Self-exclusion from health care in women at high risk for postpartum depression

Background A significant proportion of women who are vulnerable to postnatal depression refuse to engage in treatment programmes. Little is known about them, other than some general demographic characteristics. In particular, their access to health care and their own and their infants' health outcomes are uncharted. Methods We conducted a nested cohort case-control study, using data from computerized health systems, and general practitioner (GP) and maternity records, to identify the characteristics, health service contacts, and maternal and infant health outcomes for primiparous antenatal clinic attenders at high risk for postnatal depression who either refused (self-exclusion group) or else agreed (take-up group) to receive additional Health Visiting support in pregnancy and the first 2 months postpartum. Results Women excluding themselves from Health Visitor support were younger and less highly educated than women willing to take up the support. They were less likely to attend midwifery, GP and routine Health Visitor appointments, but were more likely to book in late and to attend accident and emergency department (A&E). Their infants had poorer outcome in terms of gestation, birthweight and breastfeeding. Differences between the groups still obtained when age and education were taken into account for midwifery contacts, A&E attendance and gestation;the difference in the initiation of breast feeding was attenuated, but not wholly explained, by age and education. Conclusion A subgroup of psychologically vulnerable childbearing women are at particular risk for poor access to health care and adverse infant outcome. Barriers to take-up of services need to be understood in order better to deliver care.

Health informatics: improving patient-centred healthcare pathway

Nowadays the use of information and communication technology is becoming prevalent in many aspects of healthcare services from patient registration, to consultation, treatment and pathology tests request. Manual interface techniques have dominated data-capture activities in primary care and secondary care settings for decades. Despites the improvements made in IT, usability issues still remain over the use of I/O devices like the computer keyboard, touch-sensitive screens, light pen and barcodes. Furthermore, clinicians have to use several computer applications when providing healthcare services to patients. One of the problems faced by medical professionals is the lack of data integrity between the different software applications which in turn can hinder the provision of healthcare services tailored to the needs of the patients. The use of digital pen and paper technology integrated with legacy medical systems hold the promise of improving healthcare quality. This paper discusses the issue of data integrity in e-health systems and proposes the modelling of "Smart Forms" via semiotics to potentially improve integrity between legacy systems, making the work of medical professionals easier and improve the quality of care in primary care practices and hospitals.

Mapping power law distributions in digital health social networks: methods, interpretations, and practical implications

BACKGROUND: Social networks are common in digital health. A new stream of research is beginning to investigate the mechanisms of digital health social networks (DHSNs), how they are structured, how they function, and how their growth can be nurtured and managed. DHSNs increase in value when additional content is added, and the structure of networks may resemble the characteristics of power laws. Power laws are contrary to traditional Gaussian averages in that they demonstrate correlated phenomena. OBJECTIVES: The objective of this study is to investigate whether the distribution frequency in four DHSNs can be characterized as following a power law. A second objective is to describe the method used to determine the comparison. METHODS: Data from four DHSNs—Alcohol Help Center (AHC), Depression Center (DC), Panic Center (PC), and Stop Smoking Center (SSC)—were compared to power law distributions. To assist future researchers and managers, the 5-step methodology used to analyze and compare datasets is described. RESULTS: All four DHSNs were found to have right-skewed distributions, indicating the data were not normally distributed. When power trend lines were added to each frequency distribution, R(2) values indicated that, to a very high degree, the variance in post frequencies can be explained by actor rank (AHC .962, DC .975, PC .969, SSC .95). Spearman correlations provided further indication of the strength and statistical significance of the relationship (AHC .987. DC .967, PC .983, SSC .993, P<.001). CONCLUSIONS: This is the first study to investigate power distributions across multiple DHSNs, each addressing a unique condition. Results indicate that despite vast differences in theme, content, and length of existence, DHSNs follow properties of power laws. The structure of DHSNs is important as it gives insight to researchers and managers into the nature and mechanisms of network functionality. The 5-step process undertaken to compare actor contribution patterns can be replicated in networks that are managed by other organizations, and we conjecture that patterns observed in this study could be found in other DHSNs. Future research should analyze network growth over time and examine the characteristics and survival rates of superusers.

Health Benefits of Organic Food: effects of the environment

Public concern over impacts of chemicals in plant and animal production on health and the environment has led to increased demand for organic produce, which is usually promoted and often perceived as containing fewer contaminants, more nutrients, and being positive for the environment. These benefits are difficult to quantify, and potential environmental impacts on such benefits have not been widely studied. This book addresses these key points, examining factors such as the role of certain nutrients in prevention and promotion of chronic disease, potential health benefits of bioactive compounds in plants, the prevalence of food-borne pesticides and pathogens and how both local and global environmental factors may affect any differences between organic and conventionally produced food. This book is an essential resource for researchers and students in human health and nutrition, environmental science, agriculture and organic farming. Main Contents 1. Organic farming and food systems: definitions and key characteristics. 2. The health benefits of n-3 fatty acids and their concentrations in organic and conventional animal-derived foods. 3. Environmental impacts on n-3 content of foods from ruminant animals. 4. Health benefits and selenium content of organic vs conventional foods. 5. Environmental impacts concerning the selenium content of foods. 6. Contaminants in organic and conventional food: the missing link between contaminant levels and health effects. 7. Mycotoxins in organic and conventional foods and effects of the environment. 8. Human pathogens in organic and conventional foods and effects of the environment. 9. What does consumer science tell us about organic foods? 10. The beneficial effects of dietary flavonoids: sources, bioavailability and biological functions. 11. Environmental regulation of flavonoid biosynthesis. 12. Nitrates in the human diet. 13. Impacts of environment and management on nitrate in vegetables and water. 14. Effects of the environment on the nutritional quality and safety of organically produced foods: Round-up and summary.

The dangers of hanging baskets: 'Regulatory myths' and media representations of health and safety regulation

The successful enforcement of health and safety regulation is reliant upon the ability of regulatory agencies to demonstrate the legitimacy of the system of regulatory controls. While 'big cases' are central to this process, there are also significant legitimatory implications associated with 'minor' cases, including media-reported tales of pettiness and heavy-handedness in the interpretation and enforcement of the law. The popular media regularly report stories of 'regulatory unreasonableness', and they can pass quickly into mainstream public knowledge. A story's appeal becomes more important than its factual veracity; they are a form of 'regulatory myth'. This paper discusses the implications of regulatory myths for health and safety regulators, and analyses their challenges for regulators, paying particular attention to the Health and Safety Executive (HSE) which has made concerted efforts to address regulatory myths attaching to its activities. It will be shown that such stories constitute sustained normative challenges to the legitimacy of the regulator, and political challenges to the burgeoning regulatory state, because they reflect some of the key concerns of late-modern society.

The sociology of childhood as scientific communication - Observations from a social systems perspective

This article begins by identifying a close relationship between the image of children generated by several sociologists working within the new sociology of childhood perspective and the claims and ambitions of the proponents of children's autonomy rights. The image of the child as a competent, self-controlled human agent are then subjected to observation from the perspective of Niklas Luhmann's social systems theory. The new sociology of childhood's constructivist approach is compared and contrasted with Niklas Luhmann's theory of 'operational constructivism'. The article applies tenets of Luhmann's theory, to the emergence of the new childhood sociologist's image of the child as a competent, self-controlled social agent, to the epistemological status of this image and, in particular, to claims that it derives from scientific endeavour. The article proceeds to identify two theoretical developments within sociology - sociology of identity and social agency - which have brought about fundamental changes in what may be considered 'sociological' and so 'scientific' and paved the way for sociological communications about what children,really are'. In conclusion, it argues that the merging of sociology with polemics, ideology, opinion and personal beliefs and, at the level of social systems, between science and politics represents in Luhmann's terms 'dedifferentiation'- a tendency he claims may have serious adverse consequences for modern society. This warning is applied to the scientific status of sociology - its claim to be able to produce 'facts' for society, upon which social systems, such as politics and law, may rely. Like the mass media, sociology may now be capable of producing only information, and not facts, about children.