Low-income first time mothers: Effects on advanced practice nurse (APN) follow up telephone calls on maternal and infant health and health care charges

The United States has over 4 million births annually. Currently healthy women with non-complicated deliveries receive little to no routine postpartum support when discharged from the hospital. This is especially problematic if mothers are first time mothers, poor, have language barriers and little to no social support after giving birth. The purpose of this randomized clinical trial was to compare maternal and infant health outcomes, and health care charges between 2 groups of mothers and newborns. A control ( n = 69) group received routine posthospital discharge care. An intervention group (n = 70) received routine posthospital discharge care plus follow up telephone calls by advanced practice nurses (APNs) on days 3,7,14,21,28 and week 8. Both groups were followed for the first 8 weeks posthospital discharge following delivery to examine maternal health outcomes (perceived maternal stress, social support and perceived maternal physical health), infant health outcomes (routine medical follow up visits immunizations, weight gain), morbidity (urgent care visits, emergency room visits, rehospitalizations), health care charges (urgent care visits, emergency room visits, rehospitalizations) in both groups and charges for APN follow up in the intervention group only. Data were analyzed using descriptive statistics and two-sample t-tests. Study findings indicated that intervention group had significantly lower perceived maternal stress, significantly higher rating of perceived maternal health and higher levels of social support and by the end of the 2nd month posthospital discharge compared to control group mothers. Infants in the intervention group had: increased number of immunizations; fewer emergency room visits; and 1 infant rehospitalization compared to 3 infant rehospitalizations in the control group. The intervention groups' health care charges were significantly lower compared to the control group $14,333/$497 vs. $70,834/$1,068. These study results indicate that an intervention of APN follow up telephone calls in this sample of first time low-income culturally diverse mothers was an effective, safe, low cost, easy to apply intervention which improved mothers' and infants' health outcomes and reduced healthcare charges.

The representation of motherhood in contemporary Catalan fiction

This dissertation analyzes four twenty-first-century Catalan novels which present the complex positions occupied by mothers in the last seven decades. Its conceptual framework posits motherhood as both a changing social construction and a political institution in a constant state of flux. In Inma Monsó´s Todo un carácter (2001), Eva Piquer´s Una victoria diferente (2002), Carme Riera´s La mitad del alma (2004), and Najat El Hachmi´s El último patriarca (2008) motherhood is explored as a metaphorical act, a gender-constructing experience, as well as the locus of expression with regard to gender and power relations. During the dictatorship of Francisco Franco (1939–1975), the majority of women were excluded from public spaces, and forced to stay home to care for their husbands and children. Furthermore, the state criminalized abortion, made contraception and divorce illegal, and promoted an ideal of femininity based on silence, sacrifice, and self-denial. The political changes of the late 1970s allowed women greater personal autonomy, and many women writers began to challenge stereotypical views of women’s social roles. Yet in the 70s and 80s, the narratives of Esther Tusquets, Ana María Moix, and Montserrat Roig represent the mother as a repressive figure whom the daughter must reject in order to liberate herself and regain her voice. It is not until the 90s when the novelists Mercedes Abad, Maruja Torres, Carme Riera, Imma Monsó, Eva Piquer, and María Barbal rehumanize the mother figure, recovering their matrilineal heritage. However, far from suggesting a unified trend in representations of motherhood in Catalan fiction, the diverse points of view of the novels under discussion here reveal that differences in attitudes among women authors about mother-daughter conflict are far from resolved. The theoretical background for this dissertation draws mainly on the work of Adrienne Rich, Nancy Chodorow, and Julia Kristeva. It includes psychoanalytic studies as well as sociologically based essays by Anna López Puig, Amparo Acereda, Jacqueline Cruz, Barbara Zecchi, Ángeles de la Concha, and Raquel Osborne, among others.

European integration and democratic consolidation: Spain, Poland and Turkey in comparative perspective

The study explored when, under what conditions, and to what extent did European integration, particularly the European Union’s requirement for democratic conditionality, contribute to democratic consolidation in Spain, Poland, and Turkey? On the basis of a four-part definition, the dissertation examined the democratizing impact of European integration process on each of the following four components of consolidation: (i) holding of fair, free and competitive elections, (ii) protection of fundamental rights, including human and minority rights, (iii) high prospects of regime survival and civilian control of the military, and (iv) legitimacy, elite consensus, and stateness. To assess the relative significance of EU’s democratizing leverage, the thesis also examined domestic and non-EU international dynamics of democratic consolidation in the three countries. By employing two qualitative methods (case study and process-tracing), the study focused on three specific time frames: 1977–1986 for Spain, 1994–2004 for Poland, and 1999–present for Turkey. In addition to official documents, newspapers, and secondary sources, face-to-face interviews made with politicians, academics, experts, bureaucrats, and journalists in the three countries were utilized. The thesis generated several conclusions. First of all, the EU’s democratizing impact is not uniform across different components of democratic consolidation. Moreover, the EU’s democratizing leverage in Spain, Poland, and Turkey involved variations over time for three major reasons: (i) the changing nature of EU’s democratic conditionality over time (ii) varying levels of the EU’s credible commitment to the candidate country’s prospect for membership, and (iii) domestic dynamics in the candidate countries. Furthermore, the European integration process favors democratic consolidation but its magnitude is shaped by the candidate country’s prospect for EU membership and domestic factors in the candidate country. Finally, the study involves a major policy implication for the European Union: unless the EU provides a clear prospect for membership, its democratizing leverage will be limited in the candidate countries.

The discursive construction of Japanese identity and its haunting others

This dissertation examined the formation of Japanese identity politics after World War II. Since World War II, Japan has had to deal with a contradictory image of its national self. On the one hand, as a nation responsible for colonizing fellow Asian countries in the 1930s and 1940s, Japan has struggled with an image/identity as a regional aggressor. On the other hand, having faced the harsh realities of defeat after the war, Japan has seen itself depicted as a victim. By employing the technique of discourse analysis as a way to study identity formation through official foreign policy documents and news media narratives, this study reconceptualized Japanese foreign policy as a set of discursive practices that attempt to produce renewed images of Japan's national self. The dissertation employed case studies to analyze two key sites of Japanese postwar identity formation: (1) the case of Okinawa, an island/territory integral to postwar relations between Japan and the United States and marked by a series of US military rapes of native Okinawan girls; and (2) the case of comfort women in Japan and East Asia, which has led to Japan being blamed for its wartime sexual enslavement of Asian women. These case studies found that it was through coping with the haunting ghost of its wartime past that Japan sought to produce "postwar Japan" as an identity distinct from "wartime imperial Japan" or from "defeated, emasculated Japan" and, thus, hoped to emerge as a "reborn" moral and pacifist nation. The research showed that Japan struggled to invent a new self in a way that mobilized gendered dichotomies and, furthermore, created "others" who were not just spatially located (the United States, Asian neighboring nations) but also temporally marked ("old Japan"). The dissertation concluded that Japanese foreign policy is an ongoing struggle to define the Japanese national self vis-à-vis both spatial and historical "others," and that, consequently, postwar Japan has always been haunted by its past self, no matter how much Japan's foreign policy discourses were trying to make this past self into a distant or forgotten other.

Disciplining democracy: United Nations peacekeeping, international security and democratization in the post -Cold War era

After the end of the Cold War, democratization and good governance became the organizing concepts for activities of the United Nations, regional organizations and states in the fields of peace, development and security. How can this increasing interest in democratization and its connection with international security be explained? This dissertation applies the theoretical tools developed by Michel Foucault in his discussions of disciplinarity and government to the analysis of the United Nations debate on democracy in the 1990s, and of two United Nations pro-democracy peacekeeping operations and their aftermath: the United Nations interventions in Haiti and Croatia. It probes “how” certain techniques of power came into being and describes their effects, using as data the texts that elaborate the United Nations understanding of democracy and the texts that constitute peacekeeping. ^ In the face of the proliferation of unpredictable threats in the last decades of the twentieth century a new form of international power emerged. Order in the international arena increasingly was maintained through activities aimed at reducing risk and increasing predictability through the normalization of “rogue” states. The dissertation shows that in the context of these activities, which included but were not limited to UN peacekeeping, normality was identified with democracy, non-democratic regimes with international threats, and democratization with international security. “Good governance” doctrines translated the political debate on democracy into the technical language of functioning state institutions. International organizations adopted good governance as the framework that made democratization a universal task within the reach of their expertise. In Haiti, the United Nations engaged in efforts to transform punishment institutions (the judiciary, police and the prison) into disciplined and disciplinary machines. In Croatia, agreements signed in the context of peacekeeping established in detail the rules of functioning of administrations and the monitoring mechanisms for their implementation. However, in Haiti, the institutions promoted were not sustainable. And in Croatia reforms are stalled by lack of consensus. ^ This dissertation puts efforts to bring about democracy through peacekeeping in the context of a specific modality of power and suggests caution in engaging in universal normalizing endeavors. ^

Political strategy, leadership, and policy entrepreneurship in Japanese defense policy and politics: A comparison of three prime ministerships

Since the end of the Cold War, Japan's defense policy and politics has gone through significant changes. Throughout the post cold war period, US-Japan alliance managers, politicians with differing visions and preferences, scholars, think tanks, and the actions of foreign governments have all played significant roles in influencing these changes. Along with these actors, the Japanese prime minister has played an important, if sometimes subtle, role in the realm of defense policy and politics. Japanese prime ministers, though significantly weaker than many heads of state, nevertheless play an important role in policy by empowering different actors (bureaucratic actors, independent commissions, or civil actors), through personal diplomacy, through agenda-setting, and through symbolic acts of state. The power of the prime minister to influence policy processes, however, has frequently varied by prime minister. My dissertation investigates how different political strategies and entrepreneurial insights by the prime minister have influenced defense policy and politics since the end of the Cold War. In addition, it seeks to explain how the quality of political strategy and entrepreneurial insight employed by different prime ministers was important in the success of different approaches to defense. My dissertation employs a comparative case study approach to examine how different prime ministerial strategies have mattered in the realm of Japanese defense policy and politics. Three prime ministers have been chosen: Prime Minister Hashimoto Ryutaro (1996-1998); Prime Minister Koizumi Junichiro (2001-2006); and Prime Minister Hatoyama Yukio (2009-2010). These prime ministers have been chosen to provide maximum contrast on issues of policy preference, cabinet management, choice of partners, and overall strategy. As my dissertation finds, the quality of political strategy has been an important aspect of Japan's defense transformation. Successful strategies have frequently used the knowledge and accumulated personal networks of bureaucrats, supplemented bureaucratic initiatives with top-down personal diplomacy, and used a revitalized US-Japan strategic relationship as a political resource for a stronger prime ministership. Though alternative approaches, such as those that have looked to displace the influence of bureaucrats and the US in defense policy, have been less successful, this dissertation also finds theoretical evidence that alternatives may exist.

Different Wars Require Different Strategies: Separating the “War on Drugs” from the “War on Drug [Traffickers]”

Using the securitization framework to highlight the arguments that facilitated the “War on Drugs”, this paper highlights a separate war against drug traffickers. Facilitated by ideology through the rhetoric promoted by the “War on Drugs,” the fear of communist expansion and democratic contraction, the “War on Drug Traffickers” was implemented, requiring its own strategy separate from the “War on Drugs.” This is an important distinction because the play on words changes the perception of the issue from one of drug addiction to one of weak institutions and insurgent/terrorist threat to those institutions. Furthermore, one cannot propose strategy to win, lose, or retreat in a war that one has been unable to identify properly. And while the all-encompassing “War on Drugs” has motivated tremendous discourse on its failure and possible solutions to remedy its failure, the generalizations made as a result of the inability to distinguish between the policies behind drug addiction and the militarized policies behind drug trafficking have discounted the effect of violence perpetrated by the state, the rationale for the state perpetrating that violence, and the dependence that the state has on foreign actors to perpetrate such violence. This makes it impossible to not only propose effective strategy but also to persuade states that participate in the “War on Drug Traffickers” to adopt the proposed strategy.

Identity and Conflict: PKK vs. Turkey (1984-Present)

This paper offers a causal analysis of the conflict between the Kurdistan Workers’ Party (PKK) and Turkey that has been ongoing since 1984. The history of Kurdish politics in Turkey is investigated in order to uncover the conflict’s causes. The conflict’s origins in the Turkish state’s refusal to recognize Kurdish identity and its forced attempts to assimilate Kurds into Turkish society are examined. Other causal factors such as the political turmoil of the decades prior to the conflict’s initiation, the involvement of the student youth in politics, the rise of the PKK, and the interrelationships between the causal factors are also analyzed. Further discussion on the conflict’s influence on sociopolitical and interstate motivations and how the causes of this conflict compare with other conflicts is provided.

The effects of resilience and social influences on preventing repeat adolescent pregnancies in parenting adolescent mothers

Every year, 16 million women aged 15 to 19 years give birth globally. Adolescent births account for 11% of all births globally and 23% of the overall burden of disability and diseases due to pregnancy and childbirth. In the United States, 750,000 adolescents (15-19 years) become pregnant each year, making the United States the developed country with the highest rates of adolescent pregnancy. The economic burden of adolescent pregnancy in the U. S. is $7-15 billion per year. Adolescent pregnancy brings risks associated with pregnancy induced hypertension, preterm infants, maternal and neonatal mortality. Social factors include poverty, low educational levels, alcohol, and drug use. Between 30-50% of adolescent mothers who have a first birth before age 18 years will have a second child within 12 to 24 months. Subsequent adolescent pregnancies compound fetal and maternal risks. Many vulnerable adolescent mothers succumb to external pressures and have a repeat adolescent pregnancy while others are able to overcome the challenges of an adolescent pregnancy and prevent a repeat adolescent pregnancy. This cross sectional survey designed study investigated the effects of resilience and social influences on contraceptive use or abstinence by Black and Hispanic adolescent parenting mothers to prevent a repeat adolescent pregnancy. 140 adolescent mothers were recruited from three postpartum units of a tertiary hospital system in Miami, Florida. The Wagnild and Young Resilience Scale and the Adolescent Social Influence Scale were used to measure resilience and social influences, respectively. Demographic data, length of labor, plan for contraceptive use or abstinence were measured by an investigator developed instrument. Point biserial correlation showed a significant positive correlation between Black adolescent mothers' resilience and contraceptive use (r =.366, p2(11, N=133) = 27.08, p =.004. (OR = .28). These results indicate a need for interventional strategies to maximize resilience in parenting adolescents to prevent a repeat adolescent pregnancy.

Does U.S counter-drug policy affect nationalism in the Anglophone Caribbean? A comparative study on the impact of counter-drug policy on nationalism in Jamaica and Trinidad and Tobago

This dissertation examined the effect of United States counter-drug policy on nationalism in small states, focusing on Jamaica and Trinidad and Tobago. The states were selected for their roles and geostrategic importance in the illegal drug trade; Jamaica being the largest drug producing country in the Anglophone Caribbean and having strong links to the trade of Colombian cocaine, and Trinidad being a mere seven miles from the South American coast. Since U.S. counterdrug policies have frequently been viewed in the region as imperialistic, this dovetails into ideas on the perceptions of smallness and powerlessness of Caribbean nations. Hence, U.S. drug policies affect every vulnerability faced by the Caribbean, individually and collectively. Thus, U.S. drug policy was deemed the most appropriate independent variable, with nationalism as the dependent variable. In both countries four Focus Groups and one Delphi Study were conducted resulting in a total of 60 participants. Focus Group participants, recruited from the general population, were asked about their perception of the illegal drug trade in the country and the policies their government had created. They were also asked their perception on how deeply involved the U.S. was in the creation of these policies and their opinions on whether this involvement was positive or negative. The Delphi Study participants were experts in the field of local drug policies and also gave their interpretations of the role the U.S. played in local policy creation. Coupled with this data, content analysis was conducted on various newspaper articles, press releases, and speeches made regarding the topic. In comparing both countries, it was found that there is a disconnect between government actions and the knowledge and perceptions of the general public. In Trinidad and Tobago this disconnect was more apparent given the lack of awareness of local drug policies and the utter lack of faith in government solutions. The emerging conclusion was that the impact of U.S. drug policy on nationalism was more visible in Trinidad and Tobago where there was a weaker civil society-government relationship, while the impact on nationalism was more obscure in Jamaica, which had a stronger civil-society government relationship.

A Land That Has Yet to Heal: The Burmese Civil War (1948 – present)

Since its independence from Great Britain in 1948, the state of Burma has been at war with itself. Ethnic and religious tension fuel the conflict and has led to territorial disputes while no resolution to this strife is expected under a fragile and corrupt central government. Additionally, proxy wars have delayed any peaceful negotiations. The combinations of failing social welfare programs and prolonged peace talks have led many Burmese people join the military as soldiers in either the Burmese military or any one of the numerous ethnic paramilitary groups in the country. Human rights violations are common in Burma, including rape, pillaging, and ethnic cleansing. Essentially, Burma has had the longest ongoing civil war due to combination of grievances, many of which predate the 21st century.

China's Building of a Blue-Water Fleet

In recent years the People’s Republic of China has begun to exhibit a more aggressive naval policy as a result of its decision to switch its naval force from a primarily green-water fleet (coastal) to a blue-water fleet (expeditionary) (“China’s New,” n.d.). This decision has brought China to loggerheads not only with other local East and South Asian powers such as India and Japan, but also with the predominant blue-water power of the world, the United States, that sees its supremacy threatened (“When Grand,” n.d.). Why would China embark on a route that would pit it against the world naval superpower, the United States, which has a huge lead on China in terms of naval blue-water power? Why would China try to challenge and match the U.S. Navy’s eleven aircraft carriers (“The World’s,” n.d.)? What could compel China to embark on a plan that would so disrupt the balance of power in the waters around Asia? To fully understand the Chinese government’s decision, one must first look at Chinese import figures and Chinese trade routes.

World coffee markets and national coffee parastatals since 1989: a comparative study of Colombia and Cote D'ivoire

The International Coffee Agreements (ICA) involved the majority of nations producing and consuming coffee and provided relative economic stability to the coffee sectors of the exporting Third World countries. This study focuses on the serious impact of the 1989 collapse of the ICA on the domestic coffee sectors of Colombia and Cote d'Ivoire. In particular, the dissertation examines the role of the Colombian and Ivoirian coffee parastatals, the Federacion Nacional de Cafeteros de Colombia and the Caisse de Stabilisation et Soutien des Prix des Produits Agricoles, during the crisis and their transformation by it. The theoretical framework employed in this study is borrowed from the literature on state-society relations. The methodology includes: in-depth analysis of the historical roles of the parastatal agencies in coffee production, state-society relations and economic development in Colombia and Côte d'Ivoire; interviews with parastatal administrators, producers and other knowledgeable informants in both countries; and a comprehensive review of newspaper articles and official statements of coffee policy published in Colombia and Côte d'Ivoire prior to, during, and after the crisis. The Colombian and Ivoirian coffee sectors and their producers faced serious economic and social problems following the drop in coffee prices. The coffee parastatals in Colombia and Côte d'Ivoire first lost some of their responsibilities following the world coffee crisis. The Caisse was in the end eliminated while FEDECAFE struggled to remain in existence. Along the way, both entities faced protests from disgruntled coffee producers, who organized politically for the first time in their nations' histories. I argue that the outcome for the parastatals depended in part on the conditions of their formation, particularly the level of societal involvement in their creation. I also posit that the country's dependence on foreign aid played a key role in the fate of the parastatals. This dissertation concludes that developments in the Colombian and Ivoirian coffee sectors have significantly contributed to the creation of the difficult political and economic conditions of both countries today.

Foreign aid and the national interest : the cases of the United States and Japan

Developed countries give foreign assistance for many reasons, one of which is the protection of national interests. Foreign aid gives a donor country leverage in international relations and is used as a tool of foreign policy. The United States and Japan are the two largest aid donors in the world. Each of these countries exert influence over specific regions through foreign assistance. Although the national interests of each country are different, both use foreign aid to protect these interests. This thesis discusses the means by which the United States and Japan use foreign aid in foreign policy. It looks specifically at U.S. food aid to Central America and Japanese aid to Asia.

Political Strategy, Leadership, and Policy Entrepreneurship in Japanese Defense Policy and Politics: A Comparison of Three Prime Ministerships

Since the end of the Cold War, Japan’s defense policy and politics has gone through significant changes. Throughout the post cold war period, US-Japan alliance managers, politicians with differing visions and preferences, scholars, think tanks, and the actions of foreign governments have all played significant roles in influencing these changes. Along with these actors, the Japanese prime minister has played an important, if sometimes subtle, role in the realm of defense policy and politics. Japanese prime ministers, though significantly weaker than many heads of state, nevertheless play an important role in policy by empowering different actors (bureaucratic actors, independent commissions, or civil actors), through personal diplomacy, through agenda-setting, and through symbolic acts of state. The power of the prime minister to influence policy processes, however, has frequently varied by prime minister. My dissertation investigates how different political strategies and entrepreneurial insights by the prime minister have influenced defense policy and politics since the end of the Cold War. In addition, it seeks to explain how the quality of political strategy and entrepreneurial insight employed by different prime ministers was important in the success of different approaches to defense. My dissertation employs a comparative case study approach to examine how different prime ministerial strategies have mattered in the realm of Japanese defense policy and politics. Three prime ministers have been chosen: Prime Minister Hashimoto Ryutaro (1996-1998); Prime Minister Koizumi Junichiro (2001-2006); and Prime Minister Hatoyama Yukio (2009-2010). These prime ministers have been chosen to provide maximum contrast on issues of policy preference, cabinet management, choice of partners, and overall strategy. As my dissertation finds, the quality of political strategy has been an important aspect of Japan’s defense transformation. Successful strategies have frequently used the knowledge and accumulated personal networks of bureaucrats, supplemented bureaucratic initiatives with top-down personal diplomacy, and used a revitalized US-Japan strategic relationship as a political resource for a stronger prime ministership. Though alternative approaches, such as those that have looked to displace the influence of bureaucrats and the US in defense policy, have been less successful, this dissertation also finds theoretical evidence that alternatives may exist.