Feelings and Concerns of New Fathers When Their Spouses Have Epidural Anesthesia During Childbirth

Over the past years, the use of epidural anesthesia as an intervention for pain relief has increased in the labor and delivery setting. Exploration of the literature has not identified what effects the addition of this technology has had on the normal childbirth process and those participating in childbirth, specifically the new father. The purpose of this study was to explore first-time fathers\u27 perceptions of their feelings and concerns during the various phases of the labor and delivery experience in which epidural anesthesia is used. The study addresses the following research questions: (a) What are the perceptions of first-time fathers regarding their feelings and concerns at each of the following three stages in the labor and delivery experience: pre-epidural, post-epidural, and at time of delivery of their newborn?; and b) Do the levels of concerns and feelings differ during the various stages identified previously? The convenience sample consisted of first-time fathers whose newborns were delivered in a small Midwest, community hospital. Subjects met the following criteria: a) married at least one year; (b) first baby for both father and mother; (c) attendance at childbirth education classes; and (d) use of epidural anesthesia on spouse during childbirth. Fathers were surveyed through a self-administered questionnaire which was partly derived from The Berry Expectant Fathers Stress Index (BEFSI). Prior to administration, the questionnaire was reviewed by a panel of expert nurses for content and readability. The data from the questionnaires regarding perception and relevant demographic data were analyzed using the Statistical Package for the Social Sciences (SPSS/PC+). The results of the study found that fathers had five feelings and four concerns during childbirth. Feelings included: anxiousness, fear, happiness, confidence and closeness. Concerns included: concern for spouse, concern for baby, concern for self, and concern for the progress of labor. These feelings and concerns were reported at different levels during childbirth

Estimating the Impact of Newly Arrived Foreign-Born Persons on Tuberculosis in the United States

Background: Among approximately 163.5 million foreign-born persons admitted to the United States annually, only 500,000 immigrants and refugees are required to undergo overseas tuberculosis (TB) screening. It is unclear what extent of the unscreened nonimmigrant visitors contributes to the burden of foreign-born TB in the United States. Methodology/Principal Findings: We defined foreign-born persons within 1 year after arrival in the United States as ‘‘newly arrived’’, and utilized data from U.S. Department of Homeland Security, U.S. Centers for Disease Control and Prevention, and World Health Organization to estimate the incidence of TB among newly arrived foreign-born persons in the United States. During 2001 through 2008, 11,500 TB incident cases, including 291 multidrug-resistant TB incident cases, were estimated to occur among 20,989,738 person-years for the 1,479,542,654 newly arrived foreign-born persons in the United States. Of the 11,500 estimated TB incident cases, 41.6 % (4,783) occurred among immigrants and refugees, 36.6 % (4,211) among students/ exchange visitors and temporary workers, 13.8 % (1,589) among tourists and business travelers, and 7.3 % (834) among Canadian and Mexican nonimmigrant visitors without an I-94 form (e.g., arrival-departure record). The top 3 newly arrived foreign-born populations with the largest estimated TB incident cases per 100,000 admissions were immigrants and refugees from high-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of $100 cases/100,000 population/ year; 235.8 cases/100,000 admissions, 95 % confidence interval [CI], 228.3 to 243.3), students/exchange visitors an

An epidemiological investigation into an outbreak of rash illness among methadone maintenance clients in Australia

In late 2004, NSW Health received several reports of a serious desquamating rash among clients of the methadone program. We sought to identify the extent and likely cause of this outbreak. We initiated active surveillance for cases throughout Australia, a survey of dosing points in NSW, and a case control study of clients receiving methadone syrup (MS) at two clinics. Between October 2004 and March 2005, 388 cases were identified, largely in NSW. The dosing point survey found almost all cases were clients prescribed MS (attack rate 4.5%). In multivariate analysis of data from dosing points that dispensed MS, use of take away doses or location of the dosing point in greater western Sydney were associated with illness. In the case control study, MS injection, use of street MS, high doses of MS, frequent takeaway doses, or use of benzodiazepines were associated with illness. Testing found no abnormality in associated batches of MS. Batches of MS temporally associated with the outbreak were quarantined from use and the outbreak subsided. While a direct causal link could not be established, available evidence suggests that a contaminant may have caused the outbreak. Epidemiological analyses are important for assessing concerns about product safety following marketing approval

PrEP for people who use opioids: A NIDA clinical trials network survey study in Southern U.S. cities where HIV incidence is high

People who use opioids (PWUO) are at increased risk for HIV. Pre-exposure prophylaxis (PrEP) is effective but underutilized as HIV prevention among PWUO. This study examined predictors of willingness to take daily oral PrEP and long-acting injectable (LAI) PrEP among PWUO across eight Southern urban cities with high HIV incidence. HIV-negative PWUO (N = 308) seeking services in community-based programs participated in this cross-sectional survey study. Measures included demographics, sexual risk behavior, substance use frequency, and awareness of and willingness to take oral and injectable PrEP. Data were analyzed using mixed-effects models. Willingness to take daily oral and LAI PrEP was moderately high (69.16% and 62.02%, respectively). Half had heard of PrEP, but only 4% had ever taken it. Only education and condomless vaginal sex predicted willingness to take oral PrEP. Only education predicted willingness to take LAI PrEP. Polysubstance use was prevalent, with substantial proportions of PWUO reporting frequent use of injection drugs (opioids or stimulants, 79.5%), non-injection opioids (73.3%), non-injection stimulants (71.1%), cannabis (62.6%), and hazardous drinking (29.6%). About 20% reported past-year condomless anal sex, and one-third reported past-year condomless vaginal sex. PWUO in this study were amenable to PrEP, particularly in light of education and condomless vaginal sex. Careful consideration for matching PrEP messaging to the PWUO audience is needed. PrEP promotion should expand beyond men who have sex with men to include groups such as these predominantly heterosexual, polysubstance-using PWUO with HIV risk who were open to both formulations of PrEP. •Willingness for oral and long-acting injectable PrEP was moderately high in community settings.•Half of people who use opioids had heard of PrEP but few had ever taken it.•Education and condomless vaginal sex predicted willingness to take daily oral PrEP.•Education predicted willingness to take long-acting injectable PrEP.•Actively using, non-injecting PWUO are open to PrEP

Towards a constitutional theory of corporate governance

Matthias Benz and Bruno S. Frey critically examines the theoretical perspective that the corporations should aspire for an uniformly optimal structure of governance structure in "Towards a Constitutional Theory of Corporate Governance." They make a comparative study of the pros & cons of limited constitutional rights to shareholders under the US corporate laws with the extensive constitutional rights under the Swiss corporate laws. They advocate the democratic approach under Swiss law as a better alternative to direct approach of the US that allows shareholders to set up corporate governance according to their preferences