Cost-Effectiveness of Universal Prophylaxis in Pregnancy with Prior Group B Streptococci Colonization

Objective. To estimate the costs and outcomes of rescreening for group B streptococci (GBS) compared to universal treatment of term women with history of GBS colonization in a previous pregnancy. Study Design. A decision analysis model was used to compare costs and outcomes. Total cost included the costs of screening, intrapartum antibiotic prophylaxis (IAP), treatment for maternal anaphylaxis and death, evaluation of well infants whose mothers received IAP, and total costs for treatment of term neonatal early onset GBS sepsis. Results. When compared to screening and treating, universal treatment results in more women treated per GBS case prevented (155 versus 67) and prevents more cases of early onset GBS (1732 versus 1700) and neonatal deaths (52 versus 51) at a lower cost per case prevented ($8 805 versus$12 710). Conclusion. Universal treatment of term pregnancies with a history of previous GBS colonization is more cost-effective than the strategy of screening and treating based on positive culture results

Marketing: El marketing en el siglo XXI

El presente documento de carácter bibliográfico tiene como tema el marketing y su subtema el marketing en el siglo XXI. Se tiene como objetivo general analizar el marketing en el siglo XXI a través de los distintos elementos, herramientas y estrategias que lo conforman. La base teórica que sustenta este informe se hace énfasis en tres capítulos esenciales tales como capítulo uno: marketing presente y futuro, capítulo dos: investigación de mercado y capítulo tres: estrategias del marketing en el siglo XXI. Las técnicas utilizadas para el desarrollo de este informe fueron la lectura y recolección de documentación bibliográfica basada en el marketing, así mismo el desarrollo del informe se realizó aplicando las normas APAS 6 y aplicación de la normativa de seminario de graduación plan 2013 de la UNAN Managua. Los principales términos descriptores del informe son dedicatoria, agradecimiento, introducción, justificación, objetivos del informe, desarrollo, conclusiones y bibliografía

Leadership Styles in Public Schools in the Andean Region

La investigación abordó como tema los estilos de liderazgo de algunos municipios que hacen parte de la region central de Colombia, cuya investigación pretendió identificar los diferentes estilos de liderazgo de la población docente y roles directivos que forman parte de estas comunidades educativas. La metodología que caracterizó este estudio fue de tipo descriptivo con un enfoque mixto que proporcionó recolectar información por medio de la entrevista semiestructurada y la escala de likert de manera voluntaria a directivos, docentes y rectores. Los resultados evidenciaron que el liderazgo que predomina es democrático y participativo porque los directivos generan espacios en toma de decisiones encaminadas a tener una calidad educativa, mejorar el clima laboral en la institución académica.The research addresses as a topic the leadership styles of some municipalities that are part of the central region of Colombia, whose research sought to identify the different leadership styles of the teaching population and managerial roles that are part of these educational communities. The methodology that characterized this study was descriptive with a mixed approach that provided for collecting information through the semi-structured interview and the Likert scale on a voluntary basis from managers, teachers and principals. The results showed that the leadership that predominates is democratic and participatory because the managers generate spaces for decision-making aimed at having educational quality and improving the work environment in the academic institution

Maternal and neonatal outcomes by labor onset type and gestational age.

OBJECTIVE: We sought to determine maternal and neonatal outcomes by labor onset type and gestational age. STUDY DESIGN: We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean). Neonatal and maternal outcomes were calculated by labor onset type and gestational age. RESULTS: Neonatal intensive care unit admissions and sepsis improved with each week of gestational age until 39 weeks (P \u3c .001). After adjusting for complications, elective induction of labor was associated with a lower risk of ventilator use (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.28-0.53), sepsis (OR, 0.36; 95% CI, 0.26-0.49), and neonatal intensive care unit admissions (OR, 0.52; 95% CI, 0.48-0.57) compared to spontaneous labor. The relative risk of hysterectomy at term was 3.21 (95% CI, 1.08-9.54) with elective induction, 1.16 (95% CI, 0.24-5.58) with indicated induction, and 6.57 (95% CI, 1.78-24.30) with cesarean without labor compared to spontaneous labor. CONCLUSION: Some neonatal outcomes improved until 39 weeks. Babies born with elective induction are associated with better neonatal outcomes compared to spontaneous labor. Elective induction may be associated with an increased hysterectomy risk

Mode of Delivery in Women with Antepartum Fetal Death and Prior Cesarean Delivery

We describe obstetric outcomes in a group of patients with prior cesarean delivery (CD) presenting with an intrauterine fetal demise (IUFD). A secondary analysis of an observational study of women with prior CD was performed. All antepartum singleton pregnancies with a prior CD and IUFD ≥ 20 weeks’ gestation or 500 grams were evaluated. Two hundred nine patients met inclusion criteria for analysis. The mean gestational age ± standard deviation at delivery was 31.3 ± 6.5 weeks. The trial of labor rate was 75.6% (158/209), and the vaginal birth after cesarean (VBAC) success rate was 86.7%. Labor induction or augmentation occurred in 83.3% of attempted VBAC. Uterine rupture occurred in five women (2.4%), and in 3.4% of those being induced but none of these required hysterectomy. Women with a history of previous CD and an IUFD often undergo trial of labor with a high VBAC success rate. Uterine rupture complicates 2.4% of such cases

Predictors of becoming redomiciled among older homeless women.

The authors test a model to predict residential outcome among 201 homeless women aged 50 and over. On two-year follow-up, 47% were successfully domiciled. Of 12 variables examined using logistic regression analysis, only 2 variables, perceived support and number of community facilities attended were significant predictors of being domiciled on follow-up. Three additional variables — absence of psychosis, a lifetime history of less than one year of homelessness, and number of entitlements — attained near-significance. Although residential outcome is predicted by a few individual characteristics, what is most striking is the lack of suitable housing options