Magnitude of income-related disparities in adverse perinatal outcomes

BACKGROUND: To assess and compare multiple measurements of socioeconomic position (SEP) in order to determine the relationship with adverse perinatal outcomes across various contexts. METHODS: A birth registry, the Nova Scotia Atlee Perinatal Database, was confidentially linked to income tax and related information for the year in which delivery occurred. Multiple logistic regression was used to examine odds ratios between multiple indicators of SEP and multiple adverse perinatal outcomes in 117734 singleton births between 1988 and 2003. Models for after tax family income were also adjusted for neighborhood deprivation to gauge the relative magnitude of effects related to SEP at both levels. Effects of SEP were stratified by single- versus multiple-parent family composition, and by urban versus rural location of residence. RESULTS: The risk of small for gestational age and spontaneous preterm birth was higher across all the indicators of lower SEP, while risk for large for gestational age was lower across indicators of lower SEP. Higher risk of postneonatal death was demonstrated for several measures of lower SEP. Higher material deprivation in the neighborhood of residence was associated with increased risk for perinatal death, small for gestational age birth, and iatrogenic and spontaneous preterm birth. Family composition and urbanicity were shown to modify the association between income and some perinatal outcomes. CONCLUSIONS: This study highlights the importance of understanding the definitions of SEP and the mechanisms that lead to the association between income and poor perinatal outcomes, and broadening the types of SEP measures used in some cases

How collective participation impacts social identity: a longitudinal study from India

A key issue for political psychology concerns the processes whereby people come to psychologically invest in socially and politically significant group identities. Since Durkheim, it has been assumed that participation in group-relevant collective events increases one’s investment in such group identities. However, little empirical research explicitly addresses this or the processes involved. We investigated these issues in a longitudinal questionnaire study conducted at one of the world’s largest collective events – a month-long Hindu festival in north India (the Magh Mela). Data gathered from pilgrims and comparable others who did not attend the event show that one month after the event, those who had participated (but not the controls) exhibited heightened social identification as Hindu and increased frequency of prayer rituals. Data gathered from pilgrims during the festival predicted these outcomes. Specifically, perceptions of sharing a common identity with other pilgrims, and of being able to enact their social identity in this event, helped predict changes in participants’ identification and behavior. The wider significance of these data for political psychology is discussed

Students response to a Massage & Meditation medical school course elective.

This article was migrated. The article was marked as recommended. Objectives: Due to high incidence of medical student and physician burnout, medical education needs to include skills for life-work balance. Patients complain that clinicians depend on technology during clinic visits, and use less touch. To address this educational need, we designed an 18-hour curriculum that combines massage (to reduce anxiety and teach skillful touch) and meditation (for burnout prevention). We explored whether learning basics of massage and meditation could give medical students tools for self-care and skillful touch. Methods: The curriculum was implemented as an elective at the Medical School since 14 years. We collected 181 anonymous student evaluations and conducted pre-post surveys to evaluate the curriculum. We assess mindful bodily awareness (by Multidimensional Assessment of Interoceptive Awareness questionnaire) and conducted thematic analysis of students comments. Results: Students appeared highly satisfied with the class (4.94 [Range 1-5]) and reported confidence in being able to apply massage and meditation in their personal and professional life. They commented on the importance of skillful touch and gained more confidence in using touch in clinical care. The pre-post survey showed improvements in interoceptive bodily awareness. Students felt that they developed new skills for self-care and stress management, experienced a sense of community among peers, and stated that the class provided necessary teaching complementary to the mandatory medical school curriculum. Conclusions: A course of Meditation and Massage may be a valuable complementary elective to medical school education, supporting self-care and stress management in preparation for a demanding profession, and may improve palpatory examination skills

Clinical outcomes of splenectomy in children: Report of the splenectomy in congenital hemolytic anemia registry

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110704/1/ajh23888.pd

Hospital clusters of invasive Group B Streptococcal disease: A systematic review.

OBJECTIVES: To characterize outbreaks of invasive Group B Streptococcal (iGBS) disease in hospitals. METHODS: Systematic review using electronic databases to identify studies describing iGBS outbreaks/clusters or cross-infection/acquisition in healthcare settings where 'cluster' was defined as ≥2 linked cases. PROSPERO CRD42018096297. RESULTS: Twenty-five references were included describing 30 hospital clusters (26 neonatal, 4 adult) in 11 countries from 1966 to 2019. Cross-infection between unrelated neonates was reported in 19 clusters involving an early-onset (<7 days of life; n = 3), late-onset (7-90 days; n = 13) index case or colonized infant (n = 3) followed by one or more late-onset cases (median serial interval 9 days (IQR 3-17, range 0-50 days, n = 45)); linkage was determined by phage typing in 3 clusters, PFGE/MLST/PCR in 8, WGS in 4, non-molecular methods in 4. Postulated routes of transmission in neonatal clusters were via clinical personnel and equipment, particularly during periods of crowding and high patient-to-nurse ratio. Of 4 adult clusters, one was attributed to droplet spread between respiratory cases, one to handling of haemodialysis catheters and two unspecified. CONCLUSIONS: Long intervals between cases were identified in most of the clusters, a characteristic which potentially hinders detection of GBS hospital outbreaks without enhanced surveillance supported by genomics

Paediatric Obesity Research in Early Childhood and the Primary Care Setting: The TARGet Kids! Research Network

Primary paediatric health care is the foundation for preventative child health. In light of the recent obesity epidemic, paediatricians find themselves at the frontline of identification and management of childhood obesity. However, it is well recognized that evidence based approaches to obesity prevention and subsequent translation of this evidence into practice are critically needed. This paper explores the role of primary care in obesity prevention and introduces a novel application and development of a primary care research network in Canada—TARGet Kids!—to develop and translate an evidence-base on effective screening and prevention of childhood obesity

Embodied pain—negotiating the boundaries of possible action

Pain is a protective strategy, which emerges from on-going interaction between body and world. However, pain is often thought of as a unitary output—an end product experienced as an intrusion upon an often unsuspecting perceiver.55 We know a lot about how nociception relates to pain, informed by both biological and psychological influences,30,68,96 how pain intrudes into awareness,5,26,29,34 and how it relates to clinical variables, such as suffering and disability.35 However, despite significant advances, the mechanisms of pain intrusion remain elusive.62 In this article, we stress a functional view of pain as more than experience, as defensive action operating in the context of uncertain threat.Although traditional characterisations of perception as a product of sensory information have been critiqued,19,41,52 including in pain,87,94 there is now a well-advanced contemporary view that all perception is embodied and embedded.41,46,65,77,84,86 Here, embodied is defined by action, the premise that cognition extends beyond the brain so that an ever-changing body is at the core of how our experiences are shaped; this may be the unconscious workings of our immune system or the collaborative efforts made to avoid movement. Embedded refers to the situated interaction between the embodied being and the external environment, in both place (current context) and time (evolutionary context).From this view, all experience is inferential,78 dynamic,22,54 and related to action in the world.2,21,24 Thus, to describe the experience of pain, we must understand it within its evolved, learned, and ultimately threat-defined context.33,99 Theories of embodied experience are well advanced elsewhere, most notably in cybernetics,4,23,79 evolutionary biology,39,73,80 and consciousness.81,82 Its provenance can be traced to structural psychology,91 phenomenology,47,52,61 and perception.41,75 However, embodied domains have avoided pain, considering it either too simple32 or paradoxically too difficult.6Our embodied view, in many ways, complements the existing literature,18,27,36,42,93,95 supporting the growing understanding of pain as an experience inferred from uncertain information.3,17,83,98 However, it critically looks to extend this work beyond a passive information processing model that has come to dominate.48 Here, we emphasise the body, not separate from the brain nor the world, but part of the facility that actively shapes our experience of pain. This perspective defines pain in terms of action: an experience that, as part of a protective strategy, attempts to defend one's self in the presence of inferred threat

The Geographic Contribution to Studies of Pilgrimage: Introduction to \u3ci\u3eSacred Places, Sacred Spaces\u3c/i\u3e

The religions of humankind, from the great traditions of Islam, Christianity, Buddhism, and Hinduism, to sectarian cults arid tribal religions, have all singled out spatial referents as places that embody or enshrine the religious ideals of the culture. These sacred referents and the complex web of logistics, demographics, economics, and related activities that associate with the visitation patterns to such sacred places are the subject of this book