Length of Stay after Vaginal Birth: Sociodemographic and Readiness-for-Discharge Factors

Background: The impact of reductions in postpartum length of stay have been widely reported, but factors influencing length of hospital stay after vaginal birth have received less attention. The study purpose was to compare the sociodemographic characteristics and readiness for discharge of new mothers and their newborns at 3 discharge time intervals, and to determine which variables were associated with postpartum length of stay. Methods: The study sample comprised 1,192 mothers who were discharged within 2 postpartum days after uncomplicated vaginal birth at a tertiary perinatal center in the midwestern United States. The sample was divided into 3 postpartum length-of-stay groups: group 1 (18–30 hr), group 2 (31–42 hr), and group 3 (43–54 hr). Sociodemographic and readiness-for-discharge data were collected by self-report and from a computerized hospital information system. Measures of readiness for discharge included perceived readiness (single item and Readiness for Discharge After Birth Scale), documented maternal and neonatal clinical problems, and feeding method. Results: Compared with other groups, the longest length-of-stay group was older; of higher socioeconomic status and education; and with more primiparous, breastfeeding, white, married mothers who were living with the baby’s father, had adequate home help, and had a private payor source. This group also reported greater readiness for discharge, but their newborns had more documented clinical problems during the postbirth hospitalization. In logistic regression modeling, earlier discharge was associated with young age, multiparity, public payor source, low socioeconomic status, lack of readiness for discharge, bottle-feeding, and absence of a neonatal clinical problem. Conclusions: Sociodemographic chracteristics and readiness for discharge (clinical and perceived) were associated with length of postpartum hospital stay. Length of stay is an outcome of a complex interface between patient, provider, and payor influences on discharge timing that requires additional study. Including perceived readiness for discharge in clinical discharge criteria will add an important dimension to assessment of readiness for discharge after birth

Complex sample design effects and inference for mental health survey data

Mental health researchers world-wide are using large-scale sample survey methods to study mental health epidemiology and services utilization in general, non-clinical populations (Alegria et al. in press). This article reviews important statistical methods and software that apply to descriptive and multivariate analysis of data collected in sample surveys. A comparative analysis of mental health surveys in international locations is used to illustrate analysis procedures and ‘design effects’ for survey estimates of population statistics, model parameters and test statistics. This article addresses the following questions. How should a research analyst approach the analysis of sample survey data? Are there software tools available to perform this analysis? Is the use of ‘correct’ survey analysis methods important to interpretation of survey data? It addresses the question of approaches to the analysis of complex sample survey data. The latest developments in software tools for the analysis of complex sample survey data are covered, and empirical examples are presented that illustrate the impact of survey sample design features on the interpretation of confidence intervals and test statistics for univariate and multivariate analyses. Copyright © 1998 Whurr Publishers Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/35145/1/34_ftp.pd

Μελέτη επί της τρισδιάστατης απεικόνισης και αυτόματης ανακατασκευής τρισδιάστατων προϊστορικών αγγείων

88 σ.Στην παρούσα διπλωματική εργασία γίνεται, αρχικά, μία αναφορά σε αρχές της θεωρίας των καμπυλών και επιφανειών της διαφορικής γεωμετρίας οι οποίες αποτελούν ένα απαραίτητο μαθηματικό υπόβαθρό της σχετικής προσέγγισης. Δίνεται έμφαση σε βασικές έννοιες, όπως της καμπύλης, της επιφάνειας αλλά και άλλων μεγεθών-εργαλείων που τις συνοδεύουν, ούτως ώστε να γίνει εφικτή η προσέγγιση στο θέμα της αυτόματης ανασυγκρότησης θραυσμάτων. Στην συνέχεια, ακολουθεί περιγραφή της επεξεργασίας, την οποία υπέστησαν τρισδιάστατες απεικονίσεις θραυσμάτων αγγείων, οι οποίες προέρχονται από την τρισδιάστατη σάρωση των πραγματικών θραυσμάτων με τρισδιάστατο σαρωτή. Η παραπάνω επεξεργασία αποτελεί προκαταρκτικό στάδιο για την εφαρμογή μίας νέας μεθόδου η οποία προσφέρει αποτελεσματική λύση στο πρόβλημα της αυτόματης εικονικής ανασυγκρότησης των θραυσμένων αγγείων για την οποία γίνεται αναφορά στη συνέχεια.In this thesis, initially, a report on principles of the theory of curves and surfaces, in differential geometry, takes place. These principles are the mathematical background of this thesis. The understanding of basic concepts such as curve , surface and other sizes–tools which surround them, is emphasized thanks to which the approach to automatic reconstruction of fragments is feasible. Then, follows a description of the processing that was applied in three-dimensional representations of broken vessels. These represantations derived from the three-dimensional scan of the real fragments with three-dimensional scanner. The above process is a preliminary step for the implementation of a new method which is an effective solution to the problem of automatic virtual reconstruction of broken vessels to which reference is made below.Ιωάννης Γ. Κοτζά

Intervening to improve health indicators among Australian farm families

The Sustainable Farm Families project (http://www.sustainablefarmfamilies.org.au/) was a 3-year demonstration and education project designed to influence farmer behavior with respect to family health and well-being among cropping and grazing farmers in Victoria, New South Wales, and South Australia, Australia. The project was conducted by the Western District Health Service, Hamilton, Australia, in partnership with farmers; Farm Management 500 (peer discussion group); the Victorian Farmers Federation; Royal Melbourne Institute of Technology; and Land Connect. During the 3 years of the project, 128 farmers&mdash;men (70) and women (58)&mdash;were enrolled. The project utilized a combination of small group workshops, individualized health action plans, and health education opportunities to encourage farm safety and health behavior changes and to elicit sustained improvements in the following health indicators: body mass index (BMI), total cholesterol, fasting blood glucose, and blood pressure. Mean changes in these health indicators were analyzed using repeated measures analysis of variance (ANOVA) and McNemar\u27s test compared the proportion of individuals with elevated indicators. Among participants with elevated values at baseline, the following average reductions were observed: BMI 0.44 kg/m2 (p = .0034), total cholesterol 48.7 mg/dl (p &lt; .0001), blood glucose 10.1 mg/dl (p = .0016), systolic blood pressure 12.5 mm Hg (p &lt; .0001), and diastolic blood pressure 5.0 mm Hg (p = .0007). The proportion of participants with elevated total cholesterol at baseline decreased after 24 months (p &lt; .001). Such findings suggest that proactive intervention by farmer associations, rural health services, and government agencies may be an effective vehicle for promoting voluntary farm safety and health behavior change while empowering farm families to achieve measurable reductions in important health risk factors. <br /

Working Together for Mental Health: Evaluation of a one-day mental health course for human service providers

BACKGROUND: The Working Together For Mental Health course is an 8-hour course designed to demystify mental illness and mental health services. The main target group for the course is people working in human service organisations who provide services for people with mental illness. METHODS: A questionnaire was administered to all participants attending the course during 2003 (n = 165). Participants completed the questionnaire before and immediately after the course, and at three month follow-up. RESULTS: A response rate of 69% was achieved with 114 people completing the questionnaire on all three occasions. The responses showed a significant improvement in the self-assessed knowledge and confidence of participants to provide human services to people with a mental health problem or disorder, three months after the course. There was no significant improvement in participants' attitudes or beliefs about people with a mental health problem or disorder at three month follow-up; however, participants' attitudes were largely positive before entering the course. CONCLUSION: The Working Together For Mental Health course was successful in improving participants' confidence and knowledge around providing human services to people with a mental health illness

Exposure assessment of radon in the drinking water supplies: a descriptive study in Palestine

<p>Abstract</p> <p>Background</p> <p>Radon gas is considered as a main risk factor for lung cancer and found naturally in rock, soil, and water. The objective of this study was to determine the radon level in the drinking water sources in Nablus city in order to set up a sound policy on water management in Palestine.</p> <p>Methods</p> <p>This was a descriptive study carried out in two phases with a random sampling technique in the second phase. Primarily, samples were taken from 4 wells and 5 springs that supplied Nablus city residents. For each source, 3 samples were taken and each was analyzed in 4 cycles by RAD 7 device manufactured by Durridge Company. Secondly, from the seven regions of the Nablus city, three samples were taken from the residential tap water of each region. Regarding the old city, ten samples were taken. Finally, the mean radon concentration value for each source was calculated.</p> <p>Results</p> <p>The mean (range) concentration of radon in the main sources were 6.9 (1.5-23.4) Becquerel/liter (Bq/L). Separately, springs and wells' means were 4.6 Bq/L and 9.5 Bq/L; respectively. For the residential tap water in the 7 regions, the results of the mean (range) concentration values were found to be 1.0 (0.9-1.3) Bq/L. For the old city, the mean (range) concentration values were 2.3 (0.9-3.9) Bq/L.</p> <p>Conclusions</p> <p>Except for Al-Badan well, radon concentrations in the wells and springs were below the United State Environmental Protection Agency maximum contaminated level (U.S EPA MCL). The level was much lower for tap water. Although the concentration of radon in the tap water of old city were below the MCL, it was higher than other regions in the city. Preventive measures and population awareness on radon's exposure are recommended.</p

Latin American immigrants have limited access to health insurance in Japan: a cross sectional study

<p>Abstract</p> <p>Background</p> <p>Japan provides universal health insurance to all legal residents. Prior research has suggested that immigrants to Japan disproportionately lack health insurance coverage, but no prior study has used rigorous methodology to examine this issue among Latin American immigrants in Japan. The aim of our study, therefore, was to assess the pattern of health insurance coverage and predictors of uninsurance among documented Latin American immigrants in Japan.</p> <p>Methods</p> <p>We used a cross sectional, mixed method approach using a probability proportional to estimated size sampling procedure. Of 1052 eligible Latin American residents mapped through extensive fieldwork in selected clusters, 400 immigrant residents living in Nagahama City, Japan were randomly selected for our study. Data were collected through face-to-face interviews using a structured questionnaire developed from qualitative interviews.</p> <p>Results</p> <p>Our response rate was 70.5% (n = 282). Respondents were mainly from Brazil (69.9%), under 40 years of age (64.5%) and had lived in Japan for 9.45 years (SE 0.44; median, 8.00). We found a high prevalence of uninsurance (19.8%) among our sample compared with the estimated national average of 1.3% in the general population. Among the insured full time workers (n = 209), 55.5% were not covered by the Employee's Health Insurance. Many immigrants cited financial trade-offs as the main reasons for uninsurance. Lacking of knowledge that health insurance is mandatory in Japan, not having a chronic disease, and having one or no children were strong predictors of uninsurance.</p> <p>Conclusions</p> <p>Lack of health insurance for immigrants in Japan is a serious concern for this population as well as for the Japanese health care system. Appropriate measures should be taken to facilitate access to health insurance for this vulnerable population.</p

Genetic variances and relationship among traits of an early maturing maize population under drought-stress and low nitrogen environments

Article purchasedDrought and low soil nitrogen (low N) are major causes of low grain yield of maize (Zea mays L.) in sub-Saharan Africa (SSA). An early maturing maize population, TZE-Y Pop DT STR, had undergone four cycles of selection for drought tolerance, followed by four selection cycles for resistance to Striga hermonthica (Del.) Benth., which is normally conducted under low N (about 30 kg N ha-1). The objectives of this study were to estimate residual genetic variances, predict future gains from selection, and investigate inter-trait relationships in the population under drought-stress, low N and across research environments. North Carolina Design I was used to develop 250 full-sib progenies from the improved population, which were evaluated in three drought-stress and two low N environments in Nigeria, 2011 to 2013. Additive genetic variances were not significant for most traits under the research conditions. The predicted gains from selection for grain yield were 5.3, 8.5 and 7.5% cycle-1 under drought, low N, and across environments. These results suggested the absence of substantial genetic variability in the population to ensure progress from selection. Ears per plant (EPP), ear aspect (EASP), plant aspect (PASP), and stay green characteristic (STGR) were consistently identified as important secondary traits under both research conditions. We concluded that there is need to introgress new sources of favorable alleles for drought-stress and low N tolerance into the population for guaranteed progress from selection, using EPP, EASP, PASP, and STGR in combination with yield in a selection index under drought-stress and low N

Economic hardship associated with managing chronic illness: a qualitative inquiry

<p>Abstract</p> <p>Background</p> <p>Chronic illness and disability can have damaging, even catastrophic, socioeconomic effects on individuals and their households. We examined the experiences of people affected by chronic heart failure, complicated diabetes and chronic obstructive pulmonary disease to inform patient centred policy development. This paper provides a first level, qualitative understanding of the economic impact of chronic illness.</p> <p>Methods</p> <p>Interviews were conducted with patients aged between 45 and 85 years who had one or more of the index conditions and family carers from the Australian Capital Territory and Western Sydney, Australia (n = 66). Content analysis guided the interpretation of data.</p> <p>Results</p> <p>The affordability of medical treatments and care required to manage illness were identified as the key aspects of economic hardship, which compromised patients' capacity to proactively engage in self-management and risk reduction behaviours. Factors exacerbating hardship included ineligibility for government support, co-morbidity, health service flexibility, and health literacy. Participants who were on multiple medications, from culturally and linguistically diverse or Indigenous backgrounds, and/or not in paid employment, experienced economic hardship more harshly and their management of chronic illness was jeopardised as a consequence. Economic hardship was felt among not only those ineligible for government financial supports but also those receiving subsidies that were insufficient to meet the costs of managing long-term illness over and above necessary daily living expenses.</p> <p>Conclusion</p> <p>This research provides insights into the economic stressors associated with managing chronic illness, demonstrating that economic hardship requires households to make difficult decisions between care and basic living expenses. These decisions may cause less than optimal health outcomes and increased costs to the health system. The findings support the necessity of a critical analysis of health, social and welfare policies to identify cross-sectoral strategies to alleviate such hardship and improve the affordability of managing chronic conditions. In a climate of global economic instability, research into the economic impact of chronic illness on individuals' health and well-being and their disease management capacity, such as this study, provides timely evidence to inform policy development.</p