Pregnancy, time to pregnancy and obstetric outcomes among female childhood cancer survivors: results of the DCOG LATER-VEVO study

Purpose: To evaluate pregnancy rates, time to pregnancy (TTP) and obstetric outcomes in female childhood cancer survivors (CCSs) and to identify specific diagnosis- and treatment-related factors associated with these outcomes. Methods: The study is part of the DCOG LATER-VEVO study, a nationwide multicenter cohort study evaluating fertility among long-term Dutch female CCSs. Data were collected by questionnaire. The current study included 1095 CCSs and 812 controls, consisting of sisters of CCSs and a random sample of women from the general population. Results: Among the subgroup of women who ever had the desire to become pregnant, the chance of becoming pregnant was significantly lower for CCSs than controls (OR 0.5, 95%CI 0.4–0.8). Moreover, TTP was 1.1 times longer for CCSs compared to controls (p = 0.09) and was significantly longer in survivors of CNS and renal tumours. Overall, no differences were found between CCSs and controls regarding the probability of ever having had a miscarriage, still birth, or induced abortion. However, CCSs had a significantly increased risk of delivering preterm (OR 2.2, 95%CI 1.3–3.7) and delivering via caesarean section (OR 1.8, 95%CI 1.2–2.6). Treatment with lower abdominal/pelvic radiotherapy was strongly associated with several adverse obstetric outcomes. Conclusion: CCSs are less likely to have ever been pregnant. Among those who do become pregnant, certain subgroups of CCSs are at increased risk of longer TTP. Moreover, as pregnant CCSs, especially those treated with lower abdominal/pelvic radiotherapy, are more likely to develop various adverse obstetric outcomes, appropriate obstetric care is highly advocated

Social capital dimensions in household food security interventions: implications for rural Uganda

We demonstrate that social capital is associated with positive food security outcomes, using survey data from 378 households in rural Uganda. We measured food security with the Household Food Insecurity Access Scale. For social capital, we measured cognitive and structural indicators, with principal components analysis used to identify key factors of the concept for logistic regression analysis. Households with bridging and linking social capital, characterized by membership in groups, access to information from external institutions, and observance of norms in groups, tended to be more food secure. Households with cognitive social capital, characterized by observance of generalized norms and mutual trust, were also more food secure than others. However, we established that social capital is, by itself, insufficient. It needs to be complemented with human capital enhancement. We recommend that development interventions which focus on strengthening community associations and networks to enhance food security should support activities which enhance cognitive social capital and human capital skills. Such activities include mutual goal setting, trust building and clear communication among actors. Education efforts for community members, both formal and non-formal, should also be supported such that they potentially strengthen social capital to improve food security in rural Uganda

Social risk assessment and social capital: a significant parameter for the formation of climate change policies

Public policy issues arising from climate change projections are becoming increasingly important in terms of the range and the scope of their effects. In order to effectively confront them it is important to address social, environmental and economic aspects as fully as possible in decision-making processes. In this context, social risk assessment techniques have begun to be applied to explore citizens’ risk perceptions of climate change projections. The present study aims to contribute to this area by examining the influence of four social capital parameters (social trust, institutional trust, social norms and social networks) on public risk perceptions of climate change. An empirical study was conducted for this purpose in Greece's fourth largest city, Heraklion. Results demonstrate that social capital is a significant explanatory parameter for citizens’ risk perceptions. Specifically, individuals with lower levels of social capital tend to perceive higher risks from climate change impacts. The most important parameter explaining this result is the low level of institutional trust, revealing that Heraklion's citizens do not believe that existing public institutions will be able to effectively manage projected climate change impacts

Relationship of patient characteristics and inpatient rehabilitation services to 5-year outcomes following spinal cord injury: A follow up of the SCIRehab project

Objective: To examine associations of patient characteristics and treatment quantity delivered during inpatient spinal cord injury (SCI) rehabilitation with outcomes at 5 years post-injury and compare them to the associations found at 1 year post-injury. Design: Observational study using Practice-Based Evidence research methodology in which clinicians documented treatment details. Regression modeling was used to predict outcomes. Setting: Five inpatient SCI rehabilitation centers in the US. Participants: Participants were 792 SCIRehab participants who were >12 years of age, gave informed consent, and completed both a 1-year and 5-year post-injury interview. Outcome measures: Outcome data were derived from Spinal Cord Injury Model Systems (SCIMS) follow-up interviews at 5 years post-injury and, similar to the 1-year SCIMS outcomes, included measures of physical independence, societal participation, life satisfaction, and depressive symptoms, as well as place of residence, school/work attendance, rehospitalization, and presence of pressure ulcers. Results: Consistent with 1-year findings, patient characteristics continue to be strong predictors of outcomes 5-years post-injury, although several variables add to the prediction of some of the outcomes. More time in physical therapy and therapeutic recreation were positive predictors of 1-year outcomes, which held less true at 5 years. Greater time spent with psychology and social work/case management predicted greater depressive symptomatology 5-years post-injury. Greater clinician experience was a predictor at both 1- and 5 -years, although the related positive outcomes varied across years. Conclusion: Various outcomes 5-years post-injury were primarily explained by pre-and post-injury characteristics, with little additional variance offered by the quantity of treatment received during inpatient rehabilitation