Interventions During Labor and Birth in the United States: A Qualitative Analysis of Women’s Experiences

Objective: To explore and describe hospital-­‐birthing women’s understandings of and experiences with interventions during labor and birth. Methods: Qualitative data was collected as part of a larger ethnographic study of childbirth in the United States. The grounded theory method was employed to analyze interviews with 59 women from three states who had recently given birth in hospitals with physicians or certified nurse-­‐midwives in attendance. Results: Four themes emerged from the data. The themes safety/risk and provider match, described women’s expectations regarding intervention and their interactions with providers. A third theme addressed how women experienced interventions and their perceptions of control over decision-­‐making. A final theme characterized women’s satisfaction with maternity care. Conclusions: Women who received interventions expressed varying levels of comfort or apprehension associated with both expectations of maternity care and provider match. Women whose expectations matched those of the provider reported more positive experiences. Regardless of provider match, women expressed ambivalence about the use of interventions and confusion over their appropriate place. Women’s ability to make sense of interventions was related to how well they navigated a complicated and bureaucratic maternity system. Increasing attention needs to be paid to the impact of these factors on women’s perceptions of care during pregnancy and childbirth

Patient responses in relation to the use of a teaching guide in the preparation of school-age children for surgery

Thesis (M.S.)--Boston Universit

Prehabilitation Before Total Knee Arthroplasty Increases Strength and Function in Older Adults With Severe Osteoarthritis

Preparing for the stress of total knee arthroplasty (TKA) surgery by exercise training (prehabilitation) may improve strength and function before surgery and, if effective, has the potential to contribute to postoperative recovery. Subjects with severe osteoarthritis (OA), pain intractable to medicine and scheduled for TKA were randomized into a usual care (UC) group (n = 36) or usual care and exercise (UC + EX) group (n = 35). The UC group maintained normal daily activities before their TKA. The UC + EX group performed a comprehensive prehabilitation program that included resistance training using bands, flexibility, and step training at least 3 times per week for 4-8 weeks before their TKA in addition to UC. Leg strength (isokinetic peak torque for knee extension and flexion) and ability to perform functional tasks (6-minute walk, 30 second sit-to-stand repetitions, and the time to ascend and descend 2 flights of stairs) were assessed before randomization at baseline (T1) and 1 week before the subject\u27s TKA (T2). Repeated-measures analysis of variance indicated a significant group by time interaction (p \u3c 0.05) for the 30-second sit-to-stand repetitions, time to ascend the first flight of stairs, and peak torque for knee extension in the surgical knee. Prehabilitation increased leg strength and the ability to perform functional tasks for UC + EX when compared to UC before TKA. Short term (4-8 weeks) of prehabilitation was effective for increasing strength and function for individuals with severe OA. The program studied is easily transferred to a home environment, and clinicians working with this population should consider prehabilitation before TKA. [PUBLICATION ABSTRACT

The Influence of Neighborhood Poverty on Blood Glucose Levels: Findings from the Community Initiative to Eliminate Stroke (CITIES) program

Objectives:  To examine the relationship between both individual and neighborhood level characteristics and non-fasting blood glucose levels.Study design: This study used a cross sectional design using data from the Community Initiative to Eliminate Stroke Program in NC (2004-2008).  A total of 12,809 adults nested within 550 census block groups from two adjacent urban counties were included in the analysis.Methods:   Participants completed a cardiovascular risk factor assessment with self-reported demographics, stroke-risk behaviors, and biometric measurements.  Neighborhood level characteristics were based upon census data.  Three multilevel models were constructed for data analysis.Results:  Mean blood glucose level of this sample population was 103.61mg/dL.  The unconditional model 1 suggested a variation in mean blood glucose levels among the neighborhoods (τ00 = 13.39; P < .001).  Both models 2 and 3 suggested that the neighborhood composite deprivation index had a significant prediction on each neighborhood’s mean blood glucose level (¡01= .69; P < 0.001,¡01= .36; P = .004).  Model 3 also suggested that across all the neighborhoods, on average, after controlling for individual level risk factors, deprivation remained a significant predictor of blood glucose levels.Conclusions:  The findings provide evidence that neighborhood disadvantage is a significant predictor of neighborhood and individual level blood glucose levels.  One approach to diabetes prevention could be for policymakers to address the problems associated with environmental determinants of health

The effect of death education course on dying and death knowledge, attitudes, anxiety and fears

It is believed that socio-historical changes in the way Americans view dying and death have increased the need for formal and informal instruction in this area (Kubler-Ross 1969, Farmer 1970, Pine 1977, Simpson 1979). These and other authors postulate there was a more positive attitude toward death in the nineteenth century due in part to higher childhood mortality rates, large extended families, and shorter life expectancies. These factors often brought people into direct contact with death experiences. However, in the twentieth century, childhood mortality rates decreased, families developed a more nuclear structure, and death was removed from the family residence to institutions such as hospitals (Simpson 1970). For these reasons, it is believed that death became a taboo topic of discussion (Feifel 1963, Wass and Shaak 1976)

Performance of a diode-end-pumped Yb:YAG laser

Using an end-pumped technology developed at LLNL we have demonstrated a Yb:YAG laser capable of delivering up to 434 W of CW power and 280 W of Q-switched power. In addition, we have frequency doubled the output to 515 nm using a dual crystal scheme to produce 76 W at 10 kHz in a 30 ns pulse length

Clinical and molecular practice of European thoracic pathology laboratories during the COVID-19 pandemic. The past and the near future

Background: This study evaluated the consequences in Europe of the COVID-19 outbreak on pathology laboratories orientated toward the diagnosis of thoracic diseases. Materials and methods: A survey was sent to 71 pathology laboratories from 21 European countries. The questionnaire requested information concerning the organization of biosafety, the clinical and molecular pathology, the biobanking, the workload, the associated research into COVID-19, and the organization of education and training during the COVID- 19 crisis, from 15 March to 31 May 2020, compared with the same period in 2019. Results: Questionnaires were returned from 53/71 (75%) laboratories from 18 European countries. The biosafety procedures were heterogeneous. The workload in clinical and molecular pathology decreased dramatically by 31% (range, 3%-55%) and 26% (range, 7%-62%), respectively. According to the professional category, between 28% and 41% of the staff members were not present in the laboratories but did teleworking. A total of 70% of the laboratories developed virtual meetings for the training of residents and junior pathologists. During the period of study, none of the staff members with confirmed COVID-19 became infected as a result of handling samples. Conclusions: The COVID-19 pandemic has had a strong impact on most of the European pathology laboratories included in this study. Urgent implementation of several changes to the organization of most of these laboratories, notably to better harmonize biosafety procedures, was noted at the onset of the pandemic and maintained in the event of a new wave of infection occurring in Europe

Performance Against WELCOA’s Worksite Health Promotion Benchmarks Across Years Among Selected US Organizations

Purpose: The purpose of this study was to quantify the performance of organizations’ worksite health promotion (WHP) activities against the benchmarking criteria included in the Well Workplace Checklist (WWC). Design: The Wellness Council of America (WELCOA) developed a tool to assess WHP with its 100-item WWC, which represents WELCOA’s 7 performance benchmarks. Setting: Workplaces. Participants: This study includes a convenience sample of organizations who completed the checklist from 2008 to 2015. The sample size was 4643 entries from US organizations. Measures: The WWC includes demographic questions, general questions about WHP programs, and scales to measure the performance against the WELCOA 7 benchmarks. Analysis: Descriptive analyses of WWC items were completed separately for each year of the study period. Results: The majority of the organizations represented each year were multisite, multishift, medium- to large-sized companies mostly in the services industry. Despite yearly changes in participating organizations, results across the WELCOA 7 benchmark scores were consistent year to year. Across all years, benchmarks that organizations performed the lowest were senior-level support, data collection, and programming; wellness teams and supportive environments were the highest scoring benchmarks. Conclusion: In an era marked with economic swings and health-care reform, it appears that organizations are staying consistent in their performance across these benchmarks. The WWC could be useful for organizations, practitioners, and researchers in assessing the quality of WHP programs