Safe motherhood : development and women's health in childbirth, Binh Dinh province, Viet Nam : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Philosophy of Development Studies, Massey University, New Zealand

Safe Motherhood is one of the most important aspects of women's health, and is crucial to the development of a country. Women can only contribute to the economic, political, social and cultural development of their country if they are well and healthy. This thesis reviews the literature on poverty, health and development to examine factors which contribute to this major global issue. One of the eight United Nations Millennium Development Goals is to reduce maternal mortality by three quarters by the year 2015. Maternal mortality is the major cause of death among women of childbearing age in the developing world, with the World Health Organisation estimating that 600,000 women a year die as a result of pregnancy and childbirth (Levine et al., 2004; Thompson, 1999). Most of the deaths (99%) occur in developing countries and 80% of them are preventable, even in resource-poor countries (Lewis, 2003). The major direct cause of maternal mortality is haemorrhage at birth; if haemorrhage was reduced it would contribute significantly to reduction of maternal mortality (Wagstaff & Claeson, 2004). In this research project the author worked with the Binh Dinh Provincial Department of Health to develop a more complete picture of the problem of haemorrhage in one rural province of Viet Nam. Ethnic minority women are among the poorest and most disadvantaged in the community. In this research they were shown to receive the least amount of preventative antenatal health care, and to be at greatest risk of haemorrhage. The single greatest health factor shown to reduce maternal mortality is to have a skilled attendant at every birth who can prevent or detect problems early, and treat emergencies such as haemorrhage (Levine et al., 2004; World Bank, 2003; de Bernis et al., 2003; Kwast et al., 2003; Peters, 2000). In the second branch of the research, detailed observations were made of the technical skills of maternity staff to assess areas which could be improved through training programmes. These training programmes will enable the midwives to be better skilled and to provide safer care. Recommendations from the research include that the Department of Health invest in strengthening basic training, and ongoing postgraduate in-service education, in specific technical areas of monitoring and treating haemorrhage; that logistical support and supplies be improved so that all centres have the necessary equipment and medications to be able to prevent and treat haemorrhage; and that the Department of Health apply to the Ministry of Health for permission to teach their staff a specific haemorrhage prevention management approach called Active Management of the third stage of labour. Midwives in the province are eager for training and improved skills, and with the Department's support in these matters outlined above, they can achieve their desire of providing the best care they can to women in their communities. Improving the technical skills of midwives is one important aspect of addressing the problem of maternal mortality. However other underlying causes are complex and include poverty and the low status of women in society; these aspects will be more difficult to overcome. Safe Motherhood is a right; women in every country should be able to expect to survive the natural process of childbirth. It will take a multi-layered approach to overcome this complex problem and allow women to be safe in childbirth

AIMHI NT 'Mental Health Story Teller Mob': developing stories in mental health

The Australian Integrated Mental Health Initiative in the Northern Territory is one of a number of sites funded by the National Health and Medical Research Council. The project has been working with Aboriginal Mental Health Workers (AMHWs), and the Top End Division of General Practice (TEDGP) to adapt mental health information to the Aboriginal and Torres Strait Islander context through development of mental health stories. The stories focus on personal strengths and family support, and use local artwork and images, local language, metaphors and music. The concepts have been incorporated into service provider training and psychoeducation resources in the Northern Territory. Development and evaluation of mental health literacy initiatives is important in the context of high rates of mental illness and burden of disease in the Aboriginal and Torres Strait Islander community

Gluten cross contact in oats: retrospective database analysis 2011 to 2023

It is long-established that oats are at substantial risk for cross contact with gluten-containing grain. Specially processed gluten-free oats, whether purity protocol or mechanically/optically sorted, made it possible for this grain to be included in a gluten-free diet in the U.S. Gluten Free Watchdog (GFWD) (Manchester, Massachusetts, United States) has been assessing the gluten content of labeled gluten-free foods since 2011. In 2022, there was an apparent increase in the number of oat products testing with quantifiable gluten at or above 5 mg/kg or parts per million (ppm). The purpose of the present study was to assess the levels of gluten in foods containing oats to determine if there were any trends. In this retrospective database analysis, GFWD product test reports from April 2011 to May 1, 2023 were searched using the term “oat.” The search identified 213 individual packages of food that contained the word “oat” in the ingredients list. The test results for these packages of food were reviewed. Of these, 24 (11%) tested with quantifiable gluten greater than or equal to 5 mg/kg (ppm). The percentage of oats testing with quantifiable gluten varied per year but spiked in 2022 at 35%. It is not possible to know for certain what caused this increase. The drought during the oat growing season of 2021 could be a major factor. This drought impacted oat crops in both the US and Canada and led to one of the worst oat crops going back over 150 years. One limitation of this study is that it was a retrospective analysis. Different numbers of oat products were tested each year and these were often different brands of oats and different oat formulations. To assess the level of gluten cross contact in oats going forward a much larger prospective study should be conducted

Presence of a prothrombotic state in people with idiopathic pulmonary fibrosis: a population-based case-control study

BACKGROUND: Laboratory studies suggest that the clotting cascade is activated in fibrotic lungs. Since humans vary in their tendency to clot due to a variety of inherited or acquired defects, we investigated whether a prothrombotic state increases the chance of developing idiopathic pulmonary fibrosis (IPF) and/or worsens the prognosis of IPF. METHODS: We recruited 211 incident cases of IPF and 256 age-and sex-matched general population controls and collected data on medical history, medication, smoking habit, blood samples as well as lung function and high-resolution CT scans done as part of routine clinical care. A prothrombotic state was defined as the presence of at least one inherited or acquired clotting defect or marker of fibrinolytic dysfunction. We used logistic regression to quantify the association between a prothrombotic state and IPF adjusted for age, sex, smoking habit and highly sensitive C reactive protein. Cox regression was used to determine the influence of a prothrombotic state on survival. RESULTS: Cases were more than four times more likely than controls to have a prothrombotic state (OR 4.78, 95% CI 2.93 to 7.80; p<0.0001). Cases with a prothrombotic state were also likely to have more severe disease (forced vital capacity <70% predicted) at presentation (OR 10.79, 95% CI 2.43 to 47.91) and had a threefold increased risk of death (HR 3.26, 95% CI 1.09 to 9.75). CONCLUSIONS: People with IPF are more likely to have a prothrombotic state than general population controls and the presence of a prothrombotic state has an adverse impact on survival

Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice

Background Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management. Methods A mixed-methods case study design was used. The case was a surgical unit in a pediatric academic-affiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion. Results Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up. Conclusions Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study

Study protocol: Audit and Best Practice for Chronic Disease Extension (ABCDE) Project

<p>Abstract</p> <p>Background</p> <p>A growing body of international literature points to the importance of a system approach to improve the quality of care in primary health care settings. Continuous Quality Improvement (CQI) concepts and techniques provide a theoretically coherent and practical way for primary care organisations to identify, address, and overcome the barriers to improvements. The Audit and Best Practice for Chronic Disease (ABCD) study, a CQI-based quality improvement project conducted in Australia's Northern Territory, has demonstrated significant improvements in primary care service systems, in the quality of clinical service delivery and in patient outcomes related to chronic illness care. The aims of the extension phase of this study are to examine factors that influence uptake and sustainability of this type of CQI activity in a variety of Indigenous primary health care organisations in Australia, and to assess the impact of collaborative CQI approaches on prevention and management of chronic illness and health outcomes in Indigenous communities.</p> <p>Methods/design</p> <p>The study will be conducted in 40–50 Indigenous community health centres from 4 States/Territories (Northern Territory, Western Australia, New South Wales and Queensland) over a five year period. The project will adopt a participatory, quality improvement approach that features annual cycles of: 1) organisational system assessment and audits of clinical records; 2) feedback to and interpretation of results with participating health centre staff; 3) action planning and goal setting by health centre staff to achieve system changes; and 4) implementation of strategies for change. System assessment will be carried out using a System Assessment Tool and in-depth interviews of key informants. Clinical audit tools include two essential tools that focus on diabetes care audit and preventive service audit, and several optional tools focusing on audits of hypertension, heart disease, renal disease, primary mental health care and health promotion.</p> <p>The project will be carried out in a form of collaborative characterised by a sequence of annual learning cycles with action periods for CQI activities between each learning cycle.</p> <p>Key outcome measures include uptake and integration of CQI activities into routine service activity, state of system development, delivery of evidence-based services, intermediate patient outcomes (e.g. blood pressure and glucose control), and health outcomes (complications, hospitalisations and mortality).</p> <p>Conclusion</p> <p>The ABCD Extension project will contribute directly to the evidence base on effectiveness of collaborative CQI approaches on prevention and management of chronic disease in Australia's Indigenous communities, and to inform the operational and policy environments that are required to incorporate CQI activities into routine practice.</p

The ENIGMA sports injury working group - an international collaboration to further our understanding of sport-related brain injury

Sport-related brain injury is very common, and the potential long-term effects include a wide range of neurological and psychiatric symptoms, and potentially neurodegeneration. Around the globe, researchers are conducting neuroimaging studies on primarily homogenous samples of athletes. However, neuroimaging studies are expensive and time consuming, and thus current findings from studies of sport-related brain injury are often limited by small sample sizes. Further, current studies apply a variety of neuroimaging techniques and analysis tools which limit comparability among studies. The ENIGMA Sports Injury working group aims to provide a platform for data sharing and collaborative data analysis thereby leveraging existing data and expertise. By harmonizing data from a large number of studies from around the globe, we will work towards reproducibility of previously published findings and towards addressing important research questions with regard to diagnosis, prognosis, and efficacy of treatment for sport-related brain injury. Moreover, the ENIGMA Sports Injury working group is committed to providing recommendations for future prospective data acquisition to enhance data quality and scientific rigor

Regional Brain Differences in Cortical Thickness, Surface Area and Subcortical Volume in Individuals with Williams Syndrome

Williams syndrome (WS) is a rare genetic neurodevelopmental disorder characterized by increased non-social anxiety, sensitivity to sounds and hypersociability. Previous studies have reported contradictory findings with regard to regional brain variation in WS, relying on only one type of morphological measure (usually volume) in each study. The present study aims to contribute to this body of literature and perhaps elucidate some of these discrepancies by examining concurrent measures of cortical thickness, surface area and subcortical volume between WS subjects and typically-developing (TD) controls. High resolution MRI scans were obtained on 31 WS subjects and 50 typically developing control subjects. We derived quantitative regional estimates of cortical thickness, cortical surface area, and subcortical volume using FreeSurfer software. We evaluated between-group ROI differences while controlling for total intracranial volume. In post-hoc exploratory analyses within the WS group, we tested for correlations between regional brain variation and Beck Anxiety Inventory scores. Consistent with our hypothesis, we detected complex patterns of between-group cortical variation, which included lower surface area in combination with greater thickness in the following cortical regions: post central gyrus, cuneus, lateral orbitofrontal cortex and lingual gyrus. Additional cortical regions showed between-group differences in one (but not both) morphological measures. Subcortical volume was lower in the basal ganglia and the hippocampus in WS versus TD controls. Exploratory correlations revealed that anxiety scores were negatively correlated with gray matter surface area in insula, OFC, rostral middle frontal, superior temporal and lingual gyrus. Our results were consistent with previous reports showing structural alterations in regions supporting the socio-affective and visuospatial impairments in WS. However, we also were able to effectively capture novel and complex patterns of cortical differences using both surface area and thickness. In addition, correlation results implicate specific brain regions in levels of anxiety in WS, consistent with previous reports investigating general anxiety disorders in the general population

Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

Background Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1) explore the factors associated with variation in clinical performance; 2) examine specific strategies that have been effective in improving primary care clinical performance; and 3) work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. Methods/Design The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria) over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. Discussion By linking researchers directly to users of research (service providers, managers and policy makers), the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.Ross Bailie, Damin Si, Cindy Shannon, James Semmens, Kevin Rowley, David J Scrimgeour, Tricia Nage, Ian Anderson, Christine Connors, Tarun Weeramanthri, Sandra Thompson, Robyn McDermott, Hugh Burke, Elizabeth Moore, Dallas Leon, Richard Weston, Haylene Grogan, Andrew Stanley and Karen Gardne