Postnatal depression and reproductive success in modern, low-fertility contexts

Background and objectives: Postnatal depression (PND) presents a puzzling phenomenon to evolutionary anthropologists as it is highly prevalent and yet detrimental to child development and maternal health. Adaptive explanations have been proposed, but have not been tested with data that directly link PND to female fertility. Methodology: A survey was designed to gather complete reproductive histories and retrospective measures of PND to measure the effects of PND on fitness. Respondents were born between 1930 and 1967, with the majority based in the UK during their childrearing years. The hypothesis that PND is detrimental to fitness is assessed using Mann–Whitney U tests on completed fertility. Binary logistic regression modelling is used to test the hypothesis that PND reduces the likelihood of parity progression. Results: Women experiencing PND at their first or second birth have lower completed fertility, with PND at the first birth leading to lowered fertility. Logistic regression analyses show that this is the result of reductions in the likelihood of parity progression to a third birth when PND is experienced at the first birth or when repeat bouts occur. Conclusions and implications: Our results call into question adaptationist arguments, contribute to the growing understanding of the importance of emotional wellbeing to fertility decision making, and given the economic consequences of markedly below replacement fertility, highlight a potential new source of financial incentive to invest in screening and preventative measures to ensure good maternal mental health

Nurses Involvement in Nursing Home Culture Change: Overcoming Barriers, Advancing Opportunities

Summarizes discussions from a 2008 interdisciplinary panel convened to identify facilitators and barriers to nurses' involvement in culture change in nursing homes and actions to promote nurse competencies in resident-directed care. Makes recommendations

Parents’ experiences of neonatal care in England

With the greater need for specialist neonatal care in England over the last decade, increased attention has been given to developing and implementing quality measures to ensure that babies and their families receive the highest quality care. Patient experience is recognised as a key measure of quality, therefore it is essential to assess parents’ experiences of neonatal services to understand how these can be improved. In this paper we detail findings from the second large scale survey of parents’ experiences of neonatal care carried out in England in 2014, focusing on results that highlight aspects of family-centred care: information sharing; communication; support; and involvement. The results reveal great variations between individual units, as well as highlight key areas in which units could improve to provide family-centred care. This includes parents being able to speak to their doctor more, as well as receiving important information to understand their baby’s condition, and about support services available. Positively, many parents felt they were able to visit their baby as much as they wanted and were involved in their day-to-day care, which are fundamental to parents forming a bond with their baby. The survey is a rich data source that provides neonatal units in England with results that allow them to focus improvement efforts on what matters most to those using their services. It also enables neonatal units to evaluate how they are performing on key standards of care, supporting them in striving for clinical best practice

Economic Evaluation of Coastal Land Loss in Louisiana

Louisiana has lost approximately 1,880 square miles of land over the past eighty years. Projections suggest that in a future without action, the next fifty years could result in the loss of 1,750 additional square miles of land area. As land loss continues, a large portion of the natural and man-made capital stocks of coastal Louisiana will be at greater risk of damage, either from land loss or from the associated increase in storm damage. We estimate the replacement cost of capital stock directly at risk from land loss ranges from approximately $2.1 billion to$3.5 billion with economic activity at risk ranging from $2.4 billion to$3.1 billion in output. Increases in storm damage to capital stock range from $8.7 billion to as much as$133 billion with associated disruptions to economic activity ranging from an additional $1.9 billion to$23 billion in total lost output

TGF-β maintains dormancy of prostatic stem cells in the proximal region of ducts

We have previously shown that prostatic stem cells are located in the proximal region of mouse prostatic ducts. Here, we show that this region responds differently to transforming growth factor (TGF)-β than the distal ductal region and that under physiological conditions androgens and TGF-β are crucial overall regulators of prostatic tissue homeostasis. This conclusion is supported by the observations showing that high levels of TGF-β signaling are present in the quiescent proximal region of ducts in an androgen-replete animal and that cells in this region overexpress Bcl-2, which protects them from apoptosis. Moreover, androgen ablation reverses the proximal-distal TGF-β signaling gradient, leading to an increase in TGF-β signaling in the unprotected distal region (low Bcl-2 expression). This reversal of TGF-β–mediated signaling accompanies apoptosis of cells in the distal region and gland involution after androgen withdrawal. A physiological TGF-β signaling gradient (high proximally and low distally) and its functional correlates are restored after androgen replenishment. In addition to highlighting the regulatory role of androgens and TGF-β, these findings may have important implications for the deregulation of the stem cell compartment in the etiology of proliferative prostatic diseases

Living with cardiovascular disease (CVD): Exploring the biggest challenges for people affected by CVD in the UK, and their use (or not) of online resources

As death rates decrease, people affected by cardiovascular disease (CVD) continue to live with these diseases and the associated challenges, long-term. We aimed to identify the biggest challenges for people affected by CVD in the UK and explore the sources of support and information used to help manage conditions, to inform future service provision. An online questionnaire was sent and advertised to people over 16 years old in the UK self-identifying as affected by CVD (living with CVD, had risk factors, or a carer). There were 13,885 responses. The top five challenges were: feeling down, sad, or depressed; making changes to the way or amount of exercise; anxiety, fear, and uncertainty about the future; having one member of staff to speak to about all aspects of care; and being given information on the side effects of medications. Key challenges were not restricted to a particular condition, indicated by minimal variation between types of CVD. One-quarter of respondents indicated they do not use online resources or digital technologies to help manage their health. The volume and inconsistency of online sources were reported as barriers to using these. The results highlight the psychological and physical consequences of living with CVD. Fragmented care and variable access to information and support further compound these issues. Providing holistic care needs attention; the acknowledgement of psychological needs and access to support, alongside physical challenges is necessary. Stakeholders in healthcare and information technology should work together to ensure online information and support is clear, consistent, and reliable. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len

Reforming Policies for Small and Medium-Sized Enterprises in Indonesia

Including micro firms, SMEs are responsible for more than 97 percent of total employment in Indonesia and represent 99 percent of all firms. The Indonesian government has tried to assist SMEs through programmes, such as subsidised credit, one-stop shops to lower business registration costs and government-sponsored trade fairs. However, there is little evidence on how effective these programmes are or on ways to improve government policies aimed at helping SMEs. We conducted structured interviews with 192 firms across five provinces in Indonesia to investigate the constraints that firms face and how existing programmes do – or do not – help reduce these constraints. We conclude the report with policy recommendations targeted at the Indonesian government and other stakeholders, focusing on the importance of credit and on the need to remove information barriers

Limited sampling models to predict the pharmacokinetics of nevirapine, stavudine, and lamivudine in HIV-infected children treated with pediatric fixed-dose combination tablets.

Full 12-hour pharmacokinetic profiles of nevirapine, stavudine, and lamivudine in HIV-infected children taking fixed-dose combination antiretroviral tablets have been reported previously by us. Further studies with these formulations could benefit from less-intensive pharmacokinetic sampling. Data from 65 African children were used to relate area under the plasma concentration versus time curve over 12 hours (AUC) to plasma concentrations of nevirapine, stavudine, or lamivudine at times t = 0, 1, 2, 4, 6, 8, and 12 hours after intake using linear regression. Limited sampling models were developed using leave-one-out crossvalidation. The predictive performance of each model was evaluated using the mean relative prediction error (mpe%) as an indicator of bias and the root mean squared relative prediction error (rmse%) as a measure of precision. A priori set criteria to accept a limited sampling model were: 95% confidence limit of the mpe% should include 0, rmse% less than 10%, a high correlation coefficient, and as few (convenient) samples as possible. Using only one sample did not lead to acceptable AUC predictions for stavudine or lamivudine, although the 6-hour sample was acceptable for nevirapine (mpe%: -0.8%, 95% confidence interval: -2.2 to +0.6); rmse%: 5.8%; r: 0.98). Using two samples, AUC predictions for stavudine and lamivudine improved considerably but did not meet the predefined acceptance criteria. Using three samples (1, 2, 6 hours), an accurate and precise limited sampling model for stavudine AUC (mpe%: -0.6%, 95% confidence interval: -2.2 to +1.0; rmse%: 6.5%; r: 0.98) and lamivudine AUC (mpe%: -0.3%, 95% confidence interval: -1.7 to +1.1; rmse%: 5.6%; r: 0.99) was found; this model was also highly accurate and precise for nevirapine AUC (mpe%: -0.2%, 95% confidence interval: -1.0 to +0.7; rmse%: 3.4%; r: 0.99). A limited sampling model using three time points (1, 2, 6 hours) can be used to predict nevirapine, stavudine, and lamivudine AUC accurately and precisely in HIV-infected African children