Parir en casa, parir en el hospital : Algunas dimensiones para el análisis de los lugares del parto

En una investigación doctoral sobre la intervención médica en el proceso de embarazo, parto y puerperio, resulta relevante preguntarnos por la espacialidad del parto, de su atención/asistencia, por los actores involucrados y por las dinámicas diversas que generan y son generadas por los distintos lugares en los que sucede. En estas líneas reflexionaremos sobre los lugares del parto, poniendo el énfasis en el que propone e impone el modelo médico hegemónico en salud, el hospital, y la "alternativa" que supone el parto en casa, retomando los aportes de la perspectiva geográfica.

Parir en casa, parir en el hospital : Algunas dimensiones para el análisis de los lugares del parto

En una investigación doctoral sobre la intervención médica en el proceso de embarazo, parto y puerperio, resulta relevante preguntarnos por la espacialidad del parto, de su atención/asistencia, por los actores involucrados y por las dinámicas diversas que generan y son generadas por los distintos lugares en los que sucede. En estas líneas reflexionaremos sobre los lugares del parto, poniendo el énfasis en el que propone e impone el modelo médico hegemónico en salud, el hospital, y la "alternativa" que supone el parto en casa, retomando los aportes de la perspectiva geográfica.

Parir en casa, parir en el hospital : Algunas dimensiones para el análisis de los lugares del parto

En una investigación doctoral sobre la intervención médica en el proceso de embarazo, parto y puerperio, resulta relevante preguntarnos por la espacialidad del parto, de su atención/asistencia, por los actores involucrados y por las dinámicas diversas que generan y son generadas por los distintos lugares en los que sucede. En estas líneas reflexionaremos sobre los lugares del parto, poniendo el énfasis en el que propone e impone el modelo médico hegemónico en salud, el hospital, y la "alternativa" que supone el parto en casa, retomando los aportes de la perspectiva geográfica.

Mortalidad perinatal en los partos únicos asistidos a término en España entre 1995 y 2009 según ocurrieran en domicilio particular o en centro sanitario

Objetivo principal: Evidenciar posibles diferencias en la mortalidad perinatal de los partos únicos asistidos a término en España entre 1995 y 2009, según ocurrieran en domicilio particular o en centro sanitario. Metodología: Estudio de cohorte retrospectivo a partir del registro de partos del Instituto Nacional de Estadística de España (INE). Resultados principales: Entre 1995 y 2009 ocurrieron 23 muertes del feto o del recién nacido (hasta las primeras 24 horas de vida) sobre un total de 14.614 partos únicos asistidos a término en domicilio particular (1,57 muertes cada mil partos). El número de muertes en partos de las mismas características ocurridos en centros sanitarios fue de 7.548 sobre un total de 4.716.956 partos (1,60 muertes cada mil partos). OR=0,98 IC(95%)=0,65-1,48. Conclusión principal: Entre 1995 y 2009 no se han dado diferencias estadísticamente significativas en relación con la mortalidad del feto o el recién nacido registrada en el Boletín Estadístico del Parto, entre los partos únicos asistidos a término en domicilio particular y los partos de las mismas características atendidos en centro sanitario.

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Etiological and Clinical Features of Childhood Psychotic Symptoms Results From a Birth Cohort

Context: It has been reported that childhood psychotic symptoms are common in the general population and may signal neurodevelopmental processes that lead to schizophrenia. However, it is not clear whether these symptoms are associated with the same extensive risk factors established for adult schizophrenia. Objective: To examine the construct validity of children`s self-reported psychotic symptoms by testing whether these symptoms share the risk factors and clinical features of adult schizophrenia. Design: Prospective, longitudinal cohort study of a nationally representative birth cohort in Great Britain. Participants: A total of 2232 twelve-year-old children followed up since age 5 years ( retention, 96%). Main Outcome Measure: Children`s self-reported hallucinations and delusions. Results: Children`s psychotic symptoms are familial and heritable and are associated with social risk factors (eg, urbanicity); cognitive impairments at age 5; home-rearing risk factors ( eg, maternal expressed emotion); behavioral, emotional, and educational problems at age 5; and comorbid conditions, including self-harm. Conclusions: The results provide a comprehensive picture of the construct validity of children`s self-reported psychotic symptoms. For researchers, the findings indicate that children who have psychotic symptoms can be recruited for neuroscience research to determine the pathogenesis of schizophrenia. For clinicians, the findings indicate that psychotic symptoms in childhood are often a marker of an impaired developmental process and should be actively assessed.

Neonatal mortality: description and effect of hospital of birth after risk adjustment

OBJECTIVE: To assess the effect of hospital of birth on neonatal mortality. METHODS: A birth cohort study was carried out in Pelotas, Southern Brazil, in 2004. All hospital births were assessed by daily visits to all maternity hospitals and 4558 deliveries were included in the study. Mothers were interviewed regarding potential risk factors. Deaths were monitored through regular visits to hospitals, cemeteries and register offices. Two independent pediatricians established the underlying cause of death based on information obtained from medical records and home visits to parents. Logistic regression was used to estimate the effect of hospital of birth, controlling for confounders related to maternal and newborn characteristics, according to a conceptual model. RESULTS: Neonatal mortality rate was 12.7‰ and it was highly influenced by birthweight, gestational age, and socioeconomic variables. Immaturity was responsible for 65% of neonatal deaths, followed by congenital anomalies, infections and intrapartum asphyxia. Adjusting for maternal characteristics, a three-fold increase in neonatal mortality was seen between similar complexity hospitals. The effect of hospital remained, though lower, after controlling for newborn characteristics. CONCLUSIONS: Neonatal mortality was high, mainly related to immaturity, and varied significantly across maternity hospitals. Further investigations comparing delivery care practices across hospitals are needed to better understand NMR variation and to develop strategies for neonatal mortality reduction.

Residential Exposure to Outdoor Air Pollution during Pregnancy and Anthropometric Measures at Birth in a Multicenter Cohort in Spain

BACKGROUND. A growing body of research suggests that prenatal exposure to air pollution may be harmful to fetal development. We assessed the association between exposure to air pollution during pregnancy and anthropometric measures at birth in four areas within the Spanish Children's Health and Environment (INMA) mother and child cohort study. METHODS. Exposure to ambient nitrogen dioxide (NO2) and benzene was estimated for the residence of each woman (n = 2,337) for each trimester and for the entire pregnancy. Outcomes included birth weight, length, and head circumference. The association between residential outdoor air pollution exposure and birth outcomes was assessed with linear regression models controlled for potential confounders. We also performed sensitivity analyses for the subset of women who spent more time at home during pregnancy. Finally, we performed a combined analysis with meta-analysis techniques. RESULTS. In the combined analysis, an increase of 10 µg/m3 in NO2 exposure during pregnancy was associated with a decrease in birth length of -0.9 mm [95% confidence interval (CI), -1.8 to -0.1 mm]. For the subset of women who spent ≥ 15 hr/day at home, the association was stronger (-0.16 mm; 95% CI, -0.27 to -0.04). For this same subset of women, a reduction of 22 g in birth weight was associated with each 10-µg/m3 increase in NO2 exposure in the second trimester (95% CI, -45.3 to 1.9). We observed no significant relationship between benzene levels and birth outcomes. CONCLUSIONS. NO2 exposure was associated with reductions in both length and weight at birth. This association was clearer for the subset of women who spent more time at home.

Association between GIS-based exposure to urban air pollution during pregnancy and birth weight in the INMA Sabadell Cohort

Background: There is growing evidence that traffic-related air pollution reduces birth weight. Improving exposure assessment is a key issue to advance in this research area.Objective: We investigated the effect of prenatal exposure to traffic-related air pollution via geographic information system (GIS) models on birth weight in 570 newborns from the INMA (Environment and Childhood) Sabadell cohort.Methods: We estimated pregnancy and trimester-specific exposures to nitrogen dioxide and aromatic hydrocarbons [benzene, toluene, ethylbenzene, m/p-xylene, and o-xylene (BTEX)] by using temporally adjusted land-use regression (LUR) models. We built models for NO2 and BTEX using four and three 1-week measurement campaigns, respectively, at 57 locations. We assessed the relationship between prenatal air pollution exposure and birth weight with linear regression models. We performed sensitivity analyses considering time spent at home and time spent in nonresidential outdoor environments during pregnancy.Results: In the overall cohort, neither NO2 nor BTEX exposure was significantly associated with birth weight in any of the exposure periods. When considering only women who spent < 2 hr/day in nonresidential outdoor environments, the estimated reductions in birth weight associated with an interquartile range increase in BTEX exposure levels were 77 g [95% confidence interval (CI), 7–146 g] and 102 g (95% CI, 28–176 g) for exposures during the whole pregnancy and the second trimester, respectively. The effects of NO2 exposure were less clear in this subset.Conclusions: The association of BTEX with reduced birth weight underscores the negative role of vehicle exhaust pollutants in reproductive health. Time–activity patterns during pregnancy complement GIS-based models in exposure assessment.

Perceived stress in elderly stroke survivors after hospital discharge to home

AbstractOBJECTIVETo evaluate the relationship between perceived stress and comorbidities, neurological deficit, functional independence and depressive symptoms of stroke survivors after hospital discharge.METHODCross-sectional study with 90 elderly stroke survivors. The National Institutes of Health Stroke Scale instrument, the Functional Independence Measure instrument, the Geriatric Depression Scale and the Perceived Stress Scale were used. Bivariate Pearson correlation, independent t test and multiple regression analysis were used to evaluate the relationship between perceived stress and other variables.RESULTSThe final regression model showed that higher perceived stress was related to less functional independence (p= 0.022) and more depressive symptoms (p <0.001).CONCLUSIONAt hospital discharge, interventions should be planned for the treatment of depressive symptoms and to create adaptation strategies to the reduction of functional independence, in order to reduce the stress of the survivors.

Frequency and determinants of urgent requests to home care agencies for community-dwelling elderly.

We analyzed a one-year case series and performed a longitudinal (4 month) cohort analysis of urgent requests made to home care agencies by and for their > or = 65 years old clients in order to estimate the frequency of unscheduled services delivered by home care agencies and to identify risk factors. All 40 home care agencies located in a Swiss region were included in the study and we registered 3,816 urgent requests (75/1,000 > or = 65 years residents per year). Among home care users, the presence of a urinary catheter, incontinence and the need for assistance in bathing were predictors of unscheduled services. Resources should be planned in order to help home care teams to handle unexpected, disruptive clusters of urgent requests that may compromise their scheduled activities.

Negotiating home and belonging. Young Kurds in Finland

This study looks at negotiation of belonging and understandings of home among a generation of young Kurdish adults who were born in Iraq, Iran, and Turkey and who reached adulthood in Finland. The young Kurds taking part in the study belong to the generation of migrants who moved to Finland in their childhood and early teenage years from the region of Kurdistan and elsewhere in the Middle East, then grew to adulthood in Finland. In theoretical terms, the study draws broadly from three approaches: transnationalism, intersectionality, and narrativity. Transnationalism refers to individuals’ cross-border ties and interaction extending beyond nationstates’ borders. Young people of migrant background, it has been suggested, are raised in a transnational space that entails cross-border contacts, ties, and visits to the societies of departure. How identities and feelings of belonging become formed in relation to the transnational space is approached with an intersectional frame, for examination of individuals’ positionings in terms of their intersecting attributes of gender, age/generation, and ethnicity, among others. Focus on the narrative approach allows untangling how individuals make sense of their place in the social world and how they narrate their belonging in terms of various mechanisms of inclusion and exclusion, including institutional arrangements and discursive categorisation schemes. The empirical data for this qualitative study come from 25 semi-structured thematic interviews that were conducted with 23 young Kurdish adults living in Turku and Helsinki between 2009 and 2011. The interviewees were aged between 19 and 28 years at the time of interviewing. Interview themes involved topics such as school and working life, family relations and language-learning, political activism and citizenship, transnational ties and attachments, belonging and identification, and plans for the future and aspirations. Furthermore, data were collected from observations during political demonstrations and meetings, along with cultural get-togethers. The data were analysed via thematic analysis. The findings from the study suggest that young Kurds express a strong sense of ‘Kurdishness’ that is based partially on knowing the Kurdish language and is informed by a sense of cultural continuity in the diaspora setting. Collective Kurdish identity narratives, particularly related to the consciousness of being a marginalised ‘other’ in the context of the Middle East, are resonant in young interviewees’ narrations of ‘Kurdishness’. Thus, a sense of ‘Kurdishness’ is drawn from lived experiences indexed to a particular politico-historical context of the Kurdish diaspora movements but also from the current situation of Kurdish minorities in the Middle East. On the other hand, young Kurds construct a sense of belonging in terms of the discursive constructions of ‘Finnishness’ and ‘otherness’ in the Finnish context. The racialised boundaries of ‘Finnishness’ are echoed in young Kurds’ narrations and position them as the ‘other’ – namely, the ‘immigrant’, ‘refugee’, or ‘foreigner’ – on the basis of embodied signifiers (specifically, their darker complexions). This study also indicates that young Kurds navigate between gendered expectations and norms at home and outside the home environment. They negotiate their positionings through linguistic repertoires – for instance, through mastery of the Finnish language – and by adjusting their behaviour in light of the context. This suggests that young Kurds adopt various forms of agency to display and enact their belonging in a transnational diaspora space. Young Kurds’ narrations display both territorially-bounded and non-territorially-bounded elements with regard to the relationship between identity and locality. ‘Home’ is located in Finland, and the future and aspirations are planned in relation to it. In contrast, the region of Kurdistan is viewed as ‘homeland’ and as the place of origins and roots, where temporary stays and visits are a possibility. The emotional attachments are forged in relation to the country (Finland) and not so much relative to ‘Finnishness’, which the interviewees considered an exclusionary identity category. Furthermore, identification with one’s immediate place of residence (city) or, in some cases, with a religious identity as ‘Muslim’ provides a more flexible venue for identification than does identifying oneself with the (Finnish) nation.

Breastfeeding preterm infant from the delivery ward via nicu to home

The aim of this study was to examine how to support breastfeeding of preterm infants immediately after birth in the delivery ward, during their hospital stay in a neonatal intensive care unit (NICU), and at home after hospital discharge. Specifically, the role of early physical contact, maternal breastfeeding attitude, and an internet-based peer support group were investigated. The delivery ward practices concerning the implementation of early physical contact between a mother and her infant admitted to a NICU were examined by a structured survey in two hospitals. An Internet-based, breastfeeding peer-support intervention for the mothers of preterm infants was developed and tested in a randomized controlled design with one year follow-up. The main outcomes were the duration of exclusive and overall breastfeeding, expressing milk, and maternal attitude. In addition, the perceptions of mothers of preterm infants were investigated by analyzing the peer-support group discussions with a qualitative approach. The implementation of early physical contact was different between the two hospitals studied and was based more on hospital routines than the physiological condition of the infant. Preterm infants, who were born before a gestational age (GA) of 32 weeks, were hardly ever allowed to have early contact with their mothers. Both, a higher GA and early physical contact predicted earlier initiation and increased frequency of breastfeeding in the NICU. A maternal breastfeeding-favorable attitude predicted increased frequency of breastfeeding in the NICU and also a longer duration of overall breastfeeding. The actual duration of breastfeeding was, however, shorter than the mothers intended in advance. The internet-based, peer-support intervention had no effect on the duration of breastfeeding, expressing milk, or maternal attitude. The participating mothers enjoyed the possibility of sharing their experiences of preterm infants with other mothers in similar situations. Some of the mothers also experienced being given useful advice for breastfeeding. Based on the mothers’ discussions, a process of breastfeeding preterm infants was created. This included some paradoxical elements in the NICU where, for example, breast milk was emphasized over breastfeeding and support in the hospital varied. Hospital discharge was a critical point, when the mothers faced breastfeeding in reality. Over time, the mothers assimilated their breastfeeding experience into part of being a mother. The care practices related to early physical contact in delivery wards need to be re-evaluated to allow more infants to have a moment with the mother. Maternal attitude could be screened prenatally and attitude-focused interventions developed. Breastfeeding support in the NICU should be standardized. Internet-based breastfeeding peer-support intervention was feasible but additional research is needed.

Locating home : the diverse experiences of recent newcomer youth and first generation youth within Ontario's education system

This study has found that youth who or whose parents had left their home country for fear-based reasons were less involved within their school and wider community than youth who left or whose parents left for reasons concerning their social mobility. Many existing studies focus on the challenges newcomer youth experience within the education system (see Anisef, Brown, Phythian, & Sweet, 2010), however through the use of qualitative methodologies this study expanded on the current literature by further examining why it is some youth are successful in overcoming such challenges, while others are not. This study supported what has been demonstrated in the literature regarding challenges faced by newcomer youth and resources to address such challenges. Despite challenges experienced within the education system, youth planned to complete secondary school and attend a postsecondary institution. However, not all youth anticipated remaining in Canada upon completion of their education, with youth or youth whose parents left their home country for fear-based reasons frequently discussing the possibility of returning to their or their parents' home country. Thus, perhaps these youth were less involved within their school, as their goal was not necessarily to establish or maintain connections within their community as they may have viewed residing in Canada as temporary. This finding has important implications, as there are benefits to involvement in extracurricular activities, which may assist youth in overcoming challenges encountered within the education system. Therefore, it would seem that youth who had or whose parents had left their home country for reasons concerning their social mobility may have be at an advantage within the education system with respect to their involvement in school. Perhaps then this differential involvement may at least partially explain why it is some newcomer youth are able to overcome challenges they experience in the education system, while others are not. Both policy and theoretical implications are discussed.

Modelling risk perception and trust in food safety information within the theory of planned behaviour

This study suggests a statistical strategy for explaining how food purchasing intentions are influenced by different levels of risk perception and trust in food safety information. The modelling process is based on Ajzen's Theory of Planned Behaviour and includes trust and risk perception as additional explanatory factors. Interaction and endogeneity across these determinants is explored through a system of simultaneous equations, while the SPARTA equation is estimated through an ordered probit model. Furthermore, parameters are allowed to vary as a function of socio-demographic variables. The application explores chicken purchasing intentions both in a standard situation and conditional to an hypothetical salmonella scare. Data were collected through a nationally representative UK wide survey of 533 UK respondents in face-to-face, in-home interviews. Empirical findings show that interactions exist among the determinants of planned behaviour and socio-demographic variables improve the model's performance. Attitudes emerge as the key determinant of intention to purchase chicken, while trust in food safety information provided by media reduces the likelihood to purchase. (C) 2006 Elsevier Ltd. All rights reserved.