Maternal health care professionals perspective on the provision and use of antenatal and delivery care : a qualitative descriptive study in rural Vietnam

Background. High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. Method. The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result. Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Conclusion. Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.

"An on-going individual adjustment" : a qualitative study of midwives' experiences counselling pregnant women on physical activity in Sweden

Background: In Sweden, midwives play prominent supportive role in antenatal care by counselling and promoting healthy lifestyles. This study aimed to explore how Swedish midwives experience the counselling of pregnant women on physical activity, specifically focusing on facilitators and barriers during pregnancy. Also, addressing whether the midwives perceive that their own lifestyle and body shape may influence the content of the counselling they provide. Methods: Eight focus group discussions (FGD) were conducted with 41 midwives working in antenatal care clinics in different parts of Sweden between September 2013 and January 2014. Purposive sampling was applied to ensure a variation in age, work experience, and geographical location. The FGD were digitally recorded, transcribed verbatim, and analyzed using manifest and latent content analysis. Results: The main theme- "An on-going individual adjustment" was built on three categories: "Counselling as a challenge"; "Counselling as walking the thin ice" and "Counselling as an opportunity" reflecting the midwives on-going need to adjust their counselling depending on each woman's specific situation. Furthermore, counselling pregnant women on physical activity was experienced as complex and ambiguous, presenting challenges as well as opportunities. When midwives challenged barriers to physical activity, they risked being rejected by the pregnant women. Despite risking rejection, the midwives tried to promote increased physical activity based on their assessment of individual needs of the pregnant woman. Some participants felt that their own lifestyle and body shape might negatively influence the counselling; however, the majority of participants did not agree with this perspective. Conclusions: Counselling on physical activity during pregnancy may be a challenging task for midwives, characterized by on-going adjustments based on a pregnant woman's individual needs. Midwives strive to find individual solutions to encourage physical activity. However, to improve their counselling, midwives may benefit from further training, also organizational and financial barriers need to be addressed. Such efforts might result in improved opportunities to further support pregnant women's motivation for performance of physical activity.

Older people's experience of utilisation and administration of medicines in a health- and social care context

BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care. AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care. DESIGN: A qualitative descriptive study. METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used. FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process. CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine. RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

Ricoeur on responsibility

There are at least two themes in Paul Ricoeur’s recent essay, ‘The Concept of Responsibility: An Essay in Semantic Analysis’ (Ricoeur 2000). The first of these is in the foreground of the essay. It concerns how the concept of responsibility has evolved in recent times from a delimited juridical notion to a much broader moral concept. The second theme remains in the background of the essay and alludes to theses that Ricoeur has developed in his book, Oneself as Another (Ricoeur 1992). This theme concerns how responsibility relates to personal and moral identity and how it emerges dialectically from social formation and from an eliminable subjectivity. In this paper I will explicate Ricoeur’s first theme and also explore how the second theme might solve the problem of the unassumable scope and range of our responsibilities which the first theme might suggest.

Prototype Generation from Ontology Charts

Semantic Analysis is a business analysis method designed to capture system requirements. While these requirements may be represented as text, the method also advocates the use of Ontology Charts to formally denote the system's required roles, relationships and forms of communication. Following model driven engineering techniques, Ontology Charts can be transformed to temporal Database schemas, class diagrams and component diagrams, which can then be used to produce software systems. A nice property of these transformations is that resulting system design models lend themselves to complicated extensions that do not require changes to the design models. For example, resulting databases can be extended with new types of data without the need to modify the database schema of the legacy system. Semantic Analysis is not widely used in software engineering, so there is a lack of experts in the field and no design patterns are available. This make it difficult for the analysts to pass organizational knowledge to the engineers. This study describes an implementation that is readily usable by engineers, which includes an automated technique that can produce a prototype from an Ontology Chart. The use of such tools should enable developers to make use of Semantic Analysis with minimal expertise of ontologies and MDA.

The language of subjective well-being

The Language of Depression project is a linguistic study of the language of Acute Care Hospital patients suffering depression with the ultimate aim of enabling medical and nursing staff to become more aware of their patients’ depression and immediately refer them for psychological or psychiatric help. As part of that larger project, and following recent developments in positive psychology (e.g. Seligman 2002) this paper will focus exclusively on the control group, that is, the language of those Acute Care Hospital patients deemed non-depressed. The data comprise 30 minute interviews between the patients and a Consultation-liaison psychiatrist. Prior to interview, the patients were screened using the Brief Case-find for Depression (Clarke et al. 1994). From the screening, patients were then deemed likely to be depressed and likely to be non-depressed. This paper reports on the analysis of 10 patients deemed as non-depressed. Using the linguistic theory of Systemic Functional Linguistics, the data were analysed for their Appraisal features (e.g. Martin and Rose 2003). Appraisal analysis provides a lexico-semantic analysis that is concerned with how speakers use language to evaluate as well as negotiate relationships. The Appraisal analysis has been used to identify in the language of non-depressed patients the types of attitudes that facilitate psychological well-being. This paper will present some analysed extracts from the interviews to show how key features of subjective well-being are realised in the language of non-depressed Acute Care Hospital patients.

A statistical-driven approach for automatic classification of events in AFL video highlights

Due to the repetitive and lengthy nature, automatic content-based summarization is essential to extract a more compact and interesting representation of sport video. State-of-the art approaches have confirmed that high-level semantic in sport video can be detected based on the occurrences of specific audio and visual features (also known as cinematic). However, most of them still rely heavily on manual investigation to construct the algorithms for highlight detection. Thus, the primary aim of this paper is to demonstrate how the statistics of cinematic features within play-break sequences can be used to less-subjectively construct highlight classification rules. To verify the effectiveness of our algorithms, we will present some experimental results using six AFL (Australian Football League) matches from different broadcasters. At this stage, we have successfully classified each play-break sequence into: goal, behind, mark, tackle, and non-highlight. These events are chosen since they are commonly used for broadcasted AFL highlights. The proposed algorithms have also been tested successfully with soccer video.

Design earthquake ground motion prediction for Perth metropolitan area with microtremor measurements for site characterization

Perth is the largest city in Western Australia and home to three-quarters of the state's residents. In recent decades, there have been a lot of earthquake activities just east of Perth in an area known as the South-West Seismic Zone. Previous numerical results of site response analyses based on limited available geology information for PMA indicated that Perth Basin might amplify the bedrock motion by more than 10 times at some frequencies and at some sites. Hence, more detailed studies on site characterization and amplification are necessary. The microtremor method using spatial autocorrelation (SPAC) processing is a useful tool for gaining thickness and shear wave velocity (SWV) of sediments and has been adopted in many previous studies. In this study, the response spectrum of rock site corresponding to the 475-year return period for PMA is defined according to the probabilistic seismic hazard analysis (PSHA) based on the latest ground motion attenuation model of Southwest Western Australia. Site characterization in PMA is performed using two microtremor measurements, namely SPAC technique and H/V method. The clonal selection algorithm (CSA) is introduced to perform direct inversion of SPAC curves to determine the soil profiles of representative PMA sites investigated in this study. Using the simulated bedrock motion as input, the responses of the soil sites are estimated using numerical method based on the shear-wave velocity vs. depth profiles determined from the SPAC technique. The response spectrum of the earthquake ground motion on surface of each site is derived from the numerical results of the site response analysis, and compared with the respective design spectrum defined in the Australian Earthquake Loading Code. The comparison shows that the code spectra are conservative in the short period range, but may slightly underestimate the response spectrum at some long period range.

Investigation of population heterogeneity of diet use among middle-aged Australians

The purpose of the study was to determine patterns of diet use among middle-aged Australian men and women and the relationships between these different usage patterns and demographic characteristics, health status and health habits. A cross-sectional mail survey was conducted among a random sample of 2975 people aged 40–71 years in Victoria, Australia. A total of 1031 usable questionnaires were obtained which included information about the use of diets (e.g. low-fat and low-salt) during the past 3 months along with demographic information, health status and health habits. Based on the responses about the use of thirteen diets for both sexes, latent class analysis was employed to identify the optimal number of use of diets and the assignment of participants to particular groups. Three types of diet uses were identified and provisionally named: diet use, selected diet use and non-diet use. This classification was associated with demographics, health status and health habits, and these associations differed between men and women. The findings suggest that nutrition education programmes should be tailored to the different needs of the diet use groups.

Narrative structure detection through audio pace

We use the concept of film pace, expressed through the audio, to analyse the broad level narrative structure of film. The narrative structure is divided into visual narration, action sections, and audio narration, plot development sections. We hypothesise, that changes in the narrative structure signal a change in audio content, which is reflected by a change in audio pace. We test this hypothesis using a number of audio feature functions, that reflect the audio pace, to detect changes in narrative structure for 8 films of varying genres. The properties of the energy were then used to determine the. audio pace feature corresponding to the narrative, structure for each film analysed. The method was successful in determining the narrative structure for 1 of the films, achieving an overall precision of 76.4% and recall of 80.3%, We map the properties of the speech and energy of film audio to the higher level semantic concept of audio pace. The audio pace was in turn applied to a higher level semantic analysis of the structure of film.

Organized blood pressure control programs to prevent stroke in Australia : would they be cost-effective?

Background and Purpose—: High blood pressure (BP) is the most important modifiable stroke risk factor. Worldwide high BP in many people is uncontrolled or people are unaware of their BP status. We aimed to assess whether a program of organized multidisciplinary care and medication would be cost-effective for improving BP control for the prevention of stroke.

Methods—: A novel aspect was to simulate the intervention to match recent primary care initiatives (eg, new Medicare reimbursement items) to ensure policy relevance. Current practice and additional costs of each intervention were included using the best available evidence. The differences in the cost per quality-adjusted life year (QALY) gained for the interventions were compared against current practice. Cost-effectiveness was defined as cost per QALY gained was less than Australian dollars (AUD) 50 000 (societal perspective; reference year 2004). The robustness of estimates was assessed with probabilistic multivariable uncertainty analysis.

Results—: For primary prevention, the median cost per QALY gained was AUD11 068 (95% uncertainty interval AUD5201 to AUD18 696) in those aged 75 years or older and was AUD17 359 (95% uncertainty interval AUD10 516 to AUD26 036) in those aged 55 to 84 years with >=15% absolute risk of stroke. Primary prevention interventions were not cost-effective if aged younger than 50 years. The median cost per QALY gained for secondary prevention was AUD1811 and AUD4704, depending on which medications were modeled.

Conclusions—: Organized care for BP control targeted at specific populations offers excellent value over current practice. Organized care for secondary prevention provided the greatest benefits and strongest cost-effectiveness. Translation into clinical practice requires improved use of relevant Medicare policy in Australia.

Document clustering in correlation similarity measure space

This paper presents a new spectral clustering method called correlation preserving indexing (CPI), which is performed in the correlation similarity measure space. In this framework, the documents are projected into a low-dimensional semantic space in which the correlations between the documents in the local patches are maximized while the correlations between the documents outside these patches are minimized simultaneously. Since the intrinsic geometrical structure of the document space is often embedded in the similarities between the documents, correlation as a similarity measure is more suitable for detecting the intrinsic geometrical structure of the document space than euclidean distance. Consequently, the proposed CPI method can effectively discover the intrinsic structures embedded in high-dimensional document space. The effectiveness of the new method is demonstrated by extensive experiments conducted on various data sets and by comparison with existing document clustering methods.