocytes and degenerates. Furthermore, animals with increased body fat had significantly decreased deposits of neutral lipids in the cytoplasm of mature oocytes (Nile red staining) and showed lower reduction in DNA cytosine methylation signal in parental pronuclei (5-methylcytosine immunohistochemistry). The highly increased amount of body fat in mothers was accompanied with lower weights in newborn pups and 5-week-old offspring. We also observed several deviations from normal behavior (open-field test and forced swimming test). The females with low body fat displayed a lower fertilization index, a lower percentage of zygotes at pronuclear stage 4 with demethylated DNA cytosine in parental pronuclei, and lower newborn weights. Although delivered offspring were able to gain normal weight by the fifth week of life, there were several deviations from normal behavior observed. Our results show that periconceptional status of maternal body condition adversely affects the quality of oocytes and might be correlated with significant changes during postnatal offspring development. The data documenting later onset of DNA demethylation in zygotes and decreased

  15. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review

    PubMed Central

    2013-01-01

    Background Community Health Workers are widely utilised in low- and middle-income countries and may be an important tool in reducing maternal and child mortality; however, evidence is lacking on their effectiveness for specific types of programmes, specifically programmes of a preventive nature. This review reports findings on a systematic review analysing effectiveness of preventive interventions delivered by Community Health Workers for Maternal and Child Health in low- and middle-income countries. Methods A search strategy was developed according to the Evidence for Policy and Practice Information and Co-ordinating Centre’s (EPPI-Centre) guidelines and systematic searching of the following databases occurred between June 8 – 11th, 2012: CINAHL, Embase, Ovid Nursing Database, PubMed, Scopus, Web of Science and POPLINE. Google, Google Scholar and WHO search engines, as well as relevant systematic reviews and reference lists from included articles were also searched. Inclusion criteria were: i) Target beneficiaries should be pregnant or recently pregnant women and/or children under-5 and/or caregivers of children under-5; ii) Interventions were required to be preventive and delivered by Community Health Workers at the household level. No exclusion criteria were stipulated for comparisons/controls or outcomes. Study characteristics of included articles were extracted using a data sheet and a peer tested quality assessment. A narrative synthesis of included studies was compiled with articles being coded descriptively to synthesise results and draw conclusions. Results A total of 10,281 studies were initially identified and through the screening process a total of 17 articles detailing 19 studies were included in the review. Studies came from ten different countries and consisted of randomized controlled trials, cluster randomized controlled trials, before and after, case control and cross sectional studies. Overall quality of evidence was found to be moderate

  16. Maternal age and risk for trisomy 21 assessed by the origin of chromosome nondisjunction: a report from the Atlanta and National Down Syndrome Projects

    PubMed Central

    Freeman, Sallie B.; Druschel, Charlotte; Hobbs, Charlotte A.; O’Leary, Leslie A.; Romitti, Paul A.; Royle, Marjorie H.; Torfs, Claudine P.; Sherman, Stephanie L.

    2010-01-01

    We examined the association between maternal age and chromosome 21 nondisjunction by origin of the meiotic error. We analyzed data from two population-based, case–control studies: Atlanta Down Syndrome Project (1989–1999) and National Down Syndrome Project (2001–2004). Cases were live born infants with trisomy 21 and controls were infants without trisomy 21 delivered in the same geographical regions. We enrolled 1,215 of 1,881 eligible case families and 1,375 of 2,293 controls. We report four primary findings. First, the significant association between advanced maternal age and chromosome 21 nondisjunction was restricted to meiotic errors in the egg; the association was not observed in sperm or in post-zygotic mitotic errors. Second, advanced maternal age was significantly associated with both meiosis I (MI) and meiosis II (MII). For example, compared to mothers of controls, mothers of infants with trisomy 21 due to MI nondisjunction were 8.5 times more likely to be ≥40 years old than 20–24 years old at the birth of the index case (95% CI = 5.6–12.9). Where nondisjunction occurred in MII, mothers were 15.1 times more likely to be ≥40 years (95% CI = 8.4–27.3). Third, the ratio of MI to MII errors differed by maternal age. The ratio was lower among women <19 years of age and those ≥40 years (2.1, 2.3, respectively) and higher in the middle age group (3.6). Lastly, we found no effect of grand-maternal age on the risk for maternal nondisjunction. This study emphasizes the complex association between advanced maternal age and nondisjunction of chromosome 21 during oogenesis. PMID:19050929

  17. Cancer Electronic Quality of Life Project: Delivering Wireless Web-based Technology at the Point of Care

    PubMed Central

    Cam, KM; Trigg, LJ; Lober, WB; Giansiracusa, D; Dockrey, MR; Karras, BT

    2002-01-01

    The Cancer Electronic Quality of Life (CancerEQOL) Project utilizes wireless web-based technologies to deliver the Quality of Life (QoL) survey directly to the point of patient care. Storing the data on a remote site keeps patient information secure, while the use of web-based technologies allows it to be accessible from any location. The use of wireless technologies in conjunction with security protocols allows for easy implementation while restricting access to patient information.

  18. 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

  19. Impact of Community-Based Maternal Health Workers on Coverage of Essential Maternal Health Interventions among Internally Displaced Communities in Eastern Burma: The MOM Project

    PubMed Central

    Mullany, Luke C.; Lee, Thomas J.; Yone, Lin; Lee, Catherine I.; Teela, Katherine C.; Paw, Palae; Shwe Oo, Eh Kalu; Maung, Cynthia; Kuiper, Heather; Masenior, Nicole F.; Beyrer, Chris

    2010-01-01

    Background Access to essential maternal and reproductive health care is poor throughout Burma, but is particularly lacking among internally displaced communities in the eastern border regions. In such settings, innovative strategies for accessing vulnerable populations and delivering basic public health interventions are urgently needed. Methods Four ethnic health organizations from the Shan, Mon, Karen, and Karenni regions collaborated on a pilot project between 2005 and 2008 to examine the feasibility of an innovative three-tiered network of community-based providers for delivery of maternal health interventions in the complex emergency setting of eastern Burma. Two-stage cluster-sampling surveys among ever-married women of reproductive age (15–45 y) conducted before and after program implementation enabled evaluation of changes in coverage of essential antenatal care interventions, attendance at birth by those trained to manage complications, postnatal care, and family planning services. Results Among 2,889 and 2,442 women of reproductive age in 2006 and 2008, respectively, population characteristics (age, marital status, ethnic distribution, literacy) were similar. Compared to baseline, women whose most recent pregnancy occurred during the implementation period were substantially more likely to receive antenatal care (71.8% versus 39.3%, prevalence rate ratio [PRR] = 1.83 [95% confidence interval (CI) 1.64–2.04]) and specific interventions such as urine testing (42.4% versus 15.7%, PRR = 2.69 [95% CI 2.69–3.54]), malaria screening (55.9% versus 21.9%, PRR = 2.88 [95% CI 2.15–3.85]), and deworming (58.2% versus 4.1%, PRR = 14.18 [95% CI 10.76–18.71]. Postnatal care visits within 7 d doubled. Use of modern methods to avoid pregnancy increased from 23.9% to 45.0% (PRR = 1.88 [95% CI 1.63–2.17]), and unmet need for contraception was reduced from 61.7% to 40.5%, a relative reduction of 35% (95% CI 28%–40%). Attendance at birth by

  20. The Fort Lewis maternity care project: a pioneering program for enlisted military families in a Prewar Washington State Community.

    PubMed

    Powell, Nena J

    2014-01-01

    The Fort Lewis maternity project begun in Tacoma, Washington in 1941, was considered a pioneering project that met the identified maternal/child health care needs of enlisted military families. From the outset, local medical leaders as well as Children's Bureau advisors intended that the project would provide physician-managed pregnancy as well as hospital births and that public health nursing would play a critical role in this maternal/child initiative. The project proved so successful that the model of care established under this program was reinterpreted to meet similar needs for military families in other states as America entered World War II.

  1. MEDIA ADVISORY: Vice President Biden to Deliver Remarks at Anacostia River Tunnel Project Site

    EPA Pesticide Factsheets

    WASHINGTON, DC - On Friday, January 16 th , the Vice President, Secretary of Agriculture Tom Vilsack, EPA Administrator Gina McCarthy, and Washington D.C. Mayor Muriel Bowser will tour the Anacostia River Tunnel Project Site in Southeast Washingto

  2. Factors influencing maternal nutrition in rural Nepal: an exploratory research project.

    PubMed

    Schumer, Jean E; Bernell, Stephanie L; Bovbjerg, Viktor E; Long, Marie L

    2014-01-01

    In this pilot project we examined factors contributing to maternal nutrition among women of child-bearing age in the Western Region of Nepal. We found that rural women are interested in learning about nutrition regardless of educational attainment and that level of education is strongly associated with interest in learning about nutrition (p <.001). Although the majority of women with no education expressed interest in learning about nutrition (71%), a substantial percentage (22%) were not interested. Education and the teaching of basic health messages may hold important benefits for improving maternal and child health.

  3. Embracing Our "Otherness": A Mutually Transformative Journey in Delivering an Indigenous Heart Health Promotion Project.

    PubMed

    Prodan-Bhalla, Natasha; Middagh, Diane; Jinkerson-Brass, Sharon; Ziabakhsh, Shabnam; Pederson, Ann; King, Charlene

    2016-04-19

    Theories on the importance of holistic and spiritual healing within nonconventional models of care are vast, yet there is little written about the practical, clinical-level interventions required to deliver such practices in collaborative cross-cultural settings. This article describes the learning experiences and transformative journeys of non-Indigenous nurse practitioners working with a Cultural Lead from an Indigenous community in British Columbia, Canada. The goal of theSeven Sisters Healthy Heart Projectwas to improve heart health promotion in an Indigenous community through a model of knowledge translation. The article describes the development of a bridge between two cultures in an attempt to deliver culturally responsive programming. Our journeys are represented in a phenomenological approach regarding relationships, pedagogy, and expertise. We were able to find ways to balance two worlds-the medical health services model and Indigenous holistic models of healing. The key to building the bridge was our willingness to be vulnerable, to trust in each other's way of teaching and learning, and allowing diverse viewpoints and knowledge sources to be present. Our work has vast implications for health promotion in Indigenous communities, as it closes the gap between theory and practice by demonstrating how Indigenous models can be integrated into mainstream health promotion practices.

  4. Maternal prepregnancy obesity and child neurodevelopment in the Collaborative Perinatal Project.

    PubMed

    Huang, Lisu; Yu, Xiaodan; Keim, Sarah; Li, Ling; Zhang, Lin; Zhang, Jun

    2014-06-01

    To examine the association between maternal prepregnancy weight and child neurodevelopment, and the effect of gestational weight gain. Using the U.S. Collaborative Perinatal Project data, 1959-76, a total of 30,212 women with a calculable prepregnancy body mass index (BMI) and gestational weight gain, and term singleton children followed up for more than 7 years were included in this study. Intelligence quotient (IQ) was measured at 7 years of age by Wechsler Intelligence Scales. Maternal prepregnancy BMI displayed inverted U-shaped associations with child IQ after adjustment for maternal age, maternal education levels, maternal race, marital status, socioeconomic status, smoking during pregnancy, parity and study center. Women with BMI at around 20 kg/m2 appeared to have the highest offspring IQ scores. After controlling for familial factors in the siblings' sample, maternal obesity (BMI≥30.0 kg/m2) was associated with lower Full-scale IQ (adjusted ß=-2.0, 95% confidence interval -3.5 to -0.5), and Verbal scale IQ (adjusted ß=-2.5, 95% confidence interval -4.0 to -1.0), using BMI of 18.5-24.9 kg/m2 as the reference category. Compared with children born to normal-weight women who gained 21-25 lb. during pregnancy, those born to obese women who gained more than 40 lb. had 6.5 points deficit in IQ after adjustment for potential confounders. Maternal prepregnancy obesity was associated with lower child IQ, and excessive weight gain accelerated the association. With obesity rising steadily, these results appear to raise serious public health concerns. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  5. 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...

  6. 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.

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

    NASA Astrophysics Data System (ADS)

    Rayner, Nick

    2017-04-01

    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, in the EUSTACE project (2015-June 2018, https://www.eustaceproject.eu) we are developing 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. 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 is 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 recent progress along this road in the EUSTACE project: 1. providing new, consistent, multi-component estimates of uncertainty in surface skin temperature retrievals from satellites; 2. identifying inhomogeneities in daily surface air temperature measurement series from weather stations and correcting for these over Europe; 3. estimating surface air temperature over all surfaces of Earth from surface skin temperature retrievals; 4. 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.

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

    NASA Astrophysics Data System (ADS)

    Ghent, D.; Rayner, N. A.

    2016-12-01

    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, in the EUSTACE project (2015-June 2018, https://www.eustaceproject.eu) we are developing 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. 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 is 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 recent progress along this road in the EUSTACE project, 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 involved.

  9. 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

  10. DNA methylation signatures triggered by prenatal maternal stress exposure to a natural disaster: Project Ice Storm.

    PubMed

    Cao-Lei, Lei; Massart, Renaud; Suderman, Matthew J; Machnes, Ziv; Elgbeili, Guillaume; Laplante, David P; Szyf, Moshe; King, Suzanne

    2014-01-01

    Prenatal maternal stress (PNMS) predicts a wide variety of behavioral and physical outcomes in the offspring. Although epigenetic processes may be responsible for PNMS effects, human research is hampered by the lack of experimental methods that parallel controlled animal studies. Disasters, however, provide natural experiments that can provide models of prenatal stress. Five months after the 1998 Quebec ice storm we recruited women who had been pregnant during the disaster and assessed their degrees of objective hardship and subjective distress. Thirteen years later, we investigated DNA methylation profiling in T cells obtained from 36 of the children, and compared selected results with those from saliva samples obtained from the same children at age 8. Prenatal maternal objective hardship was correlated with DNA methylation levels in 1675 CGs affiliated with 957 genes predominantly related to immune function; maternal subjective distress was uncorrelated. DNA methylation changes in SCG5 and LTA, both highly correlated with maternal objective stress, were comparable in T cells, peripheral blood mononuclear cells (PBMCs) and saliva cells. These data provide first evidence in humans supporting the conclusion that PNMS results in a lasting, broad, and functionally organized DNA methylation signature in several tissues in offspring. By using a natural disaster model, we can infer that the epigenetic effects found in Project Ice Storm are due to objective levels of hardship experienced by the pregnant woman rather than to her level of sustained distress.

  11. DNA Methylation Signatures Triggered by Prenatal Maternal Stress Exposure to a Natural Disaster: Project Ice Storm

    PubMed Central

    Cao-Lei, Lei; Massart, Renaud; Suderman, Matthew J.; Machnes, Ziv; Elgbeili, Guillaume; Laplante, David P.; Szyf, Moshe; King, Suzanne

    2014-01-01

    Background Prenatal maternal stress (PNMS) predicts a wide variety of behavioral and physical outcomes in the offspring. Although epigenetic processes may be responsible for PNMS effects, human research is hampered by the lack of experimental methods that parallel controlled animal studies. Disasters, however, provide natural experiments that can provide models of prenatal stress. Methods Five months after the 1998 Quebec ice storm we recruited women who had been pregnant during the disaster and assessed their degrees of objective hardship and subjective distress. Thirteen years later, we investigated DNA methylation profiling in T cells obtained from 36 of the children, and compared selected results with those from saliva samples obtained from the same children at age 8. Results Prenatal maternal objective hardship was correlated with DNA methylation levels in 1675 CGs affiliated with 957 genes predominantly related to immune function; maternal subjective distress was uncorrelated. DNA methylation changes in SCG5 and LTA, both highly correlated with maternal objective stress, were comparable in T cells, peripheral blood mononuclear cells (PBMCs) and saliva cells. Conclusions These data provide first evidence in humans supporting the conclusion that PNMS results in a lasting, broad, and functionally organized DNA methylation signature in several tissues in offspring. By using a natural disaster model, we can infer that the epigenetic effects found in Project Ice Storm are due to objective levels of hardship experienced by the pregnant woman rather than to her level of sustained distress. PMID:25238154

  12. 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.

  13. 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

  14. Use of targeted medication reviews to deliver preconception care: A demonstration project.

    PubMed

    DiPietro Mager, Natalie A; Bright, David R; Markus, Dani; Weis, Lindsey; Hartzell, David M; Gartner, James

    To demonstrate the ability of a statewide network of community pharmacists to provide preconception care services with the use of targeted medication reviews (TMRs). Community pharmacists are well qualified and well positioned to assist in this public health priority; however, there are no documented case studies of pharmacists providing preconception care with the use of TMRs. Through the demonstration project, pharmacists provided educational TMRs focused on 3 elements of preconception care to women aged 15 to 45 years enrolled in a nonprofit managed care plan: (1) medications that may cause fetal harm (category D/X); (2) folic acid use; and (3) immunizations. TMRs were generated and released to the individual pharmacy where that patient had prescriptions filled. Any practicing pharmacist in Ohio participating in the medication therapy management platform with a patient in the sample received a TMR notification. The pharmacists documented and billed for the service through this commercially available platform. Nineteen weeks after implementation of the TMRs, 1149 individual pharmacists from 818 different pharmacies had completed at least 1 TMR. Pharmacists completed 33% of all TMR opportunities with a 65% success rate. Establishing new services that were focused on preconception care resulted in rapid integration into existing medication therapy management processes in hundreds of pharmacies across Ohio. These results may help to provide justification for additional payers to reimburse for similar services. Through demonstrating the impact on preconception care, the role of the community pharmacist may continue to expand to include provision of additional preventive care services following the model developed in this initiative. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  15. Issues in measuring maternal morbidity: lessons from the Philippines Safe Motherhood Survey Project.

    PubMed

    Stewart, M K; Stanton, C K; Festin, M; Jacobson, N

    1996-01-01

    This report explores the limitations of survey research for obtaining population-based data to define the magnitude of maternal morbidity in settings that lack a well-developed infrastructure to support women's health requirements. The experience gained in the Philippines Safe Motherhood Survey Project is described. The drawbacks and benefits of the preliminary validation and qualitative phase of research conducted to develop the questionnaire are presented. The survey results indicate that interview-based diagnosis, although it implies the commitment of considerable resources, may be the only way to obtain an idea of the prevalence of some kinds of maternal morbidity in a given population, information necessary to the improvement of obstetric care and women's overall health status.

  16. Childhood IQ, hearing loss, and maternal thyroid autoimmunity in the Baltimore Collaborative Perinatal Project.

    PubMed

    Wasserman, Ellen E; Pillion, Joseph P; Duggan, Anne; Nelson, Kenrad; Rohde, Charles; Seaberg, Eric C; Talor, Monica V; Yolken, Robert H; Rose, Noel R

    2012-11-01

    Maternal thyroid autoantibodies during pregnancy have been implicated in neurodevelopmental delays, including early childhood cognitive deficits. We evaluated whether maternal autoantibodies to thyroid peroxidase (TPOaAbs) during late pregnancy were associated with childhood intelligence quotient (IQ) scores in their offspring and how the children's TPOaAb-associated sensorineural hearing loss (HL) might affect the result. We evaluated banked third-trimester sera corresponding to 1,733 children for whom childhood cognitive test scores and audiology data were available. The mothers and their children participated in the National Institutes of Health (NIH)-sponsored Collaborative Perinatal Project (CPP) that ran from 1959 to 1974. A modest, statistically significant, effect of TPOaAbs on cognitive performance observed at 4 y of age lessened in both magnitude and P value by the age of 7 y. Children with sensorineural HL (SNHL) had lower IQ scores at both ages. Our data suggest that the reported effect of maternal TPOaAbs on IQ may involve early developmental delays or transient effects rather than permanent deficits. Reports associating TPOaAbs directly with IQ may reflect a portion with unexamined TPOaAb-associated SNHL. Whether the TPOaAb-associated SNHL is in the neurodevelopmental pathway of later cognitive delays or is independently associated with IQ requires investigation in other studies.

  17. Maternal risk factors for abnormal placental growth: The national collaborative perinatal project

    PubMed Central

    Baptiste-Roberts, Kesha; Salafia, Carolyn M; Nicholson, Wanda K; Duggan, Anne; Wang, Nae-Yuh; Brancati, Frederick L

    2008-01-01

    Background Previous studies of maternal risk factors for abnormal placental growth have focused on placental weight and placental ratio as measures of placental growth. We sought to identify maternal risk factors for placental weight and two neglected dimensions of placental growth: placental thickness and chorionic plate area. Methods We conducted an analysis of 24,135 mother-placenta pairs enrolled in the National Collaborative Perinatal Project, a prospective cohort study of pregnancy and child health. We defined growth restriction as < 10th percentile and hypertrophy as > 90th percentile for three placental growth dimensions: placental weight, placental thickness and chorionic plate area. We constructed parallel multinomial logistic regression analyses to identify (a) predictors of restricted growth (vs. normal) and (b) predictors of hypertrophic growth (vs. normal). Results Black race was associated with an increased likelihood of growth restriction for placental weight, thickness and chorionic plate area, but was associated with a reduced likelihood of hypertrophy for these three placental growth dimensions. We observed an increased likelihood of growth restriction for placental weight and chorionic plate area among mothers with hypertensive disease at 24 weeks or beyond. Anemia was associated with a reduced likelihood of growth restriction for placental weight and chorionic plate area. Pre-pregnancy BMI and pregnancy weight gain were associated with a reduced likelihood of growth restriction and an increased likelihood of hypertrophy for all three dimensions of placental growth. Conclusion Maternal risk factors are either associated with placental growth restriction or placental hypertrophy not both. Our findings suggest that the placenta may have compensatory responses to certain maternal risk factors suggesting different underlying biological mechanisms. PMID:18811957

  18. 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

  19. Marathon maternity oral history project: Exploring rural birthing through narrative methods.

    PubMed

    Orkin, Aaron; Newbery, Sarah

    2014-01-01

    To explore how birthing and maternity care are understood and valued in a rural community. Oral history research. The rural community of Marathon, Ont, with a population of approximately 3500. A purposive selection of mothers, grandmothers, nurses, physicians, and community leaders in the Marathon medical catchment area. 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. 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. 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 maternity services in rural Canada.

  20. Integrating community outreach into a quality improvement project to promote maternal and child health in Ghana

    PubMed Central

    Barrington, Clare; Akaligaung, Akalpa; Reid, Amy; Fried, Bruce; Singh, Kavita; Sodzi-Tettey, Sodzi; Barker, Pierre M.

    2015-01-01

    Quality improvement (QI) is used to promote and strengthen maternal and child health services in middle and low-income countries. Very little research has examined community-level factors beyond the confines of health facilities that create demand for health services and influence health outcomes. We examined the role of community outreach in the context of Project Fives Alive!, a QI project aimed at improving maternal and under-5 outcomes in Ghana. Qualitative case studies of QI teams across 6 regions of Ghana were conducted. We analyzed the data using narrative and thematic techniques. QI team members used two distinct outreach approaches: community-level outreach, including health promotion and education efforts through group activities and mass media communication; and direct outreach, including one-on-one interpersonal activities between health workers and pregnant women and/or mothers of children under-5. Specific barriers to community outreach included structural, cultural, and QI team-level factors. QI efforts in both rural and urban settings should consider including context-specific community outreach activities to develop ties with communities and address barriers to health services. Sustaining community outreach as part of QI efforts will require improving infrastructure, strengthening QI teams, and ongoing collaboration with community members. PMID:25204848

  1. Integrating community outreach into a quality improvement project to promote maternal and child health in Ghana.

    PubMed

    Cofie, Leslie E; Barrington, Clare; Akaligaung, Akalpa; Reid, Amy; Fried, Bruce; Singh, Kavita; Sodzi-Tettey, Sodzi; Barker, Pierre M

    2014-01-01

    Quality improvement (QI) is used to promote and strengthen maternal and child health services in middle- and low-income countries. Very little research has examined community-level factors beyond the confines of health facilities that create demand for health services and influence health outcomes. We examined the role of community outreach in the context of Project Fives Alive!, a QI project aimed at improving maternal and under-5 outcomes in Ghana. Qualitative case studies of QI teams across six regions of Ghana were conducted. We analysed the data using narrative and thematic techniques. QI team members used two distinct outreach approaches: community-level outreach, including health promotion and education efforts through group activities and mass media communication; and direct outreach, including one-on-one interpersonal activities between health workers, pregnant women and mothers of children under-5. Specific barriers to community outreach included structural, cultural, and QI team-level factors. QI efforts in both rural and urban settings should consider including context-specific community outreach activities to develop ties with communities and address barriers to health services. Sustaining community outreach as part of QI efforts will require improving infrastructure, strengthening QI teams, and ongoing collaboration with community members.

  2. Data-as-a-Service Platform for Delivering Healthy Lifestyle and Preventive Medicine: Concept and Structure of the DAPHNE Project.

    PubMed

    Gibbons, Catherine; Bailador Del Pozo, Gonzalo; Andrés, Javier; Lobstein, Tim; Manco, Melania; Lewy, Hadas; Bergman, Einat; O'Callaghan, David; Doherty, Gavin; Kudrautseva, Olga; Palomares, Angel; Ram, Roni; Olmo, Alberto

    2016-12-09

    Overweight and obesity is related to many health problems and diseases. The current obesity epidemic, which is a major health problem, is closely related to a lack of physical activity, high levels of sedentary behavior, and increased energy intake; with evidence to show increasing incidence of these issues in the younger population. Tackling obesity and its comorbid conditions requires a holistic approach encompassing attention on physical activity, healthy diet, and behavioral activation in order to enable and maintain meaningful and long-term weight loss and weight maintenance. The objective of the Data-as-a-Service Platform for Healthy Lifestyle and Preventive Medicine (DAPHNE) project is to develop a breakthrough information communications technology (ICT) platform for tracking health, weight, physical activity, diet, lifestyle, and psychological components within health care systems, whereby the platform and clinical support is linked. The DAPHNE platform aims to deliver personalized guidance services for lifestyle management to the citizen/patient by means of (1) advanced sensors and mobile phone apps to acquire and store continuous/real-time data on lifestyle aspects, behavior, and surrounding environment; (2) individual models to monitor their health and fitness status; (3) intelligent data processing for the recognition of behavioral trends; and (4) specific services for personalized guidance on healthy lifestyle and disease prevention. It is well known that weight loss and maintenance of weight loss are particularly difficult. This tool will address some of the issues found with conventional treatment/advice in that it will collect data in real time, thereby reducing reliability issues known with recalling events once they have passed and will also allow adjustment of behavior through timely support and recommendations sent through the platform without the necessity of formal one-to-one visits between patient and clinician. Patient motivation

  3. Data-as-a-Service Platform for Delivering Healthy Lifestyle and Preventive Medicine: Concept and Structure of the DAPHNE Project

    PubMed Central

    Bailador del Pozo, Gonzalo; Andrés, Javier; Lobstein, Tim; Manco, Melania; Lewy, Hadas; Bergman, Einat; O'Callaghan, David; Doherty, Gavin; Kudrautseva, Olga; Palomares, Angel; Ram, Roni; Olmo, Alberto

    2016-01-01

    Background Overweight and obesity is related to many health problems and diseases. The current obesity epidemic, which is a major health problem, is closely related to a lack of physical activity, high levels of sedentary behavior, and increased energy intake; with evidence to show increasing incidence of these issues in the younger population. Tackling obesity and its comorbid conditions requires a holistic approach encompassing attention on physical activity, healthy diet, and behavioral activation in order to enable and maintain meaningful and long-term weight loss and weight maintenance. Objective The objective of the Data-as-a-Service Platform for Healthy Lifestyle and Preventive Medicine (DAPHNE) project is to develop a breakthrough information communications technology (ICT) platform for tracking health, weight, physical activity, diet, lifestyle, and psychological components within health care systems, whereby the platform and clinical support is linked. Methods The DAPHNE platform aims to deliver personalized guidance services for lifestyle management to the citizen/patient by means of (1) advanced sensors and mobile phone apps to acquire and store continuous/real-time data on lifestyle aspects, behavior, and surrounding environment; (2) individual models to monitor their health and fitness status; (3) intelligent data processing for the recognition of behavioral trends; and (4) specific services for personalized guidance on healthy lifestyle and disease prevention. It is well known that weight loss and maintenance of weight loss are particularly difficult. This tool will address some of the issues found with conventional treatment/advice in that it will collect data in real time, thereby reducing reliability issues known with recalling events once they have passed and will also allow adjustment of behavior through timely support and recommendations sent through the platform without the necessity of formal one-to-one visits between patient and clinician

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

    PubMed

    Namazzi, Gertrude; N, Kiwanuka Suzanne; Peter, Waiswa; John, Bua; Olico, Okui; A, Allen Katharine; A, Hyder Adnan; Elizabeth, Ekirapa Kiracho

    2013-03-04

    services. 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.

  5. 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

  6. Novel isolation strategy to deliver pure fetal-origin and maternal-origin mesenchymal stem cell (MSC) populations from human term placenta.

    PubMed

    Patel, J; Shafiee, A; Wang, W; Fisk, N M; Khosrotehrani, K

    2014-11-01

    The placenta is an abundant source of mesenchymal stem/stromal cells (MSC). Although presumed of translationally-advantageous fetal origin, the literature instead suggests a high incidence of either contaminating or pure maternal MSC. Despite definitional criteria that MSC are CD34-, increasing evidence suggests that fetal MSC may be CD34 positive in vivo. We flow sorted term placental digests based on CD34+ expression and exploited differential culture media to isolate separately pure fetal and maternal MSC populations. This method has considerable translational implications, in particular to clinical trials underway with "placental" MSC of uncertain or decidual origin. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. 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…

  8. 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…

  9. Associations of maternal prenatal smoking with umbilical cord blood hormones: the Project Viva cohort.

    PubMed

    Fleisch, Abby F; Rifas-Shiman, Sheryl L; Rokoff, Lisa B; Hivert, Marie-France; Mantzoros, Christos S; Oken, Emily

    2017-07-01

    Maternal smoking during pregnancy is associated with low fetal growth and adverse cardiometabolic health in offspring. However, hormonal pathways underlying these associations are unclear. Therefore, we examined maternal smoking habits and umbilical cord blood hormone profiles in a large, prospective cohort. We studied 978 mother/infant pairs in Project Viva, a Boston-area cohort recruited 1999-2002. We categorized mothers as early pregnancy smokers, former smokers, or never smokers. Outcomes were cord blood concentrations of IGF-1, IGF-2, IGFBP-3, leptin, adiponectin, insulin, and C-peptide. We used linear regression models adjusted for maternal pre-pregnancy body mass index (BMI), race/ethnicity, parity, education, and infant sex. We conducted analyses in the full cohort and stratified by infant sex. Thirteen percent of women were early pregnancy smokers, 20% former smokers, and 68% never smokers. Infants of early pregnancy smokers had lower IGF-1 adjusted for IGFBP-3 [-5.2ng/mL (95% CI: -8.6, -1.7)], with more pronounced associations in girls [-10.7ng/mL (95% CI: -18.5, -2.9) vs. -4.0ng/mL (95% CI: -8.4, 0.4) for boys]. Early pregnancy smoking was not associated with cord blood hormones other than IGF-1. Infants of former smokers had a cord blood hormone profile similar to infants of never smokers. As compared to mothers who never smoked, early pregnancy smokers had infants with lower cord blood IGF-1 which could prime adverse metabolic outcomes. This provides further reason to support smoking cessation programs in women of reproductive age. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Can a quality improvement project impact maternal and child health outcomes at scale in northern Ghana?

    PubMed

    Singh, Kavita; Brodish, Paul; Speizer, Ilene; Barker, Pierre; Amenga-Etego, Issac; Dasoberi, Ireneous; Kanyoke, Ernest; Boadu, Eric A; Yabang, Elma; Sodzi-Tettey, Sodzi

    2016-06-16

    Quality improvement (QI) interventions are becoming more common in low- and middle-income countries, yet few studies have presented impact evaluations of these approaches. In this paper, we present an impact evaluation of a scale-up phase of 'Project Fives Alive!', a QI intervention in Ghana that aims to improve maternal and child health outcomes. 'Project Fives Alive!' employed a QI methodology to recognize barriers to care-seeking and care provision at the facility level and then to identify, test and implement simple and low-cost local solutions that address the barriers. A quasi-experimental design, multivariable interrupted time series analysis, with data coming from 744 health facilities and controlling for potential confounding factors, was used to study the effect of the project. The key independent variables were the change categories (interventions implemented) and implementation phase - Wave 2a (early phase) versus Wave 2b (later phase). The outcomes studied were early antenatal care (ANC), skilled delivery, facility-level under-five mortality and attendance of underweight infants at child welfare clinics. We stratified the analysis by facility type, namely health posts, health centres and hospitals. Several of the specific change categories were significantly associated with improved outcomes. For example, three of five change categories (early ANC, four or more ANC visits and skilled delivery/immediate postnatal care (PNC)) for health posts and two of five change categories (health education and triage) for hospitals were associated with increased skilled delivery. These change categories were associated with increases in skilled delivery varying from 28% to 58%. PNC changes for health posts and health centres were associated with greater attendance of underweight infants at child welfare clinics. The triage change category was associated with increased early antenatal care in hospitals. Intensity, the number of change categories tested, was associated

  11. Reduction in maternal and child mortality in sub-Saharan Africa: the yo-yo effect in delivering on the promises.

    PubMed

    Mwalali, Philip; Ngui, Emmanuel

    2009-01-01

    Trends in maternal and child mortality (MCM) in sub-Saharan Africa do not follow the patterns seen in developed nations or match the funds and effort invested so far. This paper critically explores trends in MCM, global efforts to reduce MCM, and some of the underlying policies and programmatic issues that have shaped the slow progress or failure in reducing MCM in sub-Saharan Africa. We describe a "yo-yo" effect in policies and funding of Maternal and Child Health, Family Planning, and HIV/AIDS/STI programs in the region, and how this yo-yo effect may limit sustained community level reductions in MCM. We conclude by highlighting how renewed interest in the Alma-Ata declaration, particularly its primary health care concepts with their strong emphasis on horizontally integrated linkage of programs and resources, greater community involvement in program design and implementation, and economic development can contribute to sustainable reductions in MCM in the region.

  12. 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.

  13. 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.

  14. Impact of Increasing Capacity for Generating and Using Research on Maternal and Perinatal Health Practices in South East Asia (SEA-ORCHID Project)

    PubMed Central

    2011-01-01

    Background Maternal and neonatal mortality and morbidity remain unacceptably high in many low and middle income countries. SEA-ORCHID was a five year international collaborative project in South East Asia which aimed to determine whether health care and health outcomes for mothers and babies could be improved by developing capacity for research generation, synthesis and use. Methods Nine hospitals in Indonesia, Malaysia, the Philippines and Thailand participated in SEA-ORCHID. These hospitals were supported by researchers from three Australian centres. Health care practices and outcomes were assessed for 1000 women at each hospital both before and after the intervention. The capacity development intervention was tailored to the needs and context of each hospital and delivered over an 18 month period. Main outcomes included adherence to forms of care likely to be beneficial and avoidance of forms of care likely to be ineffective or harmful. Results We observed substantial variation in clinical practice change between sites. The capacity development intervention had a positive impact on some care practices across all countries, including increased family support during labour and decreased perineal shaving before birth, but in some areas there was no significant change in practice and a few beneficial practices were followed less often. Conclusion The results of SEA-ORCHID demonstrate that investing in developing capacity for research use, synthesis and generation can lead to improvements in maternal and neonatal health practice and highlight the difficulty of implementing evidence-based practice change. PMID:21915274

  15. Impact of increasing capacity for generating and using research on maternal and perinatal health practices in South East Asia (SEA-ORCHID Project).

    PubMed

    Lumbiganon, P; McDonald, S J; Laopaiboon, M; Turner, T; Green, S; Crowther, C A

    2011-01-01

    Maternal and neonatal mortality and morbidity remain unacceptably high in many low and middle income countries. SEA-ORCHID was a five year international collaborative project in South East Asia which aimed to determine whether health care and health outcomes for mothers and babies could be improved by developing capacity for research generation, synthesis and use. Nine hospitals in Indonesia, Malaysia, the Philippines and Thailand participated in SEA-ORCHID. These hospitals were supported by researchers from three Australian centres. Health care practices and outcomes were assessed for 1000 women at each hospital both before and after the intervention. The capacity development intervention was tailored to the needs and context of each hospital and delivered over an 18 month period. Main outcomes included adherence to forms of care likely to be beneficial and avoidance of forms of care likely to be ineffective or harmful. We observed substantial variation in clinical practice change between sites. The capacity development intervention had a positive impact on some care practices across all countries, including increased family support during labour and decreased perineal shaving before birth, but in some areas there was no significant change in practice and a few beneficial practices were followed less often. The results of SEA-ORCHID demonstrate that investing in developing capacity for research use, synthesis and generation can lead to improvements in maternal and neonatal health practice and highlight the difficulty of implementing evidence-based practice change.

  16. 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

  17. 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

  18. [Applicability of lives saved tool in projecting effects of scaling up interventions on reducing maternal mortality rates in the rural area of Guangxi province in China].

    PubMed

    Luo, Da-sheng; Chen, Li-li; Wei, Ping; Jiang, Zhen; Guo, Yan

    2013-06-18

    To evaluate applicability of lives saved tool (LiST) in projecting effects of maternal health interventions on reducing maternal mortality in the rural area of Guangxi Zhuang Autonomous Region in China, and provide evidence for promoting LiST in China. By using maternal intervention coverage and other information collected through the cross-sectional household survey, literature review and expert consultation, LiST projection was performed and modeled. The maternal mortality reduction and causes of death were measured and compared, and the differences were analyzed. SPSS 19.0 was used in the household survey data analysis. Coverage of calcium supplementation, MgSO4-management of pre-eclampsia and institutional delivery reached 51.9%, 99.0% and 98.4% respectively in rural Guangxi in 2011. The LiST captured the general trend of maternal mortality in rural Guangxi. The modeled maternal mortality rate was 4.71%, lower than the measured in 2009 and 10.43% higher in 2010. Maternal mortality rate would decreased to 18/100 000 in 2015 assuming all relevant interventions reached full coverage, and 90% of the maternal morality reduction was attributed to the labor and delivery management. LiST can be applied to project effects of maternal health interventions on reducing the maternal mortality in rural Guangxi, but its accuracy was limited by the fact that the effect of relevant interventions on some major causes of maternal death, such as amniotic embolism, was not calculated in LiST and maternal deaths caused by those causes varied by the year in the area. Based on the LiST projection, labor and delivery management was found to be the priority intervention in improving maternal health in rural Guangxi. Improving the quality of obstetric care in township hospitals and facilitating referral of high-risk pregnant women were highly recommended.

  19. 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...

  20. 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...

  1. Placental weight and efficiency in relation to maternal body mass index and the risk of pregnancy complications in women delivering singleton babies.

    PubMed

    Wallace, J M; Horgan, G W; Bhattacharya, S

    2012-08-01

    Herein we report placental weight and efficiency in relation to maternal BMI and the risk of pregnancy complications in 55,105 pregnancies. Adjusted placental weight increased with increasing BMI through underweight, normal, overweight, obese and morbidly obese categories and accordingly underweight women were more likely to experience placental growth restriction [OR 1.69 (95% CI 1.46-1.95)], while placental hypertrophy was more common in overweight, obese and morbidly obese groups [OR 1.59 (95% CI 1.50-1.69), OR 1.97 (95% CI 1.81-2.15) and OR 2.34 (95% CI 2.08-2.63), respectively]. In contrast the ratio of fetal to placental weight (a proxy for placental efficiency) was lower (P < 0.001) in overweight, obese and morbidly obese than in both normal and underweight women which were equivalent. Relative to the middle tertile reference group (mean 622 g), placental weight in the lower tertile (mean 484 g) was associated with a higher risk of pre-eclampsia, induced labour, spontaneous preterm delivery, stillbirth and low birth weight (P < 0.001). Conversely placental weight in the upper tertile (mean 788 g) was associated with a higher risk of caesarean section, post-term delivery and high birth weight (P < 0.001). With respect to assumed placental efficiency a ratio in the lower tertile was associated with an increased risk of pre-eclampsia, induced labour, caesarean section and spontaneous preterm delivery (P < 0.001) and a ratio in both the lower and higher tertiles was associated with an increased risk of low birth weight (P < 0.001). Placental efficiency was not related to the risk of stillbirth or high birth weight. No interactions between maternal BMI and placental weight tertile were detected suggesting that both abnormal BMI and placental growth are independent risk factors for a range of pregnancy complications. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. The effects of maternal stress and illness during pregnancy on infant temperament: Project Ice Storm.

    PubMed

    Laplante, David P; Brunet, Alain; King, Suzanne

    2016-01-01

    To determine whether disaster-related prenatal maternal stress and maternal illness during pregnancy predict maternal-rated temperament status in 6-mo-old infants. The temperamental status of 121 infants (60 boys and 61 girls) exposed in utero to varying degrees of maternal stress and/or illness during either first (n = 40), second (n = 43), or third (n = 38) trimester of pregnancy was assessed using the Infant Characteristics Questionnaire. Higher levels of maternal subjective distress and illness were primarily independently associated with poorer temperamental status in the infants. Maternal subjective distress explained 3.4, 3.1, and 9.8% and early pregnancy illness explained 4.3, 5.8, and 2.9% of the variance of the infants' fussy/difficult, dullness, and needs attention temperament dimensions, respectively. This is the first study to assess whether temperament status is influenced by disaster-related prenatal maternal stress. Moreover, this is the first study to assess whether maternal stress and illness during pregnancy interact to determine infant temperament status. The findings suggest that while both factors predict temperament status at 6 mo, they do so primarily in an independent manner. These results suggest that pathways through which maternal stress and illness during pregnancy influence temperament status differ.

  3. A Nurse Leadership Project to Improve Health Literacy on a Maternal-Infant Unit.

    PubMed

    Stikes, Reetta; Arterberry, Katheryn; Logsdon, M Cynthia

    2015-01-01

    To describe how participation in the Sigma Theta Tau International Maternal-Child Health Nurse Leadership Academy positioned the authors to lead an interdisciplinary team through implementation and evaluation of a change project related to patient education based upon national health literacy standards. The project goal was to improve patient satisfaction with nurse communication and preparation for hospital discharge. Quality improvement. Mother/-baby unit of an academic medical center serving a high percentage of patients of a minority population and underserved clients. The five- step intervention included (a) review of current health literacy standards, (b) formation of an infrastructure for development and evaluation of existing patient education materials, (c) assessment of patient education materials currently in use, (d) assessment of literacy level and learning styles of new mothers, and (e) provision of continuing education to increase knowledge of nurses as patient teachers and of health literacy. Mean scores of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in the domains of patient satisfaction with nurse communication and discharge information were used to measure patient satisfaction with health communication. Patient satisfaction with nurse communication increased from 75.9% to 84.6%. Satisfaction with discharge information increased from 84.6% to 98.6%. The leadership academy successfully positioned the authors to guide an interdisciplinary team through development of a process to meet the education and communication needs of patients and improve their health literacy. As a result, a positive effect was noted on patient satisfaction with health communication. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  4. Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa.

    PubMed

    Honikman, Simone; van Heyningen, Thandi; Field, Sally; Baron, Emily; Tomlinson, Mark

    2012-01-01

    As one article in a series on Global Mental Health Practice, Simone Honikman and colleagues from South Africa provide a case study of the Perinatal Mental Health Project, which delivered mental health care to pregnant women in a collaborative, step-wise manner, making use of existing resources in primary care.

  5. 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

  6. Using programme theory to assess the feasibility of delivering micronutrient Sprinkles through a food-assisted maternal and child health and nutrition programme in rural Haiti.

    PubMed

    Loechl, Cornelia U; Menon, Purnima; Arimond, Mary; Ruel, Marie T; Pelto, Gretel; Habicht, Jean-Pierre; Michaud, Lesly

    2009-01-01

    This paper uses programme theory to assess, in the context of an effectiveness evaluation, the feasibility and acceptability of distributing micronutrient Sprinkles through a food-assisted maternal and child health and nutrition programme in rural Haiti. We laid out the steps related to programme delivery and household utilization of Sprinkles and used qualitative and quantitative methods to gather data on these steps. Methods included structured observations, checks of beneficiary ration cards, exit interviews, focus group discussions (FGD), individual interviews and survey data from the effectiveness evaluation. Results are as follows: (1) information on use of Sprinkles was provided before mothers first received them, as planned; (2) Sprinkles were re-packaged and distributed as planned and in the appropriate amount; (3) almost all mothers (96%) received two monthly rations of Sprinkles and received timely information on their use; (4) mothers understood instructions about use of Sprinkles and acceptance was high, and no selling of the product was reported or observed; and (5) mothers reported using Sprinkles as instructed, every day (63% in survey; 86% at exit interviews), and for the child only (99%). FGD with staff highlighted the acceptance of the intervention, with a reported 'modest' increase in workload. Within this well-established programme, it proved feasible to distribute Sprinkles and to ensure appropriate use by beneficiary mothers. Existing programme venues were suitable for distributing Sprinkles and educating mothers about their use. Use of programme theory helped to assess feasibility and acceptability of the Sprinkles intervention and provided useful information for programme replication or scale-up.

  7. Presenting Triple-Wins? Assessing Projects That Deliver Adaptation, Mitigation and Development Co-benefits in Rural Sub-Saharan Africa.

    PubMed

    Suckall, Natalie; Stringer, Lindsay C; Tompkins, Emma L

    2015-02-01

    The concept of climate compatible development (CCD) is increasingly employed by donors and policy makers seeking 'triple-wins' for development, adaptation and mitigation. While CCD rhetoric is becoming more widespread, analyses drawing on empirical cases that present triple-wins are sorely lacking. We address this knowledge gap. Drawing on examples in rural sub-Saharan Africa, we provide the first glimpse into how projects that demonstrate triple-win potential are framed and presented within the scientific literature. We identify that development projects are still commonly evaluated in terms of adaptation or mitigation benefits. Few are framed according to their benefits across all three dimensions. Consequently, where triple-wins are occurring, they are likely to be under-reported. This has important implications, which underestimates the co-benefits that projects can deliver. A more robust academic evidence base for the delivery of triple-wins is necessary to encourage continued donor investment in activities offering the potential to deliver CCD.

  8. 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

  9. 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...

  10. 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...

  11. 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.

  12. 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

    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

    2016-02-12

    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. 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. 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. 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 requires an infrastructure that supports it

  13. Caries prevention with xylitol lozenges in children related to maternal anxiety. A demonstration project.

    PubMed

    Olak, J; Saag, M; Vahlberg, T; Söderling, E; Karjalainen, S

    2012-04-01

    This was to compare the effect of a prevention program between children of anxious and non-anxious mothers. Mothers (n=120) with high and low dental anxiety scores (DAS>15 and DAS <8, respectively), and with high levels of mutans streptococci (>10(5)cfu/mL) were recruited at a maternity clinic of Tartu, Estonia. Two groups: 30 highly anxious, and 30 non-anxious mothers used xylitol (6 g/day) for 33 months and a non-treatment group of 60 mothers, both highly and low anxious (30 in each sub-group), acted as controls. All mothers were interviewed for oral health habits and education, and their dental health was examined. Due to discontinued participation 75% of the children (n=90) were examined at 2 and at 3 years of age. Anxious mothers brushed less frequently (p=0.014), had a longer time since their last dental visit (p<0.0001), and a lower level of education (p<0.0001) than their non-anxious counterparts. However, maternal anxiety had no effect on children's dental health, contrary to the caries prevention program which was effective both at 2 and at 3 years of age (p<0.01; OR 6.6, 1.8-25.0 and OR 3.9, CI 1.5-10.0, respectively). Children benefited from the caries prevention program, irrespective of maternal anxiety.

  14. Serotonin transporter gene (SLC6A4) polymorphism and susceptibility to a home-visiting maternal-infant attachment intervention delivered by community health workers in South Africa: Reanalysis of a randomized controlled trial.

    PubMed

    Morgan, Barak; Kumsta, Robert; Fearon, Pasco; Moser, Dirk; Skeen, Sarah; Cooper, Peter; Murray, Lynne; Moran, Greg; Tomlinson, Mark

    2017-02-01

    Clear recognition of the damaging effects of poverty on early childhood development has fueled an interest in interventions aimed at mitigating these harmful consequences. Psychosocial interventions aimed at alleviating the negative impacts of poverty on children are frequently shown to be of benefit, but effect sizes are typically small to moderate. However, averaging outcomes over an entire sample, as is typically done, could underestimate efficacy because weaker effects on less susceptible individuals would dilute estimation of effects on those more disposed to respond. This study investigates whether a genetic polymorphism of the serotonin transporter gene moderates susceptibility to a psychosocial intervention. We reanalyzed data from a randomized controlled trial of a home-visiting program delivered by community health workers in a black, isiXhosa-speaking population in Khayelitsha, South Africa. The intervention, designed to enhance maternal-infant attachment, began in the third trimester and continued until 6 mo postpartum. Implemented between April 1999 and February 2003, the intervention comprised 16 home visits delivered to 220 mother-infant dyads by specially trained community health workers. A control group of 229 mother-infant dyads did not receive the intervention. Security of maternal-infant attachment was the main outcome measured at infant age 18 mo. Compared to controls, infants in the intervention group were significantly more likely to be securely attached to their primary caregiver (odds ratio [OR] = 1.7, p = 0.029, 95% CI [1.06, 2.76], d = 0.29). After the trial, 162 intervention and 172 control group children were reenrolled in a follow-up study at 13 y of age (December 2012-June 2014). At this time, DNA collected from 279 children (134 intervention and 145 control) was genotyped for a common serotonin transporter polymorphism. There were both genetic data and attachment security data for 220 children (110 intervention and 110 control), of

  15. Serotonin transporter gene (SLC6A4) polymorphism and susceptibility to a home-visiting maternal-infant attachment intervention delivered by community health workers in South Africa: Reanalysis of a randomized controlled trial

    PubMed Central

    Moser, Dirk; Skeen, Sarah; Cooper, Peter; Murray, Lynne; Moran, Greg

    2017-01-01

    Background Clear recognition of the damaging effects of poverty on early childhood development has fueled an interest in interventions aimed at mitigating these harmful consequences. Psychosocial interventions aimed at alleviating the negative impacts of poverty on children are frequently shown to be of benefit, but effect sizes are typically small to moderate. However, averaging outcomes over an entire sample, as is typically done, could underestimate efficacy because weaker effects on less susceptible individuals would dilute estimation of effects on those more disposed to respond. This study investigates whether a genetic polymorphism of the serotonin transporter gene moderates susceptibility to a psychosocial intervention. Methods and findings We reanalyzed data from a randomized controlled trial of a home-visiting program delivered by community health workers in a black, isiXhosa-speaking population in Khayelitsha, South Africa. The intervention, designed to enhance maternal-infant attachment, began in the third trimester and continued until 6 mo postpartum. Implemented between April 1999 and February 2003, the intervention comprised 16 home visits delivered to 220 mother–infant dyads by specially trained community health workers. A control group of 229 mother–infant dyads did not receive the intervention. Security of maternal-infant attachment was the main outcome measured at infant age 18 mo. Compared to controls, infants in the intervention group were significantly more likely to be securely attached to their primary caregiver (odds ratio [OR] = 1.7, p = 0.029, 95% CI [1.06, 2.76], d = 0.29). After the trial, 162 intervention and 172 control group children were reenrolled in a follow-up study at 13 y of age (December 2012–June 2014). At this time, DNA collected from 279 children (134 intervention and 145 control) was genotyped for a common serotonin transporter polymorphism. There were both genetic data and attachment security data for 220 children

  16. Evaluation of a maternal health care project in South West Shoa Zone, Ethiopia: before-and-after comparison.

    PubMed

    Wilunda, Calistus; Tanaka, Shiro; Putoto, Giovanni; Tsegaye, Ademe; Kawakami, Koji

    2016-08-20

    Despite recent achievements in health targets, Ethiopia still faces challenges in health service delivery. Between 2012 and 2015, a non-governmental organisation (NGO), Doctors with Africa CUAMM, implemented a multifaceted project aimed at improving access to maternal and child health services in three districts in Ethiopia. This paper evaluates the performance of this project, based on four maternal health indicators. A before-and-after study utilising data collected through cross-sectional surveys involving 999 women was conducted. The date of delivery was used to stratify the intervention period as follows: pre-intervention, early intervention, and late intervention. Changes during the intervention in the coverage of four antenatal care (ANC) visits, receipt of three basic components of ANC, skilled birth attendant (SBA) at delivery, and postnatal care (PNC) in seven days were assessed using logistic regression, adjusting for socio-demographic factors. There was an increase in the coverage of receipt of all three ANC components and SBA at delivery between the pre-intervention period and the late intervention period. The percent of health centre deliveries increased from 7.3 % in the pre-intervention period to 35.6 % in the late intervention period. The odds of receiving all three components of ANC were twice higher in the late intervention period than in the pre-intervention period (OR 2.09; 95 % CI 1.12-3.89). The odds of SBA at delivery were five times higher in the late intervention period than in the pre-intervention period (OR 5.04; 95 % CI 2.53-10.06). There was no significant change in the coverage of four ANC visits and PNC after accounting for sociodemographic factors. This NGO implemented maternal health project in three districts in Ethiopia was associated with increased likelihood that a pregnant woman would receive three basic components of ANC and be assisted by a SBA at delivery. Increase in skilled birth attendance was driven by increased

  17. Prenatal maternal stress affects motor function in 5½-year-old children: project ice storm.

    PubMed

    Cao, Xiujing; Laplante, David P; Brunet, Alain; Ciampi, Antonio; King, Suzanne

    2014-01-01

    Evidence suggests that prenatal maternal stress (PNMS) has long-term effects on several outcomes, yet effects on neuromotor function are relatively unknown. We aimed to determine whether disaster-related PNMS predicts motor functioning in young children and whether timing of exposure and sex of the child moderate these effects. Objective and subjective PNMS levels were assessed among pregnant women exposed to a natural disaster. Their children's bilateral coordination, balance, and visual motor integration (VMI) were assessed at 5½ years. Girls performed better than boys. Objective stress exposure and subjective distress interacted such that when subjective distress was high, no added effect of objective hardship was observed; when subjective distress was low, objective hardship showed a negative effect. In girls, late pregnancy exposure was associated with poorer outcomes. In conclusion, disaster-related PNMS is associated with relatively lower motor functions in exposed offspring. Exposure timing, sex, and type of stress influenced the effects. © 2012 Wiley Periodicals, Inc.

  18. 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

  19. Disaster-related prenatal maternal stress influences birth outcomes: project Ice Storm.

    PubMed

    Dancause, Kelsey N; Laplante, David P; Oremus, Carolina; Fraser, Sarah; Brunet, Alain; King, Suzanne

    2011-12-01

    Previous research suggests that prenatal maternal stress (PNMS) impacts birth outcomes, but many human studies cannot distinguish between the effects of different types of stressors or examine effects of exposure timing on outcomes. Our goal was to determine how timing and severity of exposure during pregnancy to objective and subjective stress due to a natural disaster influenced gestation length and fetal growth patterns. We assessed objective and subjective PNMS levels among 172 women exposed to an ice storm during or shortly before pregnancy. We analyzed associations between PNMS levels and outcomes (gestation length, birth weight, birth length, head circumference, and growth ratios), controlling for other variables such as age, obstetric complications, socioeconomic status, and trait anxiety. Gestation lengths and predicted birth weights were shorter among participants exposed to the ice storm during early to mid pregnancy, compared to 3rd trimester and pre-pregnancy exposure. Birth lengths were shorter in the sample compared to population references, and predicted values were shorter among participants with a "discrepancy" between their objective and subjective PNMS levels. High objective PNMS levels predicted smaller head circumferences in early pregnancy, but we also observed patterns in predicted values of head circumference to birth length ratios suggesting the sparing of brain development relative to birth length among boys in early pregnancy. These sparing effects decreased in later pregnancy. Exposure to stressful events during pregnancy influences birth outcomes independently of other factors. Exposure timing, newborn sex, and the type of stressor influence the effects observed. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. 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. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Maternal and Newborn Outcomes Following Waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort.

    PubMed

    Bovbjerg, Marit L; Cheyney, Melissa; Everson, Courtney

    2016-01-01

    Data on the safety of waterbirth in the United States are lacking. We used data from the Midwives Alliance of North America Statistics Project, birth years 2004 to 2009. We compared outcomes of neonates born underwater waterbirth (n = 6534), neonates not born underwater nonwaterbirth (n = 10,290), and neonates whose mothers intended a waterbirth but did not have one intended waterbirth (n = 1573). Neonatal outcomes included a 5-minute Apgar score of less than 7, neonatal hospital transfer, and hospitalization or neonatal intensive care unit (NICU) admission in the first 6 weeks. Maternal outcomes included genital tract trauma, postpartum hospital transfer, and hospitalization or infection (uterine, endometrial, perineal) in the first 6 weeks. We used logistic regression for all analyses, controlling for primiparity. Waterbirth neonates experienced fewer negative outcomes than nonwaterbirth neonates: the adjusted odds ratio (aOR) for hospital transfer was 0.46 (95% confidence interval [CI], 0.32-0.68; P < .001); the aOR for infant hospitalization in the first 6 weeks was 0.75 (95% CI, 0.63-0.88; P < .001); and the aOR for NICU admission was 0.59 (95% CI, 0.46-0.76; P < .001). By comparison, neonates in the intended waterbirth group experienced more negative outcomes than the nonwaterbirth group, although only 5-minute Apgar score was significant (aOR, 2.02; 95% CI, 1.40-2.93; P < 0001). For women, waterbirth (compared to nonwaterbirth) was associated with fewer postpartum transfers (aOR, 0.65; 95% CI, 0.50-0.84; P = .001) and hospitalizations in the first 6 weeks (aOR, 0.72; 95% CI, 0.59-0.87; P < 0.001) but with an increased odds of genital tract trauma (aOR, 1.11; 95% CI, 1.04-1.18; P = .002). Waterbirth was not associated with maternal infection. Women in the intended waterbirth group had increased odds for all maternal outcomes compared to women in the nonwaterbirth group, although only genital tract trauma was significant (aOR, 1.67; 95% CI, 1.49-1.87; P < .001

  2. The Transforming Maternity Care Project: Goals, Methods, and Outcomes of a National Maternity Care Policy Initiative, With Construction of a Theoretical Model to Explain the Process

    DTIC Science & Technology

    2011-03-21

    UNIFORMED SERVICES UNIVERSITY, SCHOOL OF MEDICINE GRADUATE PROGRAMS Graduate Education Office (A 1045), 4301 Jones Bridge Road, Bethesda, MD 20814...the quality of maternity care for all mothers and babies, through research, education , policy and advocacy. 13 Despite these landmark...reform, professional liability reform, health information technology, healthcare workforce issues and health professions education , there was agreement

  3. 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.

  4. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group.

    PubMed

    Alkema, Leontine; Chou, Doris; Hogan, Daniel; Zhang, Sanqian; Moller, Ann-Beth; Gemmill, Alison; Fat, Doris Ma; Boerma, Ties; Temmerman, Marleen; Mathers, Colin; Say, Lale

    2016-01-30

    Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030. We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources. We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%. Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country

  5. Brazil's PROFORMAÇÃO Project: A Case Study of an Integrated Virtual System for Delivering In-Service Teacher Education

    ERIC Educational Resources Information Center

    Moore, Michael G.

    2016-01-01

    A systems methodology was employed to design and deliver a highly successful demonstration of the effectiveness of distance education as a means of providing high quality training to tens of thousands of teachers in the most remote areas of Brazil. Key elements in the success of the program were significant funding, top political buy-in, and…

  6. Brazil's PROFORMAÇÃO Project: A Case Study of an Integrated Virtual System for Delivering In-Service Teacher Education

    ERIC Educational Resources Information Center

    Moore, Michael G.

    2016-01-01

    A systems methodology was employed to design and deliver a highly successful demonstration of the effectiveness of distance education as a means of providing high quality training to tens of thousands of teachers in the most remote areas of Brazil. Key elements in the success of the program were significant funding, top political buy-in, and…

  7. National, regional, and global levels and trends in maternal mortality between 1990 and 2015 with scenario-based projections to 2030: a systematic analysis by the United Nations Maternal Mortality Estimation Inter-Agency Group

    PubMed Central

    Alkema, Leontine; Chou, Doris; Hogan, Daniel; Zhang, Sanqian; Moller, Ann-Beth; Gemmill, Alison; Fat, Doris Ma; Boerma, Ties; Temmerman, Marleen; Mathers, Colin; Say, Lale; Ahmed, Saifuddin; Ali, Mohamed; Amouzou, Agbessi; Braunholtz, David; Byass, Peter; Carvajal-Velez, Liliana; Gaigbe-Togbe, Victor; Gerland, Patrick; Loaiza, Edilberto; Mills, Samuel; Mutombo, Namuunda; Newby, Holly; Pullum, Thomas W.; Suzuki, Emi

    2017-01-01

    Summary Background Millennium Development Goal (MDG) 5 calls for a reduction of 75% in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed scenario-based projections to highlight the accelerations needed to accomplish the Sustainable Development Goal (SDG) global target of less than 70 maternal deaths per 100,000 live births globally by 2030. Methods We updated the open access UN Maternal Mortality Estimation Inter-agency Group (MMEIG) database. Based upon nationally-representative data for 171 countries, we generated estimates of maternal mortality and related indicators with uncertainty intervals using a Bayesian model, which extends and refines the previous UN MMEIG estimation approach. The model combines the rate of change implied by a multilevel regression model with a time series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources. Results The global MMR declined from 385 deaths per 100,000 live births (80% uncertainty interval ranges from 359 to 427) in 1990 to 216 (207 to 249) in 2015, corresponding to a relative decline of 43.9% (34.0 to 48.7) during the 25-year period, with 303,000 (291,000 to 349,000) maternal deaths globally in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1.8% (0 to 3.1) in the Caribbean to 5.0% (4.0 to 6.0) for Eastern Asia. Regional MMRs for 2015 range from 12 (11 to 14) for developed regions to 546 (511 to 652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7.5%. Interpretation Despite global progress in reducing maternal mortality, immediate action is required to begin making progress towards the

  8. 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

  9. "I was on the way to the hospital but delivered in the bush": Maternal health in Ghana's Upper West Region in the context of a traditional birth attendants' ban.

    PubMed

    Rishworth, Andrea; Dixon, Jenna; Luginaah, Isaac; Mkandawire, Paul; Tampah Prince, Caesar

    2016-01-01

    This study examines perceptions and experiences of mothers, traditional birth attendants (TBA), and skilled birth attendants (SBA) regarding Ghana's recent policy that forbids TBAs from undertaking deliveries and restricts their role to referrals. In the larger context of Ghana's highly underdeveloped and geographically uneven health care system, this study draws on the political ecology of health framework to explore the ways global safe motherhood policy discourses intersect with local socio-cultural and political environments of Ghana's Upper West Region (UWR). This study reveals that futile improvements in maternal health and the continued reliance on TBAs illustrate the government's inability to understand local realities marked by poor access to SBAs or modern health care services. Using focus group discussions (FGDs) (n = 10) and in-depth interviews (IDIs) (n = 48) conducted in Ghana's UWR, the findings suggest that mothers generally perceive TBAs as better placed to conduct deliveries in rural isolated communities, where in most cases no SBAs are present or easily accessible. The results indicate that by adhering to the World Health Organization's guidelines, the local government may be imposing detrimental, unintended consequences on maternal and child health in remote rural locations. In addition, the findings suggest that the new policy has resulted in considerable confusion among TBAs, many of whom remain oblivious or have not been officially notified about the new policy. Furthermore, participant accounts suggest that the new policy is seen as contributing to worsening relations and tensions between TBAs and SBAs, a situation that undermines the delivery of maternal health services in the region. The study concludes by suggesting relevant policy recommendations. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. AN OVERVIEW OF COMPILING, CRITICALLY EVALUATING, AND DELIVERING RELIABLE PHYSICAL PROPERTY DATA FROM AICHE/DIPPR PROJECTS 911 AND 912. (R825370C064)

    EPA Science Inventory

    The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

  11. Effect of maternal and grandmaternal care on population dynamics and human life-history evolution: a matrix projection model.

    PubMed

    Pavard, Samuel; Branger, Frédéric

    2012-12-01

    We present a matrix population model for a single-sex human population comprising non-orphan daughters (whose mothers are alive) and orphan daughters (whose mothers are dead). Orphans suffer higher mortality than non-orphans, which simulates the need for daughters to receive maternal care in order to survive. The way that maternal care affects population dynamics and life-history evolution is then analysed for demographic regimes that encompass large ranges of daughter survival, mother survival and fertility. We provide stable age-distributions of orphans and non-orphans for each regime and perform sensitivity analyses on daughter survival, adult survival and fertility. The results show that natural selection will favour (i) faster daughter independence from maternal care, (ii) higher adult survival at all ages, and (iii) early reproduction to the detriment of late reproduction. We then build scenarios concerning the coevolution of daughter survival and maternal care with adult survival and fertility. We also incorporate grandmaternal care into the model. We show that (i) the acute altriciality of human babies, (ii) the increased maternal care resulting from emergence of complex sociality and (iii) the role played by grandmothers in caring for granddaughters may have led to the emergence of specific human life-history traits: a short reproductive period characterised by a reproductive senescence and menopause, as well as an extended lifespan characterised by a post-reproductive life. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long-term mortality impact.

    PubMed

    Perry, Henry B; Rassekh, Bahie M; Gupta, Sundeep; Freeman, Paul A

    2017-06-01

    There is limited evidence about the long-term effectiveness of integrated community-based primary health care (CBPHC) in improving maternal, neonatal and child health. However, the interventions implemented and the approaches used by projects with such evidence can provide guidance for ending preventable child and maternal deaths by the year 2030. A database of 700 assessments of the effectiveness of CBPHC in improving maternal, neonatal and child health has been assembled, as described elsewhere in this series. A search was undertaken of these assessments of research studies, field project and programs (hereafter referred to as projects) with more than a single intervention that had evidence of mortality impact for a period of at least 10 years. Four projects qualified for this analysis: the Matlab Maternal Child Health and Family Planning (MCH-FP) P in Bangladesh; the Hôpital Albert Schweitzer in Deschapelles, Haiti; the Comprehensive Rural Health Project (CRHP) in Jamkhed, India; and the Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, India. These four projects have all been operating for more than 30 years, and they all have demonstrated reductions in infant mortality, 1- to 4-year mortality, or under-5 mortality for at least 10 years. They share a number of characteristics. Among the most notable of these are: they provide comprehensive maternal, child health and family planning services, they have strong community-based programs that utilize community health workers who maintain regular contact with all households, they have develop strong collaborations with the communities they serve, and they all have strong referral capabilities and provide first-level hospital care. The shared features of these projects provide guidance for how health systems around the world might improve their effectiveness in improving maternal, neonatal and child health. Strengthening these features will contribute to achieving the goal of

  13. Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long–term mortality impact

    PubMed Central

    Perry, Henry B; Rassekh, Bahie M; Gupta, Sundeep; Freeman, Paul A

    2017-01-01

    Background There is limited evidence about the long–term effectiveness of integrated community–based primary health care (CBPHC) in improving maternal, neonatal and child health. However, the interventions implemented and the approaches used by projects with such evidence can provide guidance for ending preventable child and maternal deaths by the year 2030. Methods A database of 700 assessments of the effectiveness of CBPHC in improving maternal, neonatal and child health has been assembled, as described elsewhere in this series. A search was undertaken of these assessments of research studies, field project and programs (hereafter referred to as projects) with more than a single intervention that had evidence of mortality impact for a period of at least 10 years. Four projects qualified for this analysis: the Matlab Maternal Child Health and Family Planning (MCH–FP) P in Bangladesh; the Hôpital Albert Schweitzer in Deschapelles, Haiti; the Comprehensive Rural Health Project (CRHP) in Jamkhed, India; and the Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, India. Results These four projects have all been operating for more than 30 years, and they all have demonstrated reductions in infant mortality, 1– to 4–year mortality, or under–5 mortality for at least 10 years. They share a number of characteristics. Among the most notable of these are: they provide comprehensive maternal, child health and family planning services, they have strong community–based programs that utilize community health workers who maintain regular contact with all households, they have develop strong collaborations with the communities they serve, and they all have strong referral capabilities and provide first–level hospital care. Conclusions The shared features of these projects provide guidance for how health systems around the world might improve their effectiveness in improving maternal, neonatal and child health. Strengthening these

  14. [The Millennium project of the United Nations, focusing on adequate postpartum care to reduce maternal and neonatal mortality world-wide].

    PubMed

    Lagro, M G P; Stekelenburg, J

    2006-05-20

    One of the goals of the Millennium project of the United Nations is to reduce maternal and infant mortality. This includes adequate care for mothers and newborns during childbirth. Most maternal deaths occur during the post-partum period. Postpartum haemorrhage, eclampsia and sepsis are the main causes of maternal death. Preventive measures include active management of the third stage of labour, use of magnesium sulphate in pre-eclampsia, and implementing hygienic birth practices and the use of antibiotics, respectively. Major causes of neonatal mortality are pre- and dysmaturity, infections, congenital abnormalities and birth trauma, including asphyxia. The kangaroo-method can reduce morbidity in premature infants. The use of hygienic practices and antibiotics decreases the number of newborn deaths due to infection. Antiretroviral therapy is effective in preventing mother-to-child transmission of HIV. In many resource poor countries formula feeding is not feasible and the WHO advises exclusive breastfeeding for HIV positive women in these settings. A formula of 6 hours, 6 days, 6 weeks and 6 months after birth is recommended by the WHO to check the condition of mother and baby. This should be integrated in mother and child health clinics and also includes child vaccinations and counselling the mother on family planning and prevention of sexually transmitted diseases.

  15. Role of Evidence in Maternal Health Policy Processes in Vietnam, India and China: Findings from the HEPVIC Project

    ERIC Educational Resources Information Center

    Mirzoev, Tolib; Green, Andrew; Gerein, Nancy; Pearson, Stephen; Bird, Philippa; Ha, Bui Thi Thu; Ramani, Karaikurichi; Qian, Xu; Yang, Xiaoguang; Mukhopadhyay, Maitrayee; Soors, Werner

    2013-01-01

    This paper explores the role of evidence in maternal health policy processes in Vietnam, India and China. Both formal and informal types of evidence were used; and differences were found between the stages of policy processes. Evidence used mostly covered easily quantifiable issues and clearly identifiable technical solutions. Different policy…

  16. A Standardized and Data Quality Assessed Maternal-Child Care Integrated Data Repository for Research and Monitoring of Best Practices: A Pilot Project in Spain.

    PubMed

    Sáez, Carlos; Moner, David; García-De-León-Chocano, Ricardo; Muñoz-Soler, Verónica; García-De-León-González, Ricardo; Maldonado, José Alberto; Boscá, Diego; Tortajada, Salvador; Robles, Montserrat; García-Gómez, Juan M; Alcaraz, Manuel; Serrano, Pablo; Bernal, José L; Rodríguez, Jesús; Bustos, Gerardo; Esparza, Miguel

    2017-01-01

    We present the results of a pilot project of the Spanish Ministry of Health, Social Services and Equality, envisaged to the development of a national integrated data repository of maternal-child care information. Based on health information standards and data quality assessment procedures, the developed repository is aimed to a reliable data reuse for (1) population research and (2) the monitoring of healthcare best practices. Data standardization was provided by means of two main ISO 13606 archetypes (composed of 43 sub-archetypes), the first dedicated to the delivery and birth information and the second about the infant feeding information from delivery up to two years. Data quality was assessed by means of a dedicated procedure on seven dimensions including completeness, consistency, uniqueness, multi-source variability, temporal variability, correctness and predictive value. A set of 127 best practice indicators was defined according to international recommendations and mapped to the archetypes, allowing their calculus using XQuery programs. As a result, a standardized and data quality assessed integrated data respository was generated, including 7857 records from two Spanish hospitals: Hospital Virgen del Castillo, Yecla, and Hospital 12 de Octubre, Madrid. This pilot project establishes the basis for a reliable maternal-child care data reuse and standardized monitoring of best practices based on the developed information and data quality standards.

  17. 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.

  18. 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

  19. Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects

    PubMed Central

    Perry, Henry B; Sacks, Emma; Schleiff, Meike; Kumapley, Richard; Gupta, Sundeep; Rassekh, Bahie M; Freeman, Paul A

    2017-01-01

    Background As part of our review of the evidence of the effectiveness of community–based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH), we summarize here the common delivery strategies of projects, programs and field research studies (collectively referred to as projects) that have demonstrated effectiveness in improving child mortality. Other articles in this series address specifically the effects of CBPHC on improving MNCH, while this paper explores the specific strategies used. Methods We screened 12 166 published reports in PubMed of community–based approaches to improving maternal, neonatal and child health in high–mortality, resource–constrained settings from 1950–2015. A total of 700 assessments, including 148 reports from other publicly available sources (mostly unpublished evaluation reports and books) met the criteria for inclusion and were reviewed using a data extraction form. Here we identify and categorize key strategies used in project implementation. Results Six categories of strategies for program implementation were identified, all of which required working in partnership with communities and health systems: (a) program design and evaluation, (b) community collaboration, (c) education for community–level staff, volunteers, beneficiaries and community members, (d) health systems strengthening, (e) use of community–level workers, and (f) intervention delivery. Four specific strategies for intervention delivery were identified: (a) recognition, referral, and (when possible) treatment of serious childhood illness by mothers and/or trained community agents, (b) routine systematic visitation of all homes, (c) facilitator–led participatory women’s groups, and (d) health service provision at outreach sites by mobile health teams. Conclusions The strategies identified here provide useful starting points for program design in strengthening the effectiveness of CBPHC for improving MNCH. PMID:28685044

  20. Impact evaluation of a quality improvement intervention on maternal and child health outcomes in Northern Ghana: early assessment of a national scale-up project.

    PubMed

    Singh, Kavita; Speizer, Ilene; Handa, Sudhanshu; Boadu, Richard O; Atinbire, Solomon; Barker, Pierre M; Twum-Danso, Nana A Y

    2013-10-01

    To evaluate the influence of the early phase of Project Fives Alive!, a national child survival improvement project, on key maternal and child health outcomes. The evaluation used multivariable interrupted time series analyses to determine whether change categories tested were associated with improvements in the outcomes of interest. The evaluation used program and outcome data from interventions focused on health-care staff in 27 facilities. Northern Ghana. The project uses a quality improvement (QI) approach whereby process failures are identified by health staff and process changes are tested in the health facilities and corresponding communities to address those failures. The maternal health outcomes were early antenatal care attendance and skilled delivery, and the child health outcomes were underweight infants attending child wellness clinics, facility-level neonatal mortality and facility-level infant mortality. Postnatal care changes for the first 1-2 days of life (β= 0.10, P = 0.07) and the first 6-7 days of life (β = 0.10, P = 0.07) were associated with a higher rate of visits by underweight infants to child wellness clinics. There was an association between the early pregnancy identification change category with increased skilled delivery (β = 1.36 P = 0.07). In addition, a greater number of change categories tested was associated with increased skilled delivery (β = 0.05, P = 0.01). The QI approach of testing and implementing simple and low cost locally inspired changes has the potential to lead to improved health outcomes at scale both in Ghana and other low- and middle-income countries.

  1. 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

    2015-12-10

    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.

  2. [Maternity blues].

    PubMed

    Gonidakis, F

    2007-04-01

    Maternity blues is a transient change of mood that occurs mainly between the 1st and 10th day of puerpartum and is characterized by bursts of tears, mild depressive mood, anxiety and liability of mood. The frequency of maternity blues varies in different studies form 4% to 80%. A number of biological and psychosocial parameters have been studied in order to determine their correlation with maternity blues. The most well studied biological parameters are progesterone and cortizol although their relation with maternity blues has not yet been clearly defined. Stress and the emotional state of the woman during pregnancy as well as history of mood disorders or maternity blues in a previous birth are the psychosocial parameters that are more likely to correlate with the occurrence of maternity blues. Most of the authors suggest that information on maternity blues and reassurance of the woman are the best way to deal with maternity blues both on preventive and therapeutical basis.

  3. Can solar power deliver?

    PubMed

    Nelson, Jenny; Emmott, Christopher J M

    2013-08-13

    Solar power represents a vast resource which could, in principle, meet the world's needs for clean power generation. Recent growth in the use of photovoltaic (PV) technology has demonstrated the potential of solar power to deliver on a large scale. Whilst the dominant PV technology is based on crystalline silicon, a wide variety of alternative PV materials and device concepts have been explored in an attempt to decrease the cost of the photovoltaic electricity. This article explores the potential for such emerging technologies to deliver cost reductions, scalability of manufacture, rapid carbon mitigation and new science in order to accelerate the uptake of solar power technologies.

  4. 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.

  5. 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…

  6. 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

  7. 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

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

    2014-01-01

    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. 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. 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. Guinea will need to scale up its recruitment efforts in order to improve health workforce availability. Targeted labor market interventions need to be planned and executed over several decades

  8. 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.

  9. Project Ice Storm: prenatal maternal stress affects cognitive and linguistic functioning in 5 1/2-year-old children.

    PubMed

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

    2008-09-01

    This was a prospective study designed to determine the extent to which the degree of exposure to prenatal maternal stress due to a natural disaster explains variance in the intellectual and language performance of offspring at age 5(1/2) while controlling for several potential confounding variables. Subjects were eighty-nine 5(1/2)-year-old children whose mothers were pregnant during a natural disaster: the January 1998 ice storm crisis in the Canadian province of Québec that resulted in power losses for 3 million people for as long as 40 days. In June 1998, women completed several questionnaires including those about the extent of objective stress (Storm 32) and subjective distress (Impact of Events Scale-Revised) experienced due to the storm. Their children were assessed with the Wechsler Preschool and Primary Scale of Intelligence-Revised (IQ) and Peabody Picture Vocabulary Test-Revised (language) at 5(1/2) years of age, and mothers completed assessments of recent life events and psychological functioning. Children exposed in utero to high levels of objective stress had lower Full Scale IQs, Verbal IQs, and language abilities compared to children exposed to low or moderate levels of objective prenatal maternal stress; there were no effects of subjective stress or objective stress on Performance IQs. Trend analyses show that for all outcome variables except Block Design, there was a significant curvilinear association between objective stress and functioning. Prenatal exposure to a moderately severe natural disaster is associated with lower cognitive and language abilities at 5(1/2) years of age.

  10. [Maternal phenylketonuria].

    PubMed

    Bókay, János; Kiss, Erika; Simon, Erika; Szőnyi, László

    2013-05-05

    Elevated maternal phenylalanine levels during pregnancy are teratogenic, and may result in embryo-foetopathy, which could lead to stillbirth, significant psychomotor handicaps and birth defects. This foetal damage is known as maternal phenylketonuria. Women of childbearing age with all forms of phenylketonuria, including mild variants such as hyperphenylalaninaemia, should receive detailed counselling regarding their risks for adverse foetal effects, optimally before contemplating pregnancy. The most assured way to prevent maternal phenylketonuria is to maintain the maternal phenylalanine levels within the optimal range already before conception and throughout the whole pregnancy. Authors review the comprehensive programme for prevention of maternal phenylketonuria at the Metabolic Center of Budapest, they survey the practical approach of the continuous maternal metabolic control and delineate the outcome of pregnancies of mothers with phenylketonuria from the introduction of newborn screening until most recently.

  11. Construction Management: Promises Delivered

    ERIC Educational Resources Information Center

    Building Design and Construction, 1974

    1974-01-01

    Outlines several existing case histories of projects undertaken by a management firm in which they have brought jobs in right on or under budget. With no architectural or contracting heritage to defend, the "computer boys" slip into owners' shoes and construction management becomes whatever the projects demand. (Author)

  12. Construction Management: Promises Delivered

    ERIC Educational Resources Information Center

    Building Design and Construction, 1974

    1974-01-01

    Outlines several existing case histories of projects undertaken by a management firm in which they have brought jobs in right on or under budget. With no architectural or contracting heritage to defend, the "computer boys" slip into owners' shoes and construction management becomes whatever the projects demand. (Author)

  13. 'Opening up the mind': problem-solving therapy delivered by female lay health workers to improve access to evidence-based care for depression and other common mental disorders through the Friendship Bench Project in Zimbabwe.

    PubMed

    Abas, Melanie; Bowers, Tarryn; Manda, Ethel; Cooper, Sara; Machando, Debra; Verhey, Ruth; Lamech, Neha; Araya, Ricardo; Chibanda, Dixon

    2016-01-01

    There are few accounts of evidence-based interventions for depression and other common mental disorders (CMDs) in primary care in low-income countries. The Friendship Bench Project is a collaborative care mental health intervention in primary care in Harare for CMDs which began as a pilot in 2006. We employed a mixture of quantitative and qualitative approaches to investigate the project's acceptability and implementation, 4-8 years after the initial pilot study. We carried out basic descriptive analyses of routine data on attendance collected between 2010 and 2014. We also conducted five focus group discussions (FGDs) with LHWs in 2013 and 12 in-depth interviews, six with staff and six with patients, to explore experiences of the intervention, which we analysed using grounded theory. Results show that the intervention appears highly acceptable as evidenced by a consistent number of visits between 2010 and 2014 (mean 505 per year, SD 132); by the finding that the same team of female community LHWs employed as government health promoters continue to deliver assessment and problem-solving therapy, and the perceived positive benefits expressed by those interviewed. Clients described feeling 'relieved and relaxed' after therapy, and having their 'mind opened', and LHWs describing satisfaction from being agents of change. Characteristics of the LHWs (status in the community, maturity, trustworthiness), and of the intervention (use of locally validated symptom screen, perceived relevance of problem-solving therapy) and continuity of the LHW team appeared crucial. Challenges to implementation included the LHWs ongoing need for weekly supervision despite years of experience; the supervisors need for supervision for herself; training needs in managing suicidal and hostile clients; poor documentation; lack of follow-up of depressed clients; and poor access to antidepressants. This case study shows that a collaborative care intervention for CMDs is positively received by

  14. Cable Television: A Method for Delivering Information.

    ERIC Educational Resources Information Center

    Nebraska Univ., Lincoln. Cooperative Extension Service.

    This report presents the recommendations of a committee that was formed to explore the possibility of using cable television networks as a method of delivering extension education programs to urban audiences. After developing and testing a pilot project that used cable television as a mode to disseminate horticulture and 4-H leader training…

  15. Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health

    PubMed Central

    Bergström, Anna; Hoa, Dinh Thi Phuong; Nga, Nguyen Thu; Eldh, Ann Catrine

    2017-01-01

    Background In a previous trial in Vietnam, a facilitation strategy to secure evidence-based practice in primary care resulted in reduced neonatal mortality over a period of three years. While little is known as to what ensures sustainability in the implementation of community-based strategies, the aim of this study was to investigate factors promoting or hindering implementation, and sustainability of knowledge implementation strategies, by means of the former Neonatal Knowledge Into Practice (NeoKIP) trial. Methods In 2014 we targeted all levels in the Vietnamese healthcare system: six individual interviews with representatives at national, provincial and district levels, and six focus group discussions with representatives at the commune level. The interviews were transcribed verbatim, translated to English, and analysed using inductive and deductive thematic analysis. Results To achieve successful implementation and sustained effect of community-based knowledge implementation strategies, engagement of leaders and key stakeholders at all levels of the healthcare system is vital–prior to, during and after a project. Implementation and sustainability require thorough needs assessment, tailoring of the intervention, and consideration of how to attain and manage funds. The NeoKIP trial was characterised by a high degree of engagement at the primary healthcare system level. Further, three years post trial, maternal and neonatal care was still high on the agenda for healthcare workers and leaders, even though primary aspects such as stakeholder engagement at all levels, and funding had been incomplete or lacking. Conclusions The current study illustrates factors to support successful implementation and sustain effects of community-based strategies in projects in low- and middle-income settings; some but not all factors were represented during the post-NeoKIP era. Most importantly, trials in this and similar contexts require deliberate management throughout and beyond

  16. Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health.

    PubMed

    Eriksson, Leif; Bergström, Anna; Hoa, Dinh Thi Phuong; Nga, Nguyen Thu; Eldh, Ann Catrine

    2017-01-01

    In a previous trial in Vietnam, a facilitation strategy to secure evidence-based practice in primary care resulted in reduced neonatal mortality over a period of three years. While little is known as to what ensures sustainability in the implementation of community-based strategies, the aim of this study was to investigate factors promoting or hindering implementation, and sustainability of knowledge implementation strategies, by means of the former Neonatal Knowledge Into Practice (NeoKIP) trial. In 2014 we targeted all levels in the Vietnamese healthcare system: six individual interviews with representatives at national, provincial and district levels, and six focus group discussions with representatives at the commune level. The interviews were transcribed verbatim, translated to English, and analysed using inductive and deductive thematic analysis. To achieve successful implementation and sustained effect of community-based knowledge implementation strategies, engagement of leaders and key stakeholders at all levels of the healthcare system is vital-prior to, during and after a project. Implementation and sustainability require thorough needs assessment, tailoring of the intervention, and consideration of how to attain and manage funds. The NeoKIP trial was characterised by a high degree of engagement at the primary healthcare system level. Further, three years post trial, maternal and neonatal care was still high on the agenda for healthcare workers and leaders, even though primary aspects such as stakeholder engagement at all levels, and funding had been incomplete or lacking. The current study illustrates factors to support successful implementation and sustain effects of community-based strategies in projects in low- and middle-income settings; some but not all factors were represented during the post-NeoKIP era. Most importantly, trials in this and similar contexts require deliberate management throughout and beyond the project lifetime, and engagement of

  17. 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

  18. An interprofessional quality improvement project to implement maternal/infant skin-to-skin contact during cesarean delivery.

    PubMed

    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. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  19. Relations Among Maternal Racial Identity, Maternal Parenting Behavior, and Child Outcomes in Low-Income, Urban, Black Families

    ERIC Educational Resources Information Center

    Halgunseth, Linda C.; Ispa, Jean M.; Csizmadia, Annamaria; Thornburg, Kathy R.

    2005-01-01

    This study examined maternal racial identity and its relations to maternal depression, maternal age, maternal parenting behavior, and 5-year-old children's social and cognitive outcomes. Participants included 62 African American mother-child dyads enrolled in the Early Head Start Research and Evaluation Project. Mothers completed measures on their…

  20. 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

  1. A method of teaching critical care skills to undergraduate student midwives using the Maternal-Acute Illness Management (M-AIM) training day.

    PubMed

    McCarthy, Rose; Nuttall, Janet; Smith, Joyce; Hollins Martin, Caroline J

    2014-11-01

    The most recent Confidential Enquiry into Maternal Deaths (CMACE, 2011) identified human errors, specifically those of midwives and obstetricians/doctors as a fundamental component in contributing to maternal death in the U.K. This paper discusses these findings and outlines a project to provide training in Maternal-Acute Illness Management (M-AIM) to final year student midwives. Contents of the program are designed to educate and simulate AIM skills and increase confidence and clinical ability in early recognition, management and referral of the acutely ill woman. An outline of the Maternal-AIM program delivered at the University of Salford (Greater Manchester, UK) is presented to illustrate how this particular institution has responded to a perceived need voiced by local midwifery leaders. It is proposed that developing this area of expertise in the education system will better prepare student midwives for contemporary midwifery practice.

  2. BEMFAM delivers AIDS alert.

    PubMed

    1993-05-01

    The Sociedade Civil Bem-Estar Familiar (BEMFAM) of Brazil developed a project using integrated communication strategies to alert prostitutes and their clients about the risks of contracting HIV. The project specifically promoted condom use and was conducted within the context of BEMFAM's Integrated Family Planning Program. Villa Mimoza, a prostitution zone in the Estacio neighborhood of Rio de Janeiro, was the site of the intervention. This neighborhood harbors 44 houses of prostitution where an estimated 500 female prostitutes receive clients. An agreement was reached with the Association of Prostitutes of the State of Rio de Janeiro whereby it would help mobilize local women, merchants, brothel owners, and clients. Initial needs were assessed by BEMFAM and AIDSCOM through questionnaires and focus groups. It was subsequently resolved that radio programs, counter displays of educational materials in brothels, and posters in brothel rooms would be the most effective channels through which to carry integrated, effective messages to the community. Final evaluation found a change in attitude and an awareness of the importance of measures to prevent AIDS along with a prevalent increase in condom use.

  3. 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. Copyright © 2016. Published by Elsevier Ltd.

  4. [Maternal malnutrition. The nursing task].

    PubMed

    Grotestán Liverpool, G; Grant, W A; Ibáñez Peña, E

    1990-01-01

    A retrospective study of 577 patients from urban and periurban areas of Las Tunas municipality is made. These patients were delivered in "Dr. Ernesto Guevara de la Serna" Hospital between January and April 1986, both inclusive; their characteristics included being single pregnancies and not having suffered maternal diseases that influenced fetal growth. The following variables were studied: state of maternal nutrition at implantation, initial weight and weight gain, newborn weight, as well as maternal age and place of residence; these variables were interrelated with the view to know their influence or lack of influence on fetal weight. A survey of 89 of these women is made; they had been classified as malnourished and the purpose of the survey is to analyze their knowledge and views on malnutrition, as well as the instructions received during pregnancy and after delivery. Conclusions are derived and nursing recommendations are made.

  5. MATCH: a maternal and child health information network.

    PubMed Central

    Platt, L J; Benford, M S

    1988-01-01

    The Maternal and Child Health Information Network--MATCH--was begun in 1984 as a demonstration project with support from the Division of Maternal and Child Health of the Health Resources and Services Administration, Public Health Service. The primary purpose of the project was the development of a system to manage data related to prenatal, child health, family planning, and genetic services that are delivered with State support in clinics in the State of Ohio. The design of MATCH enables the same data base to be used at both the State and local levels. Because it allows all participants, central and district, to manipulate the raw data, it is called an end-user--as opposed to a batch retrieval--system. Data recorded on individual forms during each client's visit to local service clinics are collected and entered into a microcomputer whose software package is a commercial data base. The clinic can then use the data for its purposes: program planning, management, evaluation, client referrals, appointment followup, quality control, and billing. The same data are also uploaded by central office staff to the State's DEC mainframe from data-filled disks mailed in by the clinics. Personnel who staff local projects can access their own data on the mainframe computer to generate reports for local use and send and receive messages electronically. That is, the system is "interactive."(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3128830

  6. [Beneficial effect of maternity leave on delivery].

    PubMed

    Xu, Qian; Séguin, Louise; Goulet, Lise

    2002-01-01

    To identify the contribution of the duration of the prenatal maternity leave on term delivery. Characteristics of the prenatal maternity leave and delivery among 363 working women who had delivered a full-term infant at 1 of 4 hospitals in Montreal during 1996 were studied. The presence of an intervention or complication during delivery was observed in 68.9% of the participants. The average duration of the prenatal maternity leave was about 8 weeks (SD = 7). The adjusted risk of a difficult delivery decreased significantly with the duration of the prenatal maternity leave (OR = 0.96; 95% CI: 0.93-0.99). The duration of the maternity leave before delivery is associated with an easier term delivery for working women.

  7. 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.

  8. Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh.

    PubMed

    Ahmed, Shakil; Khan, M Mahmud

    2011-05-01

    Demand-side financing (DSF) is used in the less-developed countries of the world to improve access to healthcare and to encourage market supply. Under DSF, households receive vouchers that can be used to pay for healthcare services. This study evaluated the effects of a universal DSF on maternal healthcare service utilization in Bangladesh. A household survey was conducted in and around the voucher scheme area one year after the initiation of the project. Women who gave birth within a year prior to the survey were interviewed. The utilization rates of maternal health services were found to be higher for all socioeconomic groups in the project area than in the comparison areas. Voucher recipients in the project area were 3.6 times more likely to be assisted by skilled health personnel during delivery, 2.5 times more likely to deliver the baby in a health facility, 2.8 times more likely to receive postnatal care (PNC), 2.0 times more likely to get antenatal care (ANC) services and 1.5 times more likely to seek treatment for obstetric complications than pregnant women not in the program. The degree of socioeconomic inequality in maternal health service utilization was also lower in the project area than in the comparison area. The use of vouchers evidenced much stronger demand-increasing effects on the poor. Poor voucher recipients were 4.3 times more likely to deliver in a health facility and two times more likely to use skilled health personnel at delivery than the non-poor recipients. Contrary to the inverse equity hypothesis, the voucher scheme reduced inequality even in the short run. Despite these improvements, socioeconomic disparity in the use of maternal health services has remained pro-rich, implying that demand-side financing alone will be insufficient to achieve the Millennium Development Goal for maternal health. A comprehensive system-wide approach, including supply-side strengthening, will be needed to adequately address maternal health concerns in poor

  9. Community-based interventions for improving maternal health and for reducing maternal health inequalities in high-income countries: a systematic map of research.

    PubMed

    Perry, Martha; Becerra, Francisco; Kavanagh, Josephine; Serre, Angéline; Vargas, Emily; Becerril, Victor

    2015-07-01

    This review is part of a European Commission project, MASCOT, aimed at reducing maternal and child health inequalities. The purpose was to identify and describe the literature on community-based interventions on maternal health in high-income countries (HIC) and conceptually map the literature according to country focus, topics addressed, nature of the intervention and the intervention provider, and interventions designed to address inequalities in maternal health. The research protocol for this review was based on a low-income country (LMIC) systematic review protocol within the MASCOT Project. We searched PubMED and CINAHL databases for literature published between January 2000 and April 2013. OECD countries were used to determine the HIC and different terms were used to refer to community based interventions, defined as those "delivered in community settings or any activities occurring outside of health facilities". 119 publications were selected for inclusion in this mapping study. 95 (80%) were Randomised Control Trials (RCTs) and 24 (20%) were systematic reviews (SRs). We categorised the study topics according to the main interventions covered: breastfeeding assistance and promotion, preventing and treating post-natal depression, interventions to support and build capacity around parenting and child care, antenatal interventions preparing women for birth, postnatal planning of future births and control trials around changing maternal behaviours. The home was used as the most common setting to implement these interventions and health professionals accounted for the largest group of intervention providers. This review maps and brings knowledge on the type of studies and topics being addressed in community based interventions around maternal health in HICs. It opens the opportunity for further studies on interventions' effectiveness and knowledge transfer to LMICs settings.

  10. 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.

  11. Use of Maternal Early Warning Trigger tool reduces maternal morbidity.

    PubMed

    Shields, Laurence E; Wiesner, Suzanne; Klein, Catherine; Pelletreau, Barbara; Hedriana, Herman L

    2016-04-01

    Maternal mortality in the United States has increased unabated for the past 20 years. Maternal morbidity is also affecting an increasingly large number of women in the United States. A number of national and state organizations have recommend the use of maternal early warning tools as a method to combat this problem. There are limited data suggesting that the use of these types of clinical assessment tools can reduce maternal morbidity. We sought to determine if maternal morbidity could be reduced with the implementation of a clinical pathway-specific Maternal Early Warning Trigger (MEWT) tool. The tool was developed internally and prospectively implemented as a pilot project in 6 of 29 hospitals within a large hospital system. The primary goal was early assessment and treatment of patients suspected of clinical deterioration. The tool addressed the 4 most common areas of maternal morbidity: sepsis, cardiopulmonary dysfunction, preeclampsia-hypertension, and hemorrhage. To be considered positive, triggers needed to be sustained for >20 minutes and were defined as severe (single abnormal value): maternal heart rate (HR) >130 beats/min (bpm), respiratory rate >30/min, mean arterial pressure <55 mm Hg, oxygen saturation <90%, or nurse concern; or nonsevere (required 2 abnormal values): temperature >38 or <36°C, blood pressure >160/110 or <85/45 mm Hg, HR >110 or <50 bpm, respiratory rate >24 or <10/min, oxygen saturation <93%, fetal HR >160 bpm, altered mental status, or disproportionate pain. Within each group, recommended management or assessment was also provided. Outcome measures were Centers for Disease Control and Prevention (CDC)-defined severe maternal morbidity, composite maternal morbidity, and intensive care unit (ICU) admissions. Two time intervals were used to analyze the effect of the MEWT tool: a 24-month baseline control period and a 13-month MEWT study period. To determine that the findings noted were not simply changes that would have occurred

  12. Improved accessibility of emergency obstetrics and newborn care(EmONC) services for maternal and newborn health: a community based project

    PubMed Central

    2013-01-01

    Background Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur. Method/Design This community based cluster randomized controlled trial will evaluate the impact of an Emergency Obstetric and Newborn Care (EmONC) package in the intervention arm compared to standard of care in control arm. Perinatal and neonatal mortality are primary outcome measure for this trial. The trial will be implemented in 20 clusters (Union councils) of District Rahimyar Khan, Pakistan. The EmONC package consists of provision of maternal and neonatal health pack (clean delivery kit, emollient, chlorhexidine) for safe motherhood and newborn wellbeing and training of community level and facility based health care providers with emphasis on referral of complicated cases to nearest public health facilities and community mobilization. Discussion Even though there is substantial evidence in support of effectiveness of various health interventions for improving maternal, neonatal and child health. Reduction in perinatal and neonatal mortality remains a big challenge in resource constrained and diverse countries like Pakistan and achieving MDG 4 and 5 appears to be a distant reality. A comprehensive package of community based low cost interventions along the continuum of care tailored according to the socio cultural environment coupled with existing health force capacity building may result in improving the maternal and neonatal outcomes. The findings of this proposed community

  13. Interventions Delivered in Clinical Settings are Effective in Reducing Risk of HIV Transmission Among People Living with HIV: Results from the Health Resources and Services Administration (HRSA)’s Special Projects of National Significance Initiative

    PubMed Central

    Shade, Starley B.; Rose, Carol Dawson; Koester, Kimberly; Maiorana, Andre; Malitz, Faye E.; Bie, Jennifer; Kang-Dufour, Mi-Suk; Morin, Stephen F.

    2010-01-01

    To support expanded prevention services for people living with HIV, the US Health Resources and Services Administration (HRSA) sponsored a 5-year initiative to test whether interventions delivered in clinical settings were effective in reducing HIV transmission risk among HIV-infected patients. Across 13 demonstration sites, patients were randomized to one of four conditions. All interventions were associated with reduced unprotected vaginal and/or anal intercourse with persons of HIV-uninfected or unknown status among the 3,556 participating patients. Compared to the standard of care, patients assigned to receive interventions from medical care providers reported a significant decrease in risk after 12 months of participation. Patients receiving prevention services from health educators, social workers or paraprofessional HIV-infected peers reported significant reduction in risk at 6 months, but not at 12 months. While clinics have a choice of effective models for implementing prevention programs for their HIV-infected patients, medical provider-delivered methods are comparatively robust. PMID:20229132

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

    PubMed

    Rahman, Mahfuzar; Jhohura, Fatema Tuz; Mistry, Sabuj Kanti; Chowdhury, Tridib Roy; Ishaque, Tanveen; Shah, Rasheduzzaman; Afsana, Kaosar

    2015-01-01

    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. 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. 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. 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.

  15. 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

  16. [Towards a lower maternity risk].

    PubMed

    Ekra, C W

    1989-10-01

    Pregnant women delivering in Sub-Saharan Africa (SSA) are dying from causes that are related to poverty rather than to ignorance: 1) hemorrhages; 2) infections due to the lack of sanitary conditions; 3) toxemia; 4) anemia resulting from malnutrition, intestinal parasites and malaria; and 5) too many pregnancies that are too closely spaced. Additional institutional problems are the lack of adequate health facilities, especially for maternity; the lack of personnel and services in the rural areas, and when they do exist, underutilization because of the of lack equipment, supplies and drugs, burdening the patient with such purchases. Pregnant women do not get prenatal care because health personnel are badly trained, they do not speak local languages nor know the local customs and their training is inadequate to provide crisis- intervention. The situation in the urban areas is somewhat better, with more than 2/3 of pregnant women getting prenatal care and delivering in maternity hospitals. However, the logistical problems are growing with up to 50 patients delivering per day, coupled with an insufficient number of badly trained health personnel and the unacceptable sanitary conditions in the hospitals. This situation had let to the inability of staff to diagnose and survey patients with pregnancy complications, the lack of professional assistance during deliveries, the lack of adequate health facilities and equipment to treat emergencies and the lack of ambulances to transport critical patients. The solutions require building maternity centers that are decentralized (near to people's homes in the villages) and near to hospitals; training traditional birth attendants in public health practices that are also practical for their own environments; increasing prenatal care in health centers and through home visits and providing post-partum follow-up visits that include family planning.

  17. 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

  18. 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

  19. 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

    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

    2016-02-12

    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. Qualitative interviews with trainees, trainers, district officers and others exploring the application of the training into practice. 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. 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. 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. Published by the BMJ Publishing Group Limited. For permission to

  20. 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

    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.

  1. Disaster-related prenatal maternal stress explains increasing amounts of variance in body composition through childhood and adolescence: Project Ice Storm.

    PubMed

    Liu, Guan Ting; Dancause, Kelsey N; Elgbeili, Guillaume; Laplante, David P; King, Suzanne

    2016-10-01

    The increasing prevalence of childhood obesity worldwide has become a public health issue. While many factors are involved in the development of obesity, stress during pregnancy has been linked to adiposity. However, research involving stressors that are independent of pregnant women's socioeconomic and psychological characteristics is rare. The present study made use of a natural disaster (1998 Quebec ice storm) to determine which aspect of the women's disaster experience (objective hardship, subjective stress, and/or cognitive appraisal) were associated with body mass index levels and/or waist to height ratio across childhood and adolescence. Measure of objective hardship, subjective stress, and cognitive appraisal were obtained following the 1998 Quebec ice storm. We measured height, weight, and waist circumference in children at ages 5½, 8½, 11½, 13½, and 15½. Our results show that higher prenatal maternal stress was associated with higher body mass index levels and central adiposity in children of ages 5½, 8½, 13½, and 15½. The effects of prenatal maternal stress on anthropometric measurements tend to increase as the children grew older. The findings of this study highlight the long-lasting effect of prenatal stress on body composition, and are compatible with the current theory of fetal programming. Hopefully, our increased knowledge of the effects of prenatal stress on the fetus will lead to improved awareness and the creation of early intervention programs, ultimately improving women's and children's health in the future. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. A prospective study of effects of prenatal maternal stress on later eating-disorder manifestations in affected offspring: preliminary indications based on the Project Ice Storm cohort.

    PubMed

    St-Hilaire, Annie; Steiger, Howard; Liu, Aihua; Laplante, David P; Thaler, Lea; Magill, Tara; King, Suzanne

    2015-07-01

    Research associates maternal stress exposures (especially when occurring late in gestation) with heightened risk of subsequent emotional and behavioral problems in affected offspring. However, as yet, no study has examined the association between prenatal maternal stress (PNMS) and affected children's risk of anorexia- or bulimia-type eating disturbances. To study the influences of PNMS on later disordered eating in exposed offspring. We used the Eating Attitudes Test (EAT)-26 to measure eating attitudes and behaviors in 54 thirteen-year olds whose mothers had been exposed, while pregnant with these children, to the 1998 Quebec Ice Storm-a natural disaster regarded as a model of exposure to severe environmental stress. Mothers' stress was measured shortly after exposure to the storm using established indices of objective and subjective stress. Hierarchical multiple linear regression analyses indicated that once variance owing to children's body mass index and sex was accounted for, stress exposures during the third trimester of pregnancy predicted elevated EAT-26 scores in affected children-perhaps even more so when levels of objective stress were high. Third trimester exposure to PNMS, especially when objectively severe, seems to be associated with increased eating-disorder-linked manifestations in affected early adolescents. © 2015 Wiley Periodicals, Inc.

  3. 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

  4. Maternal obesity and Caesarean delivery in sub-Saharan Africa.

    PubMed

    Cresswell, Jenny A; Campbell, Oona M R; De Silva, Mary J; Slaymaker, Emma; Filippi, Veronique

    2016-07-01

    To quantify maternal obesity as a risk factor for Caesarean delivery in sub-Saharan Africa. Multivariable logistic regression analysis using 31 nationally representative cross-sectional data sets from the Demographic and Health Surveys (DHS). Maternal obesity was a risk factor for Caesarean delivery in sub-Saharan Africa; a clear dose-response relationship (where the magnitude of the association increased with increasing BMI) was observable. Compared to women of optimal weight, overweight women (BMI 25-29 kg/m(2) ) were significantly more likely to deliver by Caesarean (OR: 1.54; 95% CI: 1.33, 1.78), as were obese women (30-34.9 kg/m(2) (OR: 2.39; 95%CI: 1.96-2.90); 35-39.9 kg/m(2) (OR: 2.47 95%CI: 1.78-3.43)) and morbidly obese women (BMI ≥40 kg/m(2) OR: 3.85; 95% CI: 2.46-6.00). BMI is projected to rise substantially in sub-Saharan Africa over the next few decades and demand for Caesarean sections already exceeds available capacity. Overweight women should be advised to lose weight prior to pregnancy. Furthermore, culturally appropriate prevention strategies to discourage further population-level rises in BMI need to be designed and implemented. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  5. The impact of training non-physician clinicians in Malawi on maternal and perinatal mortality: a cluster randomised controlled evaluation of the enhancing training and appropriate technologies for mothers and babies in Africa (ETATMBA) project

    PubMed Central

    2012-01-01

    Background Maternal mortality in much of sub-Saharan Africa is very high whereas there has been a steady decline in over the past 60 years in Europe. Perinatal mortality is 12 times higher than maternal mortality accounting for about 7 million neonatal deaths; many of these in sub-Saharan countries. Many of these deaths are preventable. Countries, like Malawi, do not have the resources nor highly trained medical specialists using complex technologies within their healthcare system. Much of the burden falls on healthcare staff other than doctors including non-physician clinicians (NPCs) such as clinical officers, midwives and community health-workers. The aim of this trial is to evaluate a project which is training NPCs as advanced leaders by providing them with skills and knowledge in advanced neonatal and obstetric care. Training that will hopefully be cascaded to their colleagues (other NPCs, midwives, nurses). Methods/design This is a cluster randomised controlled trial with the unit of randomisation being the 14 districts of central and northern Malawi (one large district was divided into two giving an overall total of 15). Eight districts will be randomly allocated the intervention. Within these eight districts 50 NPCs will be selected and will be enrolled on the training programme (the intervention). Primary outcome will be maternal and perinatal (defined as until discharge from health facility) mortality. Data will be harvested from all facilities in both intervention and control districts for the lifetime of the project (3–4 years) and comparisons made. In addition a process evaluation using both quantitative and qualitative (e.g. interviews) will be undertaken to evaluate the intervention implementation. Discussion Education and training of NPCs is a key to improving healthcare for mothers and babies in countries like Malawi. Some of the challenges faced are discussed as are the potential limitations. It is hoped that the findings from this trial will

  6. Two-Way Radio Helps Deliver Primary Health Care.

    ERIC Educational Resources Information Center

    Goldschmidt, Douglas; And Others

    1980-01-01

    The focus of this issue of Development Communication Report is the use of two-way radio to deliver medical services in isolated areas. Three articles provide (1) a discussion of the advantages, functions, and system components and costs of two-way systems--as well as problems--citing several projects in developing countries; (2) a description of a…

  7. School Nurse-Delivered Adolescent Relationship Abuse Prevention

    ERIC Educational Resources Information Center

    Raible, Claire A.; Dick, Rebecca; Gilkerson, Fern; Mattern, Cheryl S.; James, Lisa; Miller, Elizabeth

    2017-01-01

    Background: Project Connect is a national program to build partnerships among public health agencies and domestic violence services to improve the health care sector response to partner and sexual violence. Pennsylvania piloted the first school nurse-delivered adolescent relationship abuse intervention in the certified school nurses' office…

  8. Delivering Science on Day One

    SciTech Connect

    Williams, Timothy J.

    2016-03-01

    While benchmarking software is useful for testing the performance limits and stability of Argonne National Laboratory’s new Theta supercomputer, there is no substitute for running real applications to explore the system’s potential. The Argonne Leadership Computing Facility’s Theta Early Science Program, modeled after its highly successful code migration program for the Mira supercomputer, has one primary aim: to deliver science on day one. Here is a closer look at the type of science problems that will be getting early access to Theta, a next-generation machine being rolled out this year.

  9. Childhood body mass index at 5.5 years mediates the effect of prenatal maternal stress on daughters' age at menarche: Project Ice Storm.

    PubMed

    Duchesne, A; Liu, A; Jones, S L; Laplante, D P; King, S

    2017-04-01

    Early pubertal timing is known to put women at greater risk for adverse physiological and psychological health outcomes. Of the factors that influence girls' pubertal timing, stress experienced during childhood has been found to advance age at menarche (AAM). However, it is not known if stress experienced by mothers during or in the months before conception can be similarly associated with earlier pubertal timing. Prenatal maternal stress (PNMS) is associated with metabolic changes, such as increased childhood adiposity and risk of obesity, that have been associated with earlier menarchal age. Using a prospective longitudinal design, the present study tested whether PNMS induced by a natural disaster is either directly associated with earlier AAM, or whether there is an indirect association mediated through increased girls' body mass index (BMI) during childhood. A total of 31 girls, whose mothers were exposed to the Quebec's January 1998 ice storm during pregnancy were followed from 6 months to 5 1/2 to 5.5 years of age. Mother's stress was measured within 6 months of the storm. BMI was measured at 5.5 years, and AAM was assessed through teen's self-report at 13.5 and 15.5 years of age. Results revealed that greater BMI at 5.5 years mediated the effect of PNMS on decreasing AAM [B=-0.059, 95% confidence intervals (-0.18, -0.0035)]. The present study is the first to demonstrate that maternal experience of stressful conditions during pregnancy reduces AAM in the offspring through its effects on childhood BMI. Future research should consider the impact of AAM on other measures of reproductive ability.

  10. Improving maternal and newborn health: effectiveness of a community health worker program in rural Kenya.

    PubMed

    Adam, Mary B; Dillmann, Maria; Chen, Mei-kuang; Mbugua, Simon; Ndung'u, Joram; Mumbi, Priscilla; Waweru, Eunice; Meissner, Peter

    2014-01-01

    Volunteer community health workers (CHWs) form an important element of many health systems, and in Kenya these volunteers are the foundation for promoting behavior change through health education, earlier case identification, and timely referral to trained health care providers. This study examines the effectiveness of a community health worker project conducted in rural Kenya that sought to promote improved knowledge of maternal newborn health and to increase deliveries under skilled attendance. The study utilized a quasi-experimental nonequivalent design that examined relevant demographic items and knowledge about maternal and newborn health combined with a comprehensive retrospective birth history of women's children using oral interviews of women who were exposed to health messages delivered by CHWs and those who were not exposed. The project trained CHWs in three geographically distinct areas. Mean knowledge scores were higher in those women who reported being exposed to the health messages from CHWs, Eburru 32.3 versus 29.2, Kinale 21.8 vs 20.7, Nyakio 26.6 vs 23.8. The number of women delivering under skilled attendance was higher for those mothers who reported exposure to one or more health messages, compared to those who did not. The percentage of facility deliveries for women exposed to health messages by CHWs versus non-exposed was: Eburru 46% versus 19%; Kinale 94% versus 73%: and Nyakio 80% versus 78%. The delivery of health messages by CHWs increased knowledge of maternal and newborn care among women in the local community and encouraged deliveries under skilled attendance.

  11. Pegasus delivers SLS engine section

    NASA Image and Video Library

    2017-03-03

    NASA engineers install test hardware for the agency's new heavy lift rocket, the Space Launch System, into a newly constructed 50-foot structural test stand at NASA's Marshall Space Flight Center. In the stand, hydraulic cylinders will be electronically controlled to push, pull, twist and bend the test article with millions of pounds of force. Engineers will record and analyze over 3,000 channels of data for each test case to verify the capabilities of the engine section and validate that the design and analysis models accurately predict the amount of loads the core stage can withstand during launch and ascent. The engine section, recently delivered via NASA's barge Pegasus from NASA's Michoud Assembly Facility, is the first of four core stage structural test articles scheduled to be delivered to Marshall for testing. The engine section, located at the bottom of SLS's massive core stage, will house the rocket's four RS-25 engines and be an attachment point for the two solid rocket boosters.

  12. Pegasus delivers SLS engine section

    NASA Image and Video Library

    2017-05-18

    NASA engineers install test hardware for the agency's new heavy lift rocket, the Space Launch System, into a newly constructed 50-foot structural test stand at NASA's Marshall Space Flight Center. In the stand, hydraulic cylinders will be electronically controlled to push, pull, twist and bend the test article with millions of pounds of force. Engineers will record and analyze over 3,000 channels of data for each test case to verify the capabilities of the engine section and validate that the design and analysis models accurately predict the amount of loads the core stage can withstand during launch and ascent. The engine section, recently delivered via NASA's barge Pegasus from NASA's Michoud Assembly Facility, is the first of four core stage structural test articles scheduled to be delivered to Marshall for testing. The engine section, located at the bottom of SLS's massive core stage, will house the rocket's four RS-25 engines and be an attachment point for the two solid rocket boosters.

  13. Expectant management of severe preterm preeclampsia: a comparison of maternal and fetal indications for delivery.

    PubMed

    Mooney, Samantha S; Lee, Rilka M; Tong, Stephen; Brownfoot, Fiona C

    2016-12-01

    To examine the delivery indication (maternal or fetal) for patients with preterm preeclampsia and assess whether disease characteristics at presentation are predictive of delivery indication. We conducted a retrospective cohort study at a tertiary hospital in Melbourne, Australia (Mercy Hospital for Women). We assessed indication for delivery for participants presenting with preeclampsia from 23(+0) to 32(+6) weeks gestation. We compared baseline disease characteristics, disease features at delivery and postnatal outcomes between those delivered for maternal or fetal indications, or for both maternal and fetal indications. Two hundred sixty six participants presented with preterm preeclampsia and 108 were eligible for inclusion in our study. More participants were delivered for maternal indications at 65.7% compared to those requiring delivery on fetal grounds at 19.4% or for both indications at 14.8% (p < 0.0001). Maternal disease characteristics at presentation were similar between groups; however, there was a higher proportion of growth restriction and abnormal Dopplers among those delivered on fetal grounds. Participants delivered on maternal grounds gained less gestation, had higher blood pressure and higher incidence of abnormal liver function tests than those delivering for fetal indications at delivery. Participants with preterm preeclampsia were predominantly delivered due to maternal disease progression compared to fetal compromise.

  14. Maternal and feto-placental phenotypes of early-onset severe preeclampsia.

    PubMed

    Pilliod, Rachel A; Feinberg, Bruce B; Burwick, Richard M

    2016-01-01

    To characterize maternal and feto-placental phenotypes of severe preeclampsia that trigger early-onset delivery. A retrospective cohort review of pregnant women receiving care from 2000 to 2010. Subjects with early-onset severe preeclampsia delivering between 20 and 32 weeks were identified excluding multiple gestations or major anomalies. We defined indications for delivery as maternal (i.e. severe headache or abnormal laboratory parameters), feto-placental (i.e. non-reassuring tracing) or mixed (i.e. both maternal and feto-placental factors). To characterize the groups, demographic, clinical, laboratory, ultrasound and pathology data were abstracted. Statistical analysis was conducted. We identified 164 subjects meeting inclusion criteria. Indications for delivery were maternal (57.3%), feto-placental (29.9%) or mixed (12.8%). Compared to neonates delivered for maternal indications, birthweight was significantly lower among neonates delivered for feto-placental or mixed indications (p < 0.001). While placental findings were largely similar between groups, abnormal cord insertion was more common in subjects delivered for feto-placental factors (p = 0.02). Women delivered for maternal indications had more significant lab abnormalities than women delivered for feto-placental or mixed indications. In attempting to classify early-onset severe preeclampsia by delivery indication, we found patterns to suggest that feto-placental and maternal phenotypes of disease may have distinct pathophysiologic underpinnings.

  15. 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

  16. 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.

  17. 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).

    PubMed

    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 J P; Jackson, Alan A; Margetts, Barrie M; Fall, Caroline H D

    2014-11-01

    Low birth weight (LBW) is an important public health problem in undernourished populations. We tested whether improving women's dietary micronutrient quality before conception and throughout pregnancy increases birth weight in a high-risk Indian population. 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. 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/m(2)) [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. A daily snack providing additional green leafy vegetables, fruit, and milk before conception and throughout pregnancy had no overall effect on birth weight. Per

  18. 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

  19. [Maternal body mass index and breast feeding].

    PubMed

    Driul, L; Forzano, L; Londero, A P; Fachechi, G; Liva, S; Marchesoni, D

    2012-04-01

    The aim of this paper was to determine whether maternal BMI influences breast-feeding practice in quality and duration A retrospective case-control study were included Fifty women with Body Max Index (BMI) ≥25 kg/m2 considered overweigh and obese and fifty controls with BMI<25 kg/m2 who delivered in our clinic between 2010 and 2011. The incidence of breast-feeding was significantly lower in overweight and obese women compared with normal weight. Breastfeeding length was negatively related to prepregnancy BMI but not to gestational weight gain, method of delivery or lactation integration. Obese women presented an elevated Body Max Index one year apart from childbirth and are correlated to maternal complications during breastfeeding. Maternal overweight and obesity is negatively correlated to duration and quality of lactation.

  20. Maternal psychological impact of fetal echocardiography.

    PubMed

    Sklansky, Mark; Tang, Alvin; Levy, Denis; Grossfeld, Paul; Kashani, Iraj; Shaughnessy, Robin; Rothman, Abraham

    2002-02-01

    The maternal psychological impact of fetal echocardiography may be deleterious in the face of newly diagnosed congenital heart disease. This questionnaire-based study prospectively examined the psychological impact of both normal and abnormal fetal echocardiography. Normal fetal echocardiography decreased maternal anxiety, increased happiness, and increased the closeness women felt toward their unborn children. In contrast, when fetal echocardiography detected congenital heart disease, maternal anxiety typically increased, and mothers commonly felt less happy about being pregnant. However, among women who had recently delivered infants with congenital heart disease, those who had had fetal echocardiography during the pregnancy felt less responsible for their infants' defects and tended to have improved their relationships with the infants' fathers after the prenatal diagnosis of congenital heart disease. Further study of the psychological and medical impact of fetal echocardiography will be necessary to define and optimize the clinical value of this powerful diagnostic tool.

  1. Maternal mortality in Denmark, 1985-1994.

    PubMed

    Andersen, Betina Ristorp; Westergaard, Hanne Brix; Bødker, Birgit; Weber, Tom; Møller, Margrete; Sørensen, Jette Led

    2009-02-01

    In Denmark, maternal mortality has been reported over the last century, both locally through hospital reports and in national registries. The purpose of this study was to analyze data from national medical registries of pregnancy-related deaths in Denmark 1985-1994 and to classify them according to the UK Confidential Enquiry into Maternal Deaths (CEMD). All deaths of women with a registered pregnancy within 12 months prior to the death were identified by comparing the Danish medical registries, death certificates, and relevant codes according to International Classification of Diseases (ICD-10). All cases were classified using the UK CEMD classification. Cases of maternal death were further evaluated by an audit group. 311 cases were classified. 92 deaths (29.6%) occurred 42 days), 1 woman died from a direct obstetric cause, 46 from indirect causes, and 172 from fortuitous causes. Hypertensive disorders of pregnancy were the major cause of direct maternal deaths. The rate of maternal deaths constituted 9.8/100,000 maternities (i.e. the number of women delivering registrable live births at any gestation or stillbirths at 24 weeks of gestation or later). This is the first systematic report on deaths in Denmark based on data from national registries. The maternal mortality rate in Denmark is comparable to the rates in other developed countries. Fortunately, statistics are low, but each case represents potential learning. Obstetric care has changed and classification methods differ between countries. Prospective registration and registry linkage seem to be a way to ensure completion. This retrospective study has provided the background for a prospective study on registration and evaluation of maternal mortality in Denmark.

  2. Goodbye, Mandatory Maternity Leaves

    ERIC Educational Resources Information Center

    Nation's Schools, 1972

    1972-01-01

    In precedent-setting decrees, courts and federal and State authorities have branded compulsory maternity leaves either unconstitutional or illegal. School administrators are urged to prod boards of education to adopt more lenient maternity leave policies -- now. (Author)

  3. 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.

  4. Maternal anxiety, maternal sensitivity, and attachment.

    PubMed

    Stevenson-Hinde, Joan; Chicot, Rebecca; Shouldice, Anne; Hinde, Camilla A

    2013-01-01

    Previous research has related maternal anxiety to insecurity of attachment. Here we ask whether different aspects of maternal sensitivity mediate this link. From a community sample of intact families with 1-3 children, mothers with 4.5-year-olds were selected for low, medium, or high anxiety levels (N = 98). Following Mary Ainsworth's lead, our maternal sensitivity measures were primarily based on ratings of direct observations. Six sets of measures were obtained: positive maternal style at home (a mean of four different ratings); providing a sensitive framework, limit setting, allowing autonomy, criticizing/cutting in (each a mean over two laboratory joint tasks); and tension-making (a mean of three different ratings in a fear-inducing task). Regression analyses showed firstly that maternal anxiety rather than behavioral inhibition or sex of child was the significant predictor of each maternal sensitivity measure; and secondly that these measures rather than maternal anxiety or sex were the significant predictors of security of attachment. Finally, ANOVA's indicated which sets of maternal ratings were associated with each pattern of attachment (Avoidant, Secure, Ambivalent, or Controlling).

  5. Better utilization of traditional birth attendants (hilots) in the delivery of maternal-child health services in Philippine rural communities: a pilot project (1971-72).

    PubMed

    Del Mundo, F; Echevarra, R; Leuterio, L; Sarcia, S

    1972-12-01

    In the Philippines, where rapid population growth strains the health facilities, there were 8866 traditional birth attendants, hilots, in 1971. In 1970 a study of 142 hilots was conducted to train them in a 5-day course in pregnancy care and evaluate their effectiveness in Marinduque province, a rural, lower socioeconomic area. The age of the hilots ranged from 25-76; 78.2% women, 21.8% men. In the attendance of parturients hilots ranked first above midwives and nurses; 69.30% of deliveries were attended by hilots. 97.4% births occur in homes. 65.5% of the hilots were aware of the use of rural health physicians as backup help available to them. 3-4 children was the desired family size among hilots. The hilots were amenable and receptive to updating their training. The course in maternal child care with family planning was well received. The hilots were convinced of the need for early prenatal care. Since their training, the hilots have organized barrio meetings on family planning and offered to distribute pamphlets and handouts. The trained hilots send mothers they have favorably motivated to Family Planning Clinics. No tangible statistics regarding the effects on the community were available but traditional birth attendants will continue to play an important role in the delivery of health care services.

  6. Prenatal maternal stress predicts reductions in CD4+ lymphocytes, increases in innate-derived cytokines, and a Th2 shift in adolescents: Project Ice Storm.

    PubMed

    Veru, Franz; Dancause, Kelsey; Laplante, David P; King, Suzanne; Luheshi, Giamal

    2015-05-15

    The relationship between psychological stress and immunity is well established, but it is not clear if prenatal maternal stress (PNMS) affects the development of the immune system in humans. Our objective was to determine the extent of this influence in a sample of teenagers whose mothers were pregnant during the 1998 Quebec ice storm. As part of a longitudinal study of PNMS, we measured the objective stress exposure and subjective distress of the women soon after the disaster. We obtained blood samples from 37 of their children when they were 13years old to measure cell population percentages and mitogen-induced cytokine production. We found that the mothers' objective degree of PNMS exposure significantly predicted reductions in total and CD4+ lymphocyte proportions, increases in TNF-α, IL-1β, and IL-6 levels, and an enhancement of the Th2 cytokines IL-4 and IL-13. Sex and timing of PNMS exposure during gestation were also associated with some outcomes. These results show that PNMS is a programming factor that can produce long-lasting consequences on immunity, potentially explaining non-genetic variability in immune-related disorders. This information contributes to the understanding of the mechanisms underlying the influence of PNMS on immune-mediated disorders in humans.

  7. 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

    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.

  8. 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

  9. Fetal and Maternal Outcomes in Pregnancies Complicated with Fetal Macrosomia

    PubMed Central

    Alsammani, Mohamed Alkahatim; Ahmed, Salah Roshdy

    2012-01-01

    Background: Fetal macrosomia remains a considerable challenge in current obstetrics due to the fetal and maternal complications associated with this condition. Aim: This study was designed to determine the prevalence of fetal macrosomia and associated fetal and maternal morbidity and mortality in the Al Qassim Region of Saudi Arabia. Materials and Methods: This register-based study was conducted from January 1, 2011 through December 30, 2011 at the Maternity and Child Hospital, Qassim, Saudi Arabia. Macrosomia was defined as birth weight of 4 kg or greater. Malformed babies and those born dead were excluded. Results: The total number of babies delivered was 9241; of these, 418 were macrosomic. Thus, the prevalence of fetal macrosomia was 4.5%. The most common maternal complications were postpartum hemorrhage (5 cases, 1.2%), perineal tear (7 cases, 1.7%), cervical lacerations (3 cases, 0.7%), and shoulder dystocia (40 cases, 9.6%) that resulted in 4 cases of Erb's palsy (0.96%), and 6 cases of bone fractures (1.4%). The rate of cesarean section among women delivering macrosomic babies was 47.6% (199), while 52.4% (219) delivered vaginally. Conclusion: Despite extensive efforts to reduce fetal and maternal complications associated with macrosomia, considerable fetal and maternal morbidity remain associated with this condition. PMID:22754881

  10. Maternity Protection at Work.

    ERIC Educational Resources Information Center

    World of Work, 1998

    1998-01-01

    Discusses the need for maternity benefits for working women. Suggests that although most countries provide paid maternity leave by law, there is a gap between that law and practice. Includes a chart depicting maternity protection (length of leave, cash benefits, who pays) around the world. (JOW)

  11. [Maternal mortality and referral maternities in Morocco: how to (re)motivate professionals?].

    PubMed

    Péchevis, M; Fernandez, H; Cook, J; Bensalah, A; Aouraghe, M; Benbaha, A

    1999-06-01

    The very high rates of maternal mortality and perinatal mortality, as well as the deficiencies and dysfunctions observed in maternity hospitals, which play the role of referential maternity wards, led the Moroccan Minister of Public Health to implement a project in order to improve the quality of care of parturient women and new-borns. This project included 8 provinces in the country. The strategy chosen was "the team approach to resolving health problems", which is a learning process which leads local teams to implement and evaluate projects they have developed themselves. This pedagogical approach, which is carried out over a period of more than a year, proved itself to be very motivating and mobilising for the professionals included, despite the obstacles that were encountered. It also contributed to creating a true team spirit. Most activities planned within these projects were carried out and many indicators improved.

  12. Diversity and divergence: the dynamic burden of poor maternal health.

    PubMed

    Graham, Wendy; Woodd, Susannah; Byass, Peter; Filippi, Veronique; Gon, Giorgia; Virgo, Sandra; Chou, Doris; Hounton, Sennen; Lozano, Rafael; Pattinson, Robert; Singh, Susheela

    2016-10-29

    Maternal health is a big issue and is central to sustainable development. Each year, about 210 million women become pregnant and about 140 million newborn babies are delivered-the sheer scale of maternal health alone makes maternal well being and survival vital concerns. In this Series paper, we adopt primarily a numerical lens to illuminate patterns and trends in outcomes, but recognise that understanding of poor maternal health also warrants other perspectives, such as human rights. Our use of the best available evidence highlights the dynamic burden of maternal health problems. Increased diversity in the magnitude and causes of maternal mortality and morbidity between and within populations presents a major challenge to policies and programmes aiming to match varying needs with diverse types of care across different settings. This diversity, in turn, contributes to a widening gap or differences in levels of maternal mortality, seen most acutely in vulnerable populations, predominantly in sub-Saharan Africa. Strong political and technical commitment to improve equity-sensitive information systems is required to monitor the gap in maternal mortality, and robust research is needed to elucidate major interactions between the broad range of health problems. Diversity and divergence are defining characteristics of poor maternal health in the 21st century. Progress on this issue will be an ultimate judge of sustainable development.

  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. [Maternal mortality and perinatal mortality].

    PubMed

    Boutaleb, Y; Mesbahi, M; Lahlou, D; Aderdour, M

    1982-01-01

    94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of

  15. Internet-Delivered Psychological Treatments.

    PubMed

    Andersson, Gerhard

    2016-01-01

    During the past 15 years, much progress has been made in developing and testing Internet-delivered psychological treatments. In particular, therapist-guided Internet treatments have been found to be effective for a wide range of psychiatric and somatic conditions in well over 100 controlled trials. These treatments require (a) a secure web platform, (b) robust assessment procedures, (c) treatment contents that can be text based or offered in other formats, and (d) a therapist role that differs from that in face-to-face therapy. Studies suggest that guided Internet treatments can be as effective as face-to-face treatments, lead to sustained improvements, work in clinically representative conditions, and probably are cost-effective. Despite these research findings, Internet treatment is not yet disseminated in most places, and clinical psychologists should consider using modern information technology and evidence-based treatment programs as a complement to their other services, even though there will always be clients for whom face-to-face treatment is the best option.

  16. Contribution of isolated general practitioner maternity units.

    PubMed Central

    Cavenagh, A J; Phillips, K M; Sheridan, B; Williams, E M

    1984-01-01

    A postal survey of isolated general practitioner maternity units in England and Wales showed that just under 4% of deliveries take place in them. Eight per cent of general practitioners are on the staffs, and in 87% of units midwives are integrated with the community midwifery service. Sixty two per cent of units have visiting consultant cover. Fifty seven per cent of patients are booked and delivered in the unit, 28% are booked and deliberately delivered elsewhere, 5% are transferred in the antenatal period, and 10% transferred as emergencies. The perinatal mortality rate for cases booked and delivered in the units is 1.1 per 1000. The number of emergency transfers was appreciably less for those units that were prepared to do their own operations. Thirty five per cent of these units are liable to be cut off in bad weather, and they will continue to fulfil an essential role in the midwifery services. PMID:6426591

  17. Maternal near miss in low-resource areas.

    PubMed

    Goldenberg, Robert L; Saleem, Sarah; Ali, Sumera; Moore, Janet L; Lokangako, Adrien; Tshefu, Antoinette; Mwenechanya, Musaku; Chomba, Elwyn; Garces, Ana; Figueroa, Lester; Goudar, Shivaprasad; Kodkany, Bhalachandra; Patel, Archana; Esamai, Fabian; Nsyonge, Paul; Harrison, Margo S; Bauserman, Melissa; Bose, Carl L; Krebs, Nancy F; Hambidge, K Michael; Derman, Richard J; Hibberd, Patricia L; Liechty, Edward A; Wallace, Dennis D; Belizan, Jose M; Miodovnik, Menachem; Koso-Thomas, Marion; Carlo, Waldemar A; Jobe, Alan H; McClure, Elizabeth M

    2017-09-01

    To describe the Global Network Near-Miss Maternal Mortality System and its application in seven sites. In a population-based study, pregnant women eligible for enrollment in the Maternal and Newborn Health Registry at seven sites (Democratic Republic of the Congo; Guatemala; Belagavi and Nagpur, India; Kenya; Pakistan; and Zambia) between January 2014 and April 2016 were screened to identify those likely to have a near-miss event. The WHO maternal near-miss criteria were modified for low-resource settings. The ratio of near-miss events to maternal deaths was calculated. Among 122 707 women screened, 18 307 (15.0%) had a potential near-miss event, of whom 4866 (26.6%; 4.0% of all women) had a near-miss maternal event. The overall maternal mortality ratio was 155 per 100 000 live births. The ratio of near-miss events to maternal deaths was 26 to 1. The most common factors involved in near-miss cases were the hematologic/coagulation system, infection, and cardiovascular system. By using the Global Network Near-Miss Maternal Mortality System, large numbers of women were screened for near-miss events, including those delivering at home or a low-level maternity clinic. The 4.0% incidence of near-miss maternal mortality is similar to previously reported data. The ratio of 26 near-miss cases to 1 maternal death suggests that near miss might evaluate the impact of interventions more efficiently than maternal mortality. © 2017 International Federation of Gynecology and Obstetrics.

  18. Effects of Maternal Childhood Aggression and Social Withdrawal on Maternal Request Strategies and Child Compliance and Noncompliance

    ERIC Educational Resources Information Center

    Grunzeweig, Naomi; Stack, Dale M.; Serbin, Lisa A.; Ledingham, Jane; Schwartzman, Alex E.

    2009-01-01

    This prospective, intergenerational study investigated the influences of maternal histories of childhood aggression and social withdrawal on maternal request strategies and child compliance and noncompliance. Seventy-four women from the Concordia Longitudinal Risk Project, who were rated during childhood using peer nomination measures of…

  19. 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.

  20. 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

  1. Maternal corticosteroid use and hypospadias.

    PubMed

    Carmichael, Suzan L; Ma, Chen; Werler, Martha M; Olney, Richard S; Shaw, Gary M

    2009-07-01

    To explore whether women who reported corticosteroid use during pregnancy were more likely to deliver an infant with hypospadias than women who did not. The analysis encompassed data on deliveries with an estimated due date between 1997 and 2004 from the National Birth Defects Prevention Study, a large population-based, case-control study conducted in the United States. Included were 1165 cases of moderate to severe hypospadias and 3000 nonmalformed male controls. The mothers of 39 cases (3.3%) and 62 controls (2.1%) reported using a corticosteroid medication during the period extending from 4 weeks before conception to 14 weeks after conception. The odds ratio (OR) for any corticosteroid exposure versus no corticosteroid exposure was 1.6 (95% confidence interval [CI] = 1.1 to 2.5); after adjustment for maternal race/ethnicity, education, age, and study site, it was 1.3 (95% CI = 0.8 to 2.0). Analyses by route of administration and specific component suggest that elevated ORs occurred only for nasal spray/inhaled corticosteroids (OR = 1.5; 95% CI = 0.9 to 2.6). Maternal use of corticosteroid medications was weakly associated with risk of hypospadias, but the association was negligible after adjustment for potential confounders.

  2. Method for technology-delivered healthcare measures.

    PubMed

    Kramer-Jackman, Kelli Lee; Popkess-Vawter, Sue

    2011-12-01

    Current healthcare literature lacks development and evaluation methods for research and practice measures administered by technology. Researchers with varying levels of informatics experience are developing technology-delivered measures because of the numerous advantages they offer. Hasty development of technology-delivered measures can present issues that negatively influence administration and psychometric properties. The Method for Technology-delivered Healthcare Measures is designed to systematically guide the development and evaluation of technology-delivered measures. The five-step Method for Technology-delivered Healthcare Measures includes establishment of content, e-Health literacy, technology delivery, expert usability, and participant usability. Background information and Method for Technology-delivered Healthcare Measures steps are detailed.

  3. The American College of Nurse-Midwives Clarity in Collaboration Project: Describing Midwifery Care in Interprofessional Collaborative Care Models.

    PubMed

    Freytsis, Maria; Phillippi, Julia C; Cox, Kim J; Romano, Amy; Cragin, Leslie

    2017-01-01

    In 2014, the American College of Nurse-Midwives (ACNM) launched a project called Clarity in Collaboration to develop data definitions related to midwifery and maternity care delivery processes. These definitions are needed to ensure midwifery care delivered in collaborative care models is accurately and consistently captured in clinical documentation systems, data registries, and systems being developed as part of health care restructuring and payment reform. The Clarity in Collaboration project builds on the efforts of the Women's Health Registry Alliance (WHRA), which was recently established by the American College of Obstetricians and Gynecologists. Clarity in Collaboration mirrored the process used by ReVITALize, WHRA's first maternity data standardization project, which focused on establishing standardized clinical data definitions for obstetrics. The ACNM Clarity in Collaboration project brought together maternity and midwifery care experts to complete a year-long consensus process, including a period of public comment, resulting in development of 20 concept definitions. These definitions can be used to describe midwifery care within the context of collaborative care models. This article provides a summary of the ACNM Clarity in Collaboration process with discussion of implications for maternity data collection.

  4. Cesarean delivery in Finland: maternal complications and obstetric risk factors.

    PubMed

    Pallasmaa, Nanneli; Ekblad, Ulla; Aitokallio-Tallberg, Ansa; Uotila, Jukka; Raudaskoski, Tytti; Ulander, Veli-Matti; Hurme, Saija

    2010-07-01

    To assess the rate of maternal complications related to cesarean section (CS) and to compare morbidity between elective, emergency and crash-emergency CS. To establish risk factors associated with maternal CS morbidity. A prospective multicenter cohort study. Twelve delivery units in Finland. Women delivering by CS (n = 2,496) during a 6 months period in the study hospitals. Data on pregnant women, CS, and maternal recovery during the hospital stay was collected prospectively on report forms. The complication rates by different CSs were calculated, and factors associated with morbidity were analyzed by odds ratios (OR). Maternal complication rates in different types of CS. The association of risk factors with morbidity. About 27% of women delivering by CS had complications; 10% had severe complications. The complication rate was higher in emergency CS than in elective CS, and highest in crash-emergency CS. Significant independent risk factors for maternal morbidity were emergency CS and crash-emergency CS compared to elective CS (OR 1.8; 95% confidence interval (CI) 1.5-2.2), pre-eclampsia (OR 1.5; CI 1.1-2.0), maternal obesity (OR 1.4; CI 1.1-1.8) and maternal increasing age (OR 1.1; CI 1.03-1.2 per each 5 years). Maternal complications are frequent in CS, and although performing CS electively reduces the occurrence of complications, the frequency is still high. The complication rate depends on the degree of emergency, and increases with maternal obesity, older age and pre-eclampsia.

  5. 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

  6. Measuring maternal mortality.

    PubMed

    Royston, E; AbouZahr, C

    1992-07-01

    There are various methods of measuring maternal mortality each with its own advantages and disadvantages. Most official maternal mortality statistics underestimate true maternal mortality levels. Major reasons for underestimates depend on death certification practices and the advancement of the vital registration system. Only 35% of the world's population routinely record cause of death. Misclassification of the cause of death accounts for much of the bias in areas with good vital registration. In France, clerks miscode maternal-related causes of death as something else, e.g., they misclassified cerebral hemorrhages as diseases of the circulatory system and not complications of pregnancy, childbirth, and the puerperium. In countries with few maternal deaths, pregnant or puerperium women in life-threatening conditions are transferred from obstetric departments so cause of death on the certificate may not be the obstetric condition which precipitated the fatal series of events. Governments must determine the type of measurement method for maternal mortality by balancing precision against human and financial costs. Statisticians can measure the maternal mortality rate using several methods. They can include questions about maternal mortality such as maternal deaths of sisters of the adult women or of any women they know who had died from maternal causes in the last year in ongoing household surveys. These surveys tend to be expensive, however . A more cost-effective and successful method is reproductive age mortality surveys which consist of investigating the causes of all deaths of women of reproductive age. If civil registration or other population-based data do not exist, researchers can use hospital data despite their limitations. They can also use records at the primary care level. They can use incomplete data to estimate maternal mortality and to evaluate rates obtained from civil registers, studies, or other sources.

  7. Differential oxidative stress levels in mothers with preeclampsia delivering male and female babies.

    PubMed

    Roy, Suchitra; Dhobale, Madhavi; Dangat, Kamini; Mehendale, Savita; Lalwani, Sanjay; Joshi, Sadhana

    2015-11-01

    Increased oxidative stress is known to be associated with pregnancy complications like preeclampsia (PE). We hypothesize that increased maternal oxidative stress may differentially affect/program the pregnancy outcome during early postnatal periods in male and female babies. One-hundred three healthy pregnant women (gestation ≥ 37 weeks) were recruited for the normotensive control (NC) group and 57 women with term-preeclampsia (T-PE; gestation ≥ 37 weeks) and 28 women with preterm-preeclampsia (PT-PE; gestation <37 weeks) were also recruited. All infants were followed for anthropometric measurements until six months of age. Higher maternal plasma malondialdehyde (MDA) and erythrocyte superoxide dismutase and glutathione peroxidase (GPx) levels were observed in both T-PE and PT-PE groups. Higher maternal levels of MDA and GPx were seen in mothers delivering male babies in T-PE and PT-PE groups, respectively, as compared to mothers delivering female babies. Babies born to mothers with PT-PE showed poor growth and development on all the anthropometric parameters compared to those born to mothers with T-PE and NC. The altered levels of oxidative stress and antioxidant enzymes in mothers with PE delivering male babies suggest that they may be at higher risk for developing metabolic and neurodevelopmental disorders than female babies.

  8. 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…

  9. 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.

  10. Maternal representation of the self as parent: connections with maternal sensitivity and maternal structuring.

    PubMed

    Biringen, Z; Matheny, A; Bretherton, I; Renouf, A; Sherman, M

    2000-09-01

    Maternal representations of the self as parent were assessed via the Parent Attachment and Peer Relationship Interviews (Bretherton, Biringen, Ridgeway, Maslin-Cole, & Sherman, 1989; Biringen & Bretherton, 1988) when children were 39 months of age. Maternal sensitivity and maternal structuring during mother-child interactions were assessed at 18, 24 and 39 months. The central question of this study was whether maternal representations were related to aspects of observed maternal sensitivity and maternal structuring. We found that maternal sensitivity at 18 months predicted later maternal representations of the self as parent. But beginning at 24 months and continuing to 39 months maternal structuring proved to be a more important predictor of maternal representations of the self, in particular maternal self-esteem, even after controlling for maternal sensitivity.

  11. The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey

    PubMed Central

    Ziraba, Abdhalah K; Mills, Samuel; Madise, Nyovani; Saliku, Teresa; Fotso, Jean-Christophe

    2009-01-01

    Background Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1) delay in making the decision to seek care; 2) delay in reaching an appropriate obstetric facility; and 3) delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. Methods We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. Results Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums) while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden of morbidity and

  12. Maternal obesity, caesarean delivery and caesarean delivery on maternal request: a cohort analysis from China.

    PubMed

    Zhou, Yubo; Blustein, Jan; Li, Hongtian; Ye, Rongwei; Zhu, Liping; Liu, Jianmeng

    2015-05-01

    To quantify the association between maternal obesity and caesarean delivery, particularly caesarean delivery on maternal request (CDMR), a fast-growing component of caesarean delivery in many nations. We followed 1,019,576 nulliparous women registered in the Perinatal Healthcare Surveillance System during 1993-2010. Maternal body mass index (BMI, kg/m(2) ), before pregnancy or during early pregnancy, was classified as underweight (<18.5), normal (18.5 to <23; reference), overweight (23 to <27.5), or obese (≥27.5), consistent with World Health Organization guidelines for Asian people. The association between maternal obesity and overall caesarean and its subtypes was modelled using log-binomial regression. During the 18-year period, 404,971 (39.7%) caesareans and 93,927 (9.2%) CDMRs were identified. Maternal obesity was positively associated with overall caesarean and CDMR. Adjusted risk ratios for overall caesarean in the four ascending BMI categories were 0.96 [95% confidence interval (CI) 0.94, 0.97], 1.00 (Reference), 1.16 [95% CI 1.14, 1.18], 1.39 [95% CI 1.43, 1.54], and for CDMR were 0.95 [95% CI 0.94, 0.96], 1.00 (Reference), 1.20 [95% CI 1.18, 1.22], 1.48 [95% CI 1.433, 1.54]. Positive associations were consistently found in women residing in southern and northern provinces and in subgroups stratified by year of delivery, urban or rural residence, maternal age, education, level of delivering hospital, and birthweight. In a large Chinese cohort study, maternal obesity was associated with an increased risk of caesarean delivery and its subtypes, including CDMR. Given the rising global prevalence of obesity, and in view of the growth of CDMR, it seems likely that caesarean births will increase, unless there are changes in obstetrical practice. © 2015 John Wiley & Sons Ltd.

  13. Accelerated maternal responding following intra-VTA pertussis toxin treatment.

    PubMed

    Byrnes, John J; Gleason, Erin D; Schoen, Matthew K; Schoen, Mathew T; Lovelock, Dennis F; Carini, Lindsay M; Byrnes, Elizabeth M; Bridges, Robert S

    2011-10-01

    Prior studies have supported a role for mesolimbic dopaminergic mechanisms in the regulation of maternal behavior. Accordingly, the ventral tegmental area (VTA) and its dopaminergic projections to the nucleus accumbens (NAc) and medial prefrontal cortex (mPFC) have been implicated in both the onset and maintenance of normal maternal behavior. To date, studies of direct manipulation of VTA neurochemistry at the onset of maternal behavior have been limited. The current study was undertaken to directly test the hypothesis that enhancement of dopaminergic transmission in the mesolimbic dopamine system can stimulate maternal activity using a pup-induced virgin model. Nulliparous female rats were stereotaxically infused with pertussis toxin (PTX 0, 0.1, or 0.3 μg/hemisphere) into the VTA to chronically stimulate the activity of dopaminergic projection neurons. After 3 days of recovery, maternal responding to donor pups was tested daily, and latency (in days) to full maternal behavior was recorded. Intra-VTA PTX treatment produced a robust dose-dependent decrease in maternal behavior latency, and a long-lasting increase in locomotor activity. These effects were associated with significantly decreased dopamine D1 receptor mRNA expression in the NAc. No effects of PTX treatment on mesolimbic dopamine utilization or mPFC receptor expression were observed. The findings indicate that chronic neural activation in the VTA accelerates the onset of maternal behavior in virgin female rats via modification of the NAc dopamine D1 receptor.

  14. Accelerated Maternal Responding Following Intra-VTA Pertussis Toxin Treatment

    PubMed Central

    Byrnes, John J.; Gleason, Erin D.; Schoen, Mathew K.; Lovelock, Dennis F.; Carini, Lindsay M.; Byrnes, Elizabeth M.; Bridges, Robert S.

    2011-01-01

    Prior studies have supported a role for mesolimbic dopaminergic mechanisms in the regulation of maternal behavior. Accordingly, the ventral tegmental area (VTA) and its dopaminergic projections to the nucleus accumbens (NAc) and medial prefrontal cortex (mPFC) have been implicated in both the onset and maintenance of normal maternal behavior. To date, studies of direct manipulation of VTA neurochemistry at the onset of maternal behavior have been limited. The current study was undertaken to directly test the hypothesis that enhancement of dopaminergic transmission in the mesolimbic dopamine system can stimulate maternal activity using a pup-induced virgin model. Nulliparous female rats were stereotaxically infused with pertussis toxin (PTX 0, 0.1, or 0.3 μg/hemisphere) into the VTA to chronically stimulate the activity of dopaminergic projection neurons. After 3 days of recovery, maternal responding to donor pups was tested daily, and latency (in days) to full maternal behavior was recorded. Intra-VTA PTX treatment produced a robust dose-dependent decrease in maternal behavior latency, and a long-lasting increase in locomotor activity. These effects were associated with significantly decreased dopamine D1 receptor mRNA expression in the NAc. No effects of PTX treatment on mesolimbic dopamine utilization or mPFC receptor expression were observed. The findings indicate that chronic neural activation in the VTA accelerates the onset of maternal behavior in virgin female rats via modification of the NAc dopamine D1 receptor. PMID:21571006

  15. Differential levels of long chain polyunsaturated fatty acids in women with preeclampsia delivering male and female babies.

    PubMed

    Roy, Suchitra; Dhobale, Madhavi; Dangat, Kamini; Mehendale, Savita; Wagh, Girija; Lalwani, Sanjay; Joshi, Sadhana

    2014-11-01

    Maternal long chain polyunsaturated fatty acids (LCPUFA) play a key role in fetal growth and development. This study for the first time examines the maternal and cord LCPUFA levels in preeclamptic mothers delivering male and female infants. In this study 122 normotensive control pregnant women (gestation≥37 weeks) and 90 women with preeclampsia were recruited. Results indicate lower maternal plasma docosahexaenoic acid (DHA) levels (p<0.05) in women with preeclampsia delivering male babies as compared to normotensive control women delivering male babies. Similarly, cord nervonic acid levels were lower (p<0.01) in women with preeclampsia delivering male babies as compared to normotensive control group. However, cord nervonic acid levels were comparable in women with preeclampsia and normotensive control women delivering female babies. This data suggests that male babies born to mothers with preeclampsia may be at an increased risk of developing neurodevelopmental disorders as compared to female babies. Future studies need to follow up both male and female children born to mothers with preeclampsia since altered levels of LCPUFA at birth may have differential implications for the growth and development.

  16. 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.

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

    PubMed Central

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

    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

  18. '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.

  19. Maternal vitamin B12 deficiency detected in expanded newborn screening.

    PubMed

    Scolamiero, Emanuela; Villani, Guglielmo Rosario Domenico; Ingenito, Laura; Pecce, Rita; Albano, Lucia; Caterino, Marianna; di Girolamo, Maria Grazia; Di Stefano, Cristina; Franzese, Ignazio; Gallo, Giovanna; Ruoppolo, Margherita

    2014-12-01

    Besides the inherited form, vitamin B(12) deficiency may be due to diet restrictions or abnormal absorption. The spread of newborn screening programs worldwide has pointed out that non-inherited conditions are mainly secondary to a maternal deficiency. The aim of our work was to study seven cases of acquired vitamin B12 deficiency detected during our newborn screening project. Moreover, we aimed to evaluate vitamin B(12) and related biochemical parameters status on delivering female to verify the consequences on newborns of eventually altered parameters. 35,000 newborns were screened; those showing altered propionyl carnitine (C3) underwent second-tier test for methylmalonic acid (MMA) on dried blood spot (DBS). Subsequently, newborns positive to the presence of MMA on DBS and their respective mothers underwent further tests: serum vitamin B(12), holo-transcobalamin (Holo-TC), folate and homocysteine; newborns were also tested for urinary MMA content. A control study was conducted on 203 females that were tested for the same parameters when admitted to hospital for delivery. Approximately 10% of the examined newborns showed altered C3. Among these, seven cases of acquired vitamin B(12) deficiency were identified (70% of the MMA-positive cases). Moreover, our data show a high frequency of vitamin B(12) deficiency in delivering female (approximately 48% of examined pregnants). We suggest to monitor vitamin B(12) and Holo-TC until delivery and to reconsider the reference interval of vitamin B(12) for a better identification of cases at risk. Finally, newborns from mothers with low or borderline levels of vitamin B(12) should undergo second-tier test for MMA; in the presence of MMA they should be supplemented with vitamin B(12) to prevent adverse effects related to vitamin B(12) deficiency. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  20. Sepsis and maternal mortality.

    PubMed

    Acosta, Colleen D; Knight, Marian

    2013-04-01

    Despite global progress towards reducing maternal mortality, sepsis remains a leading cause of preventable maternal death. This review focuses on current measurement challenges, trends, causes and efforts to curb maternal death from sepsis in high and low-income countries. Under-reporting using routine registration data, compounded by misclassification and unreported deaths, results in significant underestimation of the burden of maternal death from sepsis. In the UK and the Netherlands the recent increase in maternal death from sepsis is mainly attributed to an increase in invasive group A streptococcal infections. Susceptibility to infection may be complicated by modulation of maternal immune response and increasing rates of risk factors such as caesarean section and obesity. Failure to recognize severity of infection is a major universal risk factor. Standardized Surviving Sepsis Campaign (SSC) recommendations for management of severe maternal sepsis are continuing to be implemented worldwide; however, outcomes differ according to models of intensive care resourcing and use. The need for robust data with subsequent analyses is apparent. This will significantly increase our understanding of risk factors and their causal pathways, which are critical to informing effective treatment strategies in consideration of resource availability.

  1. Some aspects of maternal care in rural peninsular Malaysia.

    PubMed

    Salleh, N M; Tan Boon Ann; Arshat, H

    1986-06-01

    The effectiveness and impact of the Population and Family Health Project in the rural areas of Malaysia is evaluated. A total of 790 women who delivered during the past 3 years from the time of the survey, were identified from 2,013 women aged 15-49 years, during the 2nd Family and Health Survey (1979) in Peninsular Malaysia. The rural health districts which were selected by random sampling include: Perlis, Kubang Pasu, Sebeang Perai Selatan, Kuala Selangor, Hulu Langat, Melaka Utara, Kota Bharu/Tumpat, and Pasir Mas. The pattern of maternal care during pregnancy, delivery and puerperium are examined with respect to selected variables. These women are further classified into 2 groups by type of birth attendant at delivery and these 2 groups are also examined in relation to selected socioeconomic variables. The major proportion of women had their 1st antenatal visit during the 2nd and 3rd trimester of pregnancy. The highest % (28.3%) of 1st antenatal visits occurred during the 5th month of pregnancy. Use of a trained medical practitioner is preferred (82.5%), while only 17.5% of women preferred the services of traditonal birth attendants. Women in this latter group had less education and were in lower income groups, than the former group of women. Majority of women in all ethnic and age groups had no postnatal check after their last childbirth.

  2. The maternal childbirth experience more than a decade after delivery.

    PubMed

    Bossano, Carla M; Townsend, Kelly M; Walton, Alexandra C; Blomquist, Joan L; Handa, Victoria L

    2017-09-01

    Maternal satisfaction with the birth experience is multidimensional and influenced by many factors, including mode of delivery. To date, few studies have investigated maternal satisfaction outside of the immediate postpartum period. This study investigated whether differences in satisfaction based on mode of delivery are observed more than a decade after delivery. This was a planned, supplementary analysis of data collected for the Mothers' Outcomes after Delivery study, a longitudinal cohort study of pelvic floor disorders in parous women and their association with mode of delivery. Obstetric and demographic data were obtained through patient surveys and obstetrical chart review. Maternal satisfaction with childbirth experience was assessed via the Salmon questionnaire, administered to Mothers' Outcomes after Delivery study participants >10 years from their first delivery. This validated questionnaire yields 3 scores: fulfillment, distress, and difficulty. These 3 scores were compared by mode of delivery (cesarean prior to labor, cesarean during labor, spontaneous vaginal delivery, and operative vaginal delivery). In addition, the impact of race, age, education level, parity, episiotomy, labor induction, and duration of second stage of labor on maternal satisfaction were examined. Among 576 women, 10.1-17.5 years from delivery, significant differences in satisfaction scores were noted by delivery mode. Salmon scale scores differed between women delivering by cesarean and those delivering vaginally: women delivering vaginally reported greater fulfillment (0.40 [-0.37 to 0.92] vs 0.15 [-0.88 to 0.66], P < .001) and less distress (-0.34 [-0.88 to 0.38] vs 0.20 [-0.70 to 0.93], P < .001) than those who delivered by cesarean. Women who delivered by cesarean prior to labor reported the greatest median fulfillment scores and the lowest median difficulty scores. Median distress scores were lowest among those who delivered by spontaneous vaginal birth. Among women who

  3. Time Outdoors May Deliver Better Sleep

    MedlinePlus

    ... fullstory_163389.html Time Outdoors May Deliver Better Sleep Camping and exposure to natural light helps prime ... Spending time in the outdoors may improve your sleep, a small study suggests. Researchers found that a ...

  4. Delivering HPC Systems to 132 Dock

    SciTech Connect

    Kettering, Brett Michael

    2016-03-23

    The intention of this document is to provide the subcontractor with information to enable trucks delivering HPC (High Performance Computing) systems to the 03-0132, computer rooms with the information they need to do so successfully.

  5. Balancing Quality and Access: Reducing State Policy Barriers to Electronically Delivered Higher Education Programs.

    ERIC Educational Resources Information Center

    Johnstone, Sally M.

    This project was designed to increase student access by addressing Western states' regulations on higher education programs delivered electronically across state lines, and to develop and get region-wide agreement on basic quality standards for distance education programs. The project achieved agreement on a set of "Principles of Good…

  6. Balancing Quality and Access: Reducing State Policy Barriers to Electronically Delivered Higher Education Programs.

    ERIC Educational Resources Information Center

    Johnstone, Sally M.

    This project was designed to increase student access by addressing Western states' regulations on higher education programs delivered electronically across state lines, and to develop and get region-wide agreement on basic quality standards for distance education programs. The project achieved agreement on a set of "Principles of Good…

  7. Characteristics, Adverse Events, and Racial Differences Among Delivering Mothers with Peripartum Cardiomyopathy

    PubMed Central

    Kao, David P; Hsich, Eileen; Lindenfeld, JoAnn

    2013-01-01

    Objectives To identify clinical features associated with peripartum cardiomyopathy (PPCM) and possible racial differences, and to quantify in-hospital outcomes in delivering mothers with PPCM. Background Investigation of patient characteristics and outcomes in PPCM has been limited to small cohorts. Hospital discharge data allows assembly of the largest number of PPCM cases to date. Methods Hospital records from six states were screened for PPCM. Clinical profiles, maternal, and fetal outcomes in delivering mothers with and without PPCM were compared and stratified by race. A maternal major adverse event (MAE) was defined as death, cardiac arrest, heart transplantation, or mechanical circulatory support. Logistic regression was used to identify variables associated with PPCM. Results In total, 535/4,003,914 records of delivering mothers specified a diagnosis of PPCM. Prevalence of PPCM was highest among African-Americans and similar in Caucasians and Hispanics. Established risk factors including age ≥ 30 years, African-American race, hypertension, preeclampsia/eclampsia, and multigestational status were associated with PPCM, and novel associations such as anemia and asthma were identified. Autoimmune disease and substance abuse, which can cause cardiomyopathy independently, were also associated with PPCM. Maternal MAE (odds ratio=436, p<0.0001) and stillbirth (odds ratio=3.8, p<0.0001) occurred more frequently among women with PPCM. Conclusions The prevalence of PPCM at the time of delivery in Hispanics was similar to Caucasians and lower than African-Americans. Autoimmune disease, substance abuse, anemia and asthma were conditions associated with PPCM not consistently identified in smaller cohorts. PPCM was also associated with increased risk of stillbirth and maternal MAEs at delivery. PMID:24163791

  8. Characteristics, adverse events, and racial differences among delivering mothers with peripartum cardiomyopathy.

    PubMed

    Kao, David P; Hsich, Eileen; Lindenfeld, JoAnn

    2013-10-01

    The aim of this study was to identify clinical features associated with peripartum cardiomyopathy (PPCM) and possible racial differences and to quantify in-hospital outcomes in delivering mothers with PPCM. Investigation of patient characteristics and outcomes in PPCM has been limited to small cohorts. Hospital discharge data allow assembly of the largest number of PPCM cases to date. Hospital records from 6 states were screened for PPCM. Clinical profiles, maternal, and fetal outcomes in delivering mothers with and without PPCM were compared and stratified by race. A maternal major adverse event (MAE) was defined as death, cardiac arrest, heart transplantation, or mechanical circulatory support. Logistic regression was used to identify variables associated with PPCM. In total, 535 of 4,003,914 records of delivering mothers specified a diagnosis of PPCM. Prevalence of PPCM was highest among African Americans and similar in Caucasians and Hispanics. Established risk factors including age 30 years, African- American race, hypertension, preeclampsia/eclampsia, and multigestational status were associated with PPCM, and novel associations such as anemia and asthma were identified. Autoimmune disease and substance abuse, which can cause cardiomyopathy independently, were also associated with PPCM. Maternal MAE (odds ratio: 436, p < 0.0001) and stillbirth (odds ratio: 3.8, p < 0.0001) occurred more frequently among women with PPCM. The prevalence of PPCM at the time of delivery in Hispanics was similar to Caucasians and lower than African Americans. Autoimmune disease, substance abuse, anemia and asthma were conditions associated with PPCM not consistently identified in smaller cohorts. Peripartum cardiomyopathy was also associated with increased risk of stillbirth and maternal MAEs at delivery.

  9. An impact evaluation of the safe motherhood promotion project in Bangladesh: evidence from Japanese aid-funded technical cooperation.

    PubMed

    Kamiya, Yusuke; Yoshimura, Yukie; Islam, Mohammad Tajul

    2013-04-01

    This paper reports the findings from a quasi-experimental impact evaluation of the Safe Motherhood Promotion Project (SMPP) conducted in the Narsingdi district of Bangladesh. SMPP is a Japanese aid-funded technical cooperation project aimed at developing local capacities to tackle maternal and newborn health problems in rural areas. We assessed whether the project interventions, in particular, community-based activities under the Model Union approach, had a favorable impact on women's access to and knowledge of maternal health care during pregnancy and childbirth. The project comprises a package of interlinked interventions to facilitate safe motherhood practices at primary and secondary care levels. The primary-level activities focused on community mobilization through participatory approaches. The secondary-level activities aimed at strengthening organizational and personnel capacities for delivering emergency obstetric care (EmOC) at district and sub-district level hospitals. The project impact was estimated by difference-in-differences logistic regressions using two rounds of cross-sectional household survey data. The results showed that the project successfully increased the utilization of antenatal visits and postpartum EmOC services and also enhanced women's knowledge of danger signs during pregnancy and delivery. The project also reduced income inequalities in access to antenatal care. In contrast, we found no significant increase in the use of skilled birth attendants (SBA) in the project site. Nonetheless, community mobilization activities and the government's voucher scheme played a complementary role in promoting the use of SBA. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Role of pregnancy and parturition in induction of maternal behavior in prairie voles (Microtus ochrogaster)

    PubMed Central

    Hayes, UnJa L.; De Vries, Geert J.

    2007-01-01

    In prairie voles (Microtus ochrogaster), most virgin females are infanticidal. To determine the onset of maternal responsiveness, female prairie voles were tested for maternal behavior as virgins and at different times throughout pregnancy. Female voles that were infanticidal as virgins by and large remained infanticidal throughout pregnancy. In contrast, about 30% of voles that were maternal as virgins became infanticidal during pregnancy. To test whether events associated with parturition facilitate the onset of maternal behavior, females had their litters delivered by Caesarean section within a day of expected delivery or were allowed to give birth naturally with sham surgery occurring shortly before or after birth. Females that gave birth naturally were fully maternal and did not attack unrelated pups, but females subjected to artificial delivery remained infanticidal. This suggests that events closely related to parturition are crucial for full development of maternal behavior in female prairie voles. PMID:17174957

  11. Role of pregnancy and parturition in induction of maternal behavior in prairie voles (Microtus ochrogaster).

    PubMed

    Hayes, UnJa L; De Vries, Geert J

    2007-02-01

    In prairie voles (Microtus ochrogaster), most virgin females are infanticidal. To determine the onset of maternal responsiveness, female prairie voles were tested for maternal behavior as virgins and at different times throughout pregnancy. Female voles that were infanticidal as virgins by and large remained infanticidal throughout pregnancy. In contrast, about 30% of voles that were maternal as virgins became infanticidal during pregnancy. To test whether events associated with parturition facilitate the onset of maternal behavior, females had their litters delivered by Caesarean section within a day of expected delivery or were allowed to give birth naturally with sham surgery occurring shortly before or after birth. Females that gave birth naturally were fully maternal and did not attack unrelated pups, but females subjected to artificial delivery remained infanticidal. This suggests that events closely related to parturition are crucial for full development of maternal behavior in female prairie voles.

  12. "Someone's rooting for you": continuity, advocacy and street-level bureaucracy in UK maternal healthcare.

    PubMed

    Finlay, Susanna; Sandall, Jane

    2009-10-01

    Continuity and advocacy are widely held to be important elements in maternal healthcare, yet they are often lacking from the care women receive. In order to understand this disparity, we draw upon interviews and ethnographic observational findings from The One-to-One Caseload Project, a study exploring the impacts of a caseload model of maternity care within an urban National Health Service provider in Britain. Drawing on Lipsky's (1980) and Prottas's (1979) theories of street-level bureaucracy, this paper attempts to understand how midwives, working on the frontline within caseload and standard care models, manage the competing demands of delivering a personalised service within a bureaucratic organisation. The caseload care model serves as a case study for how a client-centred model of working can assist street-level bureaucrats to manage the administrative pressures of public service organisations and provide their clients with a personalised, responsive service. Nevertheless, despite such benefits, client-centred models of working may have unintended consequences for both health carers and healthcare systems.

  13. 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.

  14. Congenital heart block and maternal systemic lupus erythematosus.

    PubMed Central

    Esscher, E; Scott, J S

    1979-01-01

    The association between infants with congenital heart block (CHB) and the presence or later development of maternal systemic lupus erythematosus or other connective-tissue disease (CTD) was reviewed in 67 cases. In 24 cases CHB was diagnosed at or before birth. Of nine necropsies on affected infants, seven showed endomyocardial fibrosis. The results suggest that one in three mothers who deliver babies with CHB have or will develop CTD. The association is probably explained by placental transfer of a maternal antibody. Awareness of the association may lead to prevention of the birth of children with CHB and better neonatal care of affected children. PMID:455010

  15. Rural maternity care.

    PubMed

    Miller, Katherine J; Couchie, Carol; Ehman, William; Graves, Lisa; Grzybowski, Stefan; Medves, Jennifer

    2012-10-01

    To provide an overview of current information on issues in maternity care relevant to rural populations. Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in

  16. Monitoring of Breast Tumor Response to Local Chemotherapeutic Agent Delivered by Biodegradable Fibers

    DTIC Science & Technology

    2005-05-01

    AD_ Award Number: DAMD17-03-1-0353 TITLE: Monitoring of Breast Tumor Response to Local Chemotherapeutic Agent Delivered by Biodegradable Fibers...30 Apr 2005 4. TITLE AND SUBTITLE Sa. CONTRACT NUMBER Monitoring of Breast Tumor Response to Local Chemotherapeutic Agent Delivered by Biodegradable...year of the project, we have investigated the cyclophosphamide dose effects on rat breast tumor hemodynamics and also monitored how tumor hemodynamics

  17. Maternal history of adoption or foster care placement in childhood: a risk factor for preterm birth.

    PubMed

    Bublitz, Margaret H; Rodriguez, Daniel; Polly Gobin, Asi; Waldemore, Marissa; Magee, Susanna; Stroud, Laura R

    2014-10-01

    The objective of the study was to assess the impact of maternal history of adoption or foster care placement in childhood on the risk for preterm birth (PTB), controlling for other known risk factors for PTB. Participants were 302 pregnant women from a low-income, diverse sample drawn from 2 intensive prospective studies of maternal mood and behavior and fetal and infant development. Gestational age was determined by best obstetric estimate. Maternal history of adoption or foster care placement prior to age 18 years was determined by maternal report. Other maternal characteristics, including maternal medical conditions, psychosocial characteristics, and health behaviors, were measured during the second and third trimesters of pregnancy. The odds of delivering preterm (gestational age <37 weeks) were approximately 4 times greater among women with a history of childhood adoption or foster care placement compared with women who were never placed out of the home during childhood. This association remained significant after adjusting for other known risk factors for PTB including maternal medical conditions, psychosocial characteristics, and negative health behaviors in pregnancy. Findings suggest that a history of adoption/foster care placement is an important risk factor for PTB and may be comparable with other established risk factors for PTB including prior history of PTB, body mass index, African-American race, and advanced maternal age. More studies are needed to understand why women with placement histories may be at increased risk to deliver preterm. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. [Maternal death of obstetrical origin. Medicolegal aspects].

    PubMed

    Chevrant-Breton, O; Lebervet, J Y; Vialard, J

    1985-01-01

    The authors have become interested in maternal mortality. This study has been carried out solely to look at the medico-legal aspect. Increasingly good health is seen as a right and the doctor the dispenser of this service. The rights of the mother (and of the infant) become of increasing importance. The improvement in obstetrical techniques, which are much better known to the public, have made families far more confident of the results of delivery. This is now seen as something without any danger. But delivering a baby still has lots of risks. Because of this, if an accident happens the obstetrician more than any other doctor perhaps can find himself in the courts. To avoid this he has to know very well the causes of maternal mortality in order to avoid them as far as possible. Furthermore, he must not undertake stupid emergency measures often initiated as measures of desperation caused by his emotional involvement for a patient who is approaching death. Finally, the expert should look for all the causes of death so that he does no wrongly blame the doctor for a maternal death.

  19. Feto-Maternal Trafficking of Exosomes in Murine Pregnancy Models

    PubMed Central

    Sheller-Miller, Samantha; Lei, Jun; Saade, George; Salomon, Carlos; Burd, Irina; Menon, Ramkumar

    2016-01-01

    Timing and initiation of labor are well-orchestrated by signals communicated between the fetal and maternal compartments; however, how these signals are communicated is not completely understood. Fetal exosomes, intercellular signaling vesicles, may play a key role in the process. The objective of this study was to evaluate exosome trafficking in vivo from fetal to maternal compartments. Pregnant CD-1 mice were intra-amniotically injected on gestational day 16 and 17 with exosomes isolated from primary human amnion epithelial cells fluorescently labeled with the lipophilic dye 1,1-dioctadecyl-3,3,3,3-tetramethylindotricarbocyanine iodide (DiR). All our analyses were performed on samples collected on Day 18. After 24 h, mice were imaged using Bruker MS FX PRO In vivo Imager and tissues were collected. In vivo imaging of mouse showed fluorescence in the uterus, on the exosome-injected side whereas the uterine tissues from the uninjected side and saline and dye alone injected animals remained negative. Histological analysis of placenta showed exosome migration from the fetal to the maternal side of the placenta. Fluorescence released from exosomes was seen in maternal blood samples as well as in maternal uterus and kidneys. This study demonstrates that exosomal cargo can be carried through systemic route from the fetal to the maternal side of the uterine tissues during pregnancy, supporting the idea that fetal signals can be delivered via exosomes. PMID:27895585

  20. Maternal factors in predicting low birth weight babies.

    PubMed

    Yadav, Hematram; Lee, Nagarajah

    2013-01-01

    This study examines the association between maternal factors and low birth weight among newborns at a tertiary hospital in Malaysia. This was a cross-sectional study where mothers were followed through from first booking till delivery. There were 666 mothers who delivered from May 2007 to March 2008. Infants' birth weight were compared with maternal age, pre-pregnancy BMI, fathers BMI, parity, ethnicity, per capita monthly income, and maternal blood pressure during pregnancy. A multiple logistic regressions was used to determine the relationship of maternal factors and low birth weight, while the ROC curve was constructed to assess the sensitivity and specificity of the predictive model. Among the significant risk factors of low birth weight were older age (35 years and above), low pre-pregnancy BMI (<20 kg/m2), parity of 4 and above, Indian origin, economically under privileged, and low and high blood pressure. Blood pressure during pregnancy was an important risk factor for LBW, by using this parameter alone the risk of LBW could be predicted with a sensitivity rate of 70% and a specificity rate of 70%. The sensitivity and specificity was further improved to 80% and 75% percent respectively when other factors like maternal factors such as maternal age, pre-pregnancy BMI, ethnicity, and per capita monthly income were included in the analysis.

  1. Feto-Maternal Trafficking of Exosomes in Murine Pregnancy Models.

    PubMed

    Sheller-Miller, Samantha; Lei, Jun; Saade, George; Salomon, Carlos; Burd, Irina; Menon, Ramkumar

    2016-01-01

    Timing and initiation of labor are well-orchestrated by signals communicated between the fetal and maternal compartments; however, how these signals are communicated is not completely understood. Fetal exosomes, intercellular signaling vesicles, may play a key role in the process. The objective of this study was to evaluate exosome trafficking in vivo from fetal to maternal compartments. Pregnant CD-1 mice were intra-amniotically injected on gestational day 16 and 17 with exosomes isolated from primary human amnion epithelial cells fluorescently labeled with the lipophilic dye 1,1-dioctadecyl-3,3,3,3-tetramethylindotricarbocyanine iodide (DiR). All our analyses were performed on samples collected on Day 18. After 24 h, mice were imaged using Bruker MS FX PRO In vivo Imager and tissues were collected. In vivo imaging of mouse showed fluorescence in the uterus, on the exosome-injected side whereas the uterine tissues from the uninjected side and saline and dye alone injected animals remained negative. Histological analysis of placenta showed exosome migration from the fetal to the maternal side of the placenta. Fluorescence released from exosomes was seen in maternal blood samples as well as in maternal uterus and kidneys. This study demonstrates that exosomal cargo can be carried through systemic route from the fetal to the maternal side of the uterine tissues during pregnancy, supporting the idea that fetal signals can be delivered via exosomes.

  2. 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.

  3. 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

  4. Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia

    PubMed Central

    Mitiku, Demissew; Zidda, Zillo; Yaya, Yaliso

    2017-01-01

    Background In a large population in Southwest Ethiopia (population 700,000), we carried out a complex set of interventions with the aim of reducing maternal mortality. This study evaluated the effects of several coordinated interventions to help improve effective coverage and reduce maternal deaths. Together with the Ministry of Health in Ethiopia, we designed a project to strengthen the health-care system. A particular emphasis was given to upgrade existing institutions so that they could carry out Basic (BEmOC) and Comprehensive Emergency Obstetric Care (CEmOC). Health institutions were upgraded by training non-clinical physicians and midwives by providing the institutions with essential and basic equipment, and by regular monitoring and supervision by staff competent in emergency obstetric work. Results In this implementation study, the maternal mortality ratio (MMR) was the primary outcome. The study was carried out from 2010 to 2013 in three districts, and we registered 38,312 births. The MMR declined by 64% during the intervention period from 477 to 219 deaths per 100,000 live births (OR 0.46; 95% CI 0.24–0.88). The decline in MMR was higher for the districts with CEmOC, while the mean number of antenatal visits for each woman was 2.6 (Inter Quartile Range 2–4). The percentage of pregnant women who attended four or more antenatal controls increased by 20%, with the number of women who delivered at home declining by 10.5% (P<0.001). Similarly, the number of deliveries at health posts, health centres and hospitals increased, and we observed a decline in the use of traditional birth attendants. Households living near to all-weather roads had lower maternal mortality rates (MMR 220) compared with households without roads (MMR 598; OR 2.72 (95% CI 1.61–4.61)). Conclusions Our results show that it is possible to achieve substantial reductions in maternal mortality rates over a short period of time if the effective coverage of well-known interventions is

  5. Maternal and perinatal outcomes of pregnancies delivered at 23 weeks' gestation.

    PubMed

    Crane, Joan M G; Magee, Laura A; Lee, Tang; Synnes, Anne; von Dadelszen, Peter; Dahlgren, Leanne; De Silva, Dane A; Liston, Robert

    2015-03-01

    Objectif : Évaluer les issues maternelles et périnatales des grossesses donnant lieu à un accouchement entre 23+0 et 23+6 semaines de gestation. Méthodes : Cette étude de cohorte prospective portait sur des femmes du Réseau périnatal canadien qui ont été admises à l’une des 16 unités périnatales tertiaires canadiennes participantes entre le 1er août 2005 et le 31 mars 2011, et qui ont accouché entre 23+0 et 23+6 semaines de gestation. Les femmes ont été admises dans le réseau si elles avaient été hospitalisées en raison d’un travail préterme spontané (s’accompagnant de contractions), d’un col court (sans contractions), d’un prolapsus des membranes (s’accompagnant d’une dilatation du col ou dans le cadre duquel les membranes se situaient au niveau de l’orifice externe ou faisaient saillie au-delà de ce dernier), d’une rupture prématurée des membranes préterme, d’un retard de croissance intra-utérin, d’une hypertension gestationnelle ou d’une hémorragie antepartum. Parmi les issues maternelles, on trouvait la césarienne, le décollement placentaire et la manifestation d’une complication grave. La morbidité grave et la mortalité constituaient les issues périnatales. Résultats : En tout, 248 femmes et 287 nouveau-nés ont été inclus dans l’étude. Le taux de césarienne était de 10,5 % (26/248) et 40,3 % des femmes (100/248) ont connu une complication grave (la plus courante étant la chorioamnionite [38,6 %], suivie de la transfusion sanguine [4,5 %]). Parmi les nouveau-nés pour lesquels les issues étaient connues, le taux de mortalité périnatale était de 89,9 % (223/248) (taux de mortinaissance : 23,3 % [67/287] et taux de décès néonatal : 62,9 % [156/248]). Une admission à l’UNSI a été requise pour 38,1 % (69/181) des enfants nés vivants pour lesquels les issues étaient connues (n = 181). Parmi ces enfants ayant dû être admis à l’UNSI, un décès néonatal a été constaté dans 63,8 % (44/69) des cas. Chez les survivants (au moment de l’obtention de leur congé de l’UNSI), le taux de lésion cérébrale grave était de 44,0 % (11/25), le taux de rétinopathie des prématurés était de 58,3 % (14/24) et le taux de quelque morbidité néonatale grave que ce soit était de 100 % (25/25). Deux analyses de sous-groupe ont été menées : dans le cadre de l’une d’entre elles, les mortinaissances pendant la période antepartum ont été exclues; dans le cadre de l’autre, seuls les centres ayant indiqué qu’ils offraient le monitorage fœtal à 23 semaines de gestation ont été inclus et les mortinaissances pendant la période antepartum ont également été exclues. Des issues périnatales semblables à celles du groupe général ont été constatées dans chacune de ces analyses. Conclusion : Les femmes enceintes qui accouchent à 23 semaines de gestation sont exposées à des risques de morbidité. Leurs nouveau-nés présentent des taux élevés de morbidité grave et de mortalité. La poursuite de la recherche s’avère requise pour permettre l’identification de stratégies et de formes de prise en charge qui entraînent non seulement une amélioration du taux de survie périnatale, mais également une baisse des taux de morbidité que connaissent ces nouveau-nés d’âge gestationnel extrêmement faible et les mères.

  6. Methods and Systems for Delivering Maternal and Child Health Care: Research Contributions. Matrix No. 4.

    ERIC Educational Resources Information Center

    Haggerty, Robert J.

    The major contributions of research to the organization and delivery of health services in the past decade (circa 1972-1982) are described and some important areas for further research are indicated in the three main sections of this paper. The first section points out problems associated with the current state of the applied field of health…

  7. Persistent organic pollutants in maternal blood plasma and breast milk from Russian arctic populations.

    PubMed

    Klopov, V; Odland, J O; Burkow, I C

    1998-10-01

    Under the auspices of Arctic Monitoring and Assessment Programme (AMAP), a Russian-Norwegian co-operation project was established to assess the exposure of delivering women to persistent organic pollutants (POPs) in Arctic areas of Russia. In the period 1993-95 blood and breast milk samples were collected from 94 delivering women in Yamal and Tajmyr Autonomous Regions of Siberia. Concentrations of chlorinated pesticides and polychlorinated biphenyls (PCBs) were determined by high resolution gas chromatography with electron capture detection. The POP levels in maternal plasma among the non-indigenous women were higher than the native population, especially in total PCB, HCHs (hexachlorocyclohexanes) and the DDT-group. The dietary questionnaires showed that the non-indigenous populations consumed considerably less local food items like reindeer meat and fresh water fish. There was no correlation between local food consumption and elevated levels of pollutants. Even if the indigenous groups had lower concentrations of the most important pollutants than the non-indigenous population, they were still higher than the levels measured in the Scandinavian countries of the AMAP-study and up to levels of medical concern. The most important sources of organic pollutants for the Russian Arctic populations of Yamal and Tajmyr seems to be imported food from other areas of Russia and local use of pesticides. It must be a high priority concern to further elucidate these trends and initiate prophylactic measures for the exposed population groups.

  8. Maternal arrhythmia and perinatal outcomes

    PubMed Central

    Henry, Dana; Gonzalez, Juan M; Harris, Ian, S.; Sparks, Teresa; Killion, Molly; Thiet, Mari-Paule; Bianco, Katherine

    2016-01-01

    Objective To determine if arrhythmia in the setting of maternal cardiac disease (MCD) affects perinatal outcomes. Study Design This is a retrospective cohort study of pregnant women with MCD who delivered from 2008 to 2013. Perinatal outcomes among women with an arrhythmia were compared to those without. Result Among 143 women; 36 (25%) had an arrhythmia. Those with an arrhythmia were more likely to have a spontaneous vaginal delivery (64% vs. 43%, p < 0.05) and required fewer operative vaginal births (8% vs. 27%, p=0.02). Pregnancies were more likely to be complicated by IUGR (17% vs. 5%, p < 0.05) although there were no differences in the rate of small for gestational age. The risk of IUGR remained increased after controlling for confounding (aOR 6.98, 95% CI 1.59–30.79, p=0.01). Two cases of placental abruption were identified among mothers with arrhythmia while none were identified in the controls (p < 0.05) Conclusion Patients with arrhythmias were more likely to have a spontaneous vaginal delivery. Our data suggests that these pregnancies were an increased risk for IUGR. PMID:27309629

  9. 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.

  10. Maternal mortality--Pumwani Maternity Hospital--1975-1984.

    PubMed

    Ngoka, W M; Bansal, Y P

    1987-04-01

    The study is purpose was to identify the avoidable factors responsible for the high maternal mortality in the Pumwani Maternity Hospital in Nairobi, Kenya and to determine how the available facilities could be used to reduce the mortality. A retrospective study of maternal deaths was carried out at the hospital for the period 1975-1984. During this period, there were 223,111 births and 150 maternal deaths, giving an incidence of maternal mortality of 67.2/100,000 births. Eclampsia and severe preeclampsia, puerperal sepsis, ruptured uterus, and postpartum hemorrhage were among the leading causes of maternal deaths. The authors also concluded that the following factors contributed to the increased maternal mortality: high maternal age; primigravidy; grandmultiparity; lack of good antenatal, intranatal, and postnatal care; lack of investigations; lack of good transfusion services; lack of better skilled anesthetic staff; and lack of discipline among the medical personnel.

  11. Severe maternal outcomes and their predictors among Pakistani women in the WHO Multicountry Survey on Maternal and Newborn Health.

    PubMed

    Mazhar, Syeda B; Batool, Afshan; Emanuel, Angela; Khan, Arif T; Bhutta, Shireen

    2015-04-01

    To determine the incidence of, and the demographic and obstetric factors associated with, severe maternal outcome (SMO) among women presenting at healthcare facilities in Pakistan. A cross-sectional study was conducted in 16 healthcare facilities across Pakistan that had been selected for the WHO Multicountry Survey on Maternal and Newborn health. The hospital records of women who delivered at a participating facility or were admitted with SMO (defined as maternal death or near miss) within 7 days of delivery/abortion were reviewed for a period of 2-3 months in 2011. The incidence of SMO, its associated demographic and obstetric characteristics, and the influence of various maternal health interventions were assessed. Among 13 175 included women, 132 (1.0%) had an SMO (94 [0.7%] near miss and 38 [0.3%] died). The maternal mortality ratio was 299 deaths per 100 000 live births. Major causes of SMO included postpartum hemorrhage (64 [48.5%] women), hypertensive disorders (34 [25.8%]), and ruptured uterus (9 [6.8]). Illiteracy, anemia, and several obstetric complications (e.g. eclampsia) were significant contributors. Improving education, nutrition, and uniform implementation of obstetric care protocols are needed for better maternal and neonatal health in Pakistan. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  12. Legislative Base: Maternal and Child Health Services Block Grant: Title V of the Social Security Act. Compilation of Maternal and Child Health Legislation, 1912-1996.

    ERIC Educational Resources Information Center

    Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Office for Maternal and Child Health Services.

    This publication is a compilation of maternal and child health and related laws enacted since 1912. It is designed as a ready reference for understanding Title V state programs and Title V discretionary project grant programs. The Maternal and Child Health (MCH) program has operated as a federal-state partnership for more than 70 years. This…

  13. Maternal and neonatal tetanus

    PubMed Central

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

    2017-01-01

    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

  14. 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…

  15. 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.

  16. Delivering Australian Vocational Qualifications through Action Learning

    ERIC Educational Resources Information Center

    Cother, Robert; Cother, Genevieve

    2017-01-01

    In 2009, Skills Tasmania approached the authors to deliver their Lean Action Learning programme in Tasmania. This programme had run successfully in South Australia for some five years. For Tasmania, a requirement was that participants in the programme be eligible for a nationally recognised VET qualification on completion of the programme. This…

  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. Delivering Solutions for the Knowledge Economy.

    ERIC Educational Resources Information Center

    Ribbler, Judith

    1996-01-01

    By placing integrated access to online information on the desktop, companies gain a competitive edge, empower their employees, and deliver higher-quality service at less cost. Information audits, focus groups, and employee interviews can determine the information needs of organizations and enhance their information infrastructure. In this light,…

  19. Interactivity in an Electronically Delivered Marketing Course.

    ERIC Educational Resources Information Center

    Larson, Paul D.

    2002-01-01

    In a marketing course delivered using Lotus Notes, 32 students were randomly assigned to large or small groups with heavy or light coaching. No differences in interactivity appeared related to group size or gender. More coaching increased the quantity, not quality, of interactivity. Quality seemed to decrease as quantity increased. (Contains 35…

  20. Interaction of maternal peroxisome proliferator-activated receptor gamma2 Pro12Ala polymorphism with fetal sex affects maternal glycemic control during pregnancy.

    PubMed

    Hocher, Berthold; Schlemm, Ludwig; Haumann, Hannah; Poralla, Christine; Chen, You-Peng; Li, Jian; Guthmann, Florian; Bamberg, Christian; Kalache, Karim D; Pfab, Thiemo

    2010-02-01

    It was suggested that fetal sex may substantially affect maternal glycemic control during pregnancy in genetically susceptible mothers. The peroxisome proliferator-activated receptor gamma2 (PPARgamma2) Pro12Ala polymorphism is known to affect glycemic control and may act in a sex-specific manner. This polymorphism is thus an attractive candidate to test this hypothesis using a second independent functionally relevant polymorphism. We analyzed the impact of fetal sex on maternal glycemic control during pregnancy in relation to the maternal PPARgamma2 Pro12Ala polymorphism. Two-thousand fourteen Caucasian women without preexisting diabetes and preexisting hypertension with singleton pregnancies delivering consecutively at the Charité obstetrics department were genotyped. Glycemic control was analyzed by measuring total glycated hemoglobin at birth. Correction for confounding factors and multiple testing was considered in the analysis. The maternal PPARgamma2 Pro12Ala polymorphism without consideration of fetal sex had no effect on blood pressure, new onset of proteinuria and total glycated hemoglobin at delivery. Mothers carrying both G alleles (GG genotype) delivering a girl had a higher (P = 0.015) total glycated hemoglobin (6.81 or - 0.50%) versus mothers carrying the same alleles but delivering boys (5.85 + or - 0.58%). Comparing mothers with the GG genotype delivering girls with mothers with CC or CG genotypes also delivering girls (6.32 + or - 0.72%) revealed a significantly higher maternal total glycated hemoglobin at delivery in the former group (P < 0.009). Fetal sex/sex chromosomes may substantially affect maternal glycemic control in mothers who are carriers of the GG alleles of the PPARgamma2 Pro12Ala polymorphism.

  1. Project: "Project!"

    ERIC Educational Resources Information Center

    Grayson, Katherine

    2007-01-01

    In November 2006, the editors of "Campus Technology" launched their first-ever High-Resolution Projection Study, to find out if the latest in projector technology could really make a significant difference in teaching, learning, and educational innovation on US campuses. The author and her colleagues asked campus educators,…

  2. Project: "Project!"

    ERIC Educational Resources Information Center

    Grayson, Katherine

    2007-01-01

    In November 2006, the editors of "Campus Technology" launched their first-ever High-Resolution Projection Study, to find out if the latest in projector technology could really make a significant difference in teaching, learning, and educational innovation on US campuses. The author and her colleagues asked campus educators,…

  3. Maternal Competition in Women.

    PubMed

    Linney, Catherine; Korologou-Linden, Laurel; Campbell, Anne

    2017-03-01

    We examined maternal competition, an unexplored form of competition between women. Given women's high investment in offspring and mothers' key role in shaping their reproductive, social, and cultural success as adults, we might expect to see maternal competition between women as well as mate competition. Predictions about the effect of maternal characteristics (age, relationship status, educational background, number of children, investment in the mothering role) and child variables (age, sex) were drawn from evolutionary theory and sociological research. Mothers of primary school children (in two samples: N = 210 and 169) completed a series of questionnaires. A novel nine-item measure of maternal competitive behavior (MCQ) and two subscales assessing Covert (MCQ-C) and Face-to-Face (MCQ-FF) forms of competition were developed using confirmatory factor analysis. Competitiveness (MCQ score) was predicted by maternal investment, single motherhood, fewer children, and (marginally) child's older age. The effect of single motherhood (but not other predictors) was partially mediated by greater maternal investment. In response to a scenario of their child underperforming relative to their peers, a mother's competitive distress was a positive function of the importance she ascribed to their success and her estimation of her child's ability. Her competitive distress was highly correlated with the distress she attributed to a female friend, hinting at bidirectional dyadic effects. Qualitative responses indicated that nonspecific bragging and boasting about academic achievements were the most common irritants. Although 40% of women were angered or annoyed by such comments, less than 5% endorsed a direct hostile response. Instead, competitive mothers were conversationally shunned and rejected as friends. We suggest that the interdependence of mothers based on reciprocal childcare has supported a culture of egalitarianism that is violated by explicit competitiveness.

  4. Maternal Infection During Pregnancy and Autism Spectrum Disorders.

    PubMed

    Zerbo, Ousseny; Qian, Yinge; Yoshida, Cathleen; Grether, Judith K; Van de Water, Judy; Croen, Lisa A

    2015-12-01

    We conducted a nested case-control study including 407 cases and 2,075 frequency matched controls to investigate the association between maternal infections during pregnancy and risk of autism spectrum disorders (ASD). Cases, controls, and maternal infections were ascertained from Kaiser Permanente Northern California clinical databases. No overall association between diagnoses of any maternal infection during pregnancy and ASD was observed [adjusted odds ratio (ORadj) = 1.15, 95 % confidence interval (CI) 0.92-1.43]. However, women with infections diagnosed during a hospital admission (ORadj = 1.48, 95 % CI 1.07-2.04), particularly bacterial infections (ORadj = 1.58, 95 % CI 1.06-2.37), were at increased risk of delivering a child with ASD. Multiple infections during pregnancy were associated with ASD (ORadj = 1.36, 95 % CI 1.05-1.78).

  5. Maternal Infection during Pregnancy and Autism Spectrum Disorders

    PubMed Central

    Zerbo, Ousseny; Qian, Yinge; Yoshida, Cathleen; Grether, Judith K.; Van de Water, Judy; Croen, Lisa A.

    2014-01-01

    We conducted a nested case-control study including 407 cases and 2075 frequency matched controls to investigate the association between maternal infections during pregnancy and risk of autism spectrum disorders (ASD). Cases, controls, and maternal infections were ascertained from Kaiser Permanente Northern California clinical databases. No overall association between diagnoses of any maternal infection during pregnancy and ASD (adjusted odds ratio [ORadj] = 1.15, 95% confidence interval [CI] 0.92 – 1.43). However, women with infections diagnosed during a hospital admission (ORadj= 1.48, 95% CI1.07 – 2.04), particularly bacterial infections (ORadj = 1.58, 95% CI 1.06 – 2.37), were at increased risk of delivering a child with ASD. Multiple infections during pregnancy were associated with ASD (ORadj = 1.36, 95% CI 1.05 – 1.78). PMID:24366406

  6. Paid Maternity Leave and Breastfeeding Outcomes.

    PubMed

    Mirkovic, Kelsey R; Perrine, Cria G; Scanlon, Kelley S

    2016-09-01

    Despite the benefits of breastfeeding, rates in the United States are low. Shorter maternity leave is associated with lower initiation and shorter durations of breastfeeding; however, little is known about how paid maternity leave may influence breastfeeding rates. We used data from the 2006-2010 U.S. National Survey of Family Growth on the most recent birth to employed women who delivered a child within the previous 5 years. Separate multivariable logistic regression models were used to describe the associations between paid leave duration (0, 1-5, 6-11, ≥ 12 weeks, maternity leave not taken) and three outcomes: 1) breastfeeding initiation, 2) 6-month duration, and 3) 6-month duration among initiators. Twenty-eight percent of prenatally employed women received no paid leave. Women who received 12 or more weeks of paid leave were more likely to initiate breastfeeding compared to women with no paid leave (87.3% vs 66.7%, adjusted odds ratio [aOR] 2.83 [95% confidence interval {CI} 1.23-6.48]). Similarly, women with 12 or more weeks of paid leave were more likely to breastfeed at 6 months, compared to women with no paid leave (24.9% vs 50.1%, aOR 2.26 [95% CI 1.20-4.26]). Among women who initiated breastfeeding, having received 12 or more weeks' paid leave increased the odds of breastfeeding for 6 or more months; however, the association was not statistically significant in the adjusted model (aOR 1.81 [95% CI 0.93-3.52]). Employed women who received 12 or more weeks of paid maternity leave were more likely to initiate breastfeeding and be breastfeeding their child at 6 months than those without paid leave. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  7. 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

  8. It Takes a Village to Deliver and Test Child and Family-Focused Services

    PubMed Central

    McKay, Mary M.; Gopalan, Geetha; Franco, Lydia M.; Kalogerogiannis, Kosta; Umpierre, Mari; Olshtain-Mann, Orly; Bannon, William; Elwyn, Laura; Goldstein, Leah

    2011-01-01

    Objectives The purpose of this article is to highlight the benefits of collaboration in child focused mental health services research. Method Three unique research projects are described. These projects address the mental health needs of vulnerable, urban, minority children and their families. In each one, service delivery was codesigned, interventions were co-delivered and a team of stakeholders collaboratively tested the impact of each one. Results The results indicate that the three interventions designed, delivered, and tested are associated with reductions in youth mental health symptoms. Conclusion These interventions are feasible alternatives to traditional individualized outpatient treatment. PMID:21274415

  9. Maternal Response to Child Affect: Role of Maternal Depression and Relationship Quality

    PubMed Central

    Morgan, Judith K.; Ambrosia, Marigrace; Forbes, Erika E.; Cyranowski, Jill M.; Amole, Marlissa C.; Silk, Jennifer S.; Elliott, Rosalind D.; Swartz, Holly A.

    2015-01-01

    Background Maternal depression is associated with negative outcomes for offspring, including increased incidence of child psychopathology. Quality of mother-child relationships can be compromised among affectively ill dyads, such as those characterized by maternal depression and child psychopathology, and negatively impact outcomes bidirectionally. Little is known about the neural mechanisms that may modulate depressed mothers’ responses to their psychiatrically ill children during middle childhood and adolescence, partially because of a need for ecologically valid personally relevant fMRI tasks that might most effectively elicit these neural mechanisms. Methods The current project evaluated maternal response to child positive and negative affective video clips in 19 depressed mothers with psychiatrically ill offspring using a novel fMRI task. Results The task elicited activation in the ventral striatum when mothers viewed positive clips and insula when mothers viewed negative clips of their own (versus unfamiliar) children. Both types of clips elicited activation in regions associated with affect regulation and self-related and social processing. Greater lifetime number of depressive episodes, comorbid anxiety, and poor mother-child relationship quality all emerged as predictors of maternal response to child affect. Limitations Findings may be specific to dyads with psychiatrically ill children. Conclusions Altered neural response to child affect may be an important characteristic of chronic maternal depression and may impact mother-child relationships negatively. Existing interventions for depression may be improved by helping mothers respond to their children’s affect more adaptively. PMID:26331684

  10. Maternal response to child affect: Role of maternal depression and relationship quality.

    PubMed

    Morgan, Judith K; Ambrosia, Marigrace; Forbes, Erika E; Cyranowski, Jill M; Amole, Marlissa C; Silk, Jennifer S; Elliott, Rosalind D; Swartz, Holly A

    2015-11-15

    Maternal depression is associated with negative outcomes for offspring, including increased incidence of child psychopathology. Quality of mother-child relationships can be compromised among affectively ill dyads, such as those characterized by maternal depression and child psychopathology, and negatively impact outcomes bidirectionally. Little is known about the neural mechanisms that may modulate depressed mothers' responses to their psychiatrically ill children during middle childhood and adolescence, partially because of a need for ecologically valid personally relevant fMRI tasks that might most effectively elicit these neural mechanisms. The current project evaluated maternal response to child positive and negative affective video clips in 19 depressed mothers with psychiatrically ill offspring using a novel fMRI task. The task elicited activation in the ventral striatum when mothers viewed positive clips and insula when mothers viewed negative clips of their own (versus unfamiliar) children. Both types of clips elicited activation in regions associated with affect regulation and self-related and social processing. Greater lifetime number of depressive episodes, comorbid anxiety, and poor mother-child relationship quality all emerged as predictors of maternal response to child affect. Findings may be specific to dyads with psychiatrically ill children. Altered neural response to child affect may be an important characteristic of chronic maternal depression and may impact mother-child relationships negatively. Existing interventions for depression may be improved by helping mothers respond to their children's affect more adaptively. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Maternal MCG Interference Cancellation Using Splined Independent Component Subtraction

    PubMed Central

    Yu, Suhong

    2011-01-01

    Signal distortion is commonly observed when using independent component analysis (ICA) to remove maternal cardiac interference from the fetal magnetocardiogram. This can be seen even in the most conservative case where only the independent components dominated by maternal interference are subtracted from the raw signal, a procedure we refer to as independent component subtraction (ICS). Distortion occurs when the subspaces of the fetal and maternal signals have appreciable overlap. To overcome this problem, we employed splining to remove the fetal signal from the maternal source component. The maternal source components were downsampled and then interpolated to their original sampling rate using a cubic spline. A key aspect of the splining procedure is that the maternal QRS complexes are downsampled much less than the rest of the maternal signal so that they are not distorted, despite their higher bandwidth. The splined maternal source components were projected back onto the magnetic field measurement space and then subtracted from the raw signal. The method was evaluated using data from 24 subjects. We compared the results of conventional, i.e., unsplined, ICS with our method, splined ICS, using matched filtering as a reference. Correlation and subjective assessment of the P-wave and QRS complex were used to assess the performance. Using ICS, we found that the P-wave was adversely affected in 7 of 24 (29%) subjects, all having correlations less than 0.8. Splined ICS showed negligible distortion and improved the signal fidelity to some extent in all subjects. We also demonstrated that maternal T-wave interference could be problematic when the fetal and maternal heartbeats were synchronous. In these instances, splined ICS was more effective than matched filtering. PMID:21712157

  12. Out of pocket expenditure to deliver at public health facilities in India: a cross sectional analysis.

    PubMed

    Issac, Anns; Chatterjee, Susmita; Srivastava, Aradhana; Bhattacharyya, Sanghita

    2016-08-24

    To expand access to safe deliveries, some developing countries have initiated demand-side financing schemes promoting institutional delivery. In the context of conditional cash incentive scheme and free maternity care in public health facilities in India, studies have highlighted high out of pocket expenditure (OOPE) of Indian families for delivery and maternity care. In this context the study assesses the components of OOPE that women incurred while accessing maternity care in public health facilities in Uttar Pradesh, India. It also assesses the determinants of OOPE and the level of maternal satisfaction while accessing care from these facilities. It is a cross-sectional analysis of 558 recently delivered women who have delivered at four public health facilities in Uttar Pradesh, India. All OOPE related information was collected through interviews using structured pre-tested questionnaires. Frequencies, Mann-Whitney test and categorical regression were used for data reduction. The analysis showed that the median OOPE was INR 700 (US$ 11.48) which varied between INR 680 (US$ 11.15) for normal delivery and INR 970 (US$ 15.9) for complicated cases. Tips for getting services (consisting of gifts and tips for services) with a median value of INR 320 (US$ 5.25) contributed to the major share in OOPE. Women from households with income more than INR 4000 (US$ 65.57) per month, general castes, primi-gravida, complicated delivery and those not accompanied by community health workers incurred higher OOPE. The significant predictors for high OOPE were caste (General Vs. OBC, SC/ST), type of delivery (Complicated Vs. Normal), and presence of ASHA (No Vs. Yes). OOPE while accessing care for delivery was one among the least satisfactory items and 76 % women expressed their dissatisfaction. Even though services at the public health facilities in India are supposed to be provided free of cost, it is actually not free, and the women in this study paid almost half of their mandated

  13. Maternal metabolic syndrome, preeclampsia, and small for gestational age infancy.

    PubMed

    Hooijschuur, Mieke C E; Ghossein-Doha, Chahinda; Al-Nasiry, Salwan; Spaanderman, Marc E A

    2015-09-01

    We sought to explore to what extent the presence of cardiometabolic and cardiovascular risk constitutions differ between pregnancies complicated by small-for-gestational-age (SGA) infancy, preeclampsia (PE), or a combination of both. We conducted a cohort study in women after pregnancies complicated by placental syndrome with fetal manifestations (SGA infancy [n = 113]), maternal manifestations (PE [n = 729]), or both (n = 461). Independent sample t test was used to compare cardiometabolic and cardiovascular risk factors between groups. Logistic regression was used to calculate odds ratios and adjusted odds ratios of the prevalence of the metabolic syndrome and its constituents between groups. Adjustments were made for maternal age, parity, smoking, interval between delivery and measurements, and intrauterine fetal demise. The metabolic syndrome was present in 7.5% of women who delivered SGA infants, 15.6% of former PE women, and 19.8% of women after pregnancy complicated by both SGA and PE. Hypertension was observed in 25% of former PE women and 15% of women with solely SGA. Women who delivered a SGA infant had lower global vascular compliance compared to former PE women without SGA. Cardiometabolic risk factors consistent with metabolic syndrome relate to the maternal rather than to the fetal presentation of placental syndrome. Nonetheless, highest incidence of metabolic syndrome was observed in women with both PE and SGA. PE relates to chronic hypertension, whereas increased arterial stiffness seems to be associated with women who deliver a SGA infant. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Reduced maternal and cord nerve growth factor levels in preterm deliveries.

    PubMed

    Dhobale, Madhavi; Mehendale, Savita; Pisal, Hemlata; Nimbargi, Vandana; Joshi, Sadhana

    2012-04-01

    Nerve growth factor (NGF) is a neurotrophin, which exerts an important role in the development and function of the central and peripheral nervous system. There is limited information regarding the levels of NGF during pregnancy and its role in fetal development. We have earlier reported increased oxidative stress in pregnancy complications. The present study examines the levels of NGF in maternal and cord samples in preterm deliveries and its association with oxidative stress marker. A total number of 96 women delivering preterm (<37 weeks gestation) and 94 women delivering at term (control group) (≥37 weeks gestation) were recruited. Plasma NGF levels were measured in both mother and cord plasma using the Emax Immuno Assay System Promega kit. Maternal and cord plasma NGF levels were significantly reduced (p<0.05 for both) in women delivering preterm as compared to term. There was a positive association between maternal and cord plasma NGF levels (p=0.022). Maternal NGF levels were negatively (p=0.017) associated with maternal malondialdehyde (MDA) levels. Reduced cord NGF levels may affect fetal growth in preterm deliveries which may have implications for the neurodevelopmental pathologies in later life. Circulating maternal NGF levels in preterm pregnancies may be a useful marker to predict NGF levels in the neonate.

  15. Update on anesthesia and the immune response in newborns delivered by cesarian section.

    PubMed

    Rizzo, Annalisa; Campanile, Debora; Spedicato, Massimo; Minoia, Giuseppe; Sciorsci, Raffaele L

    2011-12-01

    In infants delivered by cesarian section, the immune system could be influenced by anesthetic drugs that may cross the placenta and reach the fetal circulation. Factors that determine placental transfer of anesthetics and their distribution into and ultimate removal from fetal tissue include physiochemical properties of the compound; the anatomic features of the maternal circulation, placenta, and fetus; and the hemodynamic and pharmacokinetic events that occur within them. Because the anesthetic agents can interfere with many neonatal function, the aim of this manuscript is to review the interference of regional or general anesthesia on neonatal immune response.

  16. 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…

  17. 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…

  18. 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:…

  19. 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…

  20. The politics of maternity.

    PubMed

    Mander, Rosemary; Edwards, Nadine; McHugh, Nessa; Murphy-Lawless, Jo; Patterson, Jenny

    2014-02-01

    Changes in the culture of health care require that, to be effective, midwifery practice should become more woman-centred. This may be facilitated by adopting a stronger community orientation. In this way the hegemony of maternity care may be addressed. This paper seeks to draw readers' attention to political developments and to inspire midwives to greater awareness and, possibly, activity.

  1. Maternity Leave Policies

    PubMed Central

    Strang, Lucy; Broeks, Miriam

    2017-01-01

    Abstract Over recent years many European Union countries have made changes to the design of the maternity leave provision. These policy developments reflect calls for greater gender equality in the workforce and more equal share of childcare responsibilities. However, while research shows that long period of leave can have negative effects on women's labour market attachment and career advancements, early return to work can be seen as a factor preventing exclusive breastfeeding, and therefore, potentially having negative health impacts for babies. Indeed, the World Health Organisation recommends exclusive breastfeeding up to 6 months of age to provide babies with the nutrition for healthy growth and brain development, protection from life-threatening ailments, obesity and non-communicable diseases such as asthma and diabetes. Therefore, labour market demands on women may be at odds with the health benefits for children gained by longer periods of maternity leave. The aim of this article is to examine the relationship between leave provision and health benefits for children. We examine maternity and parental leave provision across European countries and its potential impact on the breastfeeding of very young babies (up to 6-months of age). We also consider economic factors of potential extension of maternity leave provision to 6 months, such as costs to businesses, effects on the female labour market attachment, and wider consequences (benefits and costs) for individuals, families, employers and the wider society. PMID:28983432

  2. 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…

  3. Maternal correlates of maternal child feeding practices: a systematic review.

    PubMed

    McPhie, Skye; Skouteris, Helen; Daniels, Lynne; Jansen, Elena

    2014-01-01

    Establishing healthy eating habits early in life is one important strategy to combat childhood obesity. Given that early maternal child feeding practices have been linked to child food intake and weight, identifying the maternal correlates of maternal child feeding practices is important in order to understand the determinants of childhood obesity; this was the overall aim of the current review. Academic databases were searched for studies examining the relationship between maternal child feeding practices and parenting, personal characteristics and psychopathology of mothers with preschoolers. Papers were limited to those published in English, between January 2000 and June 2012. Only studies with mothers of normally developing children between the ages of 2 and 6 years were included. There were no restrictions regarding the inclusion of maternal nationality or socioeconomic status (SES). Seventeen eligible studies were sourced. Information on the aim, sample, measures and findings of these was summarised into tables. The findings of this review support a relationship between maternal controlling parenting, general and eating psychopathology, and SES and maternal child feeding practices. The main methodological issues of the studies reviewed included inconsistency in measures of maternal variables across studies and cross-sectional designs. We conclude that the maternal correlates associated with maternal child feeding practices are complex, and the pathways by which maternal correlates impact these feeding practices require further investigation.

  4. 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.

  5. TMS delivered for A-3 Test Stand

    NASA Image and Video Library

    2010-03-17

    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.

  6. Reversal of foetal hydrops and foetal tachyarrhythmia associated with maternal diabetic coma.

    PubMed

    Greco, P; Vimercati, A; Giorgino, F; Loverro, G; Selvaggi, L

    2000-11-01

    Foetal hydrops is always a challenge for the clinician. We report a case of tachycardia associated with hydrops and hydramnios in a pregnancy complicated with diabetic coma at 28 weeks gestation. Normal foetal heart rate was recorded immediately after correction of maternal acidotic status and hydrops eventually disappeared. The woman was delivered at 32 weeks and the baby had an uncomplicated postnatal course. We hypothesise that maternal ketoacidosis has been the precipitating factor of tachycardia and congestive heart failure and that this case is conceptually similar to the "late death" phenomenon, reported in cases of poorly controlled maternal diabetes.

  7. 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.

  8. A simple circuit to deliver bubbling CPAP.

    PubMed

    Kaur, Charanjit; Sema, Akatoli; Beri, Rajbir S; Puliyel, Jacob M

    2008-04-01

    Nasal continuous positive airway pressure (CPAP), especially bubbling CPAP, is known to reduce the need for more invasive ventilation. We here describe a circuit that can deliver bubbling CPAP in resource poor settings. We describe how the oxygen concentration can be altered from 98% to 21% oxygen using this system. Addition of a humidifier in the circuit has the effect of reducing the oxygen concentration by 1 to 5%. The cost of putting together the system is approximately Rs 5000.

  9. Prospects for prevention of childhood infections by maternal immunization.

    PubMed

    Healy, C Mary; Baker, Carol J

    2006-06-01

    To review the literature on using maternal immunization as a strategy to prevent infections in young infants aged below 6 months Maternal immunization continues to reduce the incidence of neonatal tetanus worldwide. Despite increased influenza-related morbidity and mortality in pregnant women and in infants aged less than 6 months, compliance with US recommendations for immunization against influenza in pregnancy is poor. Polysaccharide vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis are safe and immunogenic in pregnancy. Protein conjugate vaccines against these infections would be likely to induce higher maternal antibody levels and improve placental transport, thereby further reducing the maternal and infant disease burden. Further studies of acellular pertussis vaccines for use in adolescents and adults should evaluate if maternal immunization could prevent life-threatening pertussis in young infants. Maternal immunization against group B streptococcus is projected to be superior to screening and/or chemoprophylaxis strategies in decreasing infant disease. Maternal immunization, with the passage of protective antibody to infants, is a potential strategy to prevent infection in infants who have not completed their primary immunization series from both specific infections of infancy and vaccine-preventable illnesses. Further evaluation of this strategy is supported by medical literature, but liability and educational barriers exist.

  10. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Out-of-hospital births and the supply of maternity units in France.

    PubMed

    Blondel, Béatrice; Drewniak, Nicolas; Pilkington, Hugo; Zeitlin, Jennifer

    2011-09-01

    Maternity unit closures in France have increased distances that women travel to deliver in hospital. We studied how the supply of maternity units influences the rate of out-of-hospital births using birth certificate data. In 2005-6, 4.3 per 1000 births were out-of-hospital. Rates were more than double for women living 30km or more from their nearest unit and were even higher for women of high parity. These associations persisted in multilevel analyses adjusting for other maternal characteristics. Long distances to maternity units should be a concern to health planners because of the maternal and infant health risks. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Maternal anxiety, behaviors, and expectations during a behavioral task: relation to children's self-evaluations.

    PubMed

    Becker, Kimberly D; Ginsburg, Golda S

    2011-06-01

    This study examined the associations between maternal anxiety, behaviors, and expectations and children's self-evaluations of distress, coping, and performance during a stressful performance evaluation task. Seventy-five mothers (38 clinically anxious and 37 nonanxious) along with one of their children aged 6-14 (52.0% female; 78.7% Caucasian) were videotaped while preparing the child to deliver a speech about themselves. Child and parent assessments were obtained before and after the speech, and independent coders rated maternal behavior during the speech preparation. Maternal anxiety and behaviors accounted for a greater proportion of variance in children's self-evaluations than did maternal expectations, such that children of mothers who reported higher task anxiety and demonstrated more overcontrol and anxious behavior during the task evaluated themselves more negatively. These findings extend the literature by providing information about the relative associations between maternal factors and children's self-evaluations within the context of an in vivo stressful situation.

  13. Determinants of maternal health services utilization in Uganda.

    PubMed

    Rutaremwa, Gideon; Wandera, Stephen Ojiambo; Jhamba, Tapiwa; Akiror, Edith; Kiconco, Angela

    2015-07-17

    Uganda's poor maternal health indicators have resulted from weak maternal health services delivery, including access to quality family planning, skilled birth attendance, emergency obstetric care, and postnatal care for mothers and newborns. This paper investigated the predictors of maternal health services (MHS) utilization characterized as: desirable, moderate and undesirable. We used a sample of 1728 women of reproductive ages (15-49), who delivered a child a year prior to the 2011 UDHS survey. A multinomial logistic regression model was used to analyze the relative contribution of the various predictors of ideal maternal health services package utilization. Andersen's Behavioral Model of Health Services Utilization guided the selection of covariates in the regression model. Women with secondary and higher education were more likely to utilize the desirable maternal health care package (RRR = 4.5; 95% CI = 1.5-14.0), compared to those who had none (reference = undesirable MHS package). Women who lived in regions outside Kampala, Uganda's capital, were less likely to utilize the desirable package of maternal health services (Eastern--RRR = 0.2, CI = 0.1-0.5; Western--RRR = 0.3, CI = 0.1-0.8; Central--RRR = 0.3, CI = 0.1-0.8; Northern--RRR = 0.4, CI = 0.2-1.0). Women from the richest households were more likely to utilize the desirable maternal health services package (RRR = 1.9; 95% CI = 1.0-3.7). Residence in rural areas, being Moslem and being married reduced a woman's chances of utilizing moderate maternal health care services. Utilization of maternal health services varied greatly by demographic and socio-economic characteristics. Women with a secondary and higher education, and those of higher income levels, were more likely to utilize the ideal maternal health services package. Therefore, there is need to formulate policies and design maternal health services programs that target the socially marginalized

  14. Maternal mortality in developing countries.

    PubMed

    Thuriaux, M C; Lamotte, J M

    1986-09-01

    The author stresses that uncritical reliance on the institutional maternal mortality rates in developing countries will provide spurious indications of improvement in this area. There appears to bean an important, although imprecisely known, differential in coverage between deliveries and maternal deaths. In 1 area, the institutional maternal mortality rate was 10 times higher among unbooked than among booked deliveries. Moreover, caution should be used in transposing maternal mortality estimates based on life table data from Europe and North America from the early 20th century to present-day Africa. Health statistics should be used to monitor health status; analyzed reduction in maternal mortality should be analyzed carefully to ensure they are valid.

  15. Who delivers where? The effect of obstetric risk on facility delivery in East Africa.

    PubMed

    Virgo, Sandra; Gon, Giorgia; Cavallaro, Francesca L; Graham, Wendy; Woodd, Susannah

    2017-09-01

    Skilled attendance at birth is key for the survival of pregnant women. This study investigates whether women at increased risk of maternal and newborn complications in four East African countries are more likely to deliver in a health facility than those at lower risk. Demographic and Health Survey data for Kenya 2014, Rwanda 2014-15, Tanzania 2015-16 and Uganda 2011 were used to study women with a live birth in the three years preceding the survey. A three-level obstetric risk index was created using known risk factors. Generalised linear Poisson regression was used to investigate the association between obstetric risk and facility delivery. We analysed data from 13 119 women across the four countries of whom 42-45% were considered at medium risk and 12-17% at high risk, and the remainder were at low risk. In Rwanda, 93% of all women delivered in facilities but this was lower (59-66%) in the other three countries. There was no association between a woman's obstetric risk level and her place of delivery in any country; greater wealth and more education were, however, independently strongly associated with facility delivery. In four East African countries, women at higher obstetric risk were not more likely to deliver in a facility than those with lower risk. This calls for a renewed focus on antenatal risk screening and improved communication on birth planning to ensure women with an increased chance of maternal and newborn complications are supported to deliver in facilities with skilled care. © 2017 John Wiley & Sons Ltd.

  16. 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

  17. [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.

  18. Reducing maternal mortality in St Petersburg.

    PubMed

    Stephenson, P; Chalmers, B; Kirichenko, V F; Repina, M A; Wagner, M

    1997-01-01

    Following the entry of St Petersburg into Europe's Healthy Cities Project in 1991 it was decided that the highest priority should be given to reducing the city's maternal mortality ratio, then standing at approximately 70 deaths per 100,000 live births. Preventing deaths from unsafe, illegal abortion became the main focus of attention. The use of modern contraceptive methods was promoted, information was disseminated to improve the utilization of family planning services, special outreach services for teenagers were established, and providers were given opportunities for education and training. The maternal mortality ratio and the abortion rate have now declined and contraceptive use appears to be increasing. These achievements are attributable in large measure to the commitment of a broad spectrum of St Petersburg society as well as to outside support.

  19. Developing a Core Competency Model and Educational Framework for Primary Maternity Services: a national consensus approach.

    PubMed

    Homer, Caroline S E; Griffiths, Marnie; Brodie, Pat M; Kildea, Sue; Curtin, Austin M; Ellwood, David A

    2012-09-01

    An appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals. Key stakeholders from professional organisations and providers of services related to maternity care and consumers of services. A national consensus approach was undertaken using consultation processes with a Steering Committee, a wider Reference Group and public consultation. A national Core Competencies and Educational Framework for Primary Maternity Services in Australia was developed through an iterative process with a range of key stakeholders. There are a number of strategies that may assist in the integration of these into primary maternity service provider professional groups' education and practice. The Core Competencies and Educational Framework are based on an interprofessional approach to learning and primary maternity service practice. They have sought to value professional expertise and stimulate awareness and respect for the roles of all primary maternity service providers. The competencies and framework described in this paper are now a critical component of Australian maternity services as they are included in actions in the newly released National Maternity Services Plan and thus have relevance for all providers of Australian maternity services. Copyright © 2011 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  20. Maternal deaths due to liver disease in Malaysia.

    PubMed

    Ravindran, J; Jayadev, R; Lachmanan, S R; Merican, I

    2000-06-01

    Liver disease is an important and serious condition in pregnancy. The Confidential Enquiries Into Maternal Deaths in Malaysia showed that there were 23 maternal deaths attributed to liver disease between 1991-1994. Over the same period, there were 1066 reported maternal deaths with 929 of them being due to direct and indirect causes. Thus 2.15% of such deaths were due to liver disease in Malaysia. The three main causes of maternal deaths due to liver disease in pregnancy were hepatitis (6 cases), acute fatty liver in pregnancy (6 cases) and septicaemia (4 cases). Liver disease is common at a mean of thirty weeks of gestation with a preponderance to women of low parity. Only two patients in this series had no antenatal care. The majority of cases (45.8%) presented between 28-37 weeks of gestation. All cases delivered by spontaneous vaginal delivery. Remediable factors that were identified included failure to appreciate the severity of disease. Case summaries of all the cases of maternal deaths due to liver disease are discussed and a guideline to management of liver disease in pregnancy presented.

  1. 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

  2. Delivering sound energy along an arbitrary convex trajectory.

    PubMed

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

    2014-10-15

    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.

  3. Delivering cervical cancer prevention services in low-resource settings.

    PubMed

    Bradley, J; Barone, M; Mahé, C; Lewis, R; Luciani, S

    2005-05-01

    The goals of any cervical cancer prevention program should be threefold: to achieve high coverage of the population at risk, to screen women with an accurate test as part of high-quality services, and to ensure that women with positive test results are properly managed. This article focuses on the experiences of the Alliance for Cervical Cancer Prevention (ACCP) in delivery of screening and treatment services as part of cervical cancer prevention projects in Africa, Latin America, and Asia. Research and experience show that cervical cancer can be prevented when strategies and services are well planned and well managed and when attention is paid to program monitoring and evaluation. Coordination of program components, reduction of the number of visits, improvement of service quality, and flexibility in how services are delivered are all essential features of an effective service.

  4. 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

  5. Maternity care and Human Rights: what do women think?

    PubMed

    Solnes Miltenburg, Andrea; Lambermon, Fleur; Hamelink, Cees; Meguid, Tarek

    2016-07-02

    A human rights approach to maternal health is considered as a useful framework in international efforts to reduce maternal mortality. Although fundamental human rights principles are incorporated into legal and medical frameworks, human rights have to be translated into measurable actions and outcomes. So far, their substantive applications remain unclear. The aim of this study is to explore women's perspectives and experiences of maternal health services through a human rights perspective in Magu District, Tanzania. This study is a qualitative exploration of perspectives and experiences of women regarding maternity services in government health facilities. The point of departure is a Human Rights perspective. A total of 36 semi-structured interviews were held with 17 women, between the age of 31 and 63, supplemented with one focus group discussion of a selection of the interviewed women, in three rural villages and the town centre in Magu District. Data analysis was performed using a coding scheme based on four human rights principles: dignity, autonomy, equality and safety. Women's experiences of maternal health services reflect several sub-standard care factors relating to violations of multiple human rights principles. Women were aware that substandard care was present and described a range of ways how the services could be delivered that would venerate human rights principles. Prominent themes included: 'being treated well and equal', 'being respected' and 'being given the appropriate information and medical treatment'. Women in this rural Tanzanian setting are aware that their experiences of maternity care reflect violations of their basic rights and are able to voice what basic human rights principles mean to them as well as their desired applications in maternal health service provision.

  6. Phenylketonuria and maternal phenylketonuria.

    PubMed

    Purnell, H

    2001-07-01

    Phenylketonuria is a genetic disease affecting 1:10,000 to 14,000 live births. In NSW there is an average of nine cases diagnosed each year (Dietitians Working Party 1996). This paper discusses the management of phenylketonuria, and in particular the value of breastfeeding, complemented with a low phenylalanine infant formula, in facilitating easier maintenance of satisfactory phenylalanine blood levels. The 'diet for life' approach to managing phenylketonuria is to avoid long-term neurological deficits and, in particular, the risk that maternal PKU, which is not under strict dietary control, will have adverse effects on infants born of mothers with the disease. There have been 31 successful pregnancies to 1997 managed by the Nutrition and Dietetics Department of The Children's Hospital at Westmead, Sydney. The Maternal PKU diet is presented with the case of a client with phenylketonuria who has achieved two normal pregnancies and breastfed her second child for six months.

  7. 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.

  8. Rural Redesign: Delivering Online Professional Development for Rural Teachers of ESL

    ERIC Educational Resources Information Center

    Manner, Jane Carol; Rodriguez, Diane

    2012-01-01

    This study reports the progress of a project in a teacher education program designed to deliver professional development to rural teachers through an online format addressing ESOL (English for speakers of other languages). Funded by a Professional Development Grant from the OELA (Office of English Language Acquisition) of the United States…

  9. 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.…

  10. 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...

  11. 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…

  12. 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…

  13. 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…

  14. 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.…

  15. 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…

  16. Delivering hazard information: from misunderstandings to mayhem

    NASA Astrophysics Data System (ADS)

    Kilburn, Christopher; Solana, Carmen; Michnowicz, Sabina; Edwards, Stephen

    2014-05-01

    Misunderstandings between monitoring specialists, decision makers and the public can transform a volcanic emergency into a disaster. They are especially likely to occur during unrest at long-quiescent volcanoes, where few, if any, of the key groups may have experience of such behaviour. The potential for misunderstanding strongly depends on the quality of scientific information and the manner in which it is delivered. The same factors determine the nature of a misunderstanding, which, in turn, affects the perception and response of vulnerable communities. As we illustrate with selected case studies, four classes of response can be recognised: realistic, overconfident, confused and sceptical. A response is realistic when good information has been delivered effectively and, as a result, has been well understood. Overconfidence occurs when a recipient overestimates how well they have understood the information supplied. Overestimation may not be immediately evident, so that the provider erroneously believes that the information has been understood and no further action is necessary. Confused and sceptical responses occur when the information delivered is insufficient or ambiguous. In the first case, the impact of poor information is compounded by a poor understanding; in the second, the information is recognised as being inadequate and so engenders a lack of trust. The realistic response represents an ideal outcome for hazard-mitigation procedures and is often implicitly anticipated when the procedures are being developed. In practice, however, one of the other responses usually prevails. Crucial improvements will follow when account is taken explicitly of the full range of potential response and will require raising awareness among key groups of the needs and limitations of each other.

  17. Maternal serum screening.

    PubMed Central

    Carroll, J. C.

    1994-01-01

    Maternal serum screening (MSS) measures three serum markers: alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol, from which the risk of fetal Down syndrome or open neural tube defect is calculated. Initially, 8% of women will have positive results. I present a protocol for investigating these women. Family physicians should be informed about MSS so they can give their patients information and guidance. PMID:7524838

  18. Maternal race and intergenerational preterm birth recurrence.

    PubMed

    Smid, Marcela C; Lee, Jong Hyung; Grant, Jacqueline H; Miles, Gandarvaka; Stoddard, Gregory J; Chapman, Derek A; Manuck, Tracy A

    2017-10-01

    Preterm birth is a complex disorder with a heritable genetic component. Studies of primarily White women born preterm show that they have an increased risk of subsequently delivering preterm. This risk of intergenerational preterm birth is poorly defined among Black women. Our objective was to evaluate and compare intergenerational preterm birth risk among non-Hispanic Black and non-Hispanic White mothers. This was a population-based retrospective cohort study, using the Virginia Intergenerational Linked Birth File. All non-Hispanic Black and non-Hispanic White mothers born in Virginia 1960 through 1996 who delivered their first live-born, nonanomalous, singleton infant ≥20 weeks from 2005 through 2009 were included. We assessed the overall gestational age distribution between non-Hispanic Black and White mothers born term and preterm (<37 weeks) and their infants born term and preterm (<37 weeks) using Cox regression and Kaplan-Meier survivor functions. Mothers were grouped by maternal gestational age at delivery (term, ≥37 completed weeks; late preterm birth, 34-36 weeks; and early preterm birth, <34 weeks). The primary outcomes were: (1) preterm birth among all eligible births; and (2) suspected spontaneous preterm birth among births to women with medical complications (eg, diabetes, hypertension, preeclampsia and thus higher risk for a medically indicated preterm birth). Multivariable logistic regression was used to estimate odds of preterm birth and spontaneous preterm birth by maternal race and maternal gestational age after adjusting for confounders including maternal education, maternal age, smoking, drug/alcohol use, and infant gender. Of 173,822 deliveries captured in the intergenerational birth cohort, 71,676 (41.2%) women met inclusion criteria for this study. Of the entire cohort, 30.0% (n = 21,467) were non-Hispanic Black and 70.0% were non-Hispanic White mothers. Compared to non-Hispanic White mothers, non-Hispanic Black mothers were more likely

  19. Maternal mortality in developing countries.

    PubMed

    Thuriaux, M C; Lamotte, J M

    1985-09-01

    The authors of this letter respond to earlier letters prepared in response to their article on maternal mortality in developing countries. It is conceded that maternal mortality is high in India and Bangladesh; however, statistics from Gambia are based on small populations and are therefore inconclusive. It is noted that a 7-year survey of 4000 households in Machakos, Kenya, where 73% of deliveries occurred at home, yielded a maternal mortality rate of only 0.8/1000 deliveries. Finally, it is asserted that the measurement traditionally used in estimating maternal mortality for many African countries (ratio of recorded maternal deaths to recorded deliveries) is misleading. Maternal deaths are more likely than deliveries to be recorded. In Niger, the number of maternal deaths increased from 1980 (374) to 1982 (484). The ratio of maternal deaths to expected live births also increased from 135 to 166/100,000, whereas the traditionally calculated maternal mortality rate decreased from 519 to 420/100,000 due to changes in the denominators. It is recommended that health authorities of African countries such as Niger consider setting an absolute number of maternal deaths below which they would try to bring the current toll.

  20. 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

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

    PubMed

    Huq, Nafisa Lira; Azmi, Asrafi Jahan; Quaiyum, M A; Hossain, Shahed

    2014-07-12

    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. 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. 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 to communication with

  2. Obstetric transition in the World Health Organization Multicountry Survey on Maternal and Newborn Health: exploring pathways for maternal mortality reduction.

    PubMed

    Chaves, Solange da Cruz; Cecatti, José Guilherme; Carroli, Guillermo; Lumbiganon, Pisake; Hogue, Carol J; Mori, Rintaro; Zhang, Jun; Jayaratne, Kapila; Togoobaatar, Ganchimeg; Pileggi-Castro, Cynthia; Bohren, Meghan; Vogel, Joshua Peter; Tunçalp, Özge; Oladapo, Olufemi Taiwo; Gülmezoglu, Ahmet Metin; Temmerman, Marleen; Souza, João Paulo

    2015-05-01

    To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework. This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month period in 2010-2011. The ratios of Potentially Life-Threatening Conditions, Severe Maternal Outcomes, Maternal Near Miss, and Maternal Death were estimated and stratified by stages of obstetric transition. The characteristics of each stage are defined. Data from 314 623 women showed that female fertility, indirectly estimated by parity, was higher in countries at a lower obstetric transition stage, ranging from a mean of 3 children in Stage II to 1.8 children in Stage IV. Medicalization increased with obstetric transition stage. In Stage IV, women had 2.4 times the cesarean deliveries (15.3% in Stage II and 36.7% in Stage IV) and 2.6 times the labor inductions (7.1% in Stage II and 18.8% in Stage IV) as women in Stage II. The mean age of primiparous women also increased with stage. The occurrence of uterine rupture had a decreasing trend, dropping by 5.2 times, from 178 to 34 cases per 100 000 live births, as a country transitioned from Stage II to IV. This analysis supports the concept of obstetric transition using multicountry data. The Obstetric Transition Model could provide justification for customizing strategies for reducing maternal mortality according to a country's stage in the obstetric transition.

  3. Influence of formal maternal education on the use of maternity services in Enugu, Nigeria.

    PubMed

    Ikeako, L C; Onah, H E; Iloabachie, G C

    2006-01-01

    Although some previous studies have suggested formal maternal education as the most potent tool for reducing the mortality ratio in Nigeria, other studies found that the depressed Nigerian economy since 1986 has marginalised the benefits of education with the result that educated women stopped making use of existing health facilities because they could not afford the cost of health services. This study was carried out to determine the current influence of formal maternal education and other factors on the choice of place of delivery by pregnant women in Enugu, south-eastern Nigeria. It was a pre-tested interviewer-administered questionnaire study of women who delivered within 3 months before the date of data collection in the study area. In an increasing order of level of care, the outcome variable (place where the last delivery took place) was categorised into seven, with home deliveries representing the lowest category and private hospitals run by specialist obstetricians as the highest category. These were further sub-categorised into non-institutional deliveries and institutional deliveries. Maternal educational level was the main predictor variable. Other predictor variables were sociodemographic factors. Data analysis was by means of descriptive and inferential statistics including means, frequencies and chi2-tests at the 95% confidence (CI) level. Out of a total of 1,450 women to whom the questionnaires were administered, 1,095 women responded (a response rate of 75.5%). A total of 579 (52.9%) of the respondents delivered outside health institutions, while the remaining 516 (47.1%) delivered within health institutions. Regarding the educational levels of the respondents, 301 (27.5%) had no formal education; 410 (37.4%) had primary education; 148 (13.5%) secondary education and 236 (21.5%) post-secondary education. There was a significant positive correlation between the educational levels of the respondents and their husbands (r=0.86, p=0.000). With respect

  4. Maternally acquired runt disease.

    PubMed

    Beer, A E; Billingham, R E

    1973-01-19

    Without altering the structural integrity of the placenta by irradiation or drugs, we have shown that it is possible to immunize females both adoptively and actively against the paternally inherited transplantation antigens of their fetuses. Such immunization causes a high incidence of runt disease among the litters. Although the putative chimeric status of the affected offspring has yet to be confirmed, the results of our experiments support the thesis that runt disease is caused by the activities of "unwanted" immigrant lymphocytes from the maternal circulation. Our results suggest that immunologically activated cells are more likely to cross the placenta than normal cells and that this greater mobility may not be related to the immunologic specificity of the activated cells. Two factors may have contributed to the apparent failure of numerous previous attempts to demonstrate the capacity of transplantation immunity to affect the well-being of a fetus or, more correctly, its placenta, in the way that might be expected of a homograft. (i) Investigators were preoccupied with obtaining a classic type of rejection, in utero, analogous to the rejection of an orthotopic skin homograft. The birth of consistently healthy-looking litters, interpreted as a failure of the experiment, convinced the investigators of the efficacy of nature's solution of the homograft problem and there was no reason for them to suspect its possible limitations. Observation of the litters for several weeks might have uncovered the phenomenon of maternally induced runt disease. (ii) Most investigators resorted to hyperimmunization of the mothers. This would have facilitated the synthesis of protective isoantibodies capable of interfering with the expression of the potentially harmful cellular immune response (6). Ever since the abnormalities of runt disease were first described they have repeatedly been compared to those observed in patients with certain lymphomas (17). Various theories have been

  5. Maternal exposure to radiographic exams and major structural birth defects.

    PubMed

    Lim, Hyeyeun; Beasley, Charles W; Whitehead, Lawrence W; Emery, Robert J; Agopian, A J; Langlois, Peter H; Waller, Dorothy K

    2016-07-01

    An increasing number of radiologic exams are performed in the United States, but very few studies have examined the effects of maternal exposure to radiologic exams during the periconceptional period and birth defects. To assess the association between maternal exposure to radiologic exams during the periconceptional period and 19 categories of birth defects using a large population-based study of birth defects. We studied 27,809 case mothers and 10,200 control mothers who participated in the National Birth Defects Prevention Study and delivered between 1997 and 2009. Maternal exposure to radiologic exams that delivered ionizing radiation to the urinary tract, lumbar spine, abdomen, or pelvis were identified based on the mother's report of type of radiologic exams, organ or body part scanned and the month during which the exam occurred Overall, 0.9% of mothers reported exposure to one of these types of radiographic exams during the periconceptional period. We observed significant associations between maternal exposure during the first trimester and isolated Dandy-Walker malformation (odds ratio = 7.7; 95% confidence interval, 1.8-33) and isolated d-transposition of the great arteries (odds ratio = 3.8; 95% confidence interval, 1.4-10.3). However, the result for isolated Dandy-Walker malformation was based on only two exposed cases. These results should be interpreted cautiously because multiple statistical tests were conducted and measurements of exposure were based on maternal report. However, our results may be useful for generating hypotheses for future studies. Birth Defects Research (Part A) 106:563-572, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  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.

  7. 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…

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

    PubMed

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

    2008-01-24

    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. Cross sectional analyses of the National Family Health Survey - 2 dataset. 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. 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. 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.

  9. 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

  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

    USDA-ARS?s Scientific Manuscript database

    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. [Precautionary maternity leave in Tirol].

    PubMed

    Ludescher, K; Baumgartner, E; Roner, A; Brezinka, C

    1998-01-01

    Under Austrian law, precautionary maternity leave is a decree issued by the district public health physician. It forbids a pregnant woman to work and mandates immediate maternity leave. Regular maternity leave for all women employed in all jobs begins at 32 weeks of gestation. Women who work in workplaces deemed dangerous and women with a history of obstetric problems such as premature or growth-retarded babies from previous pregnancies are regularly 'sent' into precautionary maternity leave. The public health physicians of Tirol's nine administrative districts were interviewed and supplied data on precautionary maternity leave from their districts. In 100 women who attended the clinic for pregnancies at risk of the Obstetrics/Gynecology Department of Innsbruck University Hospital and who had already obtained precautionary maternity leave, the medical/administrative procedure was studied in each case and correlated with pregnancy outcome. The town district of Innsbruck and the district that comprises the suburbs of the provincial capital had the highest rates of precautionary maternity leave. The town district of Innsbruck had a rate of 24.3% of all pregnant women (employed and not employed) in precautionary maternity leave in 1997, whereas the whole province of Tirol had 13.4%. More than 80% of decrees for precautionary maternity leave are issued by district public health physicians on the basis of written recommendations from gynecologists. One third of women who are sent into precautionary maternity leave are issued the decree prior to 12 weeks of gestation - mostly cases of multiple pregnancies and women with previous miscarriages. The present system of precautionary maternity leave appears to work in the sense that most working pregnant women with risk factors are correctly identified - with most errors on the side of caution. As the system also helps employers - the employee's pay is paid from the federal family support fund and state insurance once she is in

  13. Maternal and neonatal outcomes of pregnancies in women with Addison's disease: a population-based cohort study on 7.7 million births.

    PubMed

    Schneiderman, M; Czuzoj-Shulman, N; Spence, A R; Abenhaim, H A

    2017-10-01

    To assess if pregnancies among women with Addison's disease (AD) are at higher risk of adverse maternal and neonatal outcomes. Population-based retrospective cohort study. All births in the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. Baseline characteristics were compared between women with AD and those without, and prevalence over time was measured. Logistic regression was used to estimate the effect of AD on maternal and neonatal outcomes by calculating the crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI). We calculated a prevalence of AD in pregnancy of 5.5/100 000, increasing from 5.6 to 9.6/100 000 (P = 0.0001) over the 9-year study period. Compared with women without AD, women with AD were more likely to deliver preterm (OR 1.50, 95% CI 1.16-1.95), deliver by caesarean section (OR 1.32, 95% CI 1.08-1.61), have impaired wound healing (OR 4.28, 95% CI 2.55-7.18), develop infections (OR 2.44, 95% CI 1.66-3.58) and develop thromboembolism (OR 5.21, 95% CI 2.15-12.63), require transfusions (OR 6.69, 95% CI 4.69-9.54), and have prolonged postpartum hospital admissions (OR 5.71, 95% CI 4.37-7.47). Maternal mortality was significantly higher than in the comparison group (OR 22.30, 95% CI 6.82-72.96). Congenital anomalies (OR 3.62, 95% CI 2.05-6.39) and small-for-gestational age infants (OR 1.78, 95% CI 1.15-2.75) were more likely in these pregnancies. Addison's disease significantly increases the risk of severe adverse maternal and neonatal outcomes, so pregnant women with AD are best managed in tertiary-care centres. Pregnancies complicated by Addison's disease have an increased risk of adverse maternal and neonatal outcomes. © 2016 Royal College of Obstetricians and Gynaecologists.

  14. Maternal demographic and socioeconomic characteristics of live-born infants with isolated ocular congenital abnormalities.

    PubMed

    Puhó, Erzsebet H; Vogt, Gábor; Csáky-Szunyogh, Melinda; Metneki, Júlia; Czeizel, Andrew E

    2008-01-01

    To evaluate maternal age and birth order, in addition socioeconomic status and finally occupational background of mothers who delivered babies with different isolated ocular congenital abnormalities. The data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-2002 was used and the evaluation of maternal variables was based on both medical records and maternal information. Mean maternal age and birth order was lower in the mothers of cases with isolated an/microphthalmia. The mean birth order was also lower in the mothers with isolated congenital cataract compared with the control groups. The mothers of cases with isolated coloboma had the usual mean maternal age with a very high proportion of second birth order. The proportion of unmarried women, low maternal socio-economic status and unemployment was larger in the groups of isolated an/microphthalmia and isolated primary congenital glaucoma and these mothers frequently worked in the agriculture. Cases with different isolated ocular congenital abnormalities showed different maternal characteristics as the reference controls, therefore it is necessary to evaluate each isolated ocular congenital abnormality separately and maternal characteristics can be considered as potential confounders in the analyses of ocular congenital abnormalities.

  15. Maternal mortality in rural Zambia.

    PubMed

    Vork, F C; Kyanamina, S; van Roosmalen, J

    1997-08-01

    To assess maternal mortality. Sisterhood method survey and hospital data. Communities in Kalabo District, a very remote rural area in western Zambia; Kalabo District Hospital. The number of respondents in the sisterhood method survey was 1,978. The estimated maternal mortality ratio derived from this survey was 1,238 per 100,000 live births. The hospital study involved 2,474 deliveries of 2,374 live babies. The official number of maternal deaths was 13. Further investigation of files revealed an additional 15 maternal deaths, bringing the institutional maternal mortality rate from 548 to 1,179 per 100,000 live births. The major causes of direct maternal deaths were obstructed labor and sepsis. In 71% of all cases substandard care factors contributed. Maternal mortality in rural Zambia is among the highest as reported in the world. Official hospital data tend to underestimate maternal mortality in the community due to underreporting. The sisterhood method survey is an efficient indirect method to assess maternal mortality in rural areas of developing countries.

  16. Maternal cardiac metabolism in pregnancy

    PubMed Central

    Liu, Laura X.; Arany, Zolt

    2014-01-01

    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

  17. Maternal intelligence-mental health and child neuropsychological development at age 14 months.

    PubMed

    Forns, Joan; Julvez, Jordi; García-Esteban, Raquel; Guxens, Mònica; Ferrer, Muriel; Grellier, James; Vrijheid, Martine; Sunyer, Jordi

    2012-01-01

    To examine the relationship between maternal intelligence-mental health and neuropsychological development at age 14 months in a normal population, taking into account maternal occupational social class and education. We prospectively studied a population-based birth cohort, which forms part of the INMA (Environment and Childhood) Project. Cognitive and psychomotor development was assessed at 14 months using Bayley Scales of Infant Development. Maternal intelligence and mental health were assessed by the Cattell and Cattell test and the General Health Questionnaire-12 respectively. We observed a crude association between maternal intelligence and cognitive development in children at 14 months but this association disappeared when maternal education was included. The associations were stratified by maternal education and occupational social class. Within the manual maternal occupational social class, there was a significant difference in cognitive development between children whose mothers scored in the highest tertile of maternal IQ and those whose mothers scored in the lowest tertile. In contrast, no differences were observed among children whose mothers were in the non-manual occupational social class. The association between maternal intelligence and child cognitive development differed by occupational social class. While this association was not confounded by education or other variables in manual occupational social classes, maternal education explained this association among advantaged occupational social classes. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

  18. ISES Experience in Delivering Space Weather Services

    NASA Astrophysics Data System (ADS)

    Boteler, David

    The International Space Environment Service has over eighty years experience in providing space weather services to meet a wide variety of user needs. This started with broadcast on December 1, 2008 from the Eiffel Tower about radio conditions. The delivery of information about ionospheric effects on high frequency (HF) radio propagation continue to be a major concern in many parts of the world. The movement into space brought requirements for a new set of space weather services, ranging from radiation dangers to man in space, damage to satellites and effects on satellite communication and navigation systems. On the ground magnetic survey, power system and pipeline operators require information about magnetic disturbances that can affect their operations. In the past these services have been delivered by individual Regional Warning Centres. However, the needs of new trans-national users are stimulating the development of new collaborative international space weather services.

  19. 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

  20. 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.

  1. 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.

  2. Delivering optical power to subcutaneous implanted devices.

    PubMed

    Ayazian, Sahar; Hassibi, Arjang

    2011-01-01

    In this paper, a new, easy-to-implement, and MRI-compatible approach for delivering power to implantable devices is presented. The idea is to harvest the energy of light within the therapeutic window wavelengths, where the optical absorption is small, by using subcutaneous photovoltaic (PV) cells. Depending on the application, this energy can then be used to directly drive the embedded electronics of an implanted device or recharge its battery. To show the feasibility of this system, a CMOS chip based on this concept has been implemented and tested. The experimental results demonstrate that μW's of power in ambient light conditions can be harvested using mm(2)-size PV cells. This amount of power is sufficient to address the needs of many low-power applications.

  3. 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.

  4. Time-to-delivery after maternal transfer to a tertiary perinatal centre.

    PubMed

    Hutchinson, Fiona H; Davies, Mark W

    2014-01-01

    To determine, in women transferred antenatally for acute admission with high risk pregnancies, the numbers who deliver, the average time from transfer to delivery, and whether the reason for transfer influences the time-to-delivery. A retrospective analysis of time-to-delivery was performed in a population of women transferred to the Royal Brisbane and Women's Hospital, QLD. Data were obtained from the hospital obstetric, neonatal, and admission databases. A total of 941 women were transferred antenatally with high risk pregnancies where delivery was deemed potentially imminent. Of these 821 (87%) delivered at RBWH. The remaining 120 women (13%) were discharged prior to delivery and then delivered elsewhere. Of the 821 maternal transfers that delivered, the median time to delivery was 24.4 hrs. There were 43% who delivered within 24 hours of admission and 29% who either delivered after 7 days or delivered elsewhere. Most transfers for fetal abnormality delivered in the first 24 hours while most transfers for antepartum haemorrhage and preterm prelabour membrane rupture delivered beyond 24 hours. There are significant differences in time-to-delivery following transfer depending on the reason for transfer and many infants transferred in utero will not deliver imminently.

  5. Intranasal formulations: promising strategy to deliver vaccines.

    PubMed

    Riese, Peggy; Sakthivel, Priya; Trittel, Stephanie; Guzmán, Carlos A

    2014-10-01

    The emergence of new diseases and the lack of efficient vaccines against numerous non-treatable pathogens require the development of novel vaccination strategies. To date, only a few mucosal vaccines have been approved for humans. This was in part due to i) the use of live attenuated vaccines, which are not suitable for certain groups of individuals, ii) safety concerns derived from implementation in humans of some mucosal vaccines, iii) the poor stability, absorption and immunogenicity of antigens delivered by the mucosal route and iv) the limited number of available technologies to overcome the bottlenecks associated with mucosal antigen delivery. Recent advances make feasible the development of efficacious mucosal vaccines with adequate safety profile. Thus, currently intranasal vaccines represent an attractive and valid alternative to conventional vaccines. The present review is focused on the potentials and limitations of market-approved intranasal vaccines and promising candidates undergoing clinical investigations. Furthermore, emerging strategies to overcome main bottlenecks including efficient breaching of the mucosal barrier and safety concerns by implementation of new adjuvants and delivery systems are discussed. The rational design of intranasal vaccines requires an in-depth understanding of the anatomic, physicochemical and barrier properties of the nasal mucosa, as well as the molecular mechanisms governing the activation of the local innate and adaptive immune system. This would provide the critical knowledge to establish effective approaches to deliver vaccine antigens across the mucosal barrier, supporting the stimulation of a long-lasting protective response at both mucosal and systemic levels. Current developments in the area of adjuvants, nanotechnologies and mucosal immunology, together with the identification of surface receptors that can be exploited for cell targeting and manipulating their physiological properties, will become instrumental

  6. Temperature of gas delivered from ventilators.

    PubMed

    Chikata, Yusuke; Onodera, Mutsuo; Imanaka, Hideaki; Nishimura, Masaji

    2013-01-01

    Although heated humidifiers (HHs) are the most efficient humidifying device for mechanical ventilation, some HHs do not provide sufficient humidification when the inlet temperature to the water chamber is high. Because portable and home-care ventilators use turbines, blowers, pistons, or compressors to inhale in ambient air, they may have higher gas temperature than ventilators with piping systems. We carried out a bench study to investigate the temperature of gas delivered from portable and home-care ventilators, including the effects of distance from ventilator outlet, fraction of inspiratory oxygen (FIO2), and minute volume (MV). We evaluated five ventilators equipped with turbine, blower, piston, or compressor system. Ambient air temperature was adjusted to 24°C ± 0.5°C, and ventilation was set at FIO2 0.21, 0.6, and 1.0, at MV 5 and 10 L/min. We analyzed gas temperature at 0, 40, 80, and 120 cm from ventilator outlet and altered ventilator settings. While temperature varied according to ventilators, the outlet gas temperature of ventilators became stable after, at the most, 5 h. Gas temperature was 34.3°C ± 3.9°C at the ventilator outlet, 29.5°C ± 2.2°C after 40 cm, 25.4°C ± 1.2°C after 80 cm and 25.1°C ± 1.2°C after 120 cm (P < 0.01). FIO2 and MV did not affect gas temperature. Gas delivered from portable and home-care ventilator was not too hot to induce heated humidifier malfunctioning. Gas soon declined when passing through the limb.

  7. 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.

  8. Maternal-infant HIV transmission and circumstances of delivery.

    PubMed Central

    Kuhn, L; Stein, Z A; Thomas, P A; Singh, T; Tsai, W Y

    1994-01-01

    OBJECTIVES. Circumstances of delivery among children with acquired immunodeficiency syndrome (AIDS) were investigated to assess whether they were consistent with predictions that intrapartum factors affect the risk of maternal-infant human immunodeficiency virus (HIV) transmission. METHODS. Pediatric AIDS patients (maternal-infant transmission; n = 632) reported to the New York City Health Department through 1991 were compared with a series of infants born to predominantly uninfected women. For each case patient, five control subjects were selected and matched from birth certificate files. Hypothesized case-control comparisons for mode of delivery and preselected complications were tested. RESULTS. Compared with control subjects, case patients were less likely to have been delivered by cesarean section without complications (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.59, 1.01) and more likely to have been delivered with complications, whether delivery was by cesarean section (OR = 1.54; 95% CI = 0.98, 2.43) or vaginal (OR = 1.66; 95% CI = 1.15, 2.39). CONCLUSIONS. Assuming that HIV-infected and uninfected women have comparable circumstances of delivery, conditional on sociomedical characteristics, these results suggest that intrapartum events may be associated with maternal-infant HIV transmission. PMID:8017534

  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. Maternal body mass index and daughters' age at menarche.

    PubMed

    Keim, Sarah A; Branum, Amy M; Klebanoff, Mark A; Zemel, Babette S

    2009-09-01

    The role of intergenerational influences on age at menarche has not been explored far beyond the association between mothers' and daughters' menarcheal ages. Small size at birth and childhood obesity have been associated with younger age at menarche, but the influence of maternal overweight or obesity on daughters' age at menarche has not been thoroughly examined. In a follow-up study of the prospective Collaborative Perinatal Project, grown daughters were asked in 1987-1991 for their age at menarche. Data from the original Collaborative Perinatal Project (1959-1966) included their mothers' height and prepregnancy weight. In the follow-up study, 597 of 627 daughters had complete menarche and maternal data available and were included in the present analysis. We used polytomous logistic regression to examine the association between maternal overweight (body mass index [BMI] = 25-29.9 km/m) or obesity (BMI >or= 30) and daughter's age at menarche (maternal age at menarche, maternal parity, socioeconomic status, race, and study site (OR = 3.3 [1.1-10.0]). Effect estimates for maternal overweight were close to the null. There was limited evidence of mediation by small for gestational age or BMI at age 7. Maternal obesity is associated with younger menarcheal age among daughters in this study, possibly via unmeasured shared factors.

  11. Family Centered Maternity Care

    PubMed Central

    Enkin, Murray W.

    1973-01-01

    Current practices of obstetrical care tend to hinder rather than facilitate family development and maturation. A program of family centred maternity care is described. Husbands are invited to prenatal visits, and are involved in intensive preparation for labor and delivery. Their presence and active participation in labor, delivery, and postpartum course are encouraged. This, along with a rooming-in policy for the baby, and the utilization of the postpartum period for an intensive training in parenthood, appears to produce a safe and satisfying obstetrical experience for the family. PMID:20468914

  12. 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.

  13. 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…

  14. 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…

  15. 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 maternal…

  16. 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 maternal…

  17. Telephone Delivered Cognitive Behavioral Therapy for Chronic Pain Following Traumatic Brain Injury

    DTIC Science & Technology

    2016-10-01

    AWARD NUMBER: W81XWH-12-2-0109 TITLE: Telephone-Delivered Cognitive Behavioral Therapy for Chronic Pain Following Traumatic Brain Injury... Brain Injury 5b. GRANT NUMBER W81XWH-12-2-0109 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Jeanne M. Hoffman, Ph.D. 5d. PROJECT NUMBER 5e. TASK NUMBER...evaluate the efficacy of a telephone-delivered cognitive behavioral treatment (T-CBT) in Veterans with a history of traumatic brain injury (TBI) for the

  18. Increasing customer service behaviors using manager-delivered task clarification and social praise.

    PubMed

    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 employees who were present during the initial study period, but not for more recently hired employees. The results suggest that task clarification combined with manager-delivered social praise is an effective way to improve employee customer service behaviors.

  19. INCREASING CUSTOMER SERVICE BEHAVIORS USING MANAGER-DELIVERED TASK CLARIFICATION AND SOCIAL PRAISE

    PubMed Central

    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 employees who were present during the initial study period, but not for more recently hired employees. The results suggest that task clarification combined with manager-delivered social praise is an effective way to improve employee customer service behaviors. PMID:20190926

  20. HARVARD PROJECT PHYSICS PROGRESS REPORT.

    ERIC Educational Resources Information Center

    Harvard Univ., Cambridge, MA.

    THIS REPORT OF HARVARD PROJECT PHYSICS PRESENTS DRAFTS OF THREE SPEECHES DELIVERED TO THE AMERICAN ASSOCIATION OF PHYSICS TEACHERS (AAPT) MEETING, FEBRUARY, 1967. THE ADDRESS BY GERALD HOLTON DEALS WITH THE AIMS AND PROGRESS OF THE PROJECT. DISCUSSED ARE (1) PROJECT PARTICIPANTS, (2) AIMS AND CONTENT, (3) THE NEW EMPHASIS, (4) SURVEY OF COURSE…

  1. Delivering Sure Start in Rural Communities

    ERIC Educational Resources Information Center

    Willan, Jenny

    2007-01-01

    This paper explores and questions some of the evidence used to support early childhood interventions in the UK, and reports on discussions with three rural Mini Sure Start project leaders in Devon. Sure Start funding in the UK has been repeatedly increased to provide more centres for 0-3-year-olds and their parents. It is increasingly linked to…

  2. 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…

  3. Correlates of maternal health care utilization in rohilkhand region, India.

    PubMed

    Srivastava, A; Mahmood, Se; Mishra, P; Shrotriya, Vp

    2014-05-01

    Until date, the importance of maternal health care services in reducing maternal mortality and morbidity has received a significant recognition. Most of the maternal deaths can be prevented if women have access to basic antenatal, natal and postnatal care. However, uptake of maternal health care services is far from universal even in settings where they are extensively available. The aim of this study is to assess the pattern and identify underlying factors on maternal health care utilization in rural areas of Bareilly. This was a cross-sectional study was conducted during June-December 2011. Six villages were selected by convenience out of 99 villages in Bhojipura Block of Bareilly district, Uttar Pradesh to cover maximum number of women. All currently married women aged between 15 and 49 years who had delivered a child within last 1 year were interviewed by house-to-house survey and comprised the study unit. Their socioeconomic and demographic characteristics, reproductive history and knowledge of specific obstetric complications were taken. The information was gathered on various aspects of maternal-care utilization. In analyzing data, both bivariate and multivariate analyses were employed, using the Microsoft Excel and SPSS for Windows, Version 15.0 (SPSS Inc., Chicago, Illinois,USA). Most (88.6%; 343/387) of pregnancies had registration for antenatal care (ANC). Majority (69.7%; 239/343) of them were registered between 16 and 24 weeks. Only 28.5% (110/343) of women received ANC from a private doctor. Maternal health care service utilization from health personnel was significantly associated with age at marriage ≥18 years, family size ≤3, birth order ≤2, nuclear family and higher socio-economic status. Most of the pregnancy related complications were found among women aged >30 years, with birth order ≥3, having birth interval <24 months, among Muslims, working mothers and among those belonging to joint family. Mother's education and husband's occupation

  4. The biopsychology of maternal behavior in nonhuman mammals.

    PubMed

    Kristal, Mark B

    2009-01-01

    The term "maternal behavior," when applied to nonhuman mammals, includes the behaviors exhibited in preparation for the arrival of newborn, in the care and protection of the newly arrived young, and in the weaning of those young, and represents a complex predictable pattern that is often regarded as a single, comprehensive, species-specific phenomenon. Although the delivering first-time mammalian mother is immediately and appropriately maternal, a "virgin" with no prior exposure to young does not show immediate and appropriate behavior toward foster young. Nevertheless, the virgin female, and indeed the male, possess the neural circuitry that underlies the pattern referred to as maternal behavior, despite not exhibiting the pattern under normal circumstances. At parturition, or after extensive exposure to young, what emerges appears to be a single stereotyped maternal behavior pattern. However, it is actually a smoothly coordinated constellation of simpler actions with proximate causes that, when sequenced properly, have the appearance of a motivated, purposive, adaptive pattern of caretaking. Over the past 50 years, much research has focused on finding the principal external and internal factors that convert the nonmaternal behavior patterns of the nonpregnant nullipara, the virgin, to the almost immediate and intense maternal behavior characteristic of the puerpera, the mother. This review is an attempt to summarize the many comprehensive, even encyclopedic, reviews of these factors, with an emphasis on brain mechanisms, and to highlight the gaps that remain in understanding the processes involved in the almost immediate onset of maternal caretaking behaviors observed in mammals at delivery. Where possible, the reader is directed to some of those excellent reviews.

  5. In utero pesticide exposure, maternal paraoxonase activity, and head circumference.

    PubMed

    Berkowitz, Gertrud S; Wetmur, James G; Birman-Deych, Elena; Obel, Josephine; Lapinski, Robert H; Godbold, James H; Holzman, Ian R; Wolff, Mary S

    2004-03-01

    Although the use of pesticides in inner-city homes of the United States is of considerable magnitude, little is known about the potentially adverse health effects of such exposure. Recent animal data suggest that exposure to pesticides during pregnancy and early life may impair growth and neurodevelopment in the offspring. To investigate the relationship among prenatal pesticide exposure, paraoxonase (PON1) polymorphisms and enzyme activity, and infant growth and neurodevelopment, we are conducting a prospective, multiethnic cohort study of mothers and infants delivered at Mount Sinai Hospital in New York City. In this report we evaluate the effects of pesticide exposure on birth weight, length, head circumference, and gestational age among 404 births between May 1998 and May 2002. Pesticide exposure was assessed by a prenatal questionnaire administered to the mothers during the early third trimester as well as by analysis of maternal urinary pentachlorophenol levels and maternal metabolites of chlorpyrifos and pyrethroids. Neither the questionnaire data nor the pesticide metabolite levels were associated with any of the fetal growth indices or gestational age. However, when the level of maternal PON1 activity was taken into account, maternal levels of chlorpyrifos above the limit of detection coupled with low maternal PON1 activity were associated with a significant but small reduction in head circumference. In addition, maternal PON1 levels alone, but not PON1 genetic polymorphisms, were associated with reduced head size. Because small head size has been found to be predictive of subsequent cognitive ability, these data suggest that chlorpyrifos may have a detrimental effect on fetal neurodevelopment among mothers who exhibit low PON1 activity.

  6. 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

  7. 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

  8. 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.

  9. Maternal Employment and Adolescent Development.

    ERIC Educational Resources Information Center

    Montemayor, Raymond; Clayton, Mark D.

    1983-01-01

    The relationship between maternal employment and adolescent development is enormously complex, and no simple generalizations are possible. Many intervening variables alter the impact that maternal employment has on adolescent development. There is an urgent need to discover what impact this arrangement has on adolescent development. (CJ)

  10. 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

  11. 47 CFR 76.1705 - Performance tests (channels delivered).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 4 2011-10-01 2011-10-01 false Performance tests (channels delivered). 76.1705... tests (channels delivered). The operator of each cable television system shall maintain at its local office a current listing of the cable television channels which that system delivers to its subscribers....

  12. 47 CFR 76.1705 - Performance tests (channels delivered).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Performance tests (channels delivered). 76.1705... tests (channels delivered). The operator of each cable television system shall maintain at its local office a current listing of the cable television channels which that system delivers to its subscribers....

  13. Maternal obesity and neuroprotective magnesium sulfate.

    PubMed

    McPherson, Jessica; Smiley, Sarah; Stamilio, David

    2015-10-01

    Given the association between risk of cerebral palsy and children born to obese women, the study aim was to estimate whether maternal obesity is associated with reduced effectiveness of conventional antenatal magnesium sulfate dosing for the prevention of cerebral palsy and death. This is a secondary cohort analysis of a multicenter randomized clinical trial completed by the Maternal-Fetal Medicine Units Network. Women were included in the original trial if deemed high risk for preterm delivery in the subsequent 24 hours. The present study included singleton, nonanomalous fetuses that were randomized to and received magnesium sulfate with complete data available. Outcomes between obese (body mass index ≥30 kg/m(2)) and nonobese women were compared. A secondary analysis of outcomes between morbidly obese (body mass index ≥40 kg/m(2)) and nonmorbidly obese women was performed. The primary outcome was a composite of cerebral palsy or perinatal death before 15 months corrected age. Secondary outcomes included moderate to severe cerebral palsy or death, any cerebral palsy, moderate to severe cerebral palsy, and death. A logistic regression analysis was used to estimate the odds ratio of each outcome. Based on sample size, exposure rate (obesity) and an outcome rate of 10%, assuming an 80% power and a 0.05 alpha error, this study had sufficient power to detect a 2-fold increase in the primary outcome. Of 1188 women randomized to receive magnesium sulfate, 806 were included in this analysis. After adjusting for gestational age at delivery, maternal obesity was not associated with an increased risk of cerebral palsy or death in children born to women who received magnesium sulfate. Women with morbid obesity had higher rates of the primary outcome and cerebral palsy in an unadjusted analysis but did not have increased risks after adjusting for gestational age at delivery. In analyses stratified on gestational age, morbidly obese women who delivered after 28 weeks had

  14. Inequalities in caesarean section: influence of the type of maternity care and social class in an area with a national health system.

    PubMed

    Salvador, J; Cano-Serral, G; Rodríguez-Sanz, M; Lladonosa, A; Borrell, C

    2009-03-01

    To analyse the impact of social class inequalities and type of maternity unit in the use of caesarean sections (CSs) among residents in an urban area of Southern Europe. This was a cross-sectional study. The study population consisted of 2186 women resident in Barcelona city who gave birth to an infant without any birth defect during 1994-2003. The dependent variable was the type of delivery. Maternal age, social class and type of maternity unit (public or private) were independent variables. Maternal age-adjusted logistic regression models were used. 30% of deliveries ended in CS; 70% of less privileged women delivered in public maternity units and 72% of more privileged women delivered in private centres. A relationship between CS and social class was observed (OR 1.4; 95% CI 1.1 to 1.7), but disappeared when the analysis was done separately for each stratum of type of maternity unit (both ORs 1.0). In contrast, a relationship between CS and type of maternity unit was found (OR 2.3; 95% CI 1.9 to 2.7), which persisted when the analysis was done separately for each stratum of social class. Although strongly related to higher social class, the main determinant of the high proportion of CSs was delivering in private maternity units.

  15. Commercialisation and entrepreneurialism in maternity.

    PubMed

    Mander, Rosemary

    2011-08-01

    against an international background, to examine the implications of private sector activity for maternity care in the United Kingdom National Health Service (UK NHS). the private sector and commercial or entrepreneurial activity in maternity services have attracted limited attention in the UK compared with, for e.g., Greece and the Irish Republic. discursive paper. despite rhetoric to the contrary, financial costs have always featured in the UK NHS. Financial payments in maternity have increased gradually. Commercial and entrepreneurial activity in maternity now includes 'entertainment ultrasound', reflecting a greater hegemonic imbalance. The commercialisation of maternity raises organisational, professional, quality-related and systematic issues, which all carry implications for the childbearing woman. the childbearing woman shoulders financial costs, whose origins and implications matter to both midwife and woman. The mixed benefits of medical investigations deserve closer attention. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2015-11-01

    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.

  17. The role of health professional organizations in improving maternal and newborn health: The FIGO LOGIC experience.

    PubMed

    Taylor, David J

    2015-10-01

    The FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health improved the internal and external capacity of eight national professional organizations of obstetrics and gynecology in six African and two Asian countries. The initiative was funded by a grant from the Bill and Melinda Gates Foundation and had three key objectives: to support the eight FIGO member associations to strengthen their capacity to work effectively; to influence national policies on maternal and newborn health; and to work toward improving clinical practice in this area. Through improved capacity, and underpinned by Memoranda of Understanding with their governments, the associations influenced national policy in maternal and newborn health, impacted clinical care through the development of over forty national clinical guidelines, delivered national curricula, trained clinical and management staff, and led the development of national maternal death and near-miss review programs.

  18. 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. Copyright © 2015. Published by Elsevier Ireland Ltd.

  19. Delegation of responsibility in maternity care in Karawa rural health zone, Zaire.

    PubMed

    Duale, S

    1992-06-01

    Karawa Health Zone (KHZ) located in northwestern Zaire, comprises 19,000 km2 with about 340,000 inhabitants. As part of an expanding primary health care program, KHZ officials instituted an extensive outreach program to increase access of women to maternity care. General practitioner (GP) doctors, nurses, midwives, auxiliaries, and traditional birth attendants share responsibilities in delivering maternity care services. Nurses and midwives perform most of the obstetric functions at the Karawa Hospital Maternity Center. Data from 1988 to 1990 show that nurses and midwives attended 98% of normal deliveries and 81% of the complicated ones. Selected nurses performed cesarean section routinely. There was no significant difference in maternal and neonatal outcomes for cesarean section performed by nurses and GPs. Physicians on staff provided support through monitoring, supervision, training, and care for the most complicated cases.

  20. Where should noninvasive ventilation be delivered?

    PubMed

    Hill, Nicholas S

    2009-01-01

    Noninvasive ventilation (NIV) has assumed an important role in the management of certain types of respiratory failure in acute-care hospitals. However, the optimal location for NIV has been a matter of debate. Some have argued that all patients begun on NIV in the acute-care setting should go to an intensive care unit (ICU), but this is impractical because ICU beds are often unavailable, and it may not be a sensible use of resources. Also, relatively few studies have examined the question of location for NIV. One problem is that various units' capabilities to deliver NIV differ substantially, even in the same hospital. Choosing the appropriate environment for NIV requires consideration of the patient's need for monitoring, the monitoring capabilities of the unit, including both technical and personnel resources (nursing and respiratory therapy), and the staff's skill and experience. In some hospitals NIV is begun most often in the emergency department, but is most often managed in an ICU. Step-down units are often good locations for NIV, but many institutions do not have step-down units. With ICU beds at a premium, many hospitals are forced to manage some NIV patients on general wards, which can be safely done with more stable patients if the ward is suitably monitored and experienced. When deciding where to locate the patient, clinicians must be familiar with the capabilities of the units in their facility and try to match the patient's need for monitoring and the unit's capabilities.

  1. Delivering enhanced testosterone replacement therapy through nanochannels.

    PubMed

    Ferrati, Silvia; Nicolov, Eugenia; Bansal, Shyam; Zabre, Erika; Geninatti, Thomas; Ziemys, Arturas; Hudson, Lee; Ferrari, Mauro; Goodall, Randal; Khera, Mohit; Palapattu, Ganesh; Grattoni, Alessandro

    2015-02-18

    Primary or secondary hypogonadism results in a range of signs and symptoms that compromise quality of life and requires life-long testosterone replacement therapy. In this study, an implantable nanochannel system is investigated as an alternative delivery strategy for the long-term sustained and constant release of testosterone. In vitro release tests are performed using a dissolution set up, with testosterone and testosterone:2-hydroxypropyl-β-cyclodextrin (TES:HPCD) 1:1 and 1:2 molar ratio complexes release from the implantable nanochannel system and quantify by HPLC. 1:2 TES:HPCD complex stably achieve 10-15 times higher testosterone solubility with 25-30 times higher in vitro release. Bioactivity of delivered testosterone is verified by LNCaP/LUC cell luminescence. In vivo evaluation of testosterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels by liquid chromatography mass spectrometry (LC/MS) and multiplex assay is performed in castrated Sprague-Dawley rats over 30 d. Animals are treated with the nanochannel implants or degradable testosterone pellets. The 1:2 TES:HPCD nanochannel implant exhibits sustained and clinically relevant in vivo release kinetics and attains physiologically stable plasma levels of testosterone, LH, and FSH. In conclusion, it is demonstrated that by providing long-term steady release 1:2 TES:HPCD nanochannel implants may represent a major breakthrough for the treatment of male hypogonadism. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. Delivering flavonoids into solid tumors using nanotechnologies.

    PubMed

    Wang, Shengpeng; Zhang, Jinming; Chen, Meiwan; Wang, Yitao

    2013-10-01

    Long-term epidemiological studies have demonstrated that regular ingestion of flavonoids contained in dietary sources is associated with a reduced risk for many chronic diseases including cancer. However, although flavonoids are largely consumed in the diet and high concentrations may exist in the intestine after oral administration, the plasma/tissue concentrations of flavonoids are lower than their effective therapeutic doses due to poor bioavailability, resulting in the limited efficacy of flavonoids in various clinical studies. Therefore, the application of nanotechnology to deliver flavonoids to tumor sites has received considerable attention in recent years. In this review, after a general review of the potential benefits of flavonoids in cancer therapy and several key factors affecting their bioavailability, the current efforts in improving the delivery efficacy of promising candidates that are particularly important in the human diet, namely quercetin, epigallocatechin-3-gallate (EGCG) and genistein were focused on. Finally, the challenges of developing flavonoid delivery systems that improve flavonoid bioavailability and their anticancer therapy potentials were summarized. The design of suitable molecular carriers for flavonoids is an area of research that is in rapid progress. A large number of unheeded promising favonoids are suffering from poor in vivo parameters, their potential benefits deserves further research. Furthermore, more effort should be placed on developing active targeting systems, evaluating the efficacy and toxicity of novel flavonoid delivery systems through small and large scale clinical trials.

  3. Watchdog Project

    SciTech Connect

    Smith, Rhett; Campbell, Jack; Hadley, Mark

    2016-12-30

    The Watchdog Project completed 100% of the project Statement of Project Objective (SOPO). The Watchdog project was a very aggressive project looking to accomplish commercialization of technology that had never been commercialized, as a result it took six years to complete not the original three that were planned. No additional federal funds were requested from the original proposal and SEL contributed the additional cost share required to complete the project. The result of the Watchdog Project is the world’s first industrial rated Software Defined Network (SDN) switch commercially available. This technology achieved the SOPOO and DOE Roadmap goals to have strong network access control, improve reliability and network performance, and give the asset owner the ability to minimize attack surface before and during an attack. The Watchdog project is an alliance between CenterPoint Energy Houston Electric, Pacific Northwest National Laboratories (PNNL), and Schweitzer Engineering Laboratories, Inc. (SEL). SEL is the world’s leader in microprocessor-based electronic equipment for protecting electric power systems. PNNL performs basic and applied research to deliver energy, environmental, and national security for our nation. CenterPoint Energy is the third largest publicly traded natural gas delivery company in the U.S and third largest combined electricity and natural gas delivery company. The Watchdog Project efforts were combined with the SDN Project efforts to produce the entire SDN system solution for the critical infrastructure. The Watchdog project addresses Topic Area of Interest 5: Secure Communications, for the DEFOA- 0000359 by protecting the control system local area network itself and the communications coming from and going to the electronic devices on the local network. Local area networks usually are not routed and have little or no filtering capabilities. Combine this with the fact control system protocols are designed with inherent trust the control

  4. 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.

  5. Caesarean section by maternal age group among singleton deliveries and primiparous Japanese women: a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health.

    PubMed

    Yoshioka-Maeda, Kyoko; Ota, Erika; Ganchimeg, Togoobaatar; Kuroda, Mariko; Mori, Rintaro

    2016-02-29

    The rising caesarean section rate is an important public health concern that in turn increases maternal and perinatal risks of adverse effects, unnecessary medical consumption, and inequities in worldwide access. The aim of this study was to investigate caesarean section indications by maternal age group and examine the association between age and caesarean section in primiparous Japanese women with singleton births. We analyzed the Japanese data of primiparous women with singleton births from the WHO Global Survey on Maternal and Perinatal Health to compare maternal and neonatal characteristics and outcomes between groups with and without caesarean section. Women were divided into 3 maternal age groups (≤29, 30 to 34 and ≥35 years). We performed multivariable logistic-regression analysis to identify characteristics associated with caesarean section. Of the 3245 women with singleton births were included in the Japanese data, 610 women (18.8%) delivered by caesarean section, half of whom (n = 305) were nulliparous. We included singleton nulliparous women (1747 deliveries) in our analysis. The maternal age 35 years old was associated with higher risks for all caesarean section (adjusted odds ratio [AOR] 1.89, 95% CI 1.28-2.78) and emergency antepartum caesarean section (AOR 2.26, 95% CI 1.49-3.40). Intrapartum caesarean section, which is mainly performed for obstetric indications, was not higher among the older maternal age group. In Japan, advanced maternal age significantly increased the risk for caesarean section; however, intrapartum caesarean section was not higher risk among the older age group. Management of maternal complications would help to reduce the rate of caesarean sections and associated unnecessary medical consumption.

  6. Tailoring peripartum nursing care for women of advanced maternal age.

    PubMed

    Suplee, Patricia Dunphy; Dawley, Katy; Bloch, Joan Rosen

    2007-01-01

    Births to women of advanced maternal age have increased dramatically over the last decade in both the United States. The majority of women who deliver their first baby after age 35 are healthy and experience positive birth outcomes. According to current research, primigravidas over 35 tend to be educated consumers. Their physical and psychosocial needs differ from those of the mother in her 20s, due to advanced age and factors related to difficulty conceiving and life circumstances. This paper presents (a) an overview of the possible risks to outcomes of childbearing for women over the age of 35; (b) a discussion of how women of advanced maternal age may differ from younger women related to developmental stage, stress or anxiety or both, decision making, and support systems; and (c) an exploration of tailoring nursing care strategies during the peripartum period specifically for this age cohort.

  7. Maternal height and the outcome of labor in rural Tanzania.

    PubMed

    van Roosmalen, J; Brand, R

    1992-03-01

    The influence of maternal height (standardized for parity and birthweight) on obstetrical outcome is studied in 1095 women giving birth in Lugarawa hospital and 3869 women delivering in Mbozi hospital, both rural hospitals in the South Western Highlands of Tanzania. Short stature was found to increase the need for augmentation of labor in primiparae, the need for operative delivery (cesarean section/symphyseotomy) in all parity groups and the need for vacuum extraction in multiparae. The absence of such an effect of height on perinatal mortality is interpreted as the result of obstetric intervention. It is concluded that maternal height, which is easy to measure, remains a useful tool to predict difficult childbirth and cephalopelvic disproportion.

  8. Perinatal outcome of vaginally delivered twin gestations with a larger twin B.

    PubMed

    Usta, Ihab M; Nassar, Anwar H; Abu Musa, Antoine A; Awwad, Johnny T; Yunis, Khalid A; Seoud, Muhieddine A-F

    2003-01-01

    To study the perinatal outcome of vaginally delivered twins when twin B is more than 250 g larger than twin A. Maternal and neonatal charts of live-born, nonanomalous twins, >25 weeks' gestation and vaginally delivered over a period of 17 years were reviewed. The results of this review were distributed among two groups: (1). those with twin B more than 250 g larger than twin A (DeltaBW>250) and (2). those where the difference was <250 g (DeltaBW<250). For vaginally delivered twin gestations, the perinatal outcome of twin B in the group DeltaBW>250 was compared to that of its co-twin, and to that of twin B in the group DeltaBW<250. Of the 679 twin gestations reviewed, 138 (20.6%) were in the group DeltaBW>250, of whom 73 (52.9%) delivered vaginally despite malpresentation in 39.7%. The vaginally delivered twin pregnancies in the groups DeltaBW>250 (n=73) and DeltaBW<250 (n=303) had similar demographics, parity, presentation, gestational age at delivery, and duration of the first stage of labor. Discordant twins were more frequent in the group DeltaBW>250 (26.0 versus 9.5%, p=0.001). Twin B in the group DeltaBW<250 was smaller, with higher incidence of growth restriction, low 5 min Apgar score, and hyperbilirubinemia compared to twin B in the group DeltaBW>250. There was no difference in the incidence of intraventricular hemorrhage, seizures, sepsis, neonatal death, and median nursery stay. Except for a lower median Apgar score at 1 min in twin B and a longer median nursery stay in twin A, twins A and B in the group DeltaBW>250 were similar regarding all other neonatal outcome variables. When twin B is more than 250 g larger than A, and both are delivered vaginally, the perinatal outcome is similar to its co-twin as well as to that of twin B of all other vaginally delivered twins. That twin B is larger than A is not itself a contraindication to attempted vaginal delivery.

  9. Towards elimination of maternal deaths: maternal deaths surveillance and response.

    PubMed

    Hounton, Sennen; De Bernis, Luc; Hussein, Julia; Graham, Wendy J; Danel, Isabella; Byass, Peter; Mason, Elizabeth M

    2013-01-02

    Current methods for estimating maternal mortality lack precision, and are not suitable for monitoring progress in the short run. In addition, national maternal mortality ratios (MMRs) alone do not provide useful information on where the greatest burden of mortality is located, who is concerned, what are the causes, and more importantly what sub-national variations occur. This paper discusses a maternal death surveillance and response (MDSR) system. MDSR systems are not yet established in most countries and have potential added value for policy making and accountability and can build on existing efforts to conduct maternal death reviews, verbal autopsies and confidential enquiries. Accountability at national and sub-national levels cannot rely on global, regional and national retrospective estimates periodically generated from academia or United Nations organizations but on routine counting, investigation, sub national data analysis, long term investments in vital registration and national health information systems. Establishing effective maternal death surveillance and response will help achieve MDG 5, improve quality of maternity care and eliminate maternal mortality (MMR ≤ 30 per 100,000 by 2030).

  10. Towards elimination of maternal deaths: maternal deaths surveillance and response

    PubMed Central

    2013-01-01

    Current methods for estimating maternal mortality lack precision, and are not suitable for monitoring progress in the short run. In addition, national maternal mortality ratios (MMRs) alone do not provide useful information on where the greatest burden of mortality is located, who is concerned, what are the causes, and more importantly what sub-national variations occur. This paper discusses a maternal death surveillance and response (MDSR) system. MDSR systems are not yet established in most countries and have potential added value for policy making and accountability and can build on existing efforts to conduct maternal death reviews, verbal autopsies and confidential enquiries. Accountability at national and sub-national levels cannot rely on global, regional and national retrospective estimates periodically generated from academia or United Nations organizations but on routine counting, investigation, sub national data analysis, long term investments in vital registration and national health information systems. Establishing effective maternal death surveillance and response will help achieve MDG 5, improve quality of maternity care and eliminate maternal mortality (MMR ≤ 30 per 100,000 by 2030). PMID:23279882

  11. Relationship between maternal hypoglycaemia and small-for-gestational-age infants according to maternal weight status: a retrospective cohort study in two hospitals

    PubMed Central

    Shinohara, Satoshi; Uchida, Yuzo; Hirai, Mitsuo; Hirata, Shuji; Suzuki, Kohta

    2016-01-01

    Objective The relationship between pre-pregnancy body mass index (BMI) and low glucose challenge test (GCT) results by maternal weight status has not been examined. This study aimed to clarify the relationship between a low GCT result and small for gestational age (SGA) by maternal weight status. Design A retrospective cohort study in 2 hospitals. Setting This study evaluated the obstetric records of women who delivered in a general community hospital and a tertiary perinatal care centre. Participants The number of women who delivered in both hospitals between January 2012 and December 2013 and underwent GCT between 24 and 28 weeks of gestation was 2140. Participants with gestational diabetes mellitus or diabetes during pregnancy, and GCT results of ≥140 mg/dL were excluded. Finally, 1860 women were included in the study. Primary and secondary outcome measures The participants were divided into low-GCT (≤90 mg/dL) and non-low-GCT groups (91–139 mg/dL). The χ2 tests and multivariate logistic regression analyses were conducted to investigate the association between low GCT results and SGA by maternal weight status. Results The incidence of SGA was 11.4% (212/1860), and 17.7% (330/1860) of the women showed low GCT results. The patients were divided into 3 groups according to their BMI (underweight, normal weight and obese). When the patients were analysed separately by their weight status after controlling for maternal age, pre-pregnancy maternal weight, maternal weight gain during pregnancy, pregnancy-induced hypertension, thyroid disease and difference in hospital, low GCT results were significantly associated with SGA (OR 2.10; 95% CI 1.14 to 3.89; p=0.02) in the underweight group. Conclusions Low GCT result was associated with SGA at birth among underweight women. Examination of maternal glucose tolerance and fetal growth is necessary in future investigations. PMID:27913562

  12. 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

  13. Relationship between maternal growth, infant birthweight and nutrient partitioning in teenage pregnancies.

    PubMed

    Jones, R L; Cederberg, H M S; Wheeler, S J; Poston, L; Hutchinson, C J; Seed, P T; Oliver, R L; Baker, P N

    2010-01-01

    Teenagers are susceptible to delivering small-for-gestational-age (SGA) infants. Previous studies suggest that maternal growth may contribute, as a result of preferential nutrient partitioning to the mother. We investigated the impact of maternal growth on birthweight in pregnant teenagers in the UK, and examined endocrine mediators of nutrient partitioning. A prospective observational multicentre study, About Teenage Eating, conducted between 2004 and 2007. Four hospitals in socially-deprived areas of Manchester and London. A total of 500 pregnant adolescents (14-18 years of age) with a singleton pregnancy were recruited at 10-21 weeks of gestation, with follow-up studies on 368 subjects. A cohort of 80 pregnant adults (25-40 years of age) provided a control group for determining growth. Skeletal growth, weight gain and skinfold thickness were measured from first to third trimester, together with maternal levels of micronutrients and metabolic hormones: insulin-like growth factor (IGF) system and leptin. Dietary analyses were performed. SGA birth. Maternal growth was not associated with SGA birth: growing mothers delivered more large-for-gestational-age infants (OR 2.51; P < 0.05). Growers had greater weight gain (P < 0.001), fat accrual (P < 0.001) and red cell folate concentrations (P < 0.01) than non-growers. Maternal IGF-I (P < 0.01) and leptin (P < 0.001) were positively associated with maternal and fetal growth, whereas IGF-I (P < 0.001) was negatively associated. Teenagers that were underweight at booking or with low weight gain were at greater risk of SGA birth. Maternal growth was not detrimental to fetal growth in this UK population of teenagers. Greater weight gain and higher concentrations of IGF-I in growing teenagers may provide anabolic drive for maternal and fetal growth.

  14. Maternal employment, breastfeeding, and health: evidence from maternity leave mandates.

    PubMed

    Baker, Michael; Milligan, Kevin

    2008-07-01

    Public health agencies around the world have renewed efforts to increase the incidence and duration of breastfeeding. Maternity leave mandates present an economic policy that could help achieve these goals. We study their efficacy, focusing on a significant increase in maternity leave mandates in Canada. We find very large increases in mothers' time away from work post-birth and in the attainment of critical breastfeeding duration thresholds. We also look for impacts of the reform on self-reported indicators of maternal and child health captured in our data. For most indicators we find no effect.

  15. 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

  16. 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

  17. Operationalising the Lean principles in maternity service design using 3P methodology.

    PubMed

    Smith, Iain

    2016-01-01

    The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved largely through hospital admission. It has been argued that maternity services may have become over-medicalised and service users have expressed a preference for more personalised care. NHS England's national strategy sets out a vision for a modern maternity service that continues to deliver safe care whilst also adopting the principles of personalisation. Therefore, there is a need to develop maternity services that balance safety with personal choice. To address this challenge, a maternity unit in North East England considered improving their service through refurbishment or building new facilities. Using a design process known as the production preparation process (or 3P), the Lean principles of understanding user value, mapping value-streams, creating flow, developing pull processes and continuous improvement were applied to the design of a new maternity department. Multiple stakeholders were engaged in the design through participation in a time-out (3P) workshop in which an innovative pathway and facility for maternity services were co-designed. The team created a hybrid model that they described as "wrap around care" in which the Lean concept of pull was applied to create a service and facility design in which expectant mothers were put at the centre of care with clinicians, skills, equipment and supplies drawn towards them in line with acuity changes as needed. Applying the Lean principles using the 3P method helped stakeholders to create an innovative design in line with the aspirations and objectives of the National Maternity Review. The case provides a practical example of stakeholders applying the Lean principles to maternity services and demonstrates the potential applicability of the Lean 3P approach to design healthcare services in line with policy requirements.

  18. Operationalising the Lean principles in maternity service design using 3P methodology

    PubMed Central

    Smith, Iain

    2016-01-01

    The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved largely through hospital admission. It has been argued that maternity services may have become over-medicalised and service users have expressed a preference for more personalised care. NHS England's national strategy sets out a vision for a modern maternity service that continues to deliver safe care whilst also adopting the principles of personalisation. Therefore, there is a need to develop maternity services that balance safety with personal choice. To address this challenge, a maternity unit in North East England considered improving their service through refurbishment or building new facilities. Using a design process known as the production preparation process (or 3P), the Lean principles of understanding user value, mapping value-streams, creating flow, developing pull processes and continuous improvement were applied to the design of a new maternity department. Multiple stakeholders were engaged in the design through participation in a time-out (3P) workshop in which an innovative pathway and facility for maternity services were co-designed. The team created a hybrid model that they described as “wrap around care” in which the Lean concept of pull was applied to create a service and facility design in which expectant mothers were put at the centre of care with clinicians, skills, equipment and supplies drawn towards them in line with acuity changes as needed. Applying the Lean principles using the 3P method helped stakeholders to create an innovative design in line with the aspirations and objectives of the National Maternity Review. The case provides a practical example of stakeholders applying the Lean principles to maternity services and demonstrates the potential applicability of the Lean 3P approach to design healthcare services in line with policy requirements

  19. 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

  20. [Duration of maternity leave and sick leave during pregnancy].

    PubMed

    Tophøj, A; Sabroe, S

    1999-09-06

    The aim of the project was to describe the reasons for sick leave during pregnancy. This article presents data on a subgroup of women on sick leave. The purpose of this reanalysis was to examine whether women with short maternity leave had longer sick leave during pregnancy. Pregnant women in a Danish County applying for sick leave in a year were consecutively included in the study. Data were obtained by questionnaires during 1991-1992. Women with rights to a longer maternity leave, obtained through collective bargaining, were mainly employed in occupational groups related to the public sector and were on sick leave significantly longer, than women with short maternity leave, obtained only through legislation. The diagnoses differed among the two groups. Data suggest unequal possibilities for obtaining pregnancy related sick leave, as women with longer predelivery leave and a more secure employment situation had significantly longer sick leave than other women.

  1. 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

  2. Maternal outcomes according to mode of delivery in women with severe preeclampsia: a cohort study.

    PubMed

    Amorim, Melania M R; Katz, Leila; Barros, Amanda S; Almeida, Tainara S F; Souza, Alex Sandro R; Faúndes, Aníbal

    2015-04-01

    To determine the association between mode of delivery and maternal complications in patients with severe preeclampsia. A prospective cohort study was conducted with 500 pregnant women with severe preeclampsia. The mode of delivery, vaginal or caesarean section, was considered the exposure, while the postpartum maternal complications and severe maternal morbidity were the outcomes. Logistic regression analysis was performed to determine the adjusted risk and 95% confidence intervals (95% CI) of maternal morbidity. Labour was spontaneous in 22.0% and induced in 28.2%, while 49.8% had an elective caesarean section. Ninety-five (67.4%) of the patients in whom labour was induced delivered vaginally. Total Caesarean rate was 68.2%. The risk of severe maternal morbidity was significantly greater in patients submitted to Caesarean section (54.0% versus 32.7%) irrespective of the presence of labour. Factors that remained associated with severe maternal morbidity following multivariate analysis were a diagnosis of HELLP syndrome after delivery (OR = 3.73; 95% CI: 1.55-9.88) and having a caesarean (OR = 1.91; 95% CI: 1.52-4.57). Caesareans are often performed in patients with severe preeclampsia and are associated with significant postpartum maternal morbidity. Induction of labour should be considered a feasible option in these patients.

  3. [Use of maternal health care services in poor regions in Sichuan].

    PubMed

    Tang, Jie; Li, Ning-xiu

    2008-11-01

    To undertake a research into the maternal health care services and its determinants in poor regions in Sichuan province. Stratified cluster sampling strategy was employed to select the participants who had pregnancy since 1998 to complete the interview administered "maternal health care questionnaire". A total of 462 women participated in thè study. Of the 462 women, 387 received prenatal care services, the most common maternal health care services. Only 144 women got post-natal visits at least once. Maternal age and education had significant impacts on the use of maternal health care services including prenatal examinations and birth in hospitals (P<0.05). Low-income (< Yen 1000) women used less maternal health care services than the high-income (> Yen 5000) women (P<0.05). The women who were covered by the cooperative medical insurance scheme and poverty alleviation scheme used more prenatal care and post-natal services and were more likely to deliver babies in hospitals than those who paid the services entirely out of pocket (P<0.05). Poor social and economical situation has a detrimental impact on the use of maternal health care services, which might be associated with poor education and low financial capacities of the women.

  4. Is there an incremental rise in the risk of obstetric intervention with increasing maternal age?

    PubMed

    Rosenthal, A N; Paterson-Brown, S

    1998-10-01

    To determine whether increasing maternal age increases the risk of operative delivery and to investigate whether such a trend is due to fetal or maternal factors. DESIGN ANALYSIS: of prospectively collected data on a maternity unit database. A postgraduate teaching hospital. 6410 nulliparous women with singleton cephalic pregnancies delivering at term (3742 weeks of gestation) between 1 January 92 and 31 December 95. Mode of delivery, rates of prelabour caesarean section, induction of labour and epidural usage. There was a positive, highly significant association between increasing maternal age and obstetric intervention. Prelabour (P < 0.001) and emergency (P < 0.001) caesarean section, instrumental vaginal delivery (spontaneous labour P < 0001; induced labour P = 0.001), induction of labour (P < 0.001) and epidural usage in spontaneous labour (P = 0.005) all increased with increasing age. In the second stage of labour fetal distress and failure to advance, requiring instrumental delivery, were both more likely with increasing maternal age (in both P < 0.001). Epidural usage in induced labour and the incidence of small for gestational age newborns did not increase with increasing maternal age (P = 0.68 and P = 0.50, respectively). This study demonstrates that increasing maternal age is associated with an incremental increase in obstetric intervention. Previous studies have demonstrated a significant effect in women older than 35 years of age, but these data show changes on a continuum from teenage years. This finding may reflect a progressive, age-related deterioration in myometrial function.

  5. Financial Incentives and Maternal Health: Where Do We Go from Here?

    PubMed Central

    Stanton, Mary Ellen; Higgs, Elizabeth S.; Balster, Robert L.; Bellows, Ben W.; Brandes, Neal; Comfort, Alison B.; Eichler, Rena; Glassman, Amanda; Hatt, Laurel E.; Conlon, Claudia M.; Koblinsky, Marge

    2013-01-01

    Health financing strategies that incorporate financial incentives are being applied in many low- and middle-income countries, and improving maternal and neonatal health is often a central goal. As yet, there have been few reviews of such programmes and their impact on maternal health. The US Government Evidence Summit on Enhancing Provision and use of Maternal Health Services through Financial Incentives was convened on 24-25 April 2012 to address this gap. This article, the final in a series assessing the effects of financial incentives—performance-based incentives (PBIs), insurance, user fee exemption programmes, conditional cash transfers, and vouchers—summarizes the evidence and discusses issues of context, programme design and implementation, cost-effectiveness, and sustainability. We suggest key areas to consider when designing and implementing financial incentive programmes for enhancing maternal health and highlight gaps in evidence that could benefit from additional research. Although the methodological rigor of studies varies, the evidence, overall, suggests that financial incentives can enhance demand for and improve the supply of maternal health services. Definitive evidence demonstrating a link between incentives and improved health outcomes is lacking; however, the evidence suggests that financial incentives can increase the quantity and quality of maternal health services and address health systems and financial barriers that prevent women from accessing and providers from delivering quality, lifesaving maternal healthcare.

  6. Financial incentives and maternal health: where do we go from here?

    PubMed

    Morgan, Lindsay; Stanton, Mary Ellen; Higgs, Elizabeth S; Balster, Robert L; Bellows, Ben W; Brandes, Neal; Comfort, Alison B; Eichler, Rena; Glassman, Amanda; Hatt, Laurel E; Conlon, Claudia M; Koblinsky, Marge

    2013-12-01

    Health financing strategies that incorporate financial incentives are being applied in many low- and middle-income countries, and improving maternal and neonatal health is often a central goal. As yet, there have been few reviews of such programmes and their impact on maternal health. The US Government Evidence Summit on Enhancing Provision and use of Maternal Health Services through Financial Incentives was convened on 24-25 April 2012 to address this gap. This article, the final in a series assessing the effects of financial incentives--performance-based incentives (PBIs), insurance, user fee exemption programmes, conditional cash transfers, and vouchers--summarizes the evidence and discusses issues of context, programme design and implementation, cost-effectiveness, and sustainability. We suggest key areas to consider when designing and implementing financial incentive programmes for enhancing maternal health and highlight gaps in evidence that could benefit from additional research. Although the methodological rigor of studies varies, the evidence, overall, suggests that financial incentives can enhance demand for and improve the supply of maternal health services. Definitive evidence demonstrating a link between incentives and improved health outcomes is lacking; however, the evidence suggests that financial incentives can increase the quantity and quality of maternal health services and address health systems and financial barriers that prevent women from accessing and providers from delivering quality, lifesaving maternal healthcare.

  7. A pilot study on mobile phones as a means to access maternal health education in eastern rural Uganda.

    PubMed

    Roberts, Sanford; Birgisson, Natalia; Julia Chang, Diana; Koopman, Cheryl

    2015-01-01

    Maternal mortality in Uganda has remained relatively high since 2006. We studied access to mobile phones and people's interest in receiving audio-based maternal health lessons delivered via a toll-free telephone line. Interviews were conducted, using a male and a female translator, with 42 men and 41 women in four villages located in eastern rural Uganda. Most of the participants were recruited through systematic sampling, but some were recruited through community organizations and antenatal clinics. Ownership of a mobile phone was reported by 79% of men and by 42% of women. Among those who did not own a mobile phone, 67% of men and 88% of women reported regularly borrowing a mobile phone. Among women, 98% reported interest in receiving maternal mobile health lessons, and 100% of men. Providing local communities with mobile maternal health education offers a new potential method of reducing maternal mortality.

  8. 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

  9. Neuroendocrine regulation of maternal behavior.

    PubMed

    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 processes 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. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. 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

  11. 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

  12. Scheduled Cesarean Delivery: Maternal and Neonatal Risks in Primiparous Women in a Community Hospital Setting

    PubMed Central

    Quiroz, Lieschen H.; Chang, Howard; Blomquist, Joan L.; Okoh, Yvonne K.; Handa, Victoria L.

    2011-01-01

    We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications. PMID:19021093

  13. Scheduled cesarean delivery: maternal and neonatal risks in primiparous women in a community hospital setting.

    PubMed

    Quiroz, Lieschen H; Chang, Howard; Blomquist, Joan L; Okoh, Yvonne K; Handa, Victoria L

    2009-04-01

    We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications.

  14. Maternal body mass index and duration of labor.

    PubMed

    Carlhäll, Sara; Källén, Karin; Blomberg, Marie

    2013-11-01

    To evaluate whether the duration of the active phase of labor is associated with maternal body mass index (BMI), in nulliparous women with spontaneous onset of labor. Historical prospective cohort study including 63,829 nulliparous women with a singleton pregnancy and a spontaneous onset of labor, who delivered between January 1, 1995 and December 31, 2009. Data were collected from the Perinatal Revision South registry, a regional perinatal database in Southern Sweden. Women were categorized into six classes of BMI. Overweight and obese women were compared to normal weight women regarding duration of active labor. Adjustments were made for year of delivery, maternal age and infant birth weight. The median duration of labor was significantly longer in obese women (class I obesity (BMI 30-34.9) = 9.1h, class II obesity (BMI 35-39.9) = 9.2h and class III obesity (BMI > 40) = 9.8h) compared to normal-weight women (BMI 18.5-24.9) = 8.8h (p < 0.001). The risk of labor lasting more than 12h increased with increasing maternal BMI: OR 1.04 (1.01-1.06) (OR per 5-units BMI-increase).The risk of labor lasting more than 12h or emergency cesarean section within 12h, compared to vaginal deliveries within 12h, increased with increasing maternal BMI. Duration of the second stage of labor was significantly shorter in obese women: in class III obesity the median value was 0.45 h compared to normal weight women, 0.55 h (p < 0.001). In nulliparous women with a spontaneous onset of labor, duration of the active phase of labor increased significantly with increasing maternal BMI. Once obese women reach the second stage they deliver more quickly than normal weight women, which implies that the risk of prolonged labor is restricted to the first stage of labor. It is clinically important to consider the prolonged first stage of labor in obese women, for example when diagnosing first stage labor arrest, in order to optimize management of this rapidly growing at-risk group of women. Thus, it

  15. [Decision-to-deliver interval for forceps delivery and cesarean section: 137 extractions for abnormal fetal heart rhythm during labor].

    PubMed

    Dupuis, O; Dubuisson, J; Moreau, R; Sayegh, I; Clément, H-J; Rudigoz, R-C

    2005-12-01

    Comparison of the decision to delivery interval in cases of forceps delivery and in cases of cesarean sections. A retrospective analysis was performed on 137 cases of forceps deliver (n = 63) and cesarean section (n = 74) indicated for abnormal fetal heart rhythm. All cases were observed in a level 3 maternity unit between October 2003 and August 2004. The mean decision-to-delivery interval was significantly shorter in the forceps group (14.84 min +/- 6.54 versus 29.31 min +/- 11.79 p < 0.0001). Maternal and neonatal morbidity were comparable. This study suggest that once the fetal head is engaged, forceps delivery can significantly reduced the decision-to-delivery interval.

  16. The Stability of Maternal Interpretation of Infant's Facial Expressions during Pre- and Postnatal Period and Its Relation to Prenatal Attachment.

    ERIC Educational Resources Information Center

    Siddiqui, Anver; Eisemann, Martin; Hagglof, Bruno

    2000-01-01

    Projective methods were used to explore maternal perception and interpretation of infant's emotional expressions during the third trimester of pregnancy and 3 months postpartum. Results revealed that mothers interpreted infant emotions overwhelmingly in positive terms at both times; findings suggest consistency in maternal interpretation across…

  17. Social Media–Delivered Sexual Health Intervention

    PubMed Central

    Bull, Sheana S.; Levine, Deborah; Black, Sandra R.; Schmiege, Sarah; Santelli, John

    2012-01-01

    Background Youth are using social media regularly and represent a group facing substantial risk for sexually transmitted infection (STI). Although there is evidence that the Internet can be used effectively in supporting healthy sexual behavior, this hasn't yet extended to social networking sites. Purpose To determine whether STI prevention messages delivered via Facebook are efficacious in preventing increases in sexual risk behavior at 2 and 6 months. Design Cluster RCT, October 2010–May 2011. Setting/participants Individuals (seeds) recruited in multiple settings (online, via newspaper ads and face-to-face) were asked to recruit three friends, who in turn recruited additional friends, extending three waves from the seed. Seeds and waves of friends were considered networks and exposed to either the intervention or control condition. Intervention Exposure to Just/Us, a Facebook page developed with youth input, or to control content on 18–24 News, a Facebook page with current events for 2 months. Main outcome measures Condom use at last sex and proportion of sex acts protected by condoms. Repeated measures of nested data were used to model main effects of exposure to Just/Us and time by treatment interaction. Results 1578 participants enrolled, with 14% Latino and 35% African-American; 75% of participants completed at least one study follow-up. Time by treatment effects were observed at 2 months for condom use (intervention 68% vs control 56%, p=0.04) and proportion of sex acts protected by condoms (intervention 63% vs control 57%, p=0.03) where intervention participation reduced the tendency for condom use to decrease over time. No effects were seen at 6 months. Conclusions Social networking sites may be venues for efficacious health education interventions. More work is needed to understand what elements of social media are compelling, how network membership influences effects, and whether linking social media to clinical and social services can be beneficial

  18. Museums: Using Keyworkers to Deliver Lifelong Learning

    NASA Astrophysics Data System (ADS)

    Gray, David; Chadwick, Alan

    2001-09-01

    The article describes a major study of the activities of keyworkers (mediators between museums and their public) within the context of museums' contribution to lifelong learning and to overcoming cultural exclusion. Field studies were undertaken in the UK, Ireland and Sweden based upon live projects with keyworkers who were subsequently interviewed about their roles, professional development needs and attitudes. In the UK, the Victoria & Albert Museum's keyworkers comprised youth workers, in Sweden they were traffic wardens and taxi drivers, and the Irish Museum of Modern Art worked with a group of elderly adults. From these studies, the research was able to articulate key recommendations for developing museum policy on keyworkers to enhance adult learning in and through museums.

  19. Neonatal outcomes of Syrian refugees delivered in a tertiary hospital in Ankara, Turkey.

    PubMed

    Büyüktiryaki, Mehmet; Canpolat, Fuat Emre; Alyamaç Dizdar, Evrim; Okur, Nilüfer; Kadıoğlu Şimşek, Gülsüm

    2015-01-01

    We retrospectively reviewed the medical records of all Syrian immigrants from the TurkishSyrian border who delivered the Zekai Tahir Burak Maternity and Teaching Hospital Neonatal Intensive Care Unit (NICU) in Ankara, Turkey. Between January 2013 and December 2014 a total of 36,346 women gave birth at this center. Of these, 457 women were Syrian immigrants, comprising 1.2 % (457/36,346) of all deliveries. The number of births among Syrian refugees in Turkey appears to be increasing. Further research is needed to understand the relative morbidity of babies born to Syrian refugees compared to the local population, as well as the economic impact on facilities treating these cases.

  20. Women are designed to deliver vaginally and not by cesarean section: an obstetrician's view.

    PubMed

    Visser, Gerard H A

    2015-01-01

    Worldwide, there is a rapid increase in deliveries by cesarean section. The large differences among countries, from about 16% to more than 60%, suggest that the cesarean delivery (CD) rate has little to do with evidence-based medicine. In this review, the background for the increasing CD rate is discussed as well as the limited positive effects on neonatal outcome in both term and preterm neonates. Negative effects of CD, including direct maternal morbidity, complications of subsequent pregnancies and iatrogenic early delivery resulting in increased neonatal morbidity, are discussed in addition to long-term implications for the offspring involving altered development of the immune system. The 'battle' to lower the CD rate will be difficult, but we should not forget that women are designed to deliver vaginally and not by cesarean section.

  1. 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

  2. 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

  3. Maternity leave in normal pregnancy.

    PubMed

    Leduc, Dean

    2011-08-01

    To assist maternity care providers in recognizing and discussing health- and illness-related issues in pregnancy and their relationship to maternity benefits. Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in 2009 using appropriate controlled vocabulary (e.g., maternity benefits) and key words (e.g., maternity, benefits, pregnancy). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2009. Grey (unpublished) literature was identified through searching the web sites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

  4. Assessing Program Sustainability in an Eating Disorder Prevention Effectiveness Trial Delivered by College Clinicians

    PubMed Central

    Rohde, Paul; Shaw, Heather; Butryn, Meghan L.; Stice, Eric

    2015-01-01

    Sustainability of the Body Project, a dissonance-based selective eating disorder prevention program supported by efficacy and effectiveness trials, has not previously been examined. This mixed-methods study collected qualitative and quantitative data on training, supervision, and the intervention from 27 mental health clinicians from eight US universities who participated in an effectiveness trial and quantitative data on 2-year sustainability of program delivery. Clinicians, who were primarily masters-level mental health providers, had limited experience delivering manualized interventions. They rated the training and manual favorably, noting that they particularly liked the role-plays of session activities and intervention rationale, but requested more discussion of processes and group management issues. Clinicians were satisfied receiving emailed supervision based on videotape review. They reported enjoying delivering the Body Project but reported some challenges with the manualized format and time constraints. Most clinicians anticipated running more groups after the study ended but only four universities (50%) reported providing additional Body Project groups at the 1-year follow-up assessment and sustained delivery of the groups decreased substantially two years after study completion, with only one university (12%) continuing to deliver groups. The most commonly reported barriers for conducting additional groups were limited time and high staff turnover. PMID:26143559

  5. [Social representations of teenagers with their first-born child on maternal care to newborns].

    PubMed

    Folle, Emanuele; Geib, Lorena Teresinha Consalter

    2004-01-01

    This qualitative study aimed to analyze the social representation of teenagers who had their first child and about maternal care to newborns in the home environment. Participants were eight teenagers with their newborns. Data were collected at their homes by means of projective techniques and semi-structured interviews. Analysis was based on social representation theory, demonstrating that the teenagers represent maternal care in figurative centers of affection, family integration and maternal fulfillment. The maternal care is symbolically anchored in the appearance of a family, in the continuum of feelings and in the commitment to the psychomotor progress of the child. The teenagers who had their first child gave more value to belonging to a family than to the losses resulting from early motherhood. Maternal care is a conflictive exercise. On the one hand, it represents the status of being an adult and responsible but, on the other, it marks insecurity, lack of preparation and immaturity, which affect care to the newborn.

  6. Role of traditional birth attendants in improving reproductive health: lessons from the family health project, Sindh.

    PubMed

    Islam, A; Malik, F A

    2001-06-01

    Despite strenuous efforts, the maternal mortality rate in Pakistan remains high. The national figure of 340 maternal deaths per 100,000 live births tends to hide the fact that in some rural areas it is as high as 700 per 100,000 live births. Not surprisingly, in Pakistan only 20% of births are attended by a trained health professional. In most rural areas, home to almost 70% of the population, traditional birth attendants (TBAs) deliver 90% of the births. TBAs, therefore, play a crucial role in the delivery of maternal health care in Pakistan. Realizing the importance of TBAs, the Family Health Project (FHP) of the Department of Health Sindh, financed by the World Bank, tried to enhance their knowledge and skills through comprehensive training programs. FHP provided training to 650 TBAs in 10 districts. The training was provided by the Department of Community Health Sciences (CHS) of the Aga Khan University (AKU) who acted as technical consultant to the project. A community-based qualitative post-intervention survey. Post-intervention survey of this seven-year project (1992-1999) revealed that (a) the training enhanced the knowledge and skills of the TBAs, (b) the trained TBAs provide more broader health care services and (c) they enjoy greater community acceptance and provide greater consumer satisfaction. It also showed that the TBAs remain the most available and accessible health resource in most rural settings. It is imperative that TBAs and their continuing training should remain central to any reproductive health intervention along with an effective referral system linking them to well-equipped emergency obstetric care facilities. However, the assessment clearly demonstrated that an integrated referral system backed by effective emergency obstetric care is essential to the success of the TBA training program.

  7. Maternal health in Third World.

    PubMed

    Rosenfield, A; Maine, D

    1987-03-21

    The authors are responding to a LANCET editorial that asserted that female education, rather than family planning, should be advocated for prevention of maternal deaths in sub-Saharan Africa. Family planning can prevent maternal deaths in 2 ways. The 1st is prevention of pregnancy among women at high risk of complicated pregnancy and delivery, including illegal abortion. The 2nd is simply prevention of pregnancy and, thus, exposure to complications. If only women who say they want no more children had no further births, an estimated 33% of maternal deaths in developing countries would be prevented. In reality, the effect of family planning might well be greater, since it plays an essential part in reducing mortality from illicitly induced abortion. Although improvement of education for Third World women will improve the quality of their lives, it is not likely to reduce maternal mortality. Once pregnant, 10-15% of women will have serious complicatons of pregnancy or delivery, no matter what the setting. The primary responsibility of health professionals is not socioeconomic development but prevention of maternal deaths resulting from lack of effective medical care. Interest in the issue is growing. In February, 1987, the World Bank, with the World Health Organization and the UN Fund for Population Activities, sponsored a meeting in Nairobi to launch the "Safe Motherhood Initiative." This initiative will contain a variety of activities. The authors hope that foremost will be those that act directly to prvent maternal deaths--prevention of unwanted pregnancies and early treatment of complications.

  8. Maternal immune transfer in mollusc.

    PubMed

    Wang, Lingling; Yue, Feng; Song, Xiaorui; Song, Linsheng

    2015-02-01

    Maternal immunity refers to the immunity transferred from mother to offspring via egg, playing an important role in protecting the offspring at early life stages and contributing a trans-generational effect on offspring's phenotype. Because fertilization is external in most of the molluscs, oocytes and early embryos are directly exposed to pathogens in the seawater, and thus maternal immunity could provide a better protection before full maturation of their immunological systems. Several innate immune factors including pattern recognition receptors (PRRs) like lectins, and immune effectors like lysozyme, lipopolysaccharide binding protein/bacterial permeability-increasing proteins (LBP/BPI) and antioxidant enzymes have been identified as maternally derived immune factors in mollusc eggs. Among these immune factors, some maternally derived lectins and antibacterial factors have been proved to endue mollusc eggs with effective defense ability against pathogen infection, while the roles of other factors still remain untested. The physiological condition of mollusc broodstock has a profound effect on their offspring fitness. Many other factors such as nutrients, pathogens, environment conditions and pollutants could exert considerable influence on the maternal transfer of immunity. The parent molluscs which have encountered an immune stimulation endow their offspring with a trans-generational immune capability to protect them against infections effectively. The knowledge on maternal transfer of immunity and the trans-generational immune effect could provide us with an ideal management strategy of mollusc broodstock to improve the immunity of offspring and to establish a disease-resistant family for a long-term improvement of cultured stocks.

  9. Maternal Buprenorphine Maintenance and Lactation.

    PubMed

    Jansson, Lauren M; Spencer, Nancy; McConnell, Krystle; Velez, Martha; Tuten, Michelle; Harrow, Cheryl A; Jones, Hendrée E; Swortwood, Madeleine J; Barnes, Allan J; Scheidweiler, Karl B; Huestis, Marilyn A

    2016-11-01

    In addition to the well-known benefits of human milk and breastfeeding for the mother and infant, breastfeeding may mitigate neonatal abstinence syndrome severity in prenatally opioid-exposed infants. However, lack of conclusive data regarding the extent of the presence of buprenorphine and active metabolites in human milk makes the recommendation of breastfeeding for buprenorphine-maintained women difficult for many providers. This study seeks to determine the concentrations of buprenorphine and its active metabolites (norbuprenorphine, buprenorphine-glucuronide, and norbuprenorphine-glucuronide) in human milk, maternal plasma, and infant plasma of buprenorphine-maintained women and their infants. Up to 10 buprenorphine-maintained women provided paired breast milk and plasma samples at 2, 3, 4, 14, and 30 days postdelivery, and 9 infants provided plasma samples on day 14 of life. All samples were analyzed via liquid chromatography tandem mass spectrometry to determine concentrations of buprenorphine, norbuprenorphine, buprenorphine-glucuronide, and norbuprenorphine-glucuronide by a fully validated method. Concentrations of buprenorphine and metabolites are low in human milk and maternal plasma. Breastfed infant plasma concentrations of buprenorphine were low or undetectable and metabolite concentrations undetectable at 14 days of infant age. There were significant correlations between maternal buprenorphine dose and maternal plasma and human milk buprenorphine concentrations. These data find low concentrations of buprenorphine and metabolites in human milk and lend support to the recommendation for lactation among stable buprenorphine-maintained women. However, the correlation between maternal dose and maternal plasma and human milk buprenorphine concentrations bears further study.

  10. Maternal infanticides in Fiji.

    PubMed

    Adinkrah, M

    2000-12-01

    This essay contributes to the cross-cultural literature on childhood homicides by examining 16 infanticidal homicides that occurred in Fiji over an 11-year period. The results are compared with infanticide studies conducted in other societies. Official police data recorded in a Homicide and Manslaughter register are analyzed. These are supplemented by newspaper reports of infanticides and semi-structured interviews conducted with key criminal justice and medical personnel intimately associated with infanticide cases. The findings show that most infanticide defendants were young, poor, Fijian, with little formal education, living with nonparental kin at the time of the crime. The infanticides were precipitated by unwanted pregnancies brought on by nonmarital and extramarital sex. Pregnancy is carried to full gestation without knowledge of family, friends and neighbors of offenders and the infant is killed immediately following birth. The current findings demonstrate that the patterns of maternal infant killings in Fiji are congruous in many significant ways with those in advanced industrialized societies. It is concluded that additional research in non-Western, nonindustrialized nations is imperative to contribute to the development of sound conclusions about, and remedies for infanticide.

  11. [Breastfeeding and maternal medications].

    PubMed

    Chaves, Roberto G; Lamounier, Joel A

    2004-11-01

    To contribute with information about the adequate administration of drugs during breastfeeding. MEDLINE articles from 1993 to 2004, and Lilacs articles from 1995 to 2004 were selected in Portuguese, Spanish and English, by including the following keywords: breastfeeding, lactation, drugs and medicines. Other updated references found in articles and books were also included in this review, in order to provide additional information. Most of the drugs are compatible with breastfeeding. Few were considered inadequate, such as antineoplastic drugs, radiopharmaceuticals and drugs of abuse. Some drugs require concern, as they may cause adverse effects in breastfed babies or reduce the mother's breast milk volume. However, further knowledge on some medicines during lactation is required. The fundamental principle in the prescription of medicines for lactating mothers is mostly based on the concept of risk and benefit. The option must be, as much as possible, for a drug that has already been studied, which is little released in the maternal milk or that does not mean an apparent risk for the infant's health. Medicines that reduce the mother's production of milk should be avoided during the lactation period. The use of galactogogos is reserved for particular situations. Therefore, only safety drugs should be administered during breastfeeding, which should rarely be discouraged or discontinued in such cases.

  12. Maternity Leave in Taiwan.

    PubMed

    Feng, Joyce Yen; Han, Wen-Jui

    2010-07-01

    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.

  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. 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

  15. 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…

  16. Microelectromechanical systems technology to deliver insulin.

    PubMed

    Liepmann, D; Pisano, A P; Sage, B

    1999-01-01

    A new microfabrication technology, microelectromechanical systems (MEMS), is envisioned for improved insulin delivery in the context of a device currently being developed for the Defense Advanced Research Projects Agency (DARPA). The drug delivery system utilizes MEMS technology to move and control fluids at the microscale, making possible the reconstitution and delivery of extremely small amounts of drug with extreme precision. In this article, the required microscale components that are currently being developed for the system are described. MEMS are made using fabrication methods similar to that utilized in microelectronics. Consequently, MEMS technology can be used to fabricate devices that are extremely small. The fundamental difference is that MEMS devices can either move themselves or control the movement of other materials, such as fluids. Furthermore, this manufacturing method is intrinsically low-cost and therefore is ideal for drug delivery systems. The current development of a new drug delivery system for controlled drug reconstitution and delivery system for DARPA is described as are the MEMS-based components for the required fluidic control. The adaptation of the system for insulin delivery is addressed and is envisioned to be a fully self-contained parenteral drug delivery system about the size of a 4-mm thick credit card.

  17. Telecommunications delivers a message for energy management

    SciTech Connect

    Not Available

    1981-01-01

    Centralized energy management system use is growing in the U.S. Building automation systems (BAS), the most complex and costly, are offered either as on-site or time-shared. Now, a new BAS that incorporates telecommunications technology, is being offered. The system was developed by American Telephone and Telegraph as a compatible feature of its DIMENSION family of PBXs (private branch exchanges) available to facilities with 400 to 2000 telephone lines. With the energy management feature, the DIMENSION PBX's microprocessor does double-duty by taking over the day-to-day management of a facility's energy consumpion. The Bell Energy Communication Service (ECS) is acquired as part of the overall telecommunications system. ECS has been installed successfully in several environments. For example, at a large steel plant in Pennsylvania, the energy feature is projected to trim off more than /300,000 of the plant's mammoth /32-million annual electric bill. ECS will accomplish this by applying demand management to 14 pieces of equipment peripheral to the steel-making process. Demand charges had accounted for a significant portion of the plant's utility bills. Now when the plant approaches a peak in demand, ECS will idle 500 to 600 HP air compressors for up to three minutes, utilize back-up steam turbines for additional energy production, and halt conveyors unloading coal from barges for a few minutes.

  18. Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy.

    PubMed

    Gaillard, Romy; Durmuş, Büşra; Hofman, Albert; Mackenbach, Johan P; Steegers, Eric A P; Jaddoe, Vincent W V

    2013-05-01

    The prevalence of overweight and obesity among women of reproductive age is increasing. We aimed to determine risk factors and maternal, fetal and childhood consequences of maternal obesity and excessive gestational weight gain. The study was embedded in a population-based prospective cohort study among 6959 mothers and their children. The study was based in Rotterdam, The Netherlands (2001-2005). Maternal lower educational level, lower household income, multiparity, and FTO risk allel were associated with an increased risk of maternal obesity, whereas maternal European ethnicity, nulliparity, higher total energy intake, and smoking during pregnancy were associated with an increased risk of excessive gestational weight gain (all p-values <0.05). As compared to normal weight, maternal obesity was associated with increased risks of gestational hypertension (OR 6.31 (95% CI 4.30, 9.26)), preeclampsia (OR (3.61, (95% CI 2.04, 6.39)), gestational diabetes (OR 6.28 (95%CI 3.01, 13.06)), caesarean delivery (OR 1.91 (95% CI 1.46, 2.50)), delivering large size for gestational age infants (OR 2.97 (95% CI 2.16, 4.08)), and childhood obesity (OR 5.02 (95% CI:2.97, 8.45)). Weaker associations of excessive gestational weight gain with maternal, fetal and childhood outcomes were observed, with the strongest effects for first trimester weight gain. Our study shows that maternal obesity and excessive weight gain during pregnancy are associated with socio-demographic, lifestyle, and genetic factors and with increased risks of adverse maternal, fetal and childhood outcomes. As compared to prepregnancy overweight and obesity, excessive gestational weight gain has a limited influence on adverse pregnancy outcomes. Copyright © 2013 The Obesity Society.

  19. [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.

  20. 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…

  1. Maternal dietary patterns in pregnancy and the association with small-for-gestational-age infants.

    PubMed

    Thompson, John M D; Wall, Clare; Becroft, David M O; Robinson, Elizabeth; Wild, Chris J; Mitchell, Edwin A

    2010-06-01

    Maternal nutritional status before and during pregnancy is important for the growth and development of the fetus. The effects of pre-pregnancy nutrition (estimated by maternal size) are well documented. There is little information in today's Western society on the effect of maternal nutrition during pregnancy on the fetus. The aim of the study was to describe dietary patterns of a cohort of mothers during pregnancy (using principal components analysis with a varimax rotation) and assess the effect of these dietary patterns on the risk of delivering a small-for-gestational-age (SGA) baby. The study was a case-control study investigating factors related to SGA. The population was 1714 subjects in Auckland, New Zealand, born between October 1995 and November 1997, about half of whom were born SGA ( < or = 10th percentile for sex and gestation). Maternal dietary information was collected using FFQ after delivery for the first and last months of pregnancy. Three dietary patterns (traditional, junk and fusion) were defined. Factors associated with these dietary patterns when examined in multivariable analyses included marital status, maternal weight, maternal age and ethnicity. In multivariable analysis, mothers who had higher 'traditional' diet scores in early pregnancy were less likely to deliver a SGA infant (OR = 0.86; 95 % CI 0.75, 0.99). Maternal diet, particularly in early pregnancy, is important for the development of the fetus. Socio-demographic factors tend to be significantly related to dietary patterns, suggesting that extra resources may be necessary for disadvantaged mothers to ensure good nutrition in pregnancy.

  2. Evaluation of four maternal smoking questions.

    PubMed Central

    Kharrazi, M; Epstein, D; Hopkins, B; Kreutzer, R; Doebbert, G; Hiatt, R; Swan, S; Eskenazi, B; Pirkle, J L; Bernert, J T

    1999-01-01

    OBJECTIVE: The authors evaluated four questions about maternal smoking during pregnancy for use on birth certificates. METHODS: Question 1 (yes/no format) and Question 2 (trimester-specific design) were tested among 1171 women who delivered at two Kaiser Permanente medical centers in northern California. Responses to Questions 1 and 2 were compared with smoking information provided by participants in telephone interviews conducted during pregnancy. Question 3 (multiple choice format) and Question 4 (month- and grouped month-specific design) were tested among 900 women who enrolled in a statewide prenatal screening program and who delivered in 20 hospitals in four Central Valley counties. Responses to Questions 3 and 4 were compared with mid-pregnancy serum cotinine levels. The authors evaluated the four questions in terms of conciseness, response rate, data accuracy, and type of data requested. RESULTS: Questions 1 and 2 were the most concise. Response rates could not be calculated for Questions 1 and 2. Response rates were 86.0% for Question 3 and 74.2% for Question 4. Sensitivity was 47.3% for Question 1, 62.1% for Question 2, 83.8% for Question 3, and 86.7% for Question 4. The types of data requested by Questions 2 and 4 seem to best satisfy the needs of the broad audience of birth certificate users. CONCLUSIONS: No single question was clearly superior. The authors propose a combination of Questions 2 and 4, which asks about average number of cigarettes smoked per day in the three months before pregnancy and in each trimester of pregnancy. PMID:9925173

  3. Could alterations in maternal plasma visfatin concentration participate in the phenotype definition of preeclampsia and SGA?

    PubMed

    Mazaki-Tovi, Shali; Romero, Roberto; Kim, Sun Kwon; Vaisbuch, Edi; Kusanovic, Juan Pedro; Erez, Offer; Chaiworapongsa, Tinnakorn; Gotsch, Francesca; Mittal, Pooja; Nhan-Chang, Chia-Ling; Than, Nandor Gabor; Gomez, Ricardo; Nien, Jyh Kae; Edwin, Samuel S; Pacora, Percy; Yeo, Lami; Hassan, Sonia S

    2010-08-01

    Women with preeclampsia and those who delivered a small-for-gestational-age (SGA) neonate share several mechanisms of disease, including chronic uteroplacental ischemia and failure of physiologic transformation of the spiral arteries. However, the clinical manifestation of these obstetrical syndromes is remarkably different. It has been proposed that an altered maternal metabolic state, as well as a unique circulating cytokines milieu, predispose women to develop either preeclampsia or SGA. Compelling evidence suggests that adipose tissue orchestrates both metabolic pathways and immunological responses via the production of adipokines. Visfatin is a novel adipocytokine with metabolic and immunomodulating properties. The objective of this study was to determine whether preeclampsia and SGA are associated with alterations in maternal circulating visfatin concentrations. This cross-sectional study included pregnant women in the following groups: (1) normal pregnancy (n = 158); (2) patients with preeclampsia (n = 43) of which 32 had an AGA and 11 had an SGA neonate; (3) patients without preeclampsia who delivered an SGA neonate (n = 55). Maternal plasma visfatin concentrations were measured by ELISA. Nonparametric tests and multiple linear regression analysis were used. (1) Women who delivered an SGA neonate had a higher median maternal plasma visfatin concentration than those with a normal pregnancy (20.0 ng/ml, interquartile range: 17.2-24.6 vs. 15.2 ng/ml, 12.1-19.2, respectively; P < 0.001) and than those with preeclampsia (14.5 ng/ml, 12.5-18.7; P < 0.001); (2) the median maternal plasma visfatin concentration did not differ significantly between patients with preeclampsia and those with a normal pregnancy (P = 0.8); (3) among patients with preeclampsia, there was no significant difference in the median maternal plasma visfatin concentration between those with or without an SGA neonate (P = 0.5); (4) in a linear regression model, delivery of an SGA neonate and

  4. 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.

  5. Delivering Unidata Technology via the Cloud

    NASA Astrophysics Data System (ADS)

    Fisher, Ward; Oxelson Ganter, Jennifer

    2016-04-01

    Over the last two years, Docker has emerged as the clear leader in open-source containerization. Containerization technology provides a means by which software can be pre-configured and packaged into a single unit, i.e. a container. This container can then be easily deployed either on local or remote systems. Containerization is particularly advantageous when moving software into the cloud, as it simplifies the process. Unidata is adopting containerization as part of our commitment to migrate our technologies to the cloud. We are using a two-pronged approach in this endeavor. In addition to migrating our data-portal services to a cloud environment, we are also exploring new and novel ways to use cloud-specific technology to serve our community. This effort has resulted in several new cloud/Docker-specific projects at Unidata: "CloudStream," "CloudIDV," and "CloudControl." CloudStream is a docker-based technology stack for bringing legacy desktop software to new computing environments, without the need to invest significant engineering/development resources. CloudStream helps make it easier to run existing software in a cloud environment via a technology called "Application Streaming." CloudIDV is a CloudStream-based implementation of the Unidata Integrated Data Viewer (IDV). CloudIDV serves as a practical example of application streaming, and demonstrates how traditional software can be easily accessed and controlled via a web browser. Finally, CloudControl is a web-based dashboard which provides administrative controls for running docker-based technologies in the cloud, as well as providing user management. In this work we will give an overview of these three open-source technologies and the value they offer to our community.

  6. 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

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

    PubMed

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

    2008-09-30

    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 empower

  8. 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.

  9. Maternal characteristics and maternal limit-setting styles.

    PubMed

    LeCuyer-Maus, Elizabeth A; Houck, Gail M

    2002-01-01

    In a longitudinal study of 126 mothers and toddlers during toddlerhood, maternal limit-setting styles were assessed at 12, 24, and 36 months in relation to selected maternal characteristics. Mothers using teaching-based limit-setting styles at 12 months reported more optimal relationship histories of care and overprotection/control in their own families of origin. The main contributor to a maternal teaching-based limit-setting style in this sample was years of formal education, followed by a more multicausal conceptualization of how children develop. Thus, while years of formal education appear to facilitate the use of a teaching-based limit-setting style, formal education is not the only way to develop these skills. Maternal conceptualization of development may be amenable to intervention through a number of alternative learning activities. Further research is needed to explore the effects of different types of educational and learning opportunities on current maternal behavior, with the goal of optimizing socialization skills related to the development of toddler self-regulation.

  10. Is Maternal Periodontal Disease a Risk Factor for Preterm Delivery?

    PubMed Central

    Kungsadalpipob, Kajorn; Chanchareonsook, Prohpring; Limpongsanurak, Sompop; Vanichjakvong, Ornanong; Sutdhibhisal, Sanutm; Wongkittikraiwan, Nopmanee; Sookprome, Chulamanee; Kamolpornwijit, Wiboon; Jantarasaengaram, Surasak; Manotaya, Saknan; Siwawej, Vatcharapong; Barlow, William E.; Fitzpatrick, Annette L.; Williams, Michelle A.

    2009-01-01

    Several studies have suggested an association between maternal periodontal disease and preterm delivery, but this has not been a consistent finding. In 2006–2007, the authors examined the relation between maternal periodontal disease and preterm delivery among 467 pregnant Thai women who delivered a preterm singleton infant (<37 weeks’ gestation) and 467 controls who delivered a singleton infant at term (≥37 weeks’ gestation). Periodontal examinations were performed within 48 hours after delivery. Participants’ periodontal health status was classified into 4 categories according to the extent and severity of periodontal disease. Logistic regression was used to estimate odds ratios and 95% confidence intervals. Preterm delivery cases and controls were similar with regard to mean probing depth, mean clinical attachment loss, and mean percentage of sites exhibiting bleeding on probing. After controlling for known confounders, the authors found that severe clinical periodontal disease was not associated with an increased risk of preterm delivery (odds ratio = 1.20, 95% confidence interval: 0.67, 2.16). In addition, there was no evidence of a linear increase in risk of preterm delivery or its subtypes associated with increasing severity of periodontal disease (Ptrend > 0.05). The results of this case-control study do not provide convincing evidence that periodontal disease is associated with preterm delivery or its subtypes among Thai women. PMID:19131565

  11. 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

  12. 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.

  13. Blueprint for action: steps toward a high-quality, high-value maternity care system.

    PubMed

    Angood, Peter B; Armstrong, Elizabeth Mitchell; Ashton, Diane; Burstin, Helen; Corry, Maureen P; Delbanco, Suzanne F; Fildes, Barbara; Fox, Daniel M; Gluck, Paul A; Gullo, Sue Leavitt; Howes, Joanne; Jolivet, R Rima; Laube, Douglas W; Lynne, Donna; Main, Elliott; Markus, Anne Rossier; Mayberry, Linda; Mitchell, Lynn V; Ness, Debra L; Nuzum, Rachel; Quinlan, Jeffrey D; Sakala, Carol; Salganicoff, Alina

    2010-01-01

    Childbirth Connection hosted a 90th Anniversary national policy symposium, Transforming Maternity Care: A High Value Proposition, on April 3, 2009, in Washington, DC. Over 100 leaders from across the range of stakeholder perspectives were actively engaged in the symposium work to improve the quality and value of U.S. maternity care through broad system improvement. A multi-disciplinary symposium steering committee guided the strategy from its inception and contributed to every phase of the project. The "Blueprint for Action: Steps Toward a High Quality, High Value Maternity Care System", issued by the Transforming Maternity Care Symposium Steering Committee, answers the fundamental question, "Who needs to do what, to, for, and with whom to improve the quality of maternity care over the next five years?" Five stakeholder workgroups collaborated to propose actionable strategies in 11 critical focus areas for moving expeditiously toward the realization of the long term "2020 Vision for a High Quality, High Value Maternity Care System", also published in this issue. Following the symposium these workgroup reports and recommendations were synthesized into the current blueprint. For each critical focus area, the "Blueprint for Action" presents a brief problem statement, a set of system goals for improvement in that area, and major recommendations with proposed action steps to achieve them. This process created a clear sightline to action that if enacted could improve the structure, process, experiences of care, and outcomes of the maternity care system in ways that when anchored in the culture can indeed transform maternity care.

  14. Australian midwives' experience of delivering a counselling intervention for women reporting a traumatic birth.

    PubMed

    Reed, Maree; Fenwick, Jennifer; Hauck, Yvonne; Gamble, Jenny; Creedy, Debra K

    2014-02-01

    this paper describes midwives' experiences of learning new counselling skills and delivering a counselling intervention entitled 'Promoting Resilience on Mothers Emotions' (PRIME). a descriptive exploratory approach was used. Data collected included semi-structured interviews (n=42), midwife diary entries (18 pages) and web based postings (169 pages). Data were analysed using manual thematic method. the intervention study was conducted in two tertiary maternity hospitals in the Australian states of Queensland (QLD) and Western Australia (WA) during a 17 month period, from August 2008 to December 2009. midwives were employed as research assistants and trained to deliver a counselling intervention to women reporting a traumatic birth experience. Eighteen of a possible 20 Australian midwives participated in this study. PRIME is a midwife-led counselling intervention based on cognitive-behavioural principles and designed to ameliorate trauma symptoms. It is offered face-to-face within 72 hours of childbirth and by phone around six weeks post partum. participating midwives felt confronted by the level of emotional distress some women suffered as a consequence of their birth experience. Four major themes were extracted: The challenges of learning to change; Working with women in a different way; Making a difference to women and me; and A challenge not about to be overcome. the advanced counselling skills the midwives acquired improved their confidence to care for women distressed by their birthing experience and to personally manage stressful situations they encountered in practice. © 2013 Elsevier Ltd. All rights reserved.

  15. A framework to explore micronutrient deficiency in maternal and child health in Malawi, Southern Africa.

    PubMed

    Dickinson, Natalie; Gulliver, John; MacPherson, Gordon; Atkinson, John; Rankin, Jean; Cummings, Maria; Nisbet, Zoe; Hursthouse, Andrew; Taylor, Avril; Robertson, Chris; Burghardt, Wolfgang

    2009-12-21

    Global food insecurity is associated with micronutrient deficiencies and it has been suggested that 4.5 billion people world-wide are affected by deficiencies in iron, vitamin A and iodine. Zinc has also been identified to be of increasing concern. The most vulnerable are young children and women of childbearing age. A pilot study has been carried out in Southern Malawi, to attempt to link the geochemical and agricultural basis of micronutrient supply through spatial variability to maternal health and associated cultural and social aspects of nutrition. The aim is to establish the opportunity for concerted action to deliver step change improvements in the nutrition of developing countries. Field work undertaken in August 2007 and July/August 2008 involved the collection of blood, soil and crop samples, and questionnaires from ~100 pregnant women. Complex permissions and authorisation protocols were identified and found to be as much part of the cultural and social context of the work as the complexity of the interdisciplinary project. These issues are catalogued and discussed. A preliminary spatial evaluation is presented linking soil quality and food production to nutritional health. It also considers behavioural and cultural attitudes of women and children in two regions of southern Malawi, (the Shire Valley and Shire Highlands plateau). Differences in agricultural practice and widely varying soil quality (e.g. pH organic matter, C/N and metal content) were observed for both regions and full chemical analysis of soil and food is underway. Early assessment of blood data suggests major differences in health and nutritional status between the two regions. Differences in food availability and type and observations of life style are being evaluated through questionnaire analysis. The particular emphasis of the study is on the interdisciplinary opportunities and the barriers to progress in development support in subsistence communities. Engaging at the community level

  16. A Randomized Trial of Contingency Management Delivered by Community Therapists

    ERIC Educational Resources Information Center

    Petry, Nancy M.; Alessi, Sheila M.; Ledgerwood, David M.

    2012-01-01

    Objective: Contingency management (CM) is an evidence-based treatment, but few clinicians deliver this intervention in community-based settings. Method: Twenty-three clinicians from 3 methadone maintenance clinics received training in CM. Following a didactics seminar and a training and supervision period in which clinicians delivered CM to pilot…

  17. Delivering the Benefits of Chemical-Biological Integration in ...

    EPA Pesticide Factsheets

    Slide Presentation at the German Cheminformatics Conference on Delivering the Benefits of Chemical-Biological Integration in Computational Toxicology at the EPA. Presentation at the German Cheminformatics Conference on Delivering the Benefits of Chemical-Biological Integration in Computational Toxicology at the EPA.

  18. The Use of Freshmen Seminar Programs to Deliver Personalized Feedback

    ERIC Educational Resources Information Center

    Henslee, Amber M.; Correia, Christopher J.

    2009-01-01

    The current study tested the effectiveness of delivering personalized feedback to first-semester college freshmen in a group lecture format. Participants enrolled in semester-long courses were randomly assigned to receive either personalized feedback or general information about alcohol. Both lecture conditions were delivered during a standard…

  19. Delivering value to multiple stakeholders: 2013 and beyond.

    PubMed

    Nugent, Michael E

    2012-12-01

    To deliver greater value, top payers and providers should: Measure the value they deliver to their business partners and customers, Create value through continuous performance improvement, Package and price value to optimize their margin, mission, and market share, Organize for value through new legal entities, employed medical groups, or both.

  20. A Randomized Trial of Contingency Management Delivered by Community Therapists

    ERIC Educational Resources Information Center

    Petry, Nancy M.; Alessi, Sheila M.; Ledgerwood, David M.

    2012-01-01

    Objective: Contingency management (CM) is an evidence-based treatment, but few clinicians deliver this intervention in community-based settings. Method: Twenty-three clinicians from 3 methadone maintenance clinics received training in CM. Following a didactics seminar and a training and supervision period in which clinicians delivered CM to pilot…

  1. Placenta mediates the association between maternal second-hand smoke exposure during pregnancy and small for gestational age.

    PubMed

    Niu, Z; Xie, C; Wen, X; Tian, F; Ding, P; He, Y; Lin, J; Yuan, S; Guo, X; Jia, D; Chen, W-Q

    2015-08-01

    The causal relationship between maternal second-hand smoke (SHS) exposure during pregnancy and small for gestational-age (SGA) has been affirmed, but the mechanism is still unclear. Previous studies have found that the placenta remarkably affects fetal intrauterine growth and that SHS exposure during pregnancy impairs placental growth and decreases placental weight. Therefore, the placenta may mediate the association between maternal SHS exposure during pregnancy and SGA. This study explores whether and to what extent the association between maternal SHS exposure during pregnancy and SGA is mediated by the placenta. We investigated 562 pregnant women delivering SGA newborns (cases) and 1581 delivering appropriate-for-gestational-age newborns (controls) in this case-control study. Information on maternal SHS exposure during pregnancy, socio-demographic characteristics and obstetric conditions, including placental weight, were collected at the Maternity and Child Health Care Hospitals of Shenzhen and Foshan in Guangdong, China. Linear and hierarchical logistic regression models were fitted to examine the mediation effects of placental weight on the association between maternal SHS exposure during pregnancy and SGA. After controlling for ethnicity, maternal age, educational level, family income, pre-pregnancy body mass index (BMI), parity, gestational age and newborn gender, maternal SHS exposure during pregnancy was associated with a higher SGA risk (adjusted odds ratio (OR) = 1.26; 95% confidence interval (CI) = 1.03-1.55) and lower placental weight (standard deviation (SD) = -0.15, SE = 0.04). Regression models illustrated that placental weight partially mediated (49.6%; 95% CI = 35.9-63.3%) the association between SHS exposure during pregnancy and SGA. Our findings suggest that the placenta plays an intermediary role in how maternal prenatal SHS exposure affects fetal growth. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Maternal and child health in Indonesia.

    PubMed

    Okamoto, A

    1993-12-01

    AIIKU-HAN activity was initiated by the Imperial Gift Foundation BOSHI-AIIKU-KAI in Japan in 1936 and has been introduced and accepted to community-based maternal and child health development in Indonesia through the international cooperation project conducted by Japan International Cooperation Agency (JICA) in order to encourage community health activities carried out by Indonesian women volunteers. As AIIKU-HAN activity in Japan and Dasa Wisma health activity in Indonesia have much in common, transferring concepts, methods and experiences met less obstacles when Indonesian community health volunteers learned AIIKU-HAN activity. Experience gained while developed countries were less developed can be transferred by shifting the time-scale of history in developed countries.

  3. Understanding maternal mental illness: psychiatric autopsy of a maternal death.

    PubMed

    Chen, Helen

    2012-05-01

    Maternal mental illness is a significant public health concern, with established adverse outcomes on both mother and infant, such as impaired mother-infant bonding and infant cognitive and emotional development. In severe cases, maternal mortality and infanticide can tragically occur. This is a report on the suicide of a mother who jumped to her death at three months postpartum. She suffered from puerperal psychosis with bipolar features, with onset at six weeks postpartum. The case highlights the burden of maternal mental illness in our community as well as the need for resources and services to care well for mothers. With a better understanding of its presentation and risk factors, early identification and intervention can reduce morbidity and mortality.

  4. Maternity support workers and safety in maternity care in England.

    PubMed

    Lindsay, Pat

    2014-11-01

    Errors in health care may lead to poor outcomes or even death. In maternity care the issue is more acute as most women and babies are healthy--and mistakes can have devastating effects. In the last 20 years 'patient' safety in maternity care has received significant attention in terms of both policy and research. With few exceptions, the resultant publications have been aimed at health service managers or registered health professionals. However a substantial section of the workforce now consists of support workers who may receive minimal training. This article aims to serve as a reminder that everyone is responsible for the safety of maternity care, and the learning needs of unregistered care staff require attention to strengthen safety defences.

  5. Maternal and neonatal outcomes of hospital vaginal deliveries in Tibet

    PubMed Central

    Miller, S; Tudor, C; Nyima; Thorsten, VR; Sonam; Droyoung; Craig, S; Le, P; Wright, LL; Varner, MW

    2007-01-01

    Introduction To determine the outcomes of vaginal deliveries in three study hospitals in Lhasa, Tibet Autonomous Region (TAR), People's Republic of China (PRC), at high altitude (3,650 m). Methods Prospective observational study of 1,121 vaginal deliveries. Results Pre-eclampsia/gestational hypertension (PE/GH) was the most common maternal complication 18.9% (n=212), followed by postpartum hemorrhage (blood loss ≥ 500 ml) 13.4%. There were no maternal deaths. Neonatal complications included: low birth weight (10.2%), small for gestational age (13.7%), preterm delivery (4.1%) and low Apgar (3.7%). There were 11 stillbirths (9.8/1,000 live births) and 19 early neonatal deaths (17/1,000 live births). Conclusion This is the largest study of maternal and newborn outcomes in Tibet. It provides information on the outcomes of institutional vaginal births among women delivering infants at high altitude. There was a higher incidence of PE/GH and low birth weight; rates of PPH were not increased compared to those at lower altitudes. PMID:17481630

  6. Maternal zinc deficiency and congenital anomalies in newborns.

    PubMed

    Moghimi, Mahmood; Ashrafzadeh, Sahar; Rassi, Sepehr; Naseh, Ali

    2017-04-01

    Zinc deficiency in pregnant women is common, especially in the third trimester of pregnancy. The available data, however, on the association between zinc deficiency and congenital malformations in the Iranian population are insufficient. The aim of this study was therefore to determine whether maternal serum zinc deficiency is associated with major congenital malformations in newborns. This descriptive, case-control study involved mothers of 80 neonates with congenital anomalies (study group) admitted to the Mofid Children's Hospital, Tehran, Iran. During the same period (2014 and 2015), serum zinc was measured in 80 mothers who had delivered normal newborns without congenital malformations (control group). Mothers with serum zinc deficiency had a more than sevenfold risk of malformations in the fetus compared with mothers with normal serum zinc (OR, 7.013; 95%CI: 2.716-18.110). Newborns with malformation weighing ≤2500 g were associated with lower maternal serum zinc compared with the control group (P = 0.006). There is an association between congenital malformation in newborns and maternal zinc deficiency. © 2016 Japan Pediatric Society.

  7. Are HMO enrollees being attracted by a liberal maternity benefit?

    PubMed

    Hudes, J; Young, C A; Sohrab, L; Trinh, C N

    1980-06-01

    A study of recent birth patterns in the Southern California Region of the Kaiser-Permanente Medical Care Program (KPMCP) suggests that individuals may have been attracted to the Program by a liberal maternity benefit. The attraction is reflected in both the type of members joining KPMCP and the birth rate of those members. Although the KPMCP birth rate has been below that of the general population, new members in their first year of coverage delivered approximatey one third of all KPMCP births in 1977, twice the number of births that would be anticipated from an equal number of members in the plan for one year or more. The maternity copayment of up to $350 did not deter women already pregnant from joining KPMCP. Termination rates for new members who gave birth, however, were no higher than expected. The Pregnancy Disability Amendment of Title VII of the Civil Rights Act of 1964, which became effective April 29, 1979, may alter the maternity benefits offered by alternative insurance carriers. The law could impact KPMCP's enrollment and utilization of obstetric services.

  8. Exploring the relationship between population density and maternal health coverage

    PubMed Central

    2012-01-01

    Background Delivering health services to dense populations is more practical than to dispersed populations, other factors constant. This engenders the hypothesis that population density positively affects coverage rates of health services. This hypothesis has been tested indirectly for some services at a local level, but not at a national level. Methods We use cross-sectional data to conduct cross-country, OLS regressions at the national level to estimate the relationship between population density and maternal health coverage. We separately estimate the effect of two measures of density on three population-level coverage rates (6 tests in total). Our coverage indicators are the fraction of the maternal population completing four antenatal care visits and the utilization rates of both skilled birth attendants and in-facility delivery. The first density metric we use is the percentage of a population living in an urban area. The second metric, which we denote as a density score, is a relative ranking of countries by population density. The score’s calculation discounts a nation’s uninhabited territory under the assumption those areas are irrelevant to service delivery. Results We find significantly positive relationships between our maternal health indicators and density measures. On average, a one-unit increase in our density score is equivalent to a 0.2% increase in coverage rates. Conclusions Countries with dispersed populations face higher burdens to achieve multinational coverage targets such as the United Nations’ Millennial Development Goals. PMID:23170895

  9. Exploring the relationship between population density and maternal health coverage.

    PubMed

    Hanlon, Michael; Burstein, Roy; Masters, Samuel H; Zhang, Raymond

    2012-11-21

    Delivering health services to dense populations is more practical than to dispersed populations, other factors constant. This engenders the hypothesis that population density positively affects coverage rates of health services. This hypothesis has been tested indirectly for some services at a local level, but not at a national level. We use cross-sectional data to conduct cross-country, OLS regressions at the national level to estimate the relationship between population density and maternal health coverage. We separately estimate the effect of two measures of density on three population-level coverage rates (6 tests in total). Our coverage indicators are the fraction of the maternal population completing four antenatal care visits and the utilization rates of both skilled birth attendants and in-facility delivery. The first density metric we use is the percentage of a population living in an urban area. The second metric, which we denote as a density score, is a relative ranking of countries by population density. The score's calculation discounts a nation's uninhabited territory under the assumption those areas are irrelevant to service delivery. We find significantly positive relationships between our maternal health indicators and density measures. On average, a one-unit increase in our density score is equivalent to a 0.2% increase in coverage rates. Countries with dispersed populations face higher burdens to achieve multinational coverage targets such as the United Nations' Millennial Development Goals.

  10. Success in reducing maternal and child mortality in Afghanistan.

    PubMed

    Rasooly, Mohammad Hafiz; Govindasamy, Pav; Aqil, Anwer; Rutstein, Shea; Arnold, Fred; Noormal, Bashiruddin; Way, Ann; Brock, Susan; Shadoul, Ahmed

    2014-01-01

    After the collapse of the Taliban regime in 2002, Afghanistan adopted a new development path and billions of dollars were invested in rebuilding the country's economy and health systems with the help of donors. These investments have led to substantial improvements in maternal and child health in recent years and ultimately to a decrease in maternal and child mortality. The 2010 Afghanistan Mortality Survey (AMS) provides important new information on the levels and trends in these indicators. The AMS estimated that there are 327 maternal deaths for every 100,000 live births (95% confidence interval = 260-394) and 97 deaths before the age of five years for every 1000 children born. Decreases in these mortality rates are consistent with changes in key determinants of mortality, including an increasing age at marriage, higher contraceptive use, lower fertility, better immunisation coverage, improvements in the percentage of women delivering in health facilities and receiving antenatal and postnatal care, involvement of community health workers and increasing access to the Basic Package of Health Services. Despite the impressive gains in these areas, many challenges remain. Further improvements in health services in Afghanistan will require sustained efforts on the part of both the Government of Afghanistan and international donors.

  11. 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

  12. Countdown to 2015 decade report (2000-10): taking stock of maternal, newborn, and child survival.

    PubMed

    Bhutta, Zulfiqar A; Chopra, Mickey; Axelson, Henrik; Berman, Peter; Boerma, Ties; Bryce, Jennifer; Bustreo, Flavia; Cavagnero, Eleonora; Cometto, Giorgio; Daelmans, Bernadette; de Francisco, Andres; Fogstad, Helga; Gupta, Neeru; Laski, Laura; Lawn, Joy; Maliqi, Blerta; Mason, Elizabeth; Pitt, Catherine; Requejo, Jennifer; Starrs, Ann; Victora, Cesar G; Wardlaw, Tessa

    2010-06-05

    The Countdown to 2015 for Maternal, Newborn, and Child Survival monitors coverage of priority interventions to achieve the Millennium Development Goals (MDGs) for child mortality and maternal health. We reviewed progress between 1990 and 2010 in coverage of 26 key interventions in 68 Countdown priority countries accounting for more than 90% of maternal and child deaths worldwide. 19 countries studied were on track to meet MDG 4, in 47 we noted acceleration in the yearly rate of reduction in mortality of children younger than 5 years, and in 12 countries progress had decelerated since 2000. Progress towards reduction of neonatal deaths has been slow, and maternal mortality remains high in most Countdown countries, with little evidence of progress. Wide and persistent disparities exist in the coverage of interventions between and within countries, but some regions have successfully reduced longstanding inequities. Coverage of interventions delivered directly in the community on scheduled occasions was higher than for interventions relying on functional health systems. Although overseas development assistance for maternal, newborn, and child health has increased, funding for this sector accounted for only 31% of all development assistance for health in 2007. We provide evidence from several countries showing that rapid progress is possible and that focused and targeted interventions can reduce inequities related to socioeconomic status and sex. However, much more can and should be done to address maternal and newborn health and improve coverage of interventions related to family planning, care around childbirth, and case management of childhood illnesses.

  13. 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

    2016-04-29

    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.

  14. Developing a best practice model of refugee maternity care.

    PubMed

    Correa-Velez, Ignacio; Ryan, Jennifer

    2012-03-01

    About one third of refugee and humanitarian entrants to Australia are women age 12-44 years. Pregnant women from refugee backgrounds may have been exposed to a range of medical and psychosocial issues that can impact maternal, fetal and neonatal health. What are the key elements that characterise a best practice model of maternity care for women from refugee backgrounds? This paper outlines the findings of a project which aimed at developing such a model at a major maternity hospital in Brisbane, Australia. This multifaceted project included a literature review, consultations with key stakeholders, a chart audit of hospital use by African-born women in 2006 that included their obstetric outcomes, a survey of 23 African-born women who gave birth at the hospital in 2007-08, and a survey of 168 hospital staff members. The maternity chart audit identified complex medical and social histories among the women, including anaemia, female circumcision, hepatitis B, thrombocytopenia, and barriers to access antenatal care. The rates of caesarean sections and obstetric complications increased over time. Women and hospital staff surveys indicated the need for adequate interpreting services, education programs for women regarding antenatal and postnatal care, and professional development for health care staff to enhance cultural responsiveness. The findings point towards the need for a model of refugee maternity care that comprises continuity of carer, quality interpreter services, educational strategies for both women and healthcare professionals, and the provision of psychosocial support to women from refugee backgrounds. Copyright © 2011 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  15. [Change in reproductive partner among women delivering at a Metropolitan Santiago public hospital].

    PubMed

    Vargas, Nelson A; Villar, Cristián; Lastra, Alejandro

    2004-06-01

    Previous studies in Metropolitan Santiago, showed that at least 10% of mothers changed their reproductive partner. To study the frequency of reproductive partner change and its associated factors among women delivering in a public hospital. We interviewed 859 non primiparous women that gave birth to a child in a public hospital of Metropolitan Santiago, between March 2001 and February 2002. Mean maternal age rose according to birth order from 27.4 to 33.6 years from the second to the fourth sibling. Married women were the largest group and single ones decreased from the second to the third sibling. Twenty two percent had some activity out of home and those with a high birth order (fourth or more) exhibited poorer schooling. Unwanted pregnancies increased with birth order, reaching 55% among "fourth and over" births. Thirty four percent of women delivering their second child, changed their partner. Among women delivering their third child, 38.6% had one sibling with a different father; 20.4% had changed partner during their second pregnancy and 20% during the current one. Among those in the "fourth and over, group, 56.1% had at least one sibling with a different father; 18.3% had changed partner in the second sibling; 15%, in the third and 27.8%, in the fourth and over. In all birth orders, mothers with activity out of home exhibited a higher frequency of partner change. The most common reasons to change partner were infidelity, abandon or a personal decision, while economic reasons were uncommon. A great number of children are exposed to bonding ruptures and to the consequential mental health or behavioral problems.

  16. "You Realise It Could Happen to You": The Benefits to Pupils of Young Mothers Delivering School Sex Education

    ERIC Educational Resources Information Center

    Kidger, Judi

    2004-01-01

    This paper presents data from a study of four projects in which young mothers deliver school sex education sessions, with the aim of giving pupils "informed choices" regarding their sexual behaviour. Eleven focus group discussions were carried out with pupils, and semi-structured interviews were carried out with 14 young mothers in order to assess…

  17. Maternal exposure to neighborhood carbon monoxide and risk of low infant birth weight

    SciTech Connect

    Alderman, B.W.; Baron, A.E.; Savitz, D.A.

    1987-07-01

    This case-control study investigated the potential association between ambient levels of carbon monoxide in a pregnant woman's neighborhood of residence and her chance of delivering a low birth weight infant. Low birth weight infants and normal birth weight infants were contrasted with respect to ambient levels of CO during the 3 months prior to delivery in the neighborhoods where their mothers lived at birth. After adjustment for the confounding effects of maternal race and education, there was no association between higher CO exposure and higher odds of low birth weight. These data do not support a strong association between maternal exposure to neighborhood CO during pregnancy and odds of delivering a low birth weight infant. Further investigation of the effects of CO exposure on birth weight, with direct measurement of total CO exposure, is needed.

  18. Oral microflora in infants delivered vaginally and by caesarean section.

    PubMed

    Nelun Barfod, Mette; Magnusson, Kerstin; Lexner, Michala Oron; Blomqvist, Susanne; Dahlén, Gunnar; Twetman, Svante

    2011-11-01

    BACKGROUND.  Early in life, vaginally delivered infants exhibit a different composition of the gut flora compared with infants delivered by caesarean section (C-section); however, it is unclear whether this also applies to the oral cavity. AIM.  To investigate and compare the oral microbial profile between infants delivered vaginally and by C-section. DESIGN.  This is a cross-sectional case-control study. Eighty-four infants delivered either vaginally (n = 42) or by C-section (n = 42) were randomly selected from the 2009 birth cohort at the County Hospital in Halmstad, Sweden. Medically compromised and premature children (<32 weeks) were excluded. The mean age was 8.25 months (range 6-10 months), and parents were asked to complete a questionnaire on socioeconomic factors, lifestyle, and hygiene habits. Saliva was collected and analysed using checkerboard DNA-DNA hybridization. RESULTS.  A higher prevalence of salivary Streptococcus salivarius, Lactobacillus curvata, Lactobacillus salivarius, and Lactobacuillus casei was detected in infants delivered vaginally (P < 0.05). The caries-associated bacteria Streptococcus mutans and Streptococcus sobrinus were detected in 63% and 59% of all children, respectively. CONCLUSION.  A significantly higher prevalence of certain strains of health-related streptococci and lactobacilli was found in vaginally delivered infants compared with infants delivered by C-section. The possible long-term effects on oral health need to be further investigated.

  19. Reproductive health and reproductive freedom: maternal health care and family planning in the Swedish health system.

    PubMed

    Sundström-Feigenberg, K

    1988-01-01

    Health care for mothers and children has been a cornerstone of the Swedish system of health care for many years, starting in the 1930s, when a national network of maternal health centers offered a variety of free prenatal services. This paper describes modern maternal health services whose primary goal is preventive care. Instruments for attaining this goal are regular check-ups for early detection of problems and for maintenance of good health; social and psychological support to expectant parents; information and training to prepare parents for delivery and parenting; information and education about risk factors in the parents' local environment and in society in general. Details of how these programs were developed, delivered and evaluated are provided by the author, a former Senior Medical Officer at the National Board of Health and Welfare, responsible for maternal health care and family planning on a national level.

  20. Integrating Maternal Mental Health Care in the Pediatric Medical Home: Treatment Engagement and Child Outcomes.

    PubMed

    Kimmel, Mary C; Platt, Rheanna E; Steinberg, Danielle N; Cluxton-Keller, Fallon; Osborne, Lauren M; Carter, Tracy; Payne, Jennifer L; Solomon, Barry S

    2017-10-01

    Maternal depression is associated with an array of poor child health outcomes, and low-income women face many barriers to accessing treatment. In this pilot study, we assessed treatment engagement in a maternal mental health clinic staffed by a case manager and psychiatrist in an urban pediatric practice. We also examined factors associated with engagement as well as child health outcomes and health care use. Nearly half of the women enrolled attended at least 4 sessions with a psychiatrist in 6 months. Text messaging with the case manager was associated with a greater compliance with psychiatrist sessions. Comparing index children with their siblings prior to enrollment, a higher percentage had immunizations up to date at 1 year of age (82% vs 43%, P = .01), and well-child visit compliance trended toward significance (65% vs 35%, P = .06). The pediatric setting holds promise as an innovative venue to deliver maternal mental health care.