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.

Profitability and technical efficiency of aquaculture systems in Pampanga, Philippines

We evaluate the profitability and technical efficiency of aquaculture in the Philippines. Farm-level data are used to compare two production systems corresponding to the intensive monoculture of tilapia in freshwater ponds and the extensive polyculture of shrimps and fish in brackish water ponds. Both activities are very lucrative, with brackish water aquaculture achieving the higher level of profit per farm. Stochastic frontier production functions reveal that technical efficiency is low in brackish water aquaculture, with a mean of 53%, explained primarily by the operator's experience and by the frequency of his visits to the farm. In freshwater aquaculture, the farms achieve a mean efficiency level of 83%. The results suggest that the provision of extension services to brackish water fish farms might be a cost-effective way of increasing production and productivity in that sector. By contrast, technological change will have to be the driving force of future productivity growth in freshwater aquaculture.

Evaluating the efficiency of sampling methods in assessing soil macrofauna communities in arable systems

The soil fauna is often a neglected group in many large-scale studies of farmland biodiversity due to difficulties in extracting organisms efficiently from the soil. This study assesses the relative efficiency of the simple and cheap sampling method of handsorting against Berlese-Tullgren funnel and Winkler apparatus extraction. Soil cores were taken from grassy arable field margins and wheat fields in Cambridgeshire, UK, and the efficiencies of the three methods in assessing the abundances and species densities of soil macroinver-tebrates were compared. Handsorting in most cases was as efficient at extracting the majority of the soil macrofauna as the Berlese-Tullgren funnel and Winkler bag methods, although it underestimated the species densities of the woodlice and adult beetles. There were no obvious biases among the three methods for the particular vegetation types sampled and no significant differences in the size distributions of the earthworms and beetles. Proportionally fewer damaged earthworms were recorded in larger (25 x 25 cm) soil cores when compared with smaller ones (15 x 15 cm). Handsorting has many benefits, including targeted extraction, minimum disturbance to the habitat and shorter sampling periods and may be the most appropriate method for studies of farmland biodiversity when a high number of soil cores need to be sampled. (C) 2008 Elsevier Masson SAS. All rights reserved.

Ventilation for air quality and energy efficiency

This article addresses the need for providing good standards of indoor air quality (IAQ) in buildings from the view point of health, well-being and productivity of building occupants. It briefly outlines the role of ventilation in achieving the required IAQ targets and discusses the performance of different types of ventilation systems in use. As a result of new energy efficiency directives and legislations in Europe and elsewhere, the ventilation energy component of HVAC systems has increased in relative terms and this article introduces a method for evaluating the performance air distribution systems that is based on ventilation and energy effectiveness. A range of ventilation systems are discussed, including mechanical and natural ventilation, and results for more recently developed mechanical air distribution systems are compared with conventional systems. The article provides an assessment and comparison of some of these systems with reference to ventilation performance and energy efficiency

Potassium budgets in grassland systems as affected by nitrogen and drainage

The main inputs, outputs and transfers of potassium (K) in soils and swards under typical south west England conditions were determined during 1999/00 and 2000/01 to establish soil and field gate K budgets under different fertilizer nitrogen (N) (0 and 280 kg ha(-1) yr(-1)) and drainage (undrained and drained) treatments. Plots receiving fertilizer N also received farmyard manure (FYM). Potassium soil budgets ranged, on average for the two years, from -5 (+N, drained) to +9 (no N and undrained) kg K ha(-1) yr(-1) and field gate budgets from +23 (+N, drained) to +89 (+N, undrained). The main inputs and outputs to the soil K budgets were fertilizer application (65%) and plant uptake (93%). Animals had a minor effect on K export but a major impact on K recycling. Nitrogen fertilizer application and drainage increased K uptake by the grass and, with it, the efficiency of K used. It also depleted easily available soil K, which could be associated with smaller K losses by leaching.

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.

Modelling cereal root systems for water and nitrogen capture: Towards an economic optimum

A quantitative model of wheat root systems is developed that links the size and distribution of the root system to the capture of water and nitrogen (which are assumed to be evenly distributed with depth) during grain filling, and allows estimates of the economic consequences of this capture to be assessed. A particular feature of the model is its use of summarizing concepts, and reliance on only the minimum number of parameters (each with a clear biological meaning). The model is then used to provide an economic sensitivity analysis of possible target characteristics for manipulating root systems. These characteristics were: root distribution with depth, proportional dry matter partitioning to roots, resource capture coefficients, shoot dry weight at anthesis, specific root weight and water use efficiency. From the current estimates of parameters it is concluded that a larger investment by the crop in fine roots at depth in the soil, and less proliferation of roots in surface layers, would improve yields by accessing extra resources. The economic return on investment in roots for water capture was twice that of the same amount invested for nitrogen capture. (C) 2003 Annals of Botany Company.

A conventionally managed project: a systems based case study

The technique of linear responsibility analysis is used for a retrospective case study of a private development consisting of an extension to an existing building to provide a wholesale butchery facility. The project used a conventionally organized management process. The organization structure adopted on the project is analysed using concepts from the systems theory, which are included in Walkers theoretical model of the structure of building project organizations. This model proposes that the process of building provision can be viewed as systems and sub-systems that are differentiated from each other at decision points. Further to this, the sub-systems can be viewed as the interaction of managing system and operating system. Using Walkers model, a systematic analysis of the relationships between the contributors gives a quantitative assessment of the efficiency of the organizational structure used. The project's organization structure diverged from the models propositions resulting in delay to the project's completion and cost overrun but the client was satisfied with the project functionally.