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.

Being a bridge : Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study

Background: Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence. Methods: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis. Results: The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women. Conclusion: Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

Property rights as a public policy tool: an empirical analysis of the social and economic effects

Secure property rights are considered a key determinant of economic development. However, the evaluation of the causal effects of land titling is a difficult task. The Brazilian government through a program called "Papel Passado" has issued titles, since 2004, to over 85,000 families and has the goal to reach 750,000. Furthermore, another topic in Public Policy that is crucial to developing economies is income generation and child labor force participation. Particularly, in Brazil, about 5.4 million children and teenagers between 5 and 17 years old are still working. This thesis examines the direct impact of securing a property title on income and child labor force participation. In order to isolate the causal role of ownership security, this study uses a comparison between two close and very similar communities in the City of Osasco case (a town with 650,000 people in the São Paulo metropolitan area). One of them, Jardim Canaã, was fortunated to receive the titles in 2007, the other, Jardim DR, given fiscal constraints, only will be part of the program schedule in 2012, and for that reason became the control group. Also, this thesis also aims to test if there is any relationship between land title and happiness. The estimates suggest that titling results in a substantial decrease of child labor force participation, increase of income and happiness for the families that received the title compared to the others.

Surface dental enamel lead levels and antisocial behavior in Brazilian adolescents

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Genotoxicity of cigarette smoking in maternal and newborn lymphocytes

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A new short and simple health-related quality of life measurement for paediatric rheumatic diseases: initial validation in juvenile idiopathic arthritis

Objective. To develop and validate a new short and simple measure of health-related quality of life (HRQL) in children with juvenile idiopathic arthritis (JIA).Methods. The Paediatric Rheumatology Quality of Life Scale (PRQL) is a 10-item questionnaire that explores HRQL in two domains: physical health (PhH) and psychosocial health (PsH). Validation of the parent proxy report and child self-report versions of the instrument was accomplished by evaluating 472 JIA patients and similar to 800 healthy children. Validation analyses included assessment of feasibility, face and content validity; construct and discriminative ability; internal structure and consistency; test-retest reliability; responsiveness to clinical change; and minimal clinically important difference.Results. The PRQL was found to be feasible and to possess both face and content validity. The PRQL score correlated in the predicted range with most of the other JIA outcome measures, thereby demonstrating good construct validity, and discriminated well between different levels of disease severity. Assessment of internal structure (factor analysis) revealed that the PhH and PsH subscales identify two unambiguously separated domains. The internal consistency (Cronbach's alpha) was 0.86. The intraclass correlation coefficient for test-retest reliability was 0.91. The PRQL revealed fair responsiveness, with a standardized response mean of 0.67 in improved patients. Overall, the PRQL appeared to be more able to capture physical HRQL than psychosocial HRQL.Conclusion. The PRQL was found to possess good measurement properties and is, therefore, a valid instrument for the assessment of HRQL in children with JIA. This tool is primarily proposed for use in standard clinical care.

Changes in the size of cephalic salivary glands of Apis mellifera and Scaptotrigona postica (Hymenoptera: Apidae) queens and workers in different life phases

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Vitellogenin content in fat body and ovary homogenates of workers and queens of Melipona quadrifasciata anthidioides during vitellogenesis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Mechanical and electrical driving field induced high-frequency dielectric anomalies in ferroelectric systems

Polycrystalline or single-crystal ferroelectric materials present dielectric dispersion in the frequency range 100 MHz-1 GHz that has been attributed to a dispersive ( relaxation-like) mechanism as well as a resonant mechanism. Particularly in 'normal' ferroelectric materials, a dielectric response that is indistinguishable from dispersion or a resonance has been reported. Nevertheless, the reported results are not conclusive enough to distinguish each mechanism clearly. A detailed study of the dielectric dispersion phenomenon has been carried out in PbTiO3-based ferroelectric ceramics, with the composition Pb1-xLaxTiO3 (x = 0.15), over a wide range of temperatures and frequencies, including microwave frequencies. The dielectric response of La-modified lead titanate ferroelectric ceramics, in 'virgin' and poled states, has been investigated in the temperature and frequency ranges 300-450 K and 1 kHz-2 GHz, respectively. The results revealed that the frequency dependence of the dielectric anomalies, depending on the measuring direction with respect to the orientation of the macroscopic polarization, may be described as a general mechanism related to an 'over-damped' resonant process. Applying either a uniaxial stress along the measurement field direction or a poling electric field parallel and/or perpendicular to the measuring direction, a resonant response of the real and imaginary components of the dielectric constant is observed, in contrast to the dispersion behavior obtained in the absence of the stress, for the 'virgin' samples. Both results, resonance and/or dispersion, can be explained by considering a common mechanism involving a resonant response (damped and/or over-damped) which is strongly affected by a ferroelastic-ferroelectric coupling, contributing to the low-field dielectric constant.

Histological and morphometric comparisons of worker and queen mandibular glands of Melipona bicolor bicolor (Hymenoptera, Meliponini)

In the present investigation we analyzed both histology and area of secretory cells from workers, virgin and physogastric queen mandibular glands of Melipona bicolor bicolor Lepeletier. The histological differences observed include the number of vacuoles present in the cell cytoplasm and the quantity and distribution of the secretion. The morphometry results demonstrated the occurrence of significative differences in the cell area values that were related to the secretory cell activity level, which is higher in the physogastric queens. Worker and queen glands have histological patterns quite similar, but the morphometric data indicated cast-specific differences, as well as differences between the queens, which were related to the posture activity.

The chemical composition of the mandibular gland secretion of Melipona bicolor lepeletier, 1836 (Hymenoptera, Apidae, Meliponini): A comparative study among castes and sexes

The mandibular gland secretions of newly emerged, nurse and forager workers, virgin and physogastric queens and males of Melipona bicolor were analyzed by gas chromatography-mass spectrometry. The secretion is composed of a blend of hydrocarbons, alcohols, esters, and acids. The secretion is caste-sex specific and also differs with the tasks performed by the workers and the physiological reproductive condition of the queens.

The millennium development goals and the challenges facing Latin America and the Caribbean in making progress towards higher levels of well-being, better human capital and more equal opportunities

Includes bibliography

Comparative study of intramandibular glands of workers, queens and males of stingless bee Scaptotrigona postica Latreille (Hymenoptera: Meliponini)

The mandibles of bees contain two types of tegumental glands whose function is not clear, despite the hypotheses put forward by several researchers. Although these glands have been found in all the bee species studied so far, observations have been confined mostly to workers of eusocial species in the forager phase. The work reported here involved a study of the morphology of the glands of newly emerged, nurse and forager workers, virgin and fecundated queens, and newly emerged and sexually mature males of Scaptotrigona postica, seeking to identify changes that may be linked to the bees life phase. Our findings indicate that the two types of glands are present in the species but not in all life phases or individual classes. The glands consisting of class I cells, the epithelial glands are present only in forager workers and fecundated queens. Glands of type III cells were studied in detail, and gland size was estimated from histological sections. The degree of development of the glands varies according to individual classes and life phases, suggesting different functions during the individuals life and from one individual to another. © Koninklijke Brill NV, Leiden, 2012.

An evaluative study of the implementation of domestic violence legislation: Antigua and Barbuda, St. Kitss

Includes bibliography

Child abuse: a painful reality behind closed doors

Child abuse violates the most basic rights of children and adolescents. As documented in the main article of this issue of Challenges, child abuse is a massive, daily and underreported problem that affects the population of Latin America and the Caribbean. It manifests itself in different forms, including physical and psychological aggression, rape and sexual abuse, and takes place in the home, in neighbourhoods, at school, at work and in legal and child protection institutions. Abuse tends to be transmitted from one generation to the next, and the individuals most often responsible are parents or other adult members of the household