Focused Counseling and Adequate Utilization of Maternal and Child Health (MCH) Services: Its Impact on Maternal and Infant Morbidity

Tamil Nadu has a good public health care delivery system in place making health care accessible to all. The people of Chennai have a wide access to primary, secondary and tertiary levels of health care. The proportion of antenatal women who register and receive care in the first twelve weeks of gestation is high (90%) in Chennai. But only two-thirds of them receive full antenatal care and only half of them seek care during illness. There is an obvious gap between availability of maternal and child health services and optimal utilization of these services by the mothers and babies who need it, which may influence the well being of the mother and baby. Hence this research was taken up to examine whether focused counseling of the antenatal woman and her family members would improve utilization of maternal and child health services and in turn reduce maternal and infant morbidity. OBJECTIVES: 1. To assess the influence of focused counseling of the mother, spouse and other family members on adequate utilization of recommended maternal and child health services. 2. To study the influence of focused counseling of the mother, spouse and other family members on maternal and infant morbidity. 3. To evaluate the impact of ensuring adequate utilization of recommended maternal and child health services on maternal and infant morbidity. MATERIALS AND METHODS: A non randomized controlled trial was carried out, with women in the intervention group receiving focused counseling in addition to routine care and women in the control group receiving routine care alone. The study participants were antenatal women who had registered within first 12 weeks of gestation in the designated health centers in Chennai. The women in the intervention group were given four counseling sessions during pregnancy and four counseling sessions following delivery. Information on adequate utilization of recommended maternal and child health services, delivery outcomes, breastfeeding practices, maternal and infant morbidity patterns were collected and entered in the tool developed for the study. Information was also collected from the women in the control group during specified times during pregnancy and following delivery and entered in the study tool. One hundred and fifty women each in the intervention and control group were followed up during antenatal, postnatal and up to 6 months following delivery. Their babies were followed up from birth to six months of infancy. The study was carried out between the period of April 2013 and October 2014. SUMMARY: • The characteristics of the participants in the intervention and control groups were similar at the start of the study. UTILIZATION OF SERVICES: • The women in the intervention group, who were given focused counseling, showed a statistically significant greater utilization of recommended maternal and child health services compared to the control group. • Clinical examination, blood pressure recording and weight recording were done in 99% of recommended visits in both groups and all antenatal women were given injection Tetanus toxoid as per the schedule. • Laboratory investigations at recommended visits were found lacking in both study groups, but it was found more lacking in the control group. Hemoglobin estimation was done in 66% of recommended visits in the intervention group whereas in the control it was done in only 54% of visits. Urine analysis for albumin and sugar was done in less than fifty percent of the visits in both the intervention and control groups. In the intervention group, blood sugar estimation was done in 50% of the visits, whereas in the control group it was carried out in only 35% of the visits. • About three fourths of the antenatal women in the intervention group had received more than 90 tablets of IFA in comparison to only two third of the antenatal women in the control group. WEIGHT GAIN & HEMOGLOBIN STATUS: • The mean weight gain of antenatal women in the intervention group was significantly higher than that of antenatal women in the control group. • The antenatal women in the intervention group had a significant increase in the mean hemoglobin values at the end of pregnancy. But in the control group there was a decrease in the mean hemoglobin values which was found to be statistically significant. • Among women who were not anaemic at the beginning of pregnancy, the proportion of women who continued to remain not anaemic at the end of pregnancy was 86.2% in the intervention group as compared to 62.8% in the control group. This shows that 23% more women continued to remain not anaemic in the intervention group compared to the control group at the end of pregnancy. • Among women who received 90+ tablets of IFA, women in the intervention group were significantly more likely to consume more than 90 tablets of IFA compared to the women in the control group. • Consumption of more than 90 tablets of IFA did not produce a statistically significant increase in hemoglobin levels in either of the two groups. OUTCOME OF PREGNANCY: • Five women in the intervention group and four women in the control group had abortions. All other women had live births. All mothers in the intervention and control groups had institutional deliveries. • There mean birth weight of babies was similar in the two groups. There were more preterm babies in the control group. • Combined analysis of the two groups showed that there was a statistically significant correlation between body mass index, pre pregnancy weight of the mother, weight gain during pregnancy, IFA consumption and birth weight. But the correlation was weak. • Regression analysis revealed 11.9% of variance in birth weight which was found to be statistically significant. Pre pregnancy weight, weight gain during pregnancy and number of IFA tablets consumed were significant individual predictors of birth weight. POSTNATAL OUTCOMES: • Acceptors of tubectomy were higher in the intervention group and IUD acceptors were more in the control group. • Awareness on early initiation and duration of exclusive breast feeding was high in both groups. More than 80% of the mothers in both the study groups had initiated breast feeding within one hour of delivery. The mean duration of exclusive breast feeding was also more than 5 months among the intervention and control group. There was a statistically significant correlation between utilization of MCH services and duration of exclusive breast feeding. But the correlation was weak. MATERNAL AND INFANT MORBIDITY: • The number of women with at least one maternal morbidity was similar between the intervention and control groups. • High blood pressure and gestational diabetes mellitus was found to be more in the intervention group in the antenatal period. • The number of maternal morbidities in the intranatal period was similar between the two groups. But path analysis using Structural Equation Modeling showed that there is a statistically significant path of counseling having an influence on utilization of MCH services which in turn has an influence on reducing intranatal morbidity. • Incidence of sepsis was found to be higher in the control group in the postnatal period. • Neonatal morbidities were similar between the two groups. In the postneonatal period infections (esp ARI) were found to be comparatively much higher in the control group than in the intervention group. • There were no maternal deaths or still births. There was one neonatal death each in the intervention and control group. LIMITATIONS: • Women were given focused counseling, but no services were provided by the investigator. • The views of the health care providers for assessment and improving utilization of services were not obtained. • The study assessed utilization of services availed from the public health facilities only. Information of services availed from the private sector was not fully obtained. • Pre-post counseling assessment of knowledge, attitudes and practices pertaining to maternal and child health was beyond the scope of the study. CONCLUSION: Tamil Nadu is one of the better performing states in maternal and child health indicators in India. The state has invested in the health care delivery system to provide accessible quality service to its people. The desired results can be achieved when people make adequate use of these services. The antenatal visits should be utilized to provide them with recommended maternal and child health services and counseling. Professionally qualified counselors should be engaged to provide supportive counseling to suit the needs of individual women and their families. This would help them to adopt measures to improve the health status of the mother and the infant

Diferenciación de células madre como modelo experimental de terapia en enfermedades prevalentes: osteoartritis y patología cardiovascular

[ES]Es ampliamente conocida la limitada capacidad de regeneración del cartílago y el tejido cardíaco. El objetivo principal de esta investigación es desarrollar estrategias para dirigir la diferenciación celular hacia linaje cardiaco y condrocítico con potencial para reparar y / o regenerar daños en estos tejidos. Para ello, hemos estudiado la capacidad de diferenciación de cuatro fuentes diferentes de células: i) células madre derivadas de tejido adiposo humano aisladas de lipoaspirados (hASCs); ii) hASCs obtenidas a partir de la grasa infrapatelar de pacientes con osteoartritis (OA) (IFPSCs), iii) células progenitoras endoteliales (EPCs) derivadas de la sangre del cordón umbilical (UCB) y iv) EPCs aisladas de la sangre periférica (PB) de los pacientes que sufren de infarto agudo de miocardio (IAM). En conclusión, hemos implementado nuevas estrategias para dirigir la diferenciación celular. Los resultados incluidos en este estudio podrían representar un potencial enfoque terapéutico en las enfermedades cardiovasculares y lesiones osteocondrales[EN]It is broadly known the limited regeneration capacity of cartilage and cardiac tissue. The main goal of the present study was to develop strategies to direct cell differentiation toward cardiac and cartilage linage with potential to repair and/or regenerate the damage tissue. Here we have studied the potential differentiation capacity of four different cell sources: i) human adipose derived stem cells (hASCs) isolated from lipoaspirates; ii) hASCs obtained from infrapatellar fat pad (IFPSCs) of patients with osteoarthritis (OA), iii) endothelial progenitor cells (EPCs) derived from umbilical cord blood (UCB) and iv) EPCs isolated from peripheral blood (PB) of patients suffering from acute myocardial infarction (AMI). In conclusion, we have implemented novel strategies to direct cell differentiation. The finding included in this study could represent a potential therapeutic approach in cardiovascular diseases and osteochondral injuriesTesis Univ. Jaén. Departament

Perceptions Measurement of Professional Certifications to Augment Buffalo State College Baccalaureate Technology Programs, as a Representative American Postsecondary Educational Institution

The purpose of this study was to assess, measure, and analyze whether voluntary, nationally-recognized professional certification credentials were important to augment technology programs at Buffalo State College (BSC), as a representative postsecondary baccalaureate degree-granting institution offering technology curricula. Six BSC undergraduate technology programs were evaluated within the scope of this study: 1.) Computer Information Systems; 2.) Electrical Engineering, Electronics; 3.) Electrical Engineering, Smart Grid; 4.) Industrial Technology; 5.) Mechanical Engineering; and 6.) Technology Education. This study considered the following three aspects of the problem: a.) postsecondary technology program enrollment and graduation trends; b.) the value/awareness of professional certifications to employers and students; and c.) professional certification relevancy and postsecondary curricula integration. The study was conducted through surveys and interviews with four technology-related purposive sample groups: 1.) BSC program alumni; 2.) BSC and non-BSC technology program faculty; 3.) hiring managers/industry leaders; and 4.) non-BSC alumni and certification holders. In addition, this study included an analysis of relevant professional certification organizations and student enrollment data from the six technology programs within scope. Research methods included both quantitative and qualitative analytical techniques. This study concluded undergraduate technology students benefitted from a greater awareness of relevant professional certifications and their perceived value. This study also found the academic community may be well served to acknowledge the increasing trend of professional certification integration into postsecondary technology programs

Safety and Reliability - Safe Societies in a Changing World

The contributions cover a wide range of methodologies and application areas for safety and reliability that contribute to safe societies in a changing world. These methodologies and applications include: - foundations of risk and reliability assessment and management - mathematical methods in reliability and safety - risk assessment - risk management - system reliability - uncertainty analysis - digitalization and big data - prognostics and system health management - occupational safety - accident and incident modeling - maintenance modeling and applications - simulation for safety and reliability analysis - dynamic risk and barrier management - organizational factors and safety culture - human factors and human reliability - resilience engineering - structural reliability - natural hazards - security - economic analysis in risk managemen

Examining the origin, nature, and effect of military support to Sierra Leone’s Ebola response.

The 2013–2016 West Africa Ebola Epidemic is the largest outbreak of Ebola Virus Disease (Ebola) to date. By mid-2014, cases were escalating rapidly, and response actors in Sierra Leone were overwhelmed. Consequently, the British government announced Operation Gritrock, a bespoke military mission to support the country’s Ebola response alongside the national army. This study examined the origin, nature, and effect of this militarised support and the civil-military relationships that transpired. 110 in-depth interviews were conducted between 2017 and 2018. Perspectives were sought from a range of civilian and military Ebola Response Workers (ERWs) at the chiefdom, district, national, and international levels. Interviews were complemented by analysis of 21 key policy and operational documents not in the public domain obtained through the Freedom of Information Act of 2000. Analysis drew on neo-Durkheimian theory of organisations combined with inductive thematic exploration. Across respondent groupings, the militaries’ intervention was perceived to represent valuable and life-saving assistance, including for the establishment, operation, and leadership of the hierarchically organised National and District Ebola Response Centres. However, it was also found to result in various harms, including the marginalisation of some public institutions and local groups that were insufficiently included in the formal response. In turn, Sierra Leone was left somewhat vulnerable to future crises. This concurrent positive and negative effect—a paradox this thesis terms the ‘political economy of expedience’—is one in which all civilian and military ERWs were implicated. However, the militarised response also provides lessons for how hierarchical spaces need not be exclusionary ones. Indeed, this thesis ultimately finds that when organised with ‘conflict attenuation’ in mind, hierarchy and decentralisation—and therein, localisation and inclusivity—can be co-dependent and synergistic principles that, if applied robustly, could serve to mitigate the political economy of expedience paradox during future public health emergency responses