Surveillance during pregnancy: methods and response rates from a hospital based pilot study of the Pregnancy Risk Assessment Monitoring System in Ireland

Background: Many European countries including Ireland lack high quality, on-going, population based estimates of maternal behaviours and experiences during pregnancy. PRAMS is a CDC surveillance program which was established in the United States in 1987 to generate high quality, population based data to reduce infant mortality rates and improve maternal and infant health. PRAMS is the only on-going population based surveillance system of maternal behaviours and experiences that occur before, during and after pregnancy worldwide.Methods: The objective of this study was to adapt, test and evaluate a modified CDC PRAMS methodology in Ireland. The birth certificate file which is the standard approach to sampling for PRAMS in the United States was not available for the PRAMS Ireland study. Consequently, delivery record books for the period between 3 and 5 months before the study start date at a large urban obstetric hospital [8,900 births per year] were used to randomly sample 124 women. Name, address, maternal age, infant sex, gestational age at delivery, delivery method, APGAR score and birth weight were manually extracted from records. Stillbirths and early neonatal deaths were excluded using APGAR scores and hospital records. Women were sent a letter of invitation to participate including option to opt out, followed by a modified PRAMS survey, a reminder letter and a final survey.Results: The response rate for the pilot was 67%. Two per cent of women refused the survey, 7% opted out of the study and 24% did not respond. Survey items were at least 88% complete for all 82 respondents. Prevalence estimates of socially undesirable behaviours such as alcohol consumption during pregnancy were high [>50%] and comparable with international estimates.Conclusion: PRAMS is a feasible and valid method of collecting information on maternal experiences and behaviours during pregnancy in Ireland. PRAMS may offer a potential solution to data deficits in maternal health behaviour indicators in Ireland with further work. This study is important to researchers in Europe and elsewhere who may be interested in new ways of tailoring an established CDC methodology to their unique settings to resolve data deficits in maternal health.

Computing explanations for interactive constraint-based systems

Constraint programming has emerged as a successful paradigm for modelling combinatorial problems arising from practical situations. In many of those situations, we are not provided with an immutable set of constraints. Instead, a user will modify his requirements, in an interactive fashion, until he is satisfied with a solution. Examples of such applications include, amongst others, model-based diagnosis, expert systems, product configurators. The system he interacts with must be able to assist him by showing the consequences of his requirements. Explanations are the ideal tool for providing this assistance. However, existing notions of explanations fail to provide sufficient information. We define new forms of explanations that aim to be more informative. Even if explanation generation is a very hard task, in the applications we consider, we must manage to provide a satisfactory level of interactivity and, therefore, we cannot afford long computational times. We introduce the concept of representative sets of relaxations, a compact set of relaxations that shows the user at least one way to satisfy each of his requirements and at least one way to relax them, and present an algorithm that efficiently computes such sets. We introduce the concept of most soluble relaxations, maximising the number of products they allow. We present algorithms to compute such relaxations in times compatible with interactivity, achieving this by indifferently making use of different types of compiled representations. We propose to generalise the concept of prime implicates to constraint problems with the concept of domain consequences, and suggest to generate them as a compilation strategy. This sets a new approach in compilation, and allows to address explanation-related queries in an efficient way. We define ordered automata to compactly represent large sets of domain consequences, in an orthogonal way from existing compilation techniques that represent large sets of solutions.