The Intergenerational Effects of Early Childbearing

Since World War II, the average age at which women experience their first birth has drifted up, but since 1986 there has been a resurgence of births to teenagers. Just as early fertility appears to adversely affect the life chances of the teen mother, it may also have negative effects on her children. We hypothesize that when the children of teen mothers are young adults, they will tend to have lower education, and will be more likely to be economically inactive, to have children when they are teens, and to have children out of wedlock when they are teens. In this paper, we present several models designed to reveal the impact that being born to a teenage mother has on children's chances for success as young adults. Our findings indicate that the children of mothers who first gave birth as teens are adversely affected as young adults.

Do Teens Make Rational Choices? The Case of Teen Nonmarital Childbearing

With emphasis on the role of economic incentives, we explore the determinants of a woman’s choice of whether or not to give birth as an unmarried teenager. Our data are taken from the Panel Study of Income Dynamics. Guided by a simple utility-maximization model, we represent the income possibilities available to teenaged women if they do and do not give birth out of wedlock. We estimate these choice-conditioned income possibilities through a two-stage probit procedure, relying on the observed incomes of a secondary sample of somewhat older women. The response of the young women in our primary sample to these income expectations is measured after controlling for the effects of a variety of other factors, including the characteristics of the girl’s family, the social and economic environment in which she lives (including such policy-related factors as expenditures by states on family planning programs and education), and her own prior choices. We use the estimated structural parameters from our model to simulate the effects of a variety of policy interventions on the probability of becoming an unmarried teen mother. Our estimations provide evidence that income expectations have a persistent influence on the childbearing decision. They also provide evidence that the provision of public family planning expenditures and increases in parental education could reduce the prevalence of teen nonmarital births.

Effects of mechanical site preparation on the growth of Jack Pine (Pinus banksiana)

The boreal forest in Canada provides a large volume of timber for Canadians and other countries year after year and effective silviculture is the key to sustainable harvesting. Site preparation can be a critical step in effective regeneration of sites, as it alters soil conditions and vegetative competition. The objective of this study is to be able to determine the difference in mean annual increment (MAI) in terms of height growth and root collar width that mechanical site preparation has in Jack Pine regenerated stands. A total of six regenerated harvest blocks, three with site preparation and three without site preparation, that were a mix of four and five years old were studied within the Lakehead Forest around the city of Thunder Bay in the fall of 2017. The data collected (Height in cm/yr. and root collar diameter in cm/yr.) from these plantations was analyzed using SPSS Statistics, which provided descriptive statistics and a univariate ANOVA. For the data to be significant, a 95% confidence level was required (P=0.05). The significance value for height and root collar diameter values between treatments was 0.824 and 0.755, respectively. This shows that the null hypothesis of this study was correct in that there was no significant increase in height in the site prepared sites from the non-site prepared sites. This could be due to a number of limitations involved with studying the boreal forest, and if this study was to be repeated, more consideration of these limitations could lead to different results

Parental health and children’s cognitive and non-cognitive development: New evidence from the Longitudinal Survey of Australian Children

This paper examines the effects of parental health on cognitive and non-cognitive development in Australian children. The underlying nationally representative panel data and a child fixed effects estimator are used to deal with unobserved heterogeneity. We find that only father’s serious mental illness worsens selected cognitive and non-cognitive skills of children. Maternal poor health also deteriorates some cognitive and non-cognitive outcomes of children of lone mothers only. Our results demonstrate that either failing to account for parent-child fixed effects or using child non-cognitive skills reported by parents could over-estimate the harmful impact of poor parental health on child development

A prospective cohort study evaluating screening and assessment of six modifiable risk factors in HPB cancer patients and compliance to recommended prehabilitation interventions

INTRODUCTION: Despite improvements in perioperative care, major abdominal surgery continues to be associated with significant perioperative morbidity. Accurate preoperative risk stratification and optimisation (prehabilitation) are necessary to reduce perioperative morbidity. This study evaluated the screening and assessment of modifiable risk factors amendable for prehabilitation interventions and measured the patient compliance rate with recommended interventions.METHOD: Between May 2019 and January 2020, patients referred to our hospital for HPB surgery were screened and assessed on six modifiable preoperative risk factors. The risk factors and screening tools used, with cutoff values, included (i) low physical fitness (a 6-min walk test &lt; 82% of patient's calculated norm and/or patient's activity level not meeting the global recommendations on physical activity for health). Patients who were unfit based on the screening were assessed with a cardiopulmonary exercise test (anaerobic threshold ≤ 11 mL/kg/min); (ii) malnutrition (patient-generated subjective global assessment ≥ 4); (iii) iron-deficiency anaemia (haemoglobin &lt; 12 g/dL for women, &lt; 13 g/dL for men and transferrin saturation ≤ 20%); (iv) frailty (Groningen frailty indicator/Robinson frailty score ≥ 4); (v) substance use (smoking and alcohol use of &gt; 5 units per week) and (vi) low psychological resilience (Hospital Anxiety and Depression Scale ≥ 8). Patients had a consultation with the surgeon on the same day as their screening. High-risk patients were referred for necessary interventions.RESULTS: One hundred consecutive patients were screened at our prehabilitation outpatient clinic. The prevalence of high-risk patients per risk factor was 64% for low physical fitness, 42% for malnutrition, 32% for anaemia (in 47% due to iron deficiency), 22% for frailty, 12% for smoking, 18% for alcohol use and 21% for low psychological resilience. Of the 77 patients who were eventually scheduled for surgery, 53 (68.8%) needed at least one intervention, of whom 28 (52.8%) complied with 100% of the necessary interventions. The median (IQR) number of interventions needed in the 77 patients was 1.0 (0-2).CONCLUSION: It is feasible to screen and assess all patients referred for HPB cancer surgery for six modifiable risk factors. Most of the patients had at least one risk factor that could be optimised. However, compliance with the suggested interventions remains challenging.</p

Feasibility of Perioperative eHealth Interventions for Older Surgical Patients:A Systematic Review

OBJECTIVES: EHealth interventions are increasingly being applied in perioperative care but have not been adequately studied for older surgical patients who could potentially benefit from them. Therefore, we evaluated the feasibility of perioperative eHealth interventions for this population. DESIGN: A systematic review of prospective observational and interventional studies was conducted. Three electronic databases (PubMed, EMBASE, CINAHL) were searched between January 1999 and July 2019. Study quality was assessed by Methodological Index for Non-Randomized Studies (MINORS) with and without control group. SETTING AND PARTICIPANTS: Studies of surgical patients with an average age ≥65 years undergoing any perioperative eHealth intervention with active patient participation (with the exception of telerehabilitation following orthopedic surgery) were included. MEASURES: The main outcome measure was feasibility, defined as a patient's perceptions of usability, satisfaction, and/or acceptability of the intervention. Other outcomes included compliance and study completion rate. RESULTS: Screening of 1569 titles and abstracts yielded 7 single-center prospective studies with 223 patients (range n = 9-69 per study, average age 66-74 years) undergoing oncological, cardiovascular, or orthopedic surgery. The median MINORS scores were 13.5 of 16 for 6 studies without control group, and 14 of 24 for 1 study with a control group. Telemonitoring interventions were rated as "easy to use" by 89% to 95% of participants in 3 studies. Patients in 3 studies were satisfied with the eHealth intervention and would recommend it to others. Acceptability (derived from consent rate) ranged from 71% to 89%, compliance from 53% to 86%, and completion of study follow-up from 54% to 95%. CONCLUSIONS AND IMPLICATIONS: Results of 7 studies involving perioperative eHealth interventions suggest their feasibility and encourage further development of technologies for older surgical patients. Future feasibility studies require clear definitions of appropriate feasibility outcome measures and a comprehensive description of patient characteristics such as functional performance, level of education, and socioeconomic status

Feasibility and patient’s experiences of perioperative telemonitoring in major abdominal surgery:an observational pilot study

Background: Telemonitoring during the perioperative trajectory may improve patient outcomes and self-management. The aim of this study is to assess the feasibility of and patient’s experiences with telemonitoring before and after major abdominal surgery to inform future study design. Methods: Patients planned for elective major abdominal surgery wore a sensor and answered well-being questions on a tablet daily for at least 2 weeks preoperatively up to 30-days postoperatively. Feasibility was assessed by participation and completion rate, compliance per day, weekly satisfaction scores, and reasons for nonscheduled contact. Results: Twenty-three patients were included (participation rate of 54.5%) with a completion rate of 69.6%. Median compliance with the wearable sensor and well-being questions was respectively: 94.7% and 83.3% preoperatively at home; 100% and 66.7% postoperatively in-hospital; and 95.4% and 85.8% postoperatively at home. Median weekly satisfaction scores for both wearing the sensor and well-being questions were 5 (IQR, 4–5). Contact moments were related to absence of sensor data and technological issues (76.0%) or patient discomfort and insecurity (24.0%). Conclusions: In this study, telemonitoring showed high satisfaction and compliance during the perioperative trajectory. Future trial design regarding the effectiveness of telemonitoring requires embedding in clinical practice and support for patients, relatives, and healthcare personnel

Implementing Wearable Sensors for Clinical Application at a Surgical Ward:Points to Consider before Starting

Incorporating technology into healthcare processes is necessary to ensure the availability of high-quality care in the future. Wearable sensors are an example of such technology that could decrease workload, enable early detection of patient deterioration, and support clinical decision making by healthcare professionals. These sensors unlock continuous monitoring of vital signs, such as heart rate, respiration rate, blood oxygen saturation, temperature, and physical activity. However, broad and successful application of wearable sensors on the surgical ward is currently lacking. This may be related to the complexity, especially when it comes to replacing manual measurements by healthcare professionals. This report provides practical guidance to support peers before starting with the clinical application of wearable sensors in the surgical ward. For this purpose, the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of technology adoption and innovations in healthcare organizations is used, combining existing literature and our own experience in this field over the past years. Specifically, the relevant topics are discussed per domain, and key lessons are subsequently summarized.</p

Continuous monitoring of vital signs with the Everion biosensor on the surgical ward:a clinical validation study

Background: Wearable sensors enable continuous vital sign monitoring, although information about their performance on nursing wards is scarce. Vital signs measured by telemonitoring and nurse measurements on a surgical ward were compared to assess validity and reliability. Methods: In a prospective observational study, surgical patients wore a wearable sensor (Everion, Biovotion AG, Zürich, Switzerland) that continuously measured heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and temperature during their admittance on the ward. Validity was evaluated using repeated-measures correlation and reliability using Bland-Altman plots, mean difference, and 95% limits of agreement (LoA). Results: Validity analyses of 19 patients (median age, 68; interquartile range, 62.5–72.5 years) showed a moderate relationship between telemonitoring and nurse measurements for HR (r = 0.53; 95% confidence interval, 0.44–0.61) and a poor relationship for RR, SpO2, and temperature. Reliability analyses showed that Everion measured HR close to nurse measurements (mean difference, 1 bpm; LoA, −16.7 to 18.7 bpm). Everion overestimated RR at higher values, whereas SpO2 and temperature were underestimated. Conclusions: A moderate relationship was determined between Everion and nurse measurements at a surgical ward in this study. Validity and reliability of telemonitoring should also be assessed with gold standard devices in future clinical trials