The Absorption and Elimination of Some Commonly Used Drugs,with Practical Deductions From a Knowledge of the Same.

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Predictors of early postpartum mental distress in mothers with midwifery home care - results from a nested case-control study

PRINCIPLES: The prevalence of early postpartum mental health conditions is high. Midwives and other health professionals visiting women at home may identify mothers at risk. This seems crucial given decreasing trends of length of hospital stay after childbirth. This study aimed to identify predictors of maternal mental distress in a midwifery home care setting. METHODS: Using the statistical database of independent midwives' services in Switzerland in 2007, we conducted a matched nested case-control study. Out of a source population of 34,295 mothers with midwifery home care in the first ten days after childbirth, 935 mothers with maternal distress and 3,645 controls, matched by midwife, were included. We analysed whether socio-demographic, maternal and neonatal factors predict maternal mental distress by multivariable conditional logistic regression analysis. RESULTS: Infant crying problems and not living with a partner were the strongest predictors for maternal distress, whereas higher parity was the most protective factor. Significantly elevated risks were also found for older age, lower educational levels, breast/breastfeeding problems, infant weight gain concerns, neonatal pathologies and use of midwifery care during pregnancy. A lower likelihood for maternal distress was seen for non-Swiss nationality, full-time employment before birth, intention to return to work after birth and midwife-led birth. CONCLUSION: The study informs on predictors of maternal mental distress identified in a home care setting in the early postpartum period. Midwives and other health care professionals should pay particular attention to mothers of excessively crying infants, single mothers and primipara, and assess the need for support of these mothers

Towards quantitative tissue absorption imaging by combining photoacoustics and acousto-optics

We propose a strategy for quantitative photoacoustic mapping of chromophore concentrations that can be performed purely experimentally. We exploit the possibility of acousto-optic modulation using focused ultrasound, and the principle that photons follow trajectories through a turbid medium in two directions with equal probability. A theory is presented that expresses the local absorption coefficient inside a medium in terms of noninvasively measured quantities and experimental parameters. Proof of the validity of the theory is given with Monte Carlo simulations.Comment: 14 pages, 5 figure

Antenatal care and skilled delivery service utilisation in Somali pastoral communities of Eastern Ethiopia

To assess maternal health care service utilisation and associated factors in Somali pastoral communities of eastern Ethiopia.; Community-based cross-sectional study complemented by qualitative assessments in Adadle district, Somali region, eastern Ethiopia, among 450 women in six kebeles from August to September 2016. Logistic regression was used to assess factors associated with antenatal care use and skilled delivery care use, controlling for confounders.; About 27% [95%CI 22.8-31.2%] of women used antenatal care, and 22.6% [95%CI 18.7-26.5%] received skilled delivery service. None of the respondents reported post-natal care. About 43% reported that they had no knowledge of antenatal care, and 46% did not perceive delivery at a health facility as important. Pastoral lifestyle, husband's educational status, women's attitude towards health care service and financial support from the husband were significantly associated with antenatal care utilisation. Health professionals' attitudes, perceptions of institutional delivery, antenatal care utilisation and information about exemptions from maternal health care fees were associated with skilled delivery service utilisation.; Improving community awareness of antenatal care, employing female health professionals and culturally adapted guidelines could improve skilled delivery utilisation. In a patriarchal society, involving male partners in all maternal health issues is essential to increase use of maternal health services and to decrease maternal mortality

The Role of Dwarf Galaxies in Building Large Stellar Halos

The hierarchical theory of galaxy formation rests on the idea that smaller galactic structures merge to form the galaxies that we see today. The past decade has provided remarkable observational support for this scenario, driven in part by advances in spectroscopic instrumentation. Multi-object spectroscopy enabled the discovery of kinematically cold substructures around the Milky Way and M31 that are likely the debris of disrupting satellites. Improvements in high-resolution spectroscopy have produced key evidence that the abundance patterns of the Milky Way halo and its dwarf satellites can be explained by Galactic chemical evolution models based on hierarchical assembly. These breakthroughs have depended almost entirely on observations of nearby stars in the Milky Way and luminous red giant stars in M31 and Local Group dwarf satellites. In the next decade, extremely large telescopes will allow observations far down the luminosity function in the known dwarf galaxies, and they will enable observations of individual stars far out in the Galactic halo. The chemical abundance census now available for the Milky Way will become possible for our nearest neighbor, M31. Velocity dispersion measurements now available in M31 will become possible for systems beyond the Local Group such as Sculptor and M81 Group galaxies. Detailed studies of a greater number of individual stars in a greater number of spiral galaxies and their satellites will test hierarchical assembly in new ways because dynamical and chemical evolution models predict different outcomes for halos of different masses in different environments.Comment: Astro2010 Decadal Survey White Paper, 8 page

General Practitioners' Attitudes towards Essential Competencies in End-of-Life Care: A Cross-Sectional Survey.

Identifying essential competencies in end-of-life care, as well as general practitioners' (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain. To determine which competencies in end-of-life care are considered important by GPs, to assess GPs' confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist. Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014. Survey development was informed by a previous qualitative exploration of relevant end-of-life GP competencies. Main outcome measures were GPs' assessment of the importance of and confidence in 18 attributes of end-of-life care competencies, and reasons for transferring care of terminally-ill patients to a specialist. GP characteristics associated with main outcome measures were tested using multivariate regression models. The response rate was 31%. Ninety-nine percent of GPs considered the recognition and treatment of pain as important, 86% felt confident about it. Few GPs felt confident in cultural (16%), spiritual (38%) and legal end-of-life competencies such as responding to patients seeking assisted suicide (35%) although more than half of the respondents regarded these competencies as important. Most frequent reasons to refer terminally ill patients to a specialist were lack of time (30%), better training of specialists (23%) and end-of-life care being incompatible with other duties (19%). In multiple regression analyses, confidence in end-of-life care was positively associated with GPs' age, practice size, home visits and palliative training. GPs considered non-somatic competencies (such as spiritual, cultural, ethical and legal aspects) nearly as important as pain and symptom control. Yet, few GPs felt confident in these non-somatic competencies. These findings should inform training and quality improvement efforts in this domain, in particular for younger, less experienced GPs