Iowa's Barriers to Prenatal Care Project, August 2013

The findings in this summary are based on the Iowa Barriers to Prenatal Care project. Ongoing since 1991, the purpose of this project is to obtain brief, accurate information about women delivering babies in Iowa hospitals. Specifically, the project seeks to learn about women’s experiences getting prenatal or delivery care during their current pregnancy. Other information is included which may be pertinent to health planners or those concerned with the systematic development of health care services. This project is a cooperative venture of all of Iowa’s maternity hospitals, the University of Northern Iowa Center for Social and Behavioral Research, and the Iowa Department of Public Health. The Robert Wood Johnson Foundation funded the first three years of this project. The current funding is provided by the Iowa Department of Public Health. The Director is Dr. Mary Losch, University of Northern Iowa Center for Social and Behavioral Research. The Coordinator for the project is Rodney Muilenburg. The questionnaire is distributed to nearly ninety maternity hospitals across the state of Iowa. Nursing staff or those responsible for obtaining birth certificate information in the obstetrics unit are responsible for approaching all birth mothers prior to dismissal and requesting their participation in the study. The questionnaire takes approximately ten minutes to complete. Completed questionnaires are returned to the University of Northern Iowa Center for Social and Behavioral Research for data entry and analysis. Returns are made monthly, weekly, or biweekly depending on the number of births per week in a given hospital. Except in the case of a mother who is too ill to complete the questionnaire, all mothers are eligible to be recruited for participation. The present yearly report includes an analysis of large Iowa cities, African American mothers, and a trend analysis of the last ten years. Also presented in this report is a frequency analysis of all variables included in the 2012 questionnaire. Unless otherwise noted, all entries reflect percentages. Please note that because percentages were rounded, total values may not equal 100%. Data presented are based upon 2012 questionnaires received to date (n = 23,674). All analyses reflect unweighted percentages of those responding.

Conocimiento del método anticonceptivo de lactancia y amenorrea (MELA) en gestantes residentes en Logroño

El rol de la mujer ha evolucionado a ser el de una madre y trabajadora a la vez, originandocambios en las expectativas a la hora de tener descendencia, retrasando la edad de tener hijosy decidiendo crear núcleos pequeños 1, 2. Uno de los paradigmas enfermeros que se tiene encuenta en estas situaciones es el del autocuidado, por lo que como profesional en el campo dela planificación familiar, una de las labores es ofrecer información sobre los métodosanticonceptivos, adaptándolos a cada persona y en cada momento, según la situacióneconómica, social, física o emocional. De esta forma se podrían evitar los embarazos nodeseados y los maltratos infantiles. Uno de los métodos anticonceptivos naturales, que estáintegrado en la planificación familiar, es el método anticonceptivo lactancia-amenorrea. Éstees un método está basado en la fertilidad de la mujer cuando está realizando lactanciamaterna exclusiva.En este trabajo se propone investigar cuál es el grado de conocimiento que tienen las futurasmadres en la actualidad sobre este método anticonceptivo, ya que esto nos servirá de guíapara ofrecer la información necesaria, pudiendo reforzar los puntos débiles que se puedandetectar con éste estudio. Se propone un estudio multicéntrico, cuantitativo, observacional,descriptivo de corte transversal. Se administrará un cuestionario autoadministrado diseñado ad hoc, en una muestra de 148 gestantes durante el tercer trimestre (semana 32-38 de gestación), residentes en Logroño.

Médecine de l'adolescence. Consultation garçons [Adolescent medicine male clinic]

The vast majority of Swiss adolescents see a physician at least once a year. However, a sizeable proportion of them indicate that they don't have the opportunity to address their own concerns and problems. While female adolescents have access to health care in the field of sexual and reproductive health through family planning clinics, this is not the case of adolescent males. The "clinic for boys only" is an open space for adolescent males where they can bring questions and health problems related to their body, their growth and their puberty, just as their difficulties and their fears regarding their normality, their sexuality, their feelings, sexual dysfunctions and questions related to violence within the couple. They can also get information/treatment in the area of sexually transmitted infections.

Iowa’s Blueprint for Forever Families, 2011

Each year approximately thirty to forty thousand children and youth come to the attention of Iowa’s child welfare and juvenile justice systems and, of those, four to five thousand enter foster care to address child safety or public safety. For most, foster care is a short-term placement designed to allow time to address the reason for removal and to receive the support and services necessary for children to return to their family and community. Unfortunately, too many children and youth remain in foster care too long. Too many youth exit care through emancipation rather than to a permanent family and enduring relationship. Too many young people never realize the security of connections to adults who will be there for a lifetime. When our system fails to find forever families for youth in foster care, long-term outcomes are bleak. A young person’s permanency status is inextricably intertwined with their overall well being.

Capacity vs Competency

“Capacity” and “competency” are terms that are often used interchangeably. However, under Iowa law and specifically within the context of an individual’s rights to make his/ her own decisions, there is a very important difference between the two words. An understanding of the difference between “capacity” and “competency” (as explained on this fact sheet) is essential to determine whether an individual’s consent is valid.

Iowa's Barriers to Prenatal Care Project, July 2015

The findings in this summary are based on the Iowa Barriers to Prenatal Care project. Ongoing since 1991, the purpose of this project is to obtain brief, accurate information about women delivering babies in Iowa hospitals. Specifically, the project seeks to learn about women’s experiences getting prenatal or delivery care during their current pregnancy. Other information is included which may be pertinent to health planners or those concerned with the systematic development of health care services. This project is a cooperative venture of all of Iowa’s maternity hospitals, the University of Northern Iowa Center for Social and Behavioral Research, and the Iowa Department of Public Health. The Robert Wood Johnson Foundation funded the first three years of this project. The current funding is provided by the Iowa Department of Public Health. The Director is Dr. Mary Losch, University of Northern Iowa Center for Social and Behavioral Research. The Coordinator for the project is Rodney Muilenburg. The questionnaire is distributed to nearly ninety maternity hospitals across the state of Iowa. Nursing staff or those responsible for obtaining birth certificate information in the obstetrics unit are responsible for approaching all birth mothers prior to dismissal to request their participation in the study. The questionnaire takes approximately ten minutes to complete. Completed questionnaires are returned to the University of Northern Iowa Center for Social and Behavioral Research for data entry and analysis. Returns are made monthly, weekly, or biweekly depending on the number of births per week in a given hospital. Except in the case of a mother who is too ill to complete the questionnaire, all mothers are eligible to be recruited for participation. The present yearly report includes an analysis of large Iowa cities, frequencies by income, and a trend analysis of the last ten years. Also presented in this report is a frequency analysis of all variables included in the 2014 questionnaire. Unless otherwise noted, all entries reflect percentages. Please note that, because percentages were rounded, total values may not equal 100%. Data presented are based upon 2014 questionnaires received to date (n = 24,696). All analyses reflect unweighted percentages of those responding.

The border of reproductive control: undocumented immigration as a risk factor for unintended pregnancy in Switzerland.

Unintended pregnancies reflect an unmet need for family planning, and are part of health disparities. Using the only database to inquire about pregnancy intention among women in Switzerland, this study examined the relationship between immigrant documentation and unintended pregnancy (UP). Among pregnant women presenting to a Swiss hospital, we compared pregnancy intention between documented and undocumented women. We used logistic regression to examine whether undocumented status was associated with UP after adjusting for other significant predictors. Undocumented women had more unintended pregnancies (75.2 vs. 20.6 %, p = 0.00). Undocumented status was associated with UP after adjustment (OR 6.23, 95 % CI 1.83-21.2), as was a history of psychological problems (OR 4.09, 95 % CI 1.32-12.7). Contraception non-use was notably associated with lower odds of UP (OR 0.01, 95 % CI 0.004-0.04). Undocumented status was significantly associated with UP, even after adjusting for well-recognized risk factors. This highlights the tremendous risk of undocumented status on UP among women in Switzerland.

Älykäs sisältötuote monimediaympäristössä, case: AVO

Diplomityön teoriaosassa tutkittiin monimedian jakelukanavia ja niiden ominaisuuksia sisältöpalveluissa. Työssä esiteltiin keinoja älykkyyden lisäämiseksi monnimediasisältötuotannossa sekä tarkasteltiin sisältöpalvelujen käytettävyyttä. Työssä keskityttiin neuroverkkoteknologiaan, sen toteuttamiseen sekä ohjelmisto-agentteihin. Empiirisessä osassa tutustuttiin työministeriön AVO-ammatinvalintaohjelman toimintaan. Työssä määriteltiin Excel-taulukkoon 280 ammatin ominaisuudet, jotka pohjautuivat AVO:n 122 kysymykseen. Työministeriöstä on saatu 5115 henkilön vastaukset AVO-ammatinvalintaohjelman kysymyksiin. Tätä vastausaineistoa ja tutkimuksessa laadittua ammattitaulukkoa käytettiin neuroverkon opettamiseen. Lopuksi analysoitiin SOM-karttoja. Analyysin tarkoituksena oli tutkia laaditun ammattitaulukon oikeellisuutta ja eri ammattien sijoittumista SOM-kartalle. Tutkimus osoitti, että neuroverkkoteknologia soveltuisi uuden urasuunnittelupalvelun ydinteknologiaksi.

ASP verkostoituneen pk-yrityksen strategisena välineenä

Verkostoitumisen ja tietotekniikan hyväksikäytön merkitys kasvaa jatkuvasti pk-yrityksissä. Tietotekniikan vuokrauspalvelu ASP antaa erityisesti pk-yrityksille uusia mahdollisuuksia toimintansa kehittämiseen. ASP-malli mahdollistaa monipuolisten ja laajojen sovellusten käytön myös pienemmissä yrityksissä. Työn tavoitteena oli selvittää ASP-mallin merkitystä pk-yritysten tietotekniikan hankintamenetelmänä sekä sitä, millaista kilpailuetua ASP-mallilla voidaan saavuttaa verkostoituneissa pk-yrityksissä. Verkostoitumista ja ASP-mallia on tutkittu kirjallisuuden avulla. Tietotekniikan merkitystä ja ASP-mallin mahdollisuuksia verkostoituneille pk-yrityksille on tutkittu kolmen case-yrityksen avulla. Työssä on esitetty perusteluja, miksi pk-yritysten tulisi valita ASP-malli yrityksen tietotekniikan hankintaratkaisuksi ja mistä ASP-mallin luoma kilpailuetu muodostuu. ASP-malli pienentää pääoman tarvetta tietotekniikkahankinnoissa ja siten parantaa yrityksen taloudellista tilannetta sekä mahdollistaa laajojenkin sovellusten käytön. Ulkoistamalla tietotekniikkansa pk-yritykset pystyvät keskittymään ydinosaamiseensa. Verkostoituminen ja ASP-malli antavat pk-yrityksille myös entistä suuremman strategisen toimintavapauden. ASP-mallin uskotaan olevan vuosikymmenen loppuun mennessä yleisin tapa hankkia sovelluksia. Mallin yleistymisen myötä siitä saatava kilpailuetu pienenee, koska tietotekniikkaratkaisuiden erilaistaminen käy vaikeammaksi.

Julkisten hyvinvointi- ja tukipalvelujen hankintastrategia - kunta tuottajasta palvelujen järjestäjäksi ja kehittäjäksi

Tutkielman tavoitteena on selvittää, millaisia tekijöitä kuntien on huomioitava hyvinvointi- ja tukipalvelujen hankinnassa. Tutkielmassa tarkastellaan julkisten palveluhankintojen taustalla vaikuttavia tekijöitä ja vertaillaan näitä tekijöitä hankintastrategian liiketaloudelliseen viitekehykseen. Tulosten valossa pohditaan myös hankintastrategian luomisen ajankohtaisuutta julkisissa palveluhankinnoissa. Tutkielman teoreettinen viitekehys perustuu aikaisempiin hankintastrategiaa ja make or buy –päätöstä käsittelevään kirjallisuuteen ja tieteellisiin tutkimuksiin. Tutkimuksen empiirinen osio koostuu kahdesta case – tapauksesta. Tutkimusmenetelmänä käytettiin henkilökohtaisia haastatteluja. Tutkimuksen kohteina olivat Espoon hyvinvointipalvelujen sekä Kotkan tukipalvelujen hankinta ja kilpailuttaminen. Tutkimuksen lähtökohdista ja viitekehyksestä johtuen kohteeksi valittiin sekä hyvinvointi- että tukipalvelujen hankinta. Lisää näkökulmaa tutkimukseen saatiin valitsemalla kohteiksi kaksi eri kuntaa, mikä sopi myös tutkimuksen toimeksiantajan tavoitteisiin. Tulosten perusteella case – tutkimuksen kohteina olevilla kunnilla ei ole hankintastrategiaa ohjaamassa hyvinvointi- ja tukipalvelujen hankintaa. Liiketaloudellisten hankintastrategiaan vaikuttavien tekijöiden katsotaan soveltuvan myös julkisten palvelujen hankintaan. Tutkimuksen kohteiden välisessä vertailussa hankintojen suunnitelmallisuus painottui hankintaprosessin onnistumiseen vaikuttavana tekijänä. Kuntien oman roolin muuttuminen palvelujen tuottajasta niiden järjestäjäksi ja kehittäjäksi edellyttää tiiviimpää yhteistyötä yksityisen sektorin palveluntuottajan kanssa. Molempien palveluntuottajien osaamisen yhdistäminen antaa puitteet laadukkaiden hyvinvointi- ja tukipalvelujen kehittämiseen.

Nouveautés dans l'ostéogenèse imparfaite: de la recherche à la prise en charge multidisciplinaire [News in osteogenesis imperfecta: from research to clinical management]

Osteogenesis imperfecta (OI) is a rare genetic disease. Today we are able to propose an adapted and efficient management to the patients with this rare disorder (and their families) thanks to a strong collaboration of clinicians and researchers. Recent knowledge regarding the genetics of OI permits an accurate diagnosis of the specific type of OI and its own molecular mechanism, a genetic counseling for family planning and prenatal diagnosis, and in addition more targeted therapeutic options. A specific support with re-education for patients with OI is necessary and efficient. To optimize patient care, a multidisciplinary consultation is proposed at the CHUV, moreover a web site is available for patients, families and therapists: www.infomaladiesrares.ch

Public and Private Production in a Mixed Delivery System: Regulation, Competition and Costs

Academics and policy makers are increasingly shifting the debate concerning the best form of public service provision beyond the traditional dilemma between pure public and pure private delivery modes, because, among other reasons, there is a growing body of evidence that casts doubt on the existence of systematic cost savings from privatization, while any competition seems to be eroded over time. In this paper we compare the relative merits of public and private delivery within a mixed delivery system. We study the role played by ownership, transaction costs, and competition on local public service delivery within the same jurisdiction. Using a stochastic cost frontier, we analyze the public-private urban bus system in the Barcelona Metropolitan Area. Our results suggest that private firms tendering the service have higher delivery costs than those incurred by the public firm, especially when transaction costs are taken into account. Tenders, therefore, do not help to reduce delivery costs. Our results suggest that under a mixed delivery scheme, which permits the co-existence of public and private production, the metropolitan government and the regulator can use private delivery to contain costs in the public firm and, at the same time, benefit from the greater flexibility of private firms for dealing with events not provided for under contract.

Similar problems, different solutions: Comparing refuse collection in the Netherlands and Spain

Local public service provision can vary greatly because of differences in institutional arrangements, public service markets, and national traditions regarding government intervention. In this paper we compare the procedures adopted by the local governments of the Netherlands and Spain in arranging for the provision of solid waste collection. We find that Spain faces a consolidation problem, opting more frequently to implement policies of privatization and cooperation, at the expense of competition. By contrast, the Netherlands has, on average, larger municipalities, resorting somewhat less to privatization and cooperation, and more to competition. The two options - cooperation and competition - have their merits when striving to strike a balance between transaction costs and scale economies. The choices made in organizational reform seem to be related to several factors, among which the nature of the political system and the size of municipalities appear to be relevant.

Towards open access networks – prototyping with the Lappeenranta model

The provision of Internet access to large numbers has traditionally been under the control of operators, who have built closed access networks for connecting customers. As the access network (i.e. the last mile to the customer) is generally the most expensive part of the network because of the vast amount of cable required, many operators have been reluctant to build access networks in rural areas. There are problems also in urban areas, as incumbent operators may use various tactics to make it difficult for competitors to enter the market. Open access networking, where the goal is to connect multiple operators and other types of service providers to a shared network, changes the way in which networks are used. This change in network structure dismantles vertical integration in service provision and enables true competition as no service provider can prevent others fromcompeting in the open access network. This thesis describes the development from traditional closed access networks towards open access networking and analyses different types of open access solution. The thesis introduces a new open access network approach (The Lappeenranta Model) in greater detail. The Lappeenranta Model is compared to other types of open access networks. The thesis shows that end users and service providers see local open access and services as beneficial. In addition, the thesis discusses open access networking in a multidisciplinary fashion, focusing on the real-world challenges of open access networks.

Veus ignorades: representacions socials, subjectivitat i resiliència en persones grans amb pèrdua d’autonomia funcional

Els processos per a l’aprovació i la implementació de la Llei per a l’Autonomia personal i l’Atenció a les Persones en situació de Dependència (LAPAD) han donat lloc a un intens debat polític i social que, coincidint també amb les millores en la provisió de serveis i els avenços mèdics, ha contribuït a un procés de classificació i d’etiquetatge basats en els dèficits de les persones que es troben en aquestes circumstàncies. Aquesta visió anul·la el subjecte i la seva experiència singular i condiciona l’abordatge dels models d’atenció i de cura. L’estudi pretén fer una aproximació a les persones grans amb pèrdua d’autonomia funcional, fent emergir les seves veus, que expressen com perceben, interpreten, afronten i es reajusten a la nova situació. Partint d’un enfocament constructivista, basat en la subjectivitat, es fa un recorregut sobre els models de la discapacitat que han reeixit en l’activitat científica dels darrers anys, els mecanismes de regulació de les pèrdues que defensen les teories del cicle vital i les aportacions que s’han fet sobre el model de la resiliència aplicat a les persones que envelleixen. El resultats de l’estudi mostren com les representacions i els significats que les persones grans atribueixen a la seva experiència s’inscriuen en les seves trajectòries vitals, donant un sentit únic i singular a la forma de viure i de respondre a la pèrdua d’autonomia funcional i les seves conseqüències. Aquelles que expressen una vivència d’integritat respecte de la vida viscuda, amb predomini d’afectes positius envers un mateix i els altres, que conserven l’esperança i el desig de continuar vivint, s’ajusten a les pèrdues de manera més satisfactòria que aquelles que expressen desconfiança i una certa amargor respecte de la pròpia vida. D’això se’n deriva que els espais d’escolta i d’acompanyament poden ser un recurs vàlid i necessari en el qual, a través de la paraula i el testimoni narrat, el subjecte pugui repensar i resignificar les seves experiències.