Examining Psychosocial Stressors Among African American Women with Postpartum Depression

Psychosocial stressors are among the causative factors of postpartum depression (PPD) in African American women. This study was a qualitative meta-analysis examining the psychosocial stressors that contribute to PPD among African American women. The aim was to identify the psychosocial stressors among African American women with PPD by examining existing literature and identifying common themes. The integrative model (IM) by Fishbein and Yzer assisted in understanding the significance of psychosocial stressors in African American women with PPD. Thematic analysis was used to generate new, more substantive meanings than those taken from individual investigations. Ten research studies were selected and examined to identify common themes and to understand the psychosocial stressors among African American women with PPD. The findings of this qualitative meta-analysis indicated that racial discrimination, social support, single motherhood, financial instability, health care, and stigma were psychosocial stressors that contributed to PPD among African American women. There is a need for an increase in ethnic-specific programs that focus on assisting African American women with PPD who are experiencing and who have experienced psychosocial stressors. This qualitative meta-analysis contributes to positive social change by assisting in raising awareness regarding the impact of psychosocial stressors among African American women with PPD. It is hoped that professionals will use these findings to develop and implement evidence-based interventions to improve the outcomes of these women

Examining Psychosocial Stressors Among African American Women with Postpartum Depression

Psychosocial stressors are among the causative factors of postpartum depression (PPD) in African American women. This study was a qualitative meta-analysis examining the psychosocial stressors that contribute to PPD among African American women. The aim was to identify the psychosocial stressors among African American women with PPD by examining existing literature and identifying common themes. The integrative model (IM) by Fishbein and Yzer assisted in understanding the significance of psychosocial stressors in African American women with PPD. Thematic analysis was used to generate new, more substantive meanings than those taken from individual investigations. Ten research studies were selected and examined to identify common themes and to understand the psychosocial stressors among African American women with PPD. The findings of this qualitative meta-analysis indicated that racial discrimination, social support, single motherhood, financial instability, health care, and stigma were psychosocial stressors that contributed to PPD among African American women. There is a need for an increase in ethnic-specific programs that focus on assisting African American women with PPD who are experiencing and who have experienced psychosocial stressors. This qualitative meta-analysis contributes to positive social change by assisting in raising awareness regarding the impact of psychosocial stressors among African American women with PPD. It is hoped that professionals will use these findings to develop and implement evidence-based interventions to improve the outcomes of these women

L'analyse de flux de matières au Québec : méthodes et enjeux d'opérationnalisation dans une perspective d'économie circulaire

L’augmentation incessante de l’extraction des ressources et de la pression exercée sur l’environnement qui en découle montre que les enjeux d’une gestion durable des ressources doivent devenir une priorité. Les sociétés sont dans l’obligation de revoir la façon dont l’économie actuelle fonctionne afin de transiter vers une économie qui vise à optimiser l’utilisation des ressources. L’économie circulaire est un concept maintenant bien connu à travers le monde qui permet de répondre aux enjeux auxquels les sociétés sont actuellement confrontées. Au Québec, la stratégie gouvernementale de développement durable 2015-2020 prévoit soutenir l’émergence de projets d’économie circulaire en créant les conditions favorables à la mise en place de ces pratiques et modèles d’affaires. Il est donc intéressant d’utiliser l’analyse de flux de matières au Québec, car cet outil permet de faciliter la transition vers une économie circulaire en améliorant la connaissance des gisements des ressources sur les territoires. Bien qu’il existe plusieurs méthodes d’analyse de flux de matières applicables à l’échelle régionale, aucune n’a été largement éprouvée. L’essai a donc pour objectif d’explorer les méthodes applicables dans le contexte québécois et de développer une approche qui vise à orienter les utilisateurs vers la méthode d’analyse de flux de matières qui répond le mieux à leurs besoins. Une revue de littérature recensant 26 études régionales d’analyse de flux de matières à travers le monde a permis de distinguer dix méthodes et d’identifier deux facteurs qui influencent le choix d’une méthode par rapport à une autre. Le premier facteur correspond aux objectifs de l’analyse de flux de matières et le deuxième facteur est le niveau d’applicabilité de la méthode qui comprend l’accessibilité de celle-ci et la disponibilité des sources de données requises. Ces deux critères ont été utilisés pour comparer les dix méthodes d’analyse de flux de matières et créer un arbre de décision qui vise à orienter les ministères, les chercheurs, les acteurs publics et les acteurs privés, vers la méthode la plus appropriée. L’essai a aussi permis de formuler des recommandations générales pour initier de façon efficace des démarches d’analyse de flux de matières au Québec. Premièrement, l’organisation d’une gouvernance régionale pour la gestion des ressources doit être une étape initiale et primordiale. Pour aider à organiser cette gouvernance, il faut d’abord développer un cadre stratégique provincial et ensuite construire des plates-formes régionales de gestion des ressources. Deuxièmement, les résultats de l’essai ont aussi montré que les données disponibles pour la réalisation d’une analyse de flux de matières étaient insuffisantes au Québec, les bases de données existantes doivent donc être bonifiées et restructurées. Troisièmement, considérant que l'analyse de flux est un processus laborieux et qui demande un travail important de réflexion en amont, il est essentiel de choisir la méthode en fonction des objectifs formulés par l’ensemble des acteurs concernés et de pérenniser la démarche dans le temps

Latest Quaternary palaeoceanographic change in the eastern North Atlantic based upon a dinoflagellate cyst event ecostratigraphy

AbstractThe analyses of dinoflagellate cyst records, from the latest Quaternary sediments recovered from DSDP Core 610A taken on the Feni Ridge in the southern Rockall Trough, and part of core MD01-2461 on the continental margin of the Porcupine Seabight in the eastern North Atlantic Ocean, has provided evidence for significant oceanographic change encompassing the Last Glacial Maximum (LGM) and part of the Holocene. This together with other published records has led to a regional evaluation of oceanographic change in the eastern North Atlantic over the past 68 ka, based upon a distinctive dinoflagellate event ecostratigraphy. These changes reflect changes in the surface waters of the North Atlantic Current (NAC), and perhaps the deeper thermohaline Atlantic Meridional Overturning Circulation (AMOC), driving fundamental regime changes within the phytoplanktonic communities. Three distinctive dinoflagellate cyst associations based upon both factor and cluster analyses have been recognised. Associations characterised by Bitectatodinium tepikiense (between 61.1 ± 6.2 to 13.4 ± 1.1 ka BP), Nematosphaeropsis labyrinthus (between 10.5 ± 0.3 and 11.45 ± 0.8 ka. BP), and the cyst of Protoceratium reticulatum (between 8.5 ± 0.9 and 5.2 ± 1.3 ka. BP) indicate major change within the eastern North Atlantic oceanography. The transitions between these changes occur over a relatively short time span (c.1.5 ka), given our sampling resolution, and have the potential to be incorporated into an event stratigraphy through the latest Quaternary as recommended by the INTIMATE (INTegrating Ice core, MArine and TErrestrial records) group. The inclusion of a dinoflagellate cyst event stratigraphy would highlight changes within the phytoplankton of the North Atlantic Ocean as a fully glacial world changed to our present interglacial

Timing and Amount of Physical Therapy Treatment are Associated with Length of Stay in the Cardiothoracic ICU

Significant variability exists in physical therapy early mobilization practice. The frequency of physical therapy or early mobilization of patients in the cardiothoracic intensive care unit and its effect on length of stay has not been investigated. The goal of our research was to examine variables that influence physical therapy evaluation and treatment in the intensive care unit using a retrospective chart review. Patients (n = 2568) were categorized and compared based on the most common diagnoses or surgical procedures. Multivariate semi-logarithmic regression analyses were used to determine correlations. Differences among patient subgroups for all independent variables other than age and for length of stay were found. The regression model determined that time to first physical therapy evaluation, Charlson Comorbidity Index score, mean days of physical therapy treatment and mechanical ventilation were associated with increased hospital length of stay. Time to first physical therapy evaluation in the intensive care unit and the hospital, and mean days of physical therapy treatment associated with hospital length of stay. Further prospective study is required to determine whether shortening time to physical therapy evaluation and treatment in a cardiothoracic intensive care unit could influence length of stay

Racial/ethnic and socioeconomic survival disparities for children and adolescents with central nervous system tumours in the United States, 2000-2015.

BACKGROUND AND OBJECTIVES: Central nervous system (CNS) malignancy is the commonest cause of cancer death in children and adolescents (0-19 years) in high-income settings. There is limited data on survival inequalities by race/ethnicity and socioeconomic position (SEP), for young patients, we aim to analyse their influence on survival from childhood CNS tumour. METHODS: 9577 children and adolescents diagnosed with primary malignant CNS tumours during 2000-2015, followed up until Dec 31 st, 2015, and reported to cancer registries (Surveillance, Epidemiology and End Results programme) were included in the analysis. Cox regression models estimated the hazard ratios for race/ethnicity, SEP, and individual insurance status, adjusting for sex, age, diagnostic period, and tumour type. Individual-level insurance status data were available from 2007. RESULTS: 62.5 % children and adolescents were non-Hispanic White, 10.6 % were non-Hispanic Black and 26.9 % were Hispanic. Race/ethnicity was strongly associated with survival (p < 0.001), even after adjusting for SEP, with Black (HR = 1.39 [95 %CI 1.23-1.58]) and Hispanic children (HR = 1.40 [95 %CI 1.28-1.54]) having higher hazards of death than White children. This association remained after adjusting for insurance status. There was an apparent positive association between SEP and survival that was largely attenuated after adjustment for insurance status (p = 0.20). Survival was comparable between those privately and Medicaid-insured. CONCLUSIONS: Non-Hispanic Black and Hispanic children had lower survival than their White counterparts. This association, not fully explained by differences in SEP, tumour subtype or health insurance, could be related to racially/ethnically-driven barriers to optimal healthcare, warranting further investigation

Neighborhood disinvestment and severe maternal morbidity in the state of California

BACKGROUND Social determinants of health, including neighborhood context, may be a key driver of severe maternal morbidity and its related racial and ethnic inequities; however, investigations remain limited. OBJECTIVE This study aimed to examine the associations between neighborhood socioeconomic characteristics and severe maternal morbidity, as well as whether the associations between neighborhood socioeconomic characteristics and severe maternal morbidity were modified by race and ethnicity. STUDY DESIGN This study leveraged a California statewide data resource on all hospital births at ≥20 weeks of gestation (1997–2018). Severe maternal morbidity was defined as having at least 1 of 21 diagnoses and procedures (eg, blood transfusion or hysterectomy) as outlined by the Centers for Disease Control and Prevention. Neighborhoods were defined as residential census tracts (n=8022; an average of 1295 births per neighborhood), and the neighborhood deprivation index was a summary measure of 8 census indicators (eg, percentage of poverty, unemployment, and public assistance). Mixed-effects logistic regression models (individuals nested within neighborhoods) were used to compare odds of severe maternal morbidity across quartiles (quartile 1 [the least deprived] to quartile 4 [the most deprived]) of the neighborhood deprivation index before and after adjustments for maternal sociodemographic and pregnancy-related factors and comorbidities. Moreover, cross-product terms were created to determine whether associations were modified by race and ethnicity. RESULTS Of 10,384,976 births, the prevalence of severe maternal morbidity was 1.2% (N=120,487). In fully adjusted mixed-effects models, the odds of severe maternal morbidity increased with increasing neighborhood deprivation index (odds ratios: quartile 1, reference; quartile 4, 1.23 [95% confidence interval, 1.20–1.26]; quartile 3, 1.13 [95% confidence interval, 1.10–1.16]; quartile 2, 1.06 [95% confidence interval, 1.03–1.08]). The associations were modified by race and ethnicity such that associations (quartile 4 vs quartile 1) were the strongest among individuals in the “other” racial and ethnic category (1.39; 95% confidence interval, 1.03–1.86) and the weakest among Black individuals (1.07; 95% confidence interval, 0.98–1.16). CONCLUSION Study findings suggest that neighborhood deprivation contributes to an increased risk of severe maternal morbidity. Future research should examine which aspects of neighborhood environments matter most across racial and ethnic groups

A quality-of-life measure for adults with primary ciliary dyskinesia: QOL-PCD

Primary ciliary dyskinesia (PCD) is characterised by chronic suppurative lung disease, rhino-sinusitis, hearing impairment and sub-fertility. We have developed the first multidimensional measure to assess health-related quality of life (HRQoL) in adults with PCD (QOL-PCD). Following a literature review and expert panel meeting, open-ended interviews with patients investigated the impact of PCD on HRQoL in the UK and North America (n=21). Transcripts were content analysed to derive saturation matrices. Items were rated for relevance by patients (n=49). Saturation matrices, relevance scores, literature review, evaluation of existing measures, and expert opinion contributed to development of a preliminary questionnaire. The questionnaire was refined following cognitive interviews (n=18). Open-ended interviews identified a spectrum of issues unique to adults with PCD. Saturation matrices confirmed comprehensive coverage of content. QOL-PCD includes 48 items covering the following seven domains: Physical Functioning, Emotional Functioning, Treatment Burden, Respiratory and Sinus Symptoms, Ears and Hearing, Social Functioning, and Vitality and Health Perceptions. Cognitive testing confirmed that content was comprehensive and the items were well-understood by respondents. Content validity and cognitive testing supported the items and structure. QOL-PCD has been translated into other languages and is awaiting psychometric testing

Primary Ciliary Dyskinesia: First Health-related Quality of Life Measures for Pediatric Patients

Rationale: Primary ciliary dyskinesia (PCD) is a rare disease. There are no available data on disease-specific pediatric patient–reported outcomes