Cesarean and Vbac Rates Among Immigrant vs. Native-Born Women: A Retrospective Observational Study From Taiwan Cesarean Delivery and Vbac Among Immigrant Women in Taiwan

Background Cultural and ethnic roots impact women\u27s fertility and delivery preferences This study investigated whether the likelihood of cesarean delivery, primary cesarean, and vaginal delivery after cesarean (VBAC) varies by maternal national origin. Methods We conducted a nation-wide, population-based, observational study using secondary data from Taiwan. De-identified data were obtained on all 392,246 singleton live births (≥500 g; ≥20 weeks) born to native-born Taiwanese, Vietnamese and mainland Chinese-born mothers between January 1 2006 and December 31 2007 from Taiwan\u27s nation-wide birth certificate data. Our analytic samples consisted of the following: for overall cesarean likelihood 392,246 births, primary cesarean 336,766 (excluding repeat cesarean and VBAC), and VBAC 55,480 births (excluding primary cesarean and vaginal births without previous cesarean). Our main outcome measures were the odds of cesarean delivery, primary cesarean delivery and VBAC for Vietnamese and Chinese immigrant mothers relative to Taiwanese mothers, using multiple regression analyses to adjust for maternal and neonatal characteristics, paternal age, institutional setting, and major obstetric complications. Results Unadjusted overall cesarean, primary cesarean, and VBAC rates were 33.9%, 23.0% and 4.0% for Taiwanese, 27.6%, 20.1% and 5.0% for mainland Chinese, and 19.3%, 13.9 and 6.1% for Vietnamese respectively. Adjusted for confounders, Vietnamese mothers were less likely than native-born Taiwanese to have overall and primary cesarean delivery (OR = 0.59 and 0.58 respectively), followed by Chinese mothers (both ORs = 0.90 relative to native-born Taiwanese). Vietnamese mothers were most likely to have successful VBAC (OR = 1.58), followed by Chinese mothers (OR = 1.25). Conclusion Immigrant Vietnamese and Chinese mothers have lower odds of cesarean and higher VBAC odds than native-born Taiwanese, consistent with lower cesarean rates prevailing in their home countries (Vietnam 10.1%; mainland China 20% - 50% rural and urban respectively)

Preparing for disaster: a comparative analysis of education for critical infrastructure collapse

This article explores policy approaches to educating populations for potential critical infrastructure collapse in five different countries: the UK, the US, Germany, Japan and New Zealand. ‘Critical infrastructure’ is not always easy to define, and indeed is defined slightly differently across countries – it includes entities vital to life, such as utilities (water, energy), transportation systems and communications, and may also include social and cultural infrastructure. The article is a mapping exercise of different approaches to critical infrastructure protection and preparedness education by the five countries. The exercise facilitates a comparison of the countries and enables us to identify distinctive characteristics of each country’s approach. We argue that contrary to what most scholars of security have argued, these national approaches diverge greatly, suggesting that they are shaped more by internal politics and culture than by global approaches

Trends in health outcomes for family caregivers of hip‐fractured elders during the first 12 months after discharge

Aim.  This article reports on trends in health outcomes for family caregivers of hip‐fractured patients and the effects of social support on these outcomes. Background.  Little is known about the impact of caregiving on the health outcomes of family caregivers of patients with hip fracture. Method.  For this prospective, correlational study, data were collected from 135 family caregivers of hip‐fractured elders (2001–2005). Data on health‐related quality of life and social support were collected from family caregivers at 1, 3, 6 and 12 months after discharge of the older hip‐fractured patient. Findings.  During the 12 months after the patients’ discharge, family caregivers’ scores improved significantly in role performance‐related scales, including bodily pain, social function, role limitations due to emotional problems and role limitations due to physical problems. However, caregivers’ scores for general health and mental health were significantly lower at 12 months [59·91 ( sd  = 24·54) and 65·91 ( sd  = 14·36) respectively] than at 1 month after discharge [64·35 ( sd  = 23·29) and 67·94 ( sd  = 18·47) respectively]. The trends for most subscale scores for health‐related quality of life were positively related to perceived availability of social support. Conclusions.  Caring for a hip‐fractured older family member over a sustained period may enhance family caregivers’ role performance, but have a negative impact on their perceived general health and mental health. These results suggest that home care nurses should develop interventions early after discharge to assess and improve family caregivers’ health perception, mental health and social support.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90349/1/j.1365-2648.2011.05778.x.pd

Development and preliminary validation of a questionnaire to measure satisfaction with home care in Greece: an exploratory factor analysis of polychoric correlations

<p>Abstract</p> <p>Background</p> <p>The primary aim of this study was to develop and psychometrically test a Greek-language instrument for measuring satisfaction with home care. The first empirical evidence about the level of satisfaction with these services in Greece is also provided.</p> <p>Methods</p> <p>The questionnaire resulted from literature search, on-site observation and cognitive interviews. It was applied in 2006 to a sample of 201 enrollees of five home care programs in the city of Thessaloniki and contains 31 items that measure satisfaction with individual service attributes and are expressed on a 5-point Likert scale. The latter has been usually considered in practice as an interval scale, although it is in principle ordinal. We thus treated the variable as an ordinal one, but also employed the traditional approach in order to compare the findings. Our analysis was therefore based on ordinal measures such as the polychoric correlation, Kendall's Tau b coefficient and ordinal Cronbach's alpha. Exploratory factor analysis was followed by an assessment of internal consistency reliability, test-retest reliability, construct validity and sensitivity.</p> <p>Results</p> <p>Analyses with ordinal and interval scale measures produced in essence very similar results and identified four multi-item scales. Three of these were found to be reliable and valid: socioeconomic change, staff skills and attitudes and service appropriateness. A fourth dimension -service planning- had lower internal consistency reliability and yet very satisfactory test-retest reliability, construct validity and floor and ceiling effects. The global satisfaction scale created was also quite reliable. Overall, participants were satisfied -yet not very satisfied- with home care services. More room for improvement seems to exist for the socio-economic and planning aspects of care and less for staff skills and attitudes and appropriateness of provided services.</p> <p>Conclusions</p> <p>The methods developed seem to be a promising tool for the measurement of home care satisfaction in Greece.</p