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Increased Exposure (increased + exposure)

Distribution by Scientific Domains

Medical Sciences	50%
Life Sciences	20%
Psychology	10%

Selected Abstracts

Australasian emergency physicians: A learning and educational needs analysis.

EMERGENCY MEDICINE AUSTRALASIA, Issue 2 2008
Part Three: Participation by FACEM in available CPD: What do they do, do they like it?
Abstract Objective: To determine the participation of Emergency Physicians (EP) in currently available continuing professional development opportunities (CPD), their perception of the usefulness of available CPD and their preferred format or method of CPD desired in the future. Method: A mailed survey of Fellows of the Australasian College for Emergency Medicine with 17 Likert type options on educational methods and qualitative analysis grouping volunteered free text responses. Results: The most frequent learning methods reported by EP are on the job contact with other clinicians, formal ED based teaching and reading journals, which were also perceived as useful or very useful learning methods by more than 90% of EP. Less than 15% often or always participate on hospital grand rounds, high fidelity simulation, computer programmes or commercially sponsored events. Increased exposure was desired to high-fidelity simulation center skills training by 58% of respondents with nearly 49% of fellows also wanting more participation in international conferences with around 44% of fellows also wanting more participation in international conferences with around 44% desiring more formal teaching in the ED, more formal feedback on performance, and more meetings with other hospital departments. Over 50% of EP want less or no exposure to commercially sponsored dinners or events. Conclusion: Whilst emergency physicians currently participate in a wide variety of learning methods, the results of this survey suggest EP most appreciate ED based teaching, would like more contact with other departments, along with increased opportunities for simulation based learning and attendance at international conferences. [source]

Exposure to opioid maintenance treatment reduces long-term mortality

ADDICTION, Issue 3 2008
Amy Gibson
ABSTRACT Aims To (i) examine the predictors of mortality in a randomized study of methadone versus buprenorphine maintenance treatment; (ii) compare the survival experience of the randomized subject groups; and (iii) describe the causes of death. Design Ten-year longitudinal follow-up of mortality among participants in a randomized trial of methadone versus buprenorphine maintenance treatment. Setting Recruitment through three clinics for a randomized trial of buprenorphine versus methadone maintenance. Participants A total of 405 heroin-dependent (DSM-IV) participants aged 18 years and above who consented to participate in original study. Measurements Baseline data from original randomized study; dates and causes of death through data linkage with Births, Deaths and Marriages registries; and longitudinal treatment exposure via State health departments. Predictors of mortality examined through survival analysis. Findings There was an overall mortality rate of 8.84 deaths per 1000 person-years of follow-up and causes of death were comparable with the literature. Increased exposure to episodes of opioid treatment longer than 7 days reduced the risk of mortality; there was no differential mortality among methadone versus buprenorphine participants. More dependent, heavier users of heroin at baseline had a lower risk of death, and also higher exposure to opioid treatment. Older participants randomized to buprenorphine treatment had significantly improved survival. Aboriginal or Torres Strait Islander participants had a higher risk of death. Conclusions Increased exposure to opioid maintenance treatment reduces the risk of death in opioid-dependent people. There was no differential reduction between buprenorphine and methadone. Previous studies suggesting differential effects may have been affected by biases in patient selection. [source]

Predeployment gender differences in stressors and mental health among U.S. National Guard troops poised for Operation Iraqi Freedom deployment,

JOURNAL OF TRAUMATIC STRESS, Issue 1 2010
Robin Carter-Visscher
Increased exposure of women soldiers to combat in current conflicts heightens interest in the question of whether risk and resilience factors differ for female and male military personnel prior to deployment. The authors examined this question in a panel of 522 National Guard soldiers (462 men and 60 women) poised for deployment to Iraq. Soldiers completed a battery of self-report measures, including the PTSD Checklist, Beck Depression Inventory-II, and scales from the Deployment Risk and Resilience Inventory. Modest differences were observed between women and men on predeployment risk factors and some risk-related correlations with PTSD and depression measures; however, gender did not moderate the associations between hypothesized risk/resilience factors and baseline mental health. Implications for interventions and future research are discussed. [source]

Increased exposure to bacterial antigen RpL7/L12 in early stage colorectal cancer patients

CANCER, Issue 17 2010
Annemarie Boleij MSc
Abstract BACKGROUND: Intestinal bacteria have long been implicated in colorectal cancer pathology, and many reports point to a close linkage between Streptococcus bovis biotype I (recently renamed Streptococcus gallolyticus) infections and tumors of the human colon. This work aims to investigate the humoral immune response to this bacterium during different stages of colorectal cancer. METHODS: The presence of serum antibodies against S. bovis antigen RpL7/L12, previously assigned as a potential diagnostic antigen, was evaluated in Dutch (n = 209) and American (n = 112) populations using a newly developed enzyme-linked immunosorbent assay. RESULTS: The analyses consistently showed that an immune response against this bacterial antigen was increased in polyp patients and stage I/II colorectal cancer patients as compared with asymptomatic individuals. This was not paralleled by increased antibody production to endotoxin, an intrinsic cell wall component of the majority of intestinal bacteria, which implies that the humoral immune response against RpL7/L12 is not a general phenomenon induced by the loss of colonic barrier function. Notably, increased anti-RpL7/L12 levels were not or were only mildly detected in late stage colorectal cancer patients having lymph node or distant metastasis. CONCLUSIONS: These findings are indicative of an increased exposure to antigen RpL7/L12 during early stages of colon carcinogenesis and suggest that intestinal bacteria such as S. bovis constitute a risk factor for the progression of premalignant lesions into early stage carcinomas. Clearly, the current findings emphasize the necessity for further studies on the possible etiologic relationship between intestinal bacteria and human colorectal cancer. Cancer 2010. © 2010 American Cancer Society. [source]

Differential regulation of trkA and p75 in noradrenergic pelvic autonomic ganglion cells after deafferentation of their cholinergic neighbours

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 2 2001
Janet R. Keast
Abstract In rats, following lesion of lumbar or sacral preganglionic axons, many pelvic ganglion cells undergo axogenesis to form baskets of terminals around select populations of nearby ganglion cells. The aim of the current study was to address mechanisms underlying initiation of this sprouting, focusing on a possible role for nerve growth factor (NGF). Immunohistochemical localization of NGF receptors (trkA and p75) showed that virtually all noradrenergic and a minority of cholinergic pelvic neurons expressed both receptors. Terminals immunoreactive for each substance were found in pelvic viscera. In pelvic ganglia, many glial cells expressed p75 but not trkA, and very few lumbar or sacral preganglionic neurons expressed either receptor. Lumbar and/or sacral preganglionic inputs were removed from ganglion cells by cutting the hypogastric, pelvic or both nerves, and tissues analysed 8 days later. Levels of receptor expression in noradrenergic pelvic ganglion cells were estimated by calculating the proportion that were receptor-immunopositive, and quantifying the intensity of trkA or p75 immunofluorescence. No lesion had a significant effect on trkA expression, however, a marked decrease in p75 occurred after cutting pelvic nerves, i.e. after deafferentation of neighbouring cholinergic neurons. These injuries appeared to cause little overall change in glial p75 expression. This study shows that manipulations that trigger sprouting from noradrenergic pelvic neurons cause downregulation of p75 but not trkA. Interestingly, this is occurring while some of their target organs are synthesizing high levels of NGF. This contrasts with other NGF-sensitive cells, in which one or both receptor types are upregulated by increased exposure to the ligand. The current study is also the first to show a change in p75 expression in neurons that are neither deafferented nor axotomized. [source]

R120G ,B-crystallin promotes the unfolding of reduced ,-lactalbumin and is inherently unstable

FEBS JOURNAL, Issue 3 2005
Teresa M. Treweek
,-Crystallin is the principal lens protein which, in addition to its structural role, also acts as a molecular chaperone, to prevent aggregation and precipitation of other lens proteins. One of its two subunits, ,B-crystallin, is also expressed in many nonlenticular tissues, and a natural missense mutation, R120G, has been associated with cataract and desmin-related myopathy, a disorder of skeletal muscles [Vicart P, Caron A, Guicheney P, Li Z, Prevost MC, Faure A, Chateau D, Chapon F, Tome F, Dupret JM, Paulin D & Fardeau M (1998) Nat Genet20, 92,95]. In the present study, real-time 1H-NMR spectroscopy showed that the ability of R120G ,B-crystallin to stabilize the partially folded, molten globule state of ,-lactalbumin was significantly reduced in comparison with wild-type ,B-crystallin. The mutant showed enhanced interaction with, and promoted unfolding of, reduced ,-lactalbumin, but showed limited chaperone activity for other target proteins. Using NMR spectroscopy, gel electrophoresis, and MS, we observed that, unlike the wild-type protein, R120G ,B-crystallin is intrinsically unstable in solution, with unfolding of the protein over time leading to aggregation and progressive truncation from the C-terminus. Light scattering, MS, and size-exclusion chromatography data indicated that R120G ,B-crystallin exists as a larger oligomer than wild-type ,B-crystallin, and its size increases with time. It is likely that removal of the positive charge from R120 of ,B-crystallin causes partial unfolding, increased exposure of hydrophobic regions, and enhances its susceptibility to proteolysis, thus reducing its solubility and promoting its aggregation and complexation with other proteins. These characteristics may explain the involvement of R120G ,B-crystallin with human disease states. [source]

Microglial dystrophy in the aged and Alzheimer's disease brain is associated with ferritin immunoreactivity

GLIA, Issue 10 2008
Kryslaine O. Lopes
Abstract Degeneration of microglial cells may be important for understanding the pathogenesis of aging-related neurodegeneration and neurodegenerative diseases. In this study, we analyzed the morphological characteristics of microglial cells in the nondemented and Alzheimer's disease (AD) human brain using ferritin immunohistochemistry. The central hypothesis was that expression of the iron storage protein ferritin increases the susceptibility of microglia to degeneration, particularly in the aged brain since senescent microglia might become less efficient in maintaining iron homeostasis and free iron can promote oxidative damage. In a primary set of 24 subjects (age range 34,97 years) examined, microglial cells immunoreactive for ferritin were found to constitute a subpopulation of the larger microglial pool labeled with an antibody for HLA-DR antigens. The majority of these ferritin-positive microglia exhibited aberrant morphological (dystrophic) changes in the aged and particularly in the AD brain. No spatial correlation was found between ferritin-positive dystrophic microglia and senile plaques in AD tissues. Analysis of a secondary set of human postmortem brain tissues with a wide range of postmortem intervals (PMI, average 10.94 ± 5.69 h) showed that the occurrence of microglial dystrophy was independent of PMI and consequently not a product of tissue autolysis. Collectively, these results suggest that microglial involvement in iron storage and metabolism contributes to their degeneration, possibly through increased exposure of the cells to oxidative stress. We conclude that ferritin immunohistochemistry may be a useful method for detecting degenerating microglia in the human brain. © 2008 Wiley-Liss, Inc. [source]

The ,oestrogen hypothesis', where do we stand now?,

INTERNATIONAL JOURNAL OF ANDROLOGY, Issue 1 2003
Richard M. Sharpe
Summary The original ,oestrogen hypothesis' postulated that the apparent increase in human male reproductive developmental disorders (testis cancer, cryptorchidism, hypospadias, low sperm counts) might have occurred because of increased oestrogen exposure of the human foetus/neonate; five potential routes of exposure were considered. This review revisits this hypothesis in the light of the data to have emerged since 1993. It addresses whether there is a secular increasing trend in the listed disorders and highlights the limitations of available data and how these are being addressed. It considers whether new data has emerged to support the suggestion that increased oestrogen exposure could cause these abnormalities and reviews new data on potential routes via which such increased exposure could have occurred. Secular trends: The disorders listed above are now considered to represent a syndrome of disorders (testicular dysgenesis syndrome, TDS) with a common origin in foetal life. Testicular cancer has increased in incidence in Caucasian men worldwide and lifetime risk is 0.3,0.8%. Secular trends in cryptorchidism are unclear but it is by far the commonest (2,4% at birth) congenital abnormality in either sex. Secular trends for hypospadias are not robust, although most studies suggest a progressive increase; registry data probably under-estimates incidence, but based on this data hypospadias is the second most common (0.3,0.7% at birth) congenital malformation. Retrospective analyses of sperm count data show a global downward trend but this is inconclusive , prospective studies using standardized methodology show significant differences between countries and very low sperm counts in the youngest cohort of men. For all disorders, other then testis cancer, standardized prospective studies are the best way forward and are in progress across Europe. Oestrogen effects: Evidence that foetal exposure to oestrogens can induce the above disorders has strengthened. New pathways via which such changes could be induced have been identified, including suppression of testosterone production by the foetal testis, suppression of androgen receptor expression and suppression of insulin-like factor-3 (InsL3) production by foetal Leydig cells. Other evidence suggests that the balance between androgen and oestrogen action may be important in induction of reproductive tract abnormalities. Oestrogen exposure: Although many new environmental oestrogens have been identified, their uniformly weak oestrogenicity excludes the possibility that they could induce the above disorders. However, emerging data implicates various environmental chemicals in being able to alter endogenous levels of androgens (certain phthalates) and oestrogens (polychlorinated biphenyls, polyhalogenated hydrocarbons), and the former have been shown to induce a similar collection of disorders to TDS. Other mechanisms via which increased fetal exposure to pregnancy oestrogens might occur (increasing trend in obesity, dietary changes) are also discussed. [source]

The Influence of Invertebrate Predators on Daphnia Spatial Distribution and Survival in Laboratory Experiments: Support for Daphnia Horizontal Migration in Shallow Lakes

INTERNATIONAL REVIEW OF HYDROBIOLOGY, Issue 1 2007
Adrianna Wojtal
Abstract The behavioural response of Daphnia cucullata to the presence of the pelagic invertebrate predator Leptodora kindtii, and the predation rate of littoral dragonfly nymphs on this species were investigated under laboratory conditions. Results of this study revealed a strong hiding response of Daphnia cucullata in the presence of the predatory cladoceran, L. kindtii, which was similar to the response of Daphnia in the presence of juvenile perch. This suggests that pelagic invertebrate predators may cause Daphnia to hide in the littoral zone which could result in increased exposure to predation by littoral invertebrates. A strong influence of dragonfly nymphs on D. cucullata, both in the presence and absence of macrophytes, was found. The average predation rate of Odonata larvae was about 5 prey ind,1 h,1 and did not differ significantly between treatments. Quantification of dragonfly pressure on Daphnia populations will require cross-verification with field experiments since in the natural conditions Daphnia seeks a shelter in the vegetation stands against predation by Leptodora, despite the occurrence of odonates. (© 2007 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source]

Promoting evidence-based practices: the adoption of a prevention support system in community settings

JOURNAL OF COMMUNITY PSYCHOLOGY, Issue 5 2009
Sarah B. Hunter
Prevention support systems (PSSs) are designed to help communities implement evidence-based practices (EBPs). Little is known about the factors that influence their adoption. In this article, we examined adoption of a PSS for substance abuse prevention called Getting To Outcomes (GTO)® among staff in two community coalitions with varying levels of exposure to it over a 2-year period. A multistage regression model was used to determine the relative predictive power of organizational, innovation-related, and practitioner characteristics on adoption. Findings indicate that GTO adoption occurred through increased exposure, especially via staff training. Perceptions of the system's complexity moderated this effect. Individuals with high GTO exposure were less likely to adopt it if they perceived it as complex. Other organizational, innovation-related, and practitioner characteristics did not predict adoption. Results from this study are useful for understanding the factors associated with PSS adoption and suggest ways to increase their use in typical delivery settings. © 2009 Wiley Periodicals, Inc. [source]

Sleep during the Antarctic winter: preliminary observations on changing the spectral composition of artificial light

JOURNAL OF SLEEP RESEARCH, Issue 3 2008
GAVIN FRANCIS
Summary Antarctic Base personnel live for 3 months in winter with no natural sunlight. This project compared sleep, by actigraphy, during periods of increased exposure to white light or blue enriched light in 2003. The primary aim was to help define the optimum spectral composition and intensity of artificial environmental light. Nine men and one woman (33 ± 7 years, mean ± SD), wore activity and light monitors continuously from 28.2 to 9.10, and kept sleep diaries. Extra light was provided by light boxes (standard white, 5300 K, or prototype blue enriched, 10 000K, Philips Lighting), which were turned on in bedrooms and in communal/work areas approximately 08.00,18.00 hours. After a no-treatment control period, 28.2,20.3, sequential 4,5 week periods of first white, then blue light, were imposed with a further control period 19.9,9.10. A limited baseline study in 2002 (no interventions) similarly measured light and activity in seven men and one woman (30 ± 7 years). Daily light exposure in winter (lux, mean ± SD) was doubled in 2003 (maximum 1039 ± 281, average 64 ± 21), compared to 2002 (572 ± 276 and 30 ± 11), P < 0.05 and P < 0.01, with no differences between white and blue light. There were no major differences in sleep between light conditions in 2003. A delay in sleep timing was found in midwinter compared to control (2003, bedtime, P < 0.05, sleep start, P < 0.05, sleep end, P < 0.01) and sleep fragmentation increased (P < 0.05). Sleep efficiency was slightly higher during all blue light periods compared to all white periods (P < 0.05). The use of higher intensity light of suitable spectral composition is proposed. [source]

Elevated platelet and leukocyte response to oral bacteria in periodontitis

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 1 2009
E. A. NICU
Summary.,Background:,Periodontitis is associated with an increased risk for cardiovascular diseases (CVD), but the underlying mechanisms are poorly understood. Recently, we showed that platelets from periodontitis patients are more activated than those from controls. Objective:,Given the regularly occurring bacteremic episodes in periodontitis patients, we hypothesized that platelets and/or leukocytes from periodontitis patients are more sensitive to stimulation by oral bacteria, in particular the known periodontal pathogens, than platelets from control subjects. Methods:,Three-color flow cytometry analysis was performed to quantify activation of platelets (P-selectin, PAC-1, CD63) and leukocytes (CD11b) in whole blood from patients with periodontitis (n = 19) and controls (n = 18), with and without stimulation by oral bacteria. Phagocytosis was assessed by using green-fluorescent protein (GFP)-expressing Aggregatibacter actinomycetemcomitans (Aa). Results:,Neutrophils and monocytes were activated by all species of oral bacteria tested, but no differences were observed between patients and controls. In response to several species of oral bacteria, platelets from periodontitis patients showed, compared with controls, increased exposure of P-selectin (P = 0.027) and increased formation of platelet-monocyte complexes (P = 0.040). Platelet-leukocyte complexes bound and/or phagocytosed more GFP- Aa than platelet-free leukocytes (for neutrophils and monocytes, in both patients and controls, P < 0.001). Conclusions:,In periodontitis, increased platelet response to oral bacteria is paralleled by increased formation of platelet-leukocyte complexes with elevated capacity for bacterial clearance. We speculate that activated platelets and leukocytes might contribute to increased atherothrombotic activity. [source]

The Effect of Trade on Employment and Wages in Italian Industry

LABOUR, Issue 2 2000
Mariano Bella
The paper analyses the labour market impact of international trade on the Italian manufacturing sector. Using data for a panel of manufacturing industries the effects of trade-induced changes in sales on employment and wages are investigated. The evidence suggests that the industry adjustment to demand shocks took place mainly through employment changes. However, increased exposure to foreign competition had a small effect on the Italian labour market, while technological change seems to have a major role in explaining the increase in unemployment. [source]

Fluorescence Study on the Interaction Between Hypericin and Lens Protein ",-Crystallin"

PHOTOCHEMISTRY & PHOTOBIOLOGY, Issue 4 2009
Tareq Youssef
Hypericin has been reported as a potent photosensitizing agent exhibiting antiviral, antibacterial, antineoplastic activities. Although its photophysics and mode of action are strongly modulated by the binding protein, detailed information about its mechanism of interaction with possible cellular targets, including proteins, is still lacking. Previous in vitro studies demonstrated that hypericin can be uptaken by intact lens and is able to bind to the major lens protein ",-crystallin." In this study, the mechanism of interaction of this potent drug with ,-crystallin was studied using the chemical denaturant guanidine hydrochloride (GdnHCl) and the hydrophobic surface probe, 8-anilino-1-naphthalenesulfonic acid (ANS). Fluorescence measurements showed that the increased exposure of tryptophan resulting from partial unfolding of ,-crystallin incubated with 1.0 mol L,1 of GdnHCl corresponds to the maximum accessibility of hydrophobic sites to ANS at the same GdnHCl concentration. Interestingly at this additional hydrophobicity of the protein, hypericin exhibited its maximum fluorescence intensity. This in vitro study implied that hydrophobic sites of ,-crystallin play a significant role in its interaction with hypericin. The binding between ,-crystallin and hypericin was found to be enhanced by partial perturbation of the protein. [source]

Perspectives on research evidence and clinical practice: a survey of Australian physiotherapists

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2007
Karen Grimmer-Somers
Abstract Background and Purpose.,Physiotherapists' use of research evidence with clinical decision-making has interested researchers world-wide since 1980; however, little is known about such practices in Australia. The present survey sought information on Australian physiotherapists' perceptions of the importance of research, and barriers to uptake of evidence in clinical practice, when compared with an international cohort from 2001.,Method.,An Australian-relevant version of an English (UK) National Health Service (NHS) survey instrument was used to canvass 453 physiotherapists, randomly selected from the South Australian Physiotherapy Registration Board 2004,2005 records. The first survey was mailed in August 2005, a reminder was sent two weeks later to non-responders and a follow-up survey was sent in April 2006 to non-responders whose addresses had changed since 2005.,Results.,There was a 51% response rate. Of the non-responders, 12% were not contactable at their listed address, highlighting the mobility of Australian physiotherapists. Most respondents had undertaken research as students (59.5%) or as students and clinicians (11.5%). Of these, 37.1% were encouraged to embark on more research, and 20.5% were discouraged. The significant predictors of positive perceived importance of research were: previous research experience; being positive about undertaking further research; working in hospitals and holding a postgraduate degree. Clinicians working privately were significantly less likely than managers to be positive about research importance. The only significant predictor for not perceiving barriers to uptake of evidence was being positive about undertaking future research.,Conclusions.,The study identified constraints on uptake of evidence into practice that were related to accessing, reading and interpreting published research, and implementing findings. Found consistently across employment categories were barriers relating to lack of time, uncertainty about what the research reported, scepticism about the value of research and being isolated from peer support and literature sources. The responses indicated a positive shift towards evidence uptake since the 2001 NHS survey, suggesting an influence of increased exposure to information on evidence-based practice. A greater focus on research whilst training, the application of educational strategies for empowerment, better knowledge transfer and upskilling within the workplace, and ensuring dedicated time and organizational support for research activities are indicated. Copyright © 2007 John Wiley & Sons, Ltd. [source]

The temporal influence of a heroin shortage on pregnant drug users and their newborn infants in Sydney, Australia

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010
Kwai Meng PONG
Background:, Heroin availability and purity decreased precipitously in Australian markets between 2000 and 2001. This led to increased use of non-opiate drugs in the general community but whether pregnant drug users and their newborn infants were affected remains unknown. Aim:, To determine if perinatal drug exposure and outcomes are affected by changes in street drug availability. Methods:, Retrospective review was carried out of known drug-exposed mothers delivering live-born infants at the Royal Hospital for Women, Randwick, Australia (n = 316). Study periods were divided into preshortage (A = 1998,2000, n = 79), shortage (B = 2001,2002, n = 92) and post-shortage (C = 2003,2006, n = 122) periods. Cannabis-only users were excluded (n = 23). Results:, The percentage of confined women who admitted to using heroin decreased significantly (65%(A) vs 34%(B), P < 0.01) as did women on methadone programmes (90%(A), 80%(B), 75%(C), P = 0.024). The use of cocaine (7% (A) vs 33% (B), P = 0.031) and amphetamines (4% (A) vs 22% (C), P = 0.01), tripled. Most infants were born full-term and healthy but the duration of infant hospitalisation increased significantly from (median [interquartile range]) 8 [10, 38](A) to 13 [7, 23](C) days (P < 0.01). Approximately 50% of infants required withdrawal treatment but more needed phenobarbitone as an adjunct to morphine during the shortage (4/80 (0.5%) vs 15/93 (16%), P = 0.026), probably because of increased exposure to non-opiate drugs. Conclusions:, The types of drugs used by pregnant drug users follow street trends and may affect infant hospitalisation and withdrawal treatment. Of concern is the rise in amphetamine-use and there needs to be increased vigilance for similar trends, especially in previously unidentified drug users. [source]

Nurse-Midwives' Experiences with Planned Home Birth: Impact on Attitudes and Practice

BIRTH, Issue 4 2009
Saraswathi Vedam RM, SciD(h.c.)
ABSTRACT: Background: Health care providers' attitudes toward maternity care options influence the nature of informed decision-making discussions and patient choice. A woman's choice of birth site may be affected by her provider's opinion and practice site. The objectives of this study were to describe American nurse-midwives' attitudes toward, and experiences with, planned home birth, and to explore correlates and predictors of their attitudes toward planned home birth as measured by the Provider Attitudes towards Planned Home Birth (PAPHB) scale.Methods: A survey instrument, which incorporates the PAPHB and assesses demographic, education, practice, personal experience, and external barrier variables that may predict attitudes toward planned home birth practice, was completed by 1,893 nurse-midwives. Bivariate analysis identified associations between variables and attitudes. Linear regression modeling identified predictors of attitudes.Results: Variables that significantly predicted favorable attitudes to planned home birth were increased clinical and educational experiences with planned home birth (p < 0.001), increased exposure to planned home birth (p < 0.001), and younger age (p < 0.001). External barriers that significantly predicted less favorable attitudes included financial (p = 0.03) and time (p < 0.001) constraints, inability to access medical consultation (p < 0.001), and fear of peer censure (p < 0.001). Willingness to practice in the home was correlated with factors related to nurse-midwives' confidence in their management abilities and beliefs about planned home birth safety.Conclusions: The results suggest that nurse-midwives' choice of practice site and comfort with planned home birth are strongly influenced by the nature and amount of exposure to home birth during professional education or practice experiences, in addition to interprofessional, logistic, and environmental factors. Findings from this research may inform interdisciplinary education and collaborative practice in the area of planned home birth. [source]

Increased exposure to bacterial antigen RpL7/L12 in early stage colorectal cancer patients

Effects of fully established Sure Start Local Programmes on 3-year-old children and their families living in England: a quasi-experimental observational study

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2009
Richard Reading
Effects of fully established Sure Start Local Programmes on 3-year-old children and their families living in England: a quasi-experimental observational study . MelhuishE., BelskyJ., LeylandA. H., BarnesJ. & the National Evaluation of Sure Start Research Team ( 2008 ) The Lancet , 372 , 1641 , 1647 . DOI: 10.1016/S0140-6736(08)61687-6 . Background Sure Start Local Programmes (SSLPs) are area-based interventions to improve services for young children and their families in deprived communities, promote health and development, and reduce inequalities. We therefore investigated whether SSLPs affect the well-being of 3-year-old children and their families. Methods In a quasi-experimental observational study, we compared 5883 3-year-old children and their families from 93 disadvantaged SSLP areas with 1879 3-year-old children and their families from 72 similarly deprived areas in England who took part in the Millennium Cohort Study. We studied 14 outcomes , children's immunizations, accidents, language development, positive and negative social behaviours and independence; parenting risk; home-learning environment; father's involvement; maternal smoking, body-mass index and life satisfaction; family's service use; and mother's rating of area. Findings After we controlled for background factors, we noted beneficial effects associated with the programmes for five of 14 outcomes. Children in the SSLP areas showed better social development than those in the non-SSLP areas, with more positive social behaviour (mean difference 0.45, 95% CI 0.09 to 0.80, P = 0.01) and greater independence (0.32, 0.18 to 0.47, P < 0.0001). Families in SSLP areas showed less negative parenting (,0.90, ,1.11 to ,0.69, P < 0.0001) and provided a better home-learning environment (1.30, 0.75 to 1.86, P < 0.0001). These families used more services for supporting child and family development than those not living in SSLP areas (0.98, 0.86 to 1.09, P < 0.0001). Effects of SSLPs seemed to apply to all subpopulations and SSLP areas. Interpretation Children and their families benefited from living in SSLP areas. The contrast between these and previous findings on the effect of SSLPs might indicate increased exposure to programmes that have become more effective. Early interventions can improve the life chances of young children living in deprived areas. [source]

The impact of exposure to domestic violence on children and young people: a review of the literature

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2008
Richard Reading
The impact of exposure to domestic violence on children and young people: a review of the literature HoltS., BuckleyH. & WhelanS. ( 2008 ) Child Abuse & Neglect , 32 , 797 , 810 . Objective This article reviews the literature concerning the impact of exposure to domestic violence on the health and developmental well-being of children and young people. Impact is explored across four separate yet interrelated domains (domestic violence exposure and child abuse, impact on parental capacity, impact on child and adolescent development and exposure to additional adversities), with potential outcomes and key messages concerning best practice responses to children's needs highlighted. Method A comprehensive search of identified databases was conducted within an 11-year framework (1995,2006). This yielded a vast literature that was selectively organized and analysed according to the four domains identified above. Results This review finds that children and adolescents living with domestic violence are at increased risk of experiencing emotional, physical and sexual abuse, of developing emotional and behavioural problems and of increased exposure to the presence of other adversities in their lives. It also highlights a range of protective factors that can mitigate against this impact, in particular a strong relationship with and attachment to a caring adult, usually the mother. Conclusion Children and young people may be significantly affected by living with domestic violence, and impact can endure even after measures have been taken to secure their safety. It also concludes that there is rarely a direct causal pathway leading to a particular outcome and that children are active in constructing their own social world. Implications for interventions suggest that timely, appropriate and individually tailored responses need to build on the resilient blocks in the child's life. Practice implications This study illustrate the links between exposure to domestic violence, various forms of child abuse and other related adversities, concluding that such exposure may have a differential yet potentially deleterious impact for children and young people. From a resilient perspective this review also highlights range of protective factors that influence the extent of the impact of exposure and the subsequent outcomes for the child. This review advocates for a holistic and child-centred approach to service delivery, derived from an informed assessment, designed to capture a picture of the individual child's experience and responsive to their individual needs. [source]