Communications Between Pregnant Women and Maternity Care Clinicians

This survey study assesses patients’ self-reported communication experiences with their maternity care clinicians and examines the association of these experiences with women’s reports of feeling pressure to have interventions during delivery

Mii and MiiBump: Supporting pregnant women to continue or commence an active lifestyle

The purpose of this study was to investigate how women perceive exercising during pregnancy and whether existing technologies could be used to support active behaviours. Information for pregnant women who wish to continue or start exercising is limited and not readily offered. With the ever growing capability and accessibility to technologies research is warranted to investigate whether it could be used to help support exercising during pregnancy. An interpretative phenomenological approach was used to conduct in-depth interviews with five women, via purposive sampling. The data revealed that the participants perceived a number of barriers to active behaviours, such as the lack of a pregnant buddy with which to exercise. A lack of provided information was evident with the women claiming to have sought appropriate information themselves. Findings highlighted the potential for existing technologies to be utilised in order to support and enhance exercise behaviours during pregnancy

Soil Settlement and Uplift Damage to Architectural Heritage Structures in Belgium: Country-Scale Results from an InSAR-Based Analysis

Soil movement may be induced by a wide variety of natural and anthropogenic causes, which are detectable in the local scale, but may influence the movement of the soil over vast geographical expanses. Space borne interferometric synthetic aperture radar (InSAR) measurements of ground movement provide a method for the remote sensing of soil settlement and uplift over wide geographic areas. Based on this settlement and uplift evaluation, the assessment of the potential damage to architectural heritage structures is possible. In this paper an interdisciplinary monitoring and analysis method is presented that processes satellite, cadastral, patrimonial and building geometry data, used for the calculation of settlement and uplift damage to architectural heritage structures in Belgium. It uses processed InSAR data for the determination of the soil movement profile around each case study, of which the typology is determined from patrimonial information databases and the geometry is calculated from digital elevation models. The impact on the historic structures is calculated from the determined soil movement profile based on various soilstructure interaction models for buildings. The resulting damage is presented in terms of a numerical index illustrating its severity according to different criteria. In this way the potential soil movement damage is quantified in a large number of buildings in an easily interpretable and user-friendly fashion. The processing of InSAR data collected over the previous 3 decades allows the determination of the progress of settlement- and uplift-induced damage in this time period. With the integration of newly acquired and more accurate data, the methodology will continue to produce results in the coming years, both for the evaluation of soil settlement and uplift in Belgium as for introducing related damage risk data for existing architectural heritage buildings. Results of the analysis chain are presented in terms of potential current damage for selected areas and buildings

Understanding interpersonal relationships and psychopathy

Although psychopathy is widely recognised for its importance in forensic and criminal justice settings, the range of interpersonal relationships that are experienced and engaged in by individuals with psychopathy is understudied. A Rapid Evidence Assessment (Study 1) examined what is known empirically about the nature and quality of relationships for individuals with psychopathy. Affective, Cognitive and Lifestyle Assessment (ACL) interviews and genograms were then analysed in conjunction with Psychopathy Checklist: Screening Version (PCL:SV) scores to explore the extent, nature, and quality of interpersonal relationships in student and forensic psychiatric samples (Study 2). Quantitative data indicated that total psychopathy score predicted a smaller number of positive interpersonal relationships. Findings regarding Factors 1 and 2 and numbers of positive and negative interpersonal relationships varied between samples. Qualitative analyses demonstrated that psychopathic participants used less positive descriptors than non-psychopathic participants when discussing their interpersonal relationships. Findings are examined with regards to implications for future research

Reduced Cortisol Metabolism during Critical Illness

Critical illness is often accompanied by hypercortisolemia, which has been attributed to stress-induced activation of the hypothalamic-pituitary-adrenal axis. However, low corticotropin levels have also been reported in critically ill patients, which may be due to reduced cortisol metabolism.status: publishe

Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys

Background: Following childbirth, women need to stay sufficiently long in health facilities to receive adequate care. Little is known about length of stay following childbirth in low- and middle-income countries or its determinants. Methods and Findings: We described length of stay after facility delivery in 92 countries. We then created a conceptual framework of the main drivers of length of stay, and explored factors associated with length of stay in 30 countries using multivariable linear regression. Finally, we used multivariable logistic regression to examine the factors associated with stays that were “too short” (<24 h for vaginal deliveries and <72 h for cesarean-section deliveries). Across countries, the mean length of stay ranged from 1.3 to 6.6 d: 0.5 to 6.2 d for singleton vaginal deliveries and 2.5 to 9.3 d for cesarean-section deliveries. The percentage of women staying too short ranged from 0.2% to 83% for vaginal deliveries and from 1% to 75% for cesarean-section deliveries. Our conceptual framework identified three broad categories of factors that influenced length of stay: need-related determinants that required an indicated extension of stay, and health-system and woman/family dimensions that were drivers of inappropriately short or long stays. The factors identified as independently important in our regression analyses included cesarean-section delivery, birthweight, multiple birth, and infant survival status. Older women and women whose infants were delivered by doctors had extended lengths of stay, as did poorer women. Reliance on factors captured in secondary data that were self-reported by women up to 5 y after a live birth was the main limitation. Conclusions: Length of stay after childbirth is very variable between countries. Substantial proportions of women stay too short to receive adequate postnatal care. We need to ensure that facilities have skilled birth attendants and effective elements of care, but also that women stay long enough to benefit from these. The challenge is to commit to achieving adequate lengths of stay in low- and middle-income countries, while ensuring any additional time is used to provide high-quality and respectful care

Implementation of a health care policy: An analysis of barriers and facilitators to practice change

BACKGROUND: Governments often create policies that rely on implementation by arms length organizations and require practice changes on the part of different segments of the health care system without understanding the differences in and complexities of these agencies. In 2000, in response to publicity about the shortening length of postpartum hospital stay, the Ontario government created a universal program offering up to a 60-hour postpartum stay and a public health follow-up to mothers and newborn infants. The purpose of this paper is to examine how a health policy initiative was implemented in two different parts of a health care system and to analyze the barriers and facilitators to achieving practice change. METHODS: The data reported came from two studies of postpartum health and service use in Ontario Canada. Data were collected from newly delivered mothers who had uncomplicated vaginal deliveries. The study samples were drawn from the same five purposefully selected hospitals for both studies. Questionnaires prior to discharge and structured telephone interviews at 4-weeks post discharge were used to collect data before and after policy implementation. Qualitative data were collected using focus groups with hospital and community-based health care practitioners and administrators at each site. RESULTS: In both studies, the respondents reflected a population of women who experienced an "average" or non-eventful hospital-based, singleton vaginal delivery. The findings of the second study demonstrated wide variance in implementation of the offer of a 60-hour stay among the sites and focus groups revealed that none of the hospitals acknowledged the 60-hour stay as an official policy. The uptake of the offer of a 60-hour stay was unrelated to the rate of offer. The percentage of women with a hospital stay of less than 25 hours and the number with the guideline that the call be within 48 hours of hospital discharge. Public health telephone contact was high although variable in relation to compliance the guideline that the call be within 48 hours of hospital discharge. Home visits were offered at consistently high rates. CONCLUSION: Policy enactment is sometimes inadequate to stimulate practice changes in health care. Policy as a tool for practice change must thoughtfully address the organizational, professional, and social contexts within which the policy is to be implemented. These contexts can either facilitate or block implementation. Our examination of Ontario's universal postpartum program provides an example of differential implementation of a common policy intended to change post-natal care practices that reflects the differential influence of context on implementation

Effect of phosphorus on the attenuation of lead and chromium

This study analyses the adsorption of Pb(II) and Cr(III) in soils. These metals are commonly found together in nature in urban wastes or industrial spillages, and the theoretical approach of the work was to evaluate the response of the soil to continuous Cr and Pb spillages to soil in terms of several physicochemical parameters. The influence of an anthropogenic input of phosphorus was evaluated. Continuous flow experiments were run in duplicates in acrylic columns (25 cm × 3.2 cm). The influent Cr(III) and Pb(II) solutions of 10 mg l−1 and 25 mg l−1 at pH 5 were pumped upward through the bottom of the columns to ensure saturation flow conditions. Also, successive experiments were run with the above concentrations of Cr(III) and Pb(II) and NaH2PO4, keeping metal to phosphorus ratio of 1:0, 1:0.1 and 1:1. Modelling parameters included Freundlich and Langmuir equations, together with the Two-site adsorption model using CXTFIT code. Results obtained allowed concluding that Pb(II) adsorption presents a certain degree of irreversibility and the continued spillages over soil increment the fraction which is not easily desorbed. Cr(III) desorption was almost complete, evidencing its high mobility in nature. The presence of an anthropogenic input of phosphorus leads to a marked increase of both Pb(II) and Cr(III) adsorption in soils. Z-potential measurements allow to discard the electrostatic attraction of Cr(III) and Pb(II) with the surface charged soil as the dominant process of metal sorption. Instead, CheaqsPro simulation allows to identify PbH2PO4 +, PbHPO4 (aq) and CrHPO4 + as the dominant species which regulate Cr(III) and Pb(II) transport in soils.Fundação para a Ciência e a Tecnologi