Assessing the performance of maternity care in Europe: A critical exploration of tools and indicators

Background: This paper critically reviews published tools and indicators currently used to measure maternity care performance within Europe, focusing particularly on whether and how current approaches enable systematic appraisal of processes of minimal (or non-) intervention in support of physiological or "normal birth". The work formed part of COST Actions IS0907: "Childbirth Cultures, Concerns, and Consequences: Creating a dynamic EU framework for optimal maternity care" (2011-2014) and IS1405: Building Intrapartum Research Through Health - an interdisciplinary whole system approach to understanding and contextualising physiological labour and birth (BIRTH) (2014-). The Actions included the sharing of country experiences with the aim of promoting salutogenic approaches to maternity care. Methods: A structured literature search was conducted of material published between 2005 and 2013, incorporating research databases, published documents in english in peer-reviewed international journals and indicator databases which measured aspects of health care at a national and pan-national level. Given its emergence from two COST Actions the work, inevitably, focused on Europe, but findings may be relevant to other countries and regions. Results: A total of 388 indicators were identified, as well as seven tools specifically designed for capturing aspects of maternity care. Intrapartum care was the most frequently measured feature, through the application of process and outcome indicators. Postnatal and neonatal care of mother and baby were the least appraised areas. An over-riding focus on the quantification of technical intervention and adverse or undesirable outcomes was identified. Vaginal birth (no instruments) was occasionally cited as an indicator; besides this measurement few of the 388 indicators were found to be assessing non-intervention or "good" or positive outcomes more generally. Conclusions: The tools and indicators identified largely enable measurement of technical interventions and undesirable health (or pathological medical) outcomes. A physiological birth generally necessitates few, or no, interventions, yet most of the indicators presently applied fail to capture (a) this phenomenon, and (b) the relationship between different forms and processes of care, mode of birth and good or positive outcomes. A need was identified for indicators which capture non-intervention, reflecting the reality that most births are low-risk, requiring few, if any, technical medical procedures

Effects of long-term construction noise on health of adult female Wistar rats

The aim of this study was to investigate the influence of long-term building construction noise from refurbishment, which including vibration, on some physiological parameters and histopathological changes of organs of Wistar rats. Twenty 12 month old female rats were divided into two groups: rats group I (n = 10) were exposed to long-term construction noise and rats group II (n = 10) were kept under normal noise level. Study results revealed that long-term construction noise from building refurbishment has an influence on body weight, haematological and some serum biochemical parameters affects caecal microbiota, and causes histopathological changes in the organs of adult female Wistar rats. It was noticed that rats in group I exihibited significantly higher mean values for total protein, albumin and lower values for glucose, AST, ALT, blood urea nitrogen, haematological and caecal microbiota parameters than rats in group II. The most common pathologies were determined in the kidney, liver and lungs. Other observed pathologies were lymphadenopathy, catarrhal inflammation of the intestines, spleen hyperplasia and mammary gland adenofibroma. Single cases were subcutaneous fibroma in the thoracic region, abortus with uterine inflammation and thymus hyperplasia with formation of cysts were found

Investigation of body image, self‐esteem, and quality of life in women with urinary incontinence

Gumussoy, Sureyya/0000-0001-5708-8988; donmez, sevgul/0000-0003-2420-8167WOS: 000489892000010PubMed: 31297932Aim the aim of this research was to investigate the effect of urinary incontinence on body image, self-esteem, and quality of life. Methods the study was conducted with 218 women with urinary incontinence. the study data were collected using the Socio-Demographic Characteristics Questionnaire, Body Cathexis Scale, Rosenberg Self-Esteem Scale, and Incontinence Quality of Life Questionnaire. Results There was a weak, statistically significant, positive relationship found between the Body Cathexis Scale total average scores and the Rosenberg Self-Esteem Scale total average scores of the women and a weak, statistically significant, negative relationship with the Incontinence Quality of Life Questionnaire total average scores. in addition, a weak, statistically significant, negative relationship was found between the Rosenberg Self-Esteem Scale total score averages and Incontinence Quality of Life Questionnaire total score averages. Significant effects were seen for body image score with pad usage; for self-esteem in relation to number of deliveries, duration, and frequency of urinary incontinence; and for incontinence quality of life and duration and frequency of urinary incontinence and pad usage. Conclusions It was concluded that most of the women with urinary incontinence had negative body image and that more than half of them had moderate or low self-esteem and a moderate quality of life