Urban women's socioeconomic status, health service needs and utilization in the four weeks after postpartum hospital discharge: findings of a Canadian cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>Postpartum women who experience socioeconomic disadvantage are at higher risk for poor health outcomes than more advantaged postpartum women, and may benefit from access to community based postpartum health services. This study examined socioeconomically disadvantaged (SED) postpartum women's health, and health service needs and utilization patterns in the first four weeks post hospital discharge, and compared them to more socioeconomically advantaged (SEA) postpartum women's health, health service needs and utilization patterns.</p> <p>Methods</p> <p>Data collected as part of a large Ontario cross-sectional mother-infant survey were analyzed. Women (N = 1000) who had uncomplicated vaginal births of single 'at-term' infants at four hospitals in two large southern Ontario, Canada cities were stratified into SED and SEA groups based on income, social support and a universally administered hospital postpartum risk screen. Participants completed a self-administered questionnaire before hospital discharge and a telephone interview four weeks after discharge. Main outcome measures were self-reported health status, symptoms of postpartum depression, postpartum service needs and health service use.</p> <p>Results</p> <p>When compared to the SEA women, the SED women were more likely to be discharged from hospital within the first 24 hours after giving birth [OR 1.49, 95% CI (1.01–2.18)], less likely to report very good or excellent health [OR 0.48, 95% CI (0.35–0.67)], and had higher rates of symptoms of postpartum depression [OR 2.7, 95% CI(1.64–4.4)]. No differences were found between groups in relation to self reported need for and ability to access services for physical and mental health needs, or in use of physicians, walk-in clinics and emergency departments. The SED group were more likely to accept public health nurse home visits [OR 2.24, 95% CI(1.47–3.40)].</p> <p>Conclusion</p> <p>Although SED women experienced poorer mental and overall health they reported similar health service needs and utilization patterns to more SEA women. The results can assist policy makers, health service planners and providers to develop and implement necessary and accessible services. Further research is needed to evaluate SED postpartum women's health service needs and barriers to service use.</p

Islet transplantation from a nationally funded UK centre reaches socially deprived groups and improves metabolic outcomes

Acknowledgements We thank the transplant nurses involved with the Scottish Islet Transplant Programme (T. McGilvray, J. Davidson, M. Phillips and C. Jansen) for help with participant assessment. We thank the Scottish National Blood Transfusion Services including the Histocompatibility and Immunogenetics Team for HLA typing and antibody screening, and the Tissue and Cells Team (A. Timpson, L. Fraser, L. Irvine and P. Henry) for islet isolation and product release testing. We acknowledge the Departments of Transplantation, Diabetes and Interventional Radiology at NHS Lothian for all aspects of patient care and the organ procurement programme. We thank J. Shaw and A. Brooks from the Department of Regenerative Medicine for Diabetes at the University of Newcastle for advice regarding CGMS. C-peptide assays were performed by the NIHR Cambridge Biomedical Research Centre, Core Biochemical Assay Laboratory. Funding: The Scottish Islet Transplant Programme is funded by the National Services Division. This research was funded by Diabetes UK (Biomedical and Psychosocial Outcomes of Islet Transplantation; Grant no. BDA 06/0003362), Diabetes Research and Wellness Foundation, Diabetes Foundation, Juvenile Diabetes Research Foundation and the Royal Infirmary Diabetes Treatment Trust Fund. Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.Peer reviewedPublisher PD

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Introduction

info:eu-repo/semantics/publishe

Appropriating Antiquity - Saisir l’Antique: Collections et collectionneurs d’antiques en Belgique et en Grande-Bretagne au XIXe siècle

Etudes d’Archéologie Classique de l’ULBinfo:eu-repo/semantics/publishe

In search of the Dioskouroi: image, myth and cult

This study explores the Greeks' experience of the Dioskouroi before the arrival of the Romans, stimulated by Cicero's assertion (Cic. Nat.D. 3.15(39)) that by his time they were worshipped widely in Greece, possibly more than the Olympians: from the archaeological evidence, a surprising claim. The task is complicated by the brothers' different incarnations in different places and at different times, and the variability and patchiness of the evidence for the period, from Homeric times to c. 146 BC. To address this (explained in Chapter 1), the study is designed around examining the evidence in selected locations over time, with an underlying theme of comparing the archaeological with the literary evidence, much of which is Roman. An overview of the evidence from literature, images and buildings sets the stage (Chapter 2). The association of Kastor and Polydeukes with 'Lakedaimon' in the literature, from Homer onwards, led the study to focus primarily on Sparta and the Peloponnese (Chapter 3), looking closely also at Sparta's near neighbours, Messene and Argos. It then looks at evidence from Thera, Kyrene and Naukratis (Chapter 4), in order to include some of the earliest material evidence we have of cult of the Dioskouroi in Greek settlements, which also have associations with Sparta and Lakonia; evidence from Thasos is included too. The final chapter considers the findings and assesses the usefulness of the methodology. The paucity of architectural evidence for major monuments and buildings specifically dedicated to the Dioskouroi, except in centres where Greeks gathered from different places for trade or religious reasons, may be explained if the primary location of their cult was the individual household, buildings only being needed for dedications to the brothers by Greeks away from home. It could also explain the seeming mismatch between Cicero's statement and the archaeological record.This thesis is not currently available via ORA

Is reporting on interventions a weak link in understanding how and why they work? A preliminary exploration using community heart health exemplars

Background: The persistent gap between research and practice compromises the impact of multi-level and multi-strategy community health interventions. Part of the problem is a limited understanding of how and why interventions produce change in population health outcomes. Systematic investigation of these intervention processes across studies requires sufficient reporting about interventions. Guided by a set of best processes related to the design, implementation, and evaluation of community health interventions, this article presents preliminary findings of intervention reporting in the published literature using community heart health exemplars as case examples. Methods: The process to assess intervention reporting involved three steps: selection of a sample of community health intervention studies and their publications; development of a data extraction tool; and data extraction from the publications. Publications from three well-resourced community heart health exemplars were included in the study: the North Karelia Project, the Minnesota Heart Health Program, and Heartbeat Wales. Results: Results are organized according to six themes that reflect best intervention processes: integrating theory, creating synergy, achieving adequate implementation, creating enabling structures and conditions, modifying interventions during implementation, and facilitating sustainability. In the publications for the three heart health programs, reporting on the intervention processes was variable across studies and across processes. Conclusion: Study findings suggest that limited reporting on intervention processes is a weak link in research on multiple intervention programs in community health. While it would be premature to generalize these results to other programs, important next steps will be to develop a standard tool to guide systematic reporting of multiple intervention programs, and to explore reasons for limited reporting on intervention processes. It is our contention that a shift to more inclusive reporting of intervention processes would help lead to a better understanding of successful or unsuccessful features of multi-strategy and multi-level interventions, and thereby improve the potential for effective practice and outcomes.Applied Science, Faculty ofNursing, School ofNon UBCReviewedFacult

Silencing of voice: an act of violence. Urban Aboriginal women speak out about their experiences with health care

This article reports some of the preliminary findings of an ongoing participatory research study exploring the provision of health and social services for urban Aboriginal communities in the Okanagan Valley. In particular, the article examines how colonial structures and systems have worked to silence Aboriginal women’s voices and how this has affected the ways in which urban Aboriginal women seek out health services. The article addresses these issues through the voices of the Aboriginal women in the study. The women’s stories reveal the many assumptions and inequities that contribute to their marginalization. They describe how their voices are often silenced when they access health services and how this can cause them to either delay seeking needed health advice or accept the status quo. The women’s stories are used to stress the importance and power of voice. This is most evident in their experiences accessing the health services offered through community-based Friendship Centres, where many felt they had more control over the care they received. In the context of this article, the impacts of colonization and the silencing of women’s voices are viewed as acts of structural violence. The women’s stories provide crucial insights into how health care provision can be changed to help prevent these acts of violence, thus leading the way to improved health for all urban Aboriginal populations

Silencing of Voice: An Act of Structural Violence Urban Aboriginal Women Speak Out About Their Experiences with Health Care

This article reports some of the preliminary findings of an ongoing participatory research study exploring the provision of health and social services for urban Aboriginal communities in the Okanagan Valley. In particular, the article examines how colonial structures and systems have worked to silence Aboriginal women’s voices and how this has affected the ways in which urban Aboriginal women seek out health services. The article addresses these issues through the voices of the Aboriginal women in the study. The women’s stories reveal the many assumptions and inequities that contribute to their marginalization. They describe how their voices are often silenced when they access health services and how this can cause them to either delay seeking needed health advice or accept the status quo. The women’s stories are used to stress the importance and power of voice. This is most evident in their experiences accessing the health services offered through community-based Friendship Centres, where many felt they had more control over the care they received. In the context of this article, the impacts of colonization and the silencing of women’s voices are viewed as acts of structural violence. The women’s stories provide crucial insights into how health care provision can be changed to help prevent these acts of violence, thus leading the way to improved health for all urban Aboriginal populations