Maternal factors, fetal parameters and the risk of shoulder dystocia

Introduction. Shoulder dystocia is a serious complication of vaginal birth, with an incidence ranging from 0.15% to 2.1% of all births. There are approximately 4 million births per year in the United States and shoulder dystocia will be experienced by approximately 20,000 women each year. Although studies have been reported on shoulder dystocia, few studies have addressed both maternal and fetal risk factors. The purpose of this study was to identify maternal and fetal risk factors for shoulder dystocia while proposing factors that could be used to predict impending shoulder dystocia. ^ Material and methods. Articles were reviewed from Medline Pubmed using the search phrase "Risk factors of shoulder dystocia" and Medline Ovid using the search words "Dystocia", "Shoulder" and "Risk factors". Rigorous selection criteria were used to identify articles to be included in the study. Data collected from identified articles were transferred to STATA 10 software for trend analysis of the incidence of shoulder dystocia and the year of publication and a pair wise correlation was also determined between these two variables. ^ Results. Among a total of 343 studies identified, only 20 met our inclusion criteria and were retained for this review. The incidence of shoulder dystocia ranged from 0.07% to 2% and there was no particular trend or correlation between the incidence of shoulder dystocia and year of publication between 1985 and 2007. Pre-gestational and gestational diabetes, postdatism, obesity, birth weight > 4000g and fundal height at last visit > 40cm were identified as major risk factors in our series of studies. ^ Conclusion. Future strategies to predict shoulder dystocia should focus on pre-gestational and gestational diabetes mellitus, postdatism, obesity, birth weight > 4000g and fundal height at last visit > 40cm. ^

Disparities in asthma prevalence: The influence of sociodemographic and workplace factors

Asthma is a serious and continuing health problem that affects millions of Americans. Our study was conducted in response to this serious health problem and for purposes of addressing the issue of potential health disparities as outlined in Healthy People 2010. Data from sub-populations of subjects who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999-2004 were used to complete the following specific aims: (1) to update nationally-based estimates of the prevalence of current and lifetime (ever) asthma among adults in the United States (U.S.) and describe by gender the relationships between potential risk factors (e.g., sociodemographics and lifestyle) and asthma; (2) to describe demographic characteristics among working adults in the U.S. and update estimates of the prevalence of asthma in this sub-population, stratified by occupation and industry; and 3) to determine the utility of adapting a population-based Job Exposure Matrix (JEM) for classifying workplace exposures to asthmagens. ^ Our findings suggest the prevalence of asthma among U.S. adults is continuing to rise, with women having a higher prevalence of asthma than men. Living below the poverty threshold, obesity, and prior history of smoking remain important determinants of asthma. Our study also adds to the increasing evidence that health care workers (HCWs) and those employed in education remain at high risk and that appropriate evaluation and control measures need to be implemented. Over 78% of HCWs and 71% of teachers in our study were females suggesting that further exploration of gender-specific risk factors of asthma in working populations is needed. ^ Our study also addressed the feasibility of adapting a population-based asthma-specific JEM to NHANES (1999-2004). We were not able to apply the asthma-specific JEM due to the broad occupational categories within NHANES. This represents a missed opportunity to examine the association between workplace exposures and asthma in U.S. working adults. However, we have identified steps that may be implemented in future population-based studies that would allow the asthma-specific JEM (and other population-based job exposure matrices) to be used in future studies of the U.S. working population.^

ASSOCIATIONS AND INTERRELATIONSHIPS OF SOCIOECONOMIC STATUS, BEHAVIORAL FACTORS AND BIOLOGICAL FACTORS WITH BIRTH WEIGHT

Although the influences of socioeconomic, behavioral and biological factors on birth weight have been extensively studied, most studies have been limited to clinical populations. This study examines such relationships in a national probability sample, the National Health and Nutrition Examination Survey of 1971-1974. The study sample consisted of 2161 white children and 812 black children, aged 1 to 5 years. Analyses were performed on a subsample consisting of 753 white and 138 black children whose mothers were also selected into the survey. Detailed analyses examined interrelationships among socio-economic, behavioral and biological factors by means of multiple regression and partial correlation procedures in the white population. These analyses were not carried out among blacks because of an observed clustering bias introduced in the black subsample that hampered generalization to the US population.^ The results among the whites indicated that the biological factors of maternal height, maternal weight, maternal size (weight/height('2)), maternal age and sex of child were independently related to birth weight and were also interrelated with socioeconomic factors such as family income, education of the mother and education of the head of the household. The joint effect was significantly associated with birth weight.^ Mothers' dietary practices represented the behavioral factors. Selected nutrients from the mothers' 24-hour dietary recall were used to develop indices of dietary quality. Dietary quality was significantly interrelated with socioeconomic status, biological factors and birth weight.^ The findings of this study suggest that smaller, younger mothers of lower socioeconomic status and female children were significantly associated with lower birth weight. The findings also suggest that dietary quality is a mediating factor among socioeconomic status and biological factors in that mothers with more financial and educational resources have better dietary practices. Such mothers may also practice other health behaviors that would prevent having a low birthweight baby. This dissertation contributes primarily to the further conceptualization and empirical testing of the interrelationships among socioeconomic, behavioral and biological factors with respect to birth weight. ^

Association between length of stay in the U.S. and diabetes risk factors among Chinese Americans in Houston, Texas in 2004-2005

Studies have suggested that acculturation is related to diabetes prevalence and risk factors among immigrant groups in the United States (U.S.), however scant data are available to investigate this relationship among Asian Americans and Asian American subgroups. The objective of this cross-sectional study was to examine the association between length of stay in the U.S. and type 2 diabetes prevalence and its risk factors among Chinese Americans in Houston, Texas. Data were obtained from the 2004-2005 Asian-American Health Needs Assessment in Houston, Texas (N=409 Chinese Americans) for secondary analysis in this study. Diabetes prevalence and risk factors (overweight/obesity and access to medical care) were based on self-report. Descriptive statistics summarized demographic characteristics, diabetes prevalence, and reasons for not seeing a doctor. Logistic regression, using an incremental modeling approach, was used to measure the association between length of stay and diabetes prevalence and related risk factors, while adjusting for the potential confounding factors of age, gender, education level, and income level. Although the prevalence of type 2 diabetes was highest among those living in the U.S. for more than 20 years, there was no significant association between length of stay in the U.S. and diabetes prevalence among these Chinese Americans after adjustment for confounding factors. No association was found between length of stay in the U.S. and overweight/obese status among this population either, after adjusting for confounding factors, too. On the other hand, a longer length of stay was significantly associated with increased health insurance coverage in both unadjusted and adjusted models. The findings of this study suggest that length of stay in the U.S. alone may not be an indicator for diabetes risk among Chinese Americans. Future research should consider alternative models to measure acculturation (e.g., models that reflect acculturation as a multi-dimensional, not uni-dimensional process), which may more accurately depict its effect on diabetes prevalence and related risk factors.^

Optimization of urban mobility measures to achieve win-win strategies

European cities are essential in the development of Europe as they constitute the living environment of more than 60% of the population in the European Union and are drivers of the European economy – just under 85% of the EU’s gross domestic product is produced in urban areas (EC, 2007a). The car has been one of the main factors of development during the 20th century, but it is at the same time the origin of the key problems cities have to face: traffic increase. This has resulted in chronic congestion with many adverse consequences such as air pollution and noise. This loss of environmental quality is one of the reasons for urban sprawl in European cities during recent decades. But this urban sprawl at the same time worsens the environmental conditions. We must return to the dense city, but clean and competitive, and this implies reducing car use yet provides quality transport alternatives sufficient to recover and maintain the competitiveness of cities (EC, 2007a). Consequently, European cities need to establish an urban transport strategy which helps reduce their environmental problems –mainly emissions and noise – but without decreasing their trip attraction. This aspect is very important because a loss of trip attraction would result in an increase of people moving to more disperse areas, contributing towards worsening the current situation. This thesis is an attempt to contribute solutions to this problem in two ways: 1) The first is to analyze the complementarity and possible synergies of several urban transport measures aimed at improving a modal split to a more sustainable means of transport. This analysis will focus on the three aspects already mentioned: emissions, noise and attractiveness or competitiveness. 2) Once possible synergies and complementarities have been analyzed, the second objective is to propose the best combination of these measures, in terms of level of implementation, to achieve the maximum benefit with respect to the three aspects previously established: emissions, noise and attractiveness or competitiveness. Therefore, within the wide range of measures enhancing sustainable urban transport, three of them have been be selected in this thesis to establish a methodology for achieving these objectives. The analysis will be based on the region of Madrid, which is also the case study selected for this research. Las ciudades europeas son piezas fundamentales para el desarrollo europeo, ya que son el lugar de residencia de más del 60% de la población de la unión europea así como los motores de su economía – casi el 85% del PIB europeo se produce en áreas urbanas (EC, 2007a). El coche ha sido uno de los principales motores de desarrollo de las ciudades durante el siglo XX, pero se ha terminado por convertir a su vez en uno de los principales problemas con los que tiene que lidiar las ciudades: el aumento del tráfico. Esto ha derivado en unos niveles crónicos de congestión, con multitud de efectos adversos, entre los que cabe destacar la contaminación del aire y el ruido. Esta pérdida de calidad ambiental es una de las razones que ha propiciado la dispersión urbana que han experimentado las ciudades europeas en las últimas décadas. Pero esta dispersión urbana a su vez contribuye a empeorar las condiciones ambientales de las ciudades. Debemos retornar a la ciudad densa, pero limpia y competitiva, y esto implica reducir el uso del coche, pero proporcionando alternativas de transporte que permitan recuperar y mantener la competitividad de las ciudades (EC, 2007a). Por lo tanto, las ciudades europeas necesitan encontrar una estrategia de transporte urbano que ayude a reducir sus problemas medio ambientales – principalmente ruido y emisiones – pero sin hacerlas perder atractividad o competitividad. Este aspecto tiene gran importancia porque una pérdida de la misma se traduciría en un aumento de dispersión de la población hacia áreas periféricas, contribuyendo a empeorar la situación actual. Esta tesis contribuye a solucionar este problema de dos maneras: 1) La primera, analizando la complementariedad y posibles sinergias de diferentes medidas de transporte urbano orientadas a promover un reparto modal hacia modos más sostenibles. Este análisis se centrará en los tres aspectos anteriormente citados: emisiones, ruido y atractividad o competitividad. 2) Una vez las posibles sinergias y complementariedades se han analizado, el segundo objetivo es proponer la mejor combinación de estas medidas – en términos de grado de aplicación - para lograr el máximo beneficio en lo que respecta a los tres objetivos previamente establecidos. Para ello, en esta tesis se han seleccionado una serie de medidas que permitan establecer una metodología para alcanzar estos objetivos previamente definidos. El análisis se centra en la ciudad de Madrid y su área metropolitana, la cual se ha escogido como caso de estudio para realizar esta investigación.

Use of model plant hosts to identify Pseudomonas aeruginosa virulence factors

We used plants as an in vivo pathogenesis model for the identification of virulence factors of the human opportunistic pathogen Pseudomonas aeruginosa. Nine of nine TnphoA mutant derivatives of P. aeruginosa strain UCBPP-PA14 that were identified in a plant leaf assay for less pathogenic mutants also exhibited significantly reduced pathogenicity in a burned mouse pathogenicity model, suggesting that P. aeruginosa utilizes common strategies to infect both hosts. Seven of these nine mutants contain TnphoA insertions in previously unknown genes. These results demonstrate that an alternative nonvertebrate host of a human bacterial pathogen can be used in an in vivo high throughput screen to identify novel bacterial virulence factors involved in mammalian pathogenesis.

Health-related quality of life and determinant factors in celiac disease. A population-based analysis of adult patients in Spain

Background: Celiac disease (CD) has a negative impact on the health-related quality of life (HRQL) of affected patients. Although HRQL and its determinants have been examined in Spanish CD patients specifically recruited in hospital settings, these aspects of CD have not been assessed among the general Spanish population. Methods: An observational, transversal study of a non-randomized, representative sample of adult celiac patients throughout all of Spain's Autonomous Regions. Subjects were recruited through celiac patient associations. A Spanish version of the self-administered Celiac Disease-Quality of Life (CD-QOL) questionnaire was used. Determinant factors of HRQL were assessed with the aid of multivariate analysis to control for confounding factors. Results: We analyzed the responses provided by 1,230 patients, 1,092 (89.2%) of whom were women. The overall mean value for the CD-QOL index was 56.3 ± 18.27 points. The dimension that obtained the most points was dysphoria, with 81.3 ± 19.56 points, followed by limitations with 52.3 ± 23.43 points; health problems, with 51.6 ± 26.08 points, and inadequate treatment, with 36.1 ± 21.18 points. Patient age and sex, along with time to diagnosis, and length of time on a gluten-free diet were all independent determinant factors of certain dimensions of HRQL: women aged 31 to 40 expressed poorer HRQL while time to diagnosis and length of time on a gluten-free diet were determinant factors for better HRQL scores. Conclusions: The HRQL of adult Spanish celiac subjects is moderate, improving with the length of time patients remain on a gluten-free diet.

Why come here if I can go there? Assessing the ‘Attractiveness’ of the EU’s Blue Card Directive for ‘Highly Qualified’ Immigrants. Paper on Liberty and Security in Europe No. 60, 14 October 2013

This paper analyses the attractiveness of the EU’s Blue Card Directive – the flagship of the EU’s labour immigration policy – for so-called ‘highly qualified’ immigrant workers from outside the EU. For this purpose, the paper deconstructs the understanding of ‘attractiveness’ in the Blue Card Directive as shaped by the various EU decision-making actors during the legislative process. It is argued that the Blue Card Directive sets forth minimum standards providing for a common floor – not a common ceiling: the Directive did not, as originally envisaged by the European Commission, create one European highly skilled admission scheme. This raises questions regarding its concrete use. A critical focus is placed on the personal scope of the Blue Card Directive and the level of rights offered, and a first comparative perspective on the implementation of the Directive in five member states is provided.

Rethinking the Attractiveness of EU Labour Immigration Policies: Comparative perspectives on the EU, the US, Canada and beyond

Is Europe's immigration policy attractive? One of the priorities driving current EU debates on labour immigration policies is the perceived need to boost Europe's attractiveness vis-á-vis 'talented' and 'highly skilled' immigrants. The EU sees itself playing a role in persuading immigrants to choose Europe over other competing destinations, such as the US or Canada. This book critically examines the determinants and challenges characterising discussions focused on the attractiveness of labour migration policies in the EU as well as other international settings. It calls for re-thinking some of the most commonly held premises and assumptions underlying the narratives of ‘attractiveness’ and ‘global competition for talent’ in migration policy debates. How can an immigration policy, in fact, be made to be ‘attractive’ and what are the incentives at play (if any)? A multidisciplinary team of leading scholars and experts in migration studies address the main issues and challenges related to the role played by rights and discrimination, qualifications and skills, and matching demand and supply in needs-based migration policies. The experiences in other jurisdictions such as South America, Canada and the United States are also covered: Are these countries indeed so ‘attractive’ and ‘competitive’, and if so what makes them more attractive than the EU? On the basis of the discussions and findings presented across the various contributions, the book identifies a number of priorities for policy formulation and design in the next generation of EU labour migration policies. In particular, it highlights important initiatives that the new European Commission should focus on in the years to come.

An investigation of organic factors in the neuropsychological functioning of patients with borderline personality disorder

The hypothesis to be tested in this study was that the cognitive deficits that have been documented in patients with Borderline Personality Disorder (BPD) are largely the consequence of organic insult, either developmental or acquired. Using a cross-sectional design, 80 subjects (males and females) who met the criteria for BPD participated in the study. They completed a battery of neuropsychological tests and a comprehensive interview assessing organic status as well as measures of the potentially confounding factors of current levels of depression and anxiety. It was expected that BPD-patients with a probable history of organic insult would perform significantly worse than would BPD patients without such a history. Analyses of the results provided partial support for the hypothesis. Subjects with both BPD and a history of organic insult were significantly more impaired on several measures including measures of attention than were BPD only subjects. The results suggested that the impaired cognitive performance of persons diagnosed with BPD may, in part, be attributed to organic factors.

An examination of the factors that influence identification and acculturation

This paper investigated the effects of print media exposure and intergroup contact on ethnic identification and acculturation attitudes of Chinese immigrants. Data was gathered from a survey participated by 265 respondents of Chinese origin. Findings indicated that exposure to the print media did not have a significant effect on ethnic identification and/or acculturation orientation. However, when the factor of intergroup contact was taken into consideration, differences began to occur. Specifically, for respondents from low intergroup contact group, ethnic identification increased with the desire to integrate into the large culture. For respondents from high intergroup contact group, opposite trends were found, i.e. as ethic identification increased, the tendency to adopt integration orientation decreased. Findings from this study suggested the need to combine factors of both interpersonal and mediated communication in the examination of ethnic identification and acculturation. This paper also drew some implications for the media industry and government policies.

Magyar egyetemi hallgatók vállalkozási attitűdjei és az attitűdöket befolyásoló tényezők elemzése a GUESSS-felmérés adatai alapján - Kik is akarnak ténylegesen vállalkozni? (Entrepreneurial attitudes of the Hungarian students and the analysis of the factors influencing attitudes based on the datas of GUESSS survey – Who want to undertake really?)

A vállalkozóvá válás meghatározó tényezőinek kutatása szakmai berkekben leginkább a Szent Grál keresésére emlékeztet: már lassan azt sem tudjuk, hogy egyáltalán léteznek-e ilyen tényezők. A kutatást nehezítik a többnyire önbevallásos kérdésekre adott torzított válaszok, a szóba jöhető tényezők számossága és a vállalkozói motivációk heterogenitása a különböző demográfiai karakterisztikákkal rendelkező népesség körében. Az egyetemi hallgatók körében némileg egyszerűbb a vizsgálat, hiszen ez egy relatíve homogén minta. Ugyanakkor itt a leginkább áttételesek a hatások, és ráadásul nem a tényleges vállalkozóvá válás, hanem többnyire csak a szándékok tesztelhetők. A vállalkozóvá válás szándékát Bandura társadalmi megismerés-elmélete, Shapero elmozduláselmélete és az Ajzen-féle tervezett magatartás elmélet alapján felállított koncepcionális modell keretén belül vizsgálják és elemzik a szerzők. Arra keresik a választ, hogy az egyes vállalkozói tulajdonságok, az egyetemi környezeti tényezők és a családi háttér hogyan hatnak a vállalkozóvá válásra. A teszteléshez a 21 országra kiterjedő 2011-es GUESSS-felmérésből a magyar egyetemi/ főiskolai hallgatók 5224-es erősségű mintáját használták fel. A multimoniális regressziós vizsgálat eredményei megerősítik, hogy a vállalkozói tulajdonságok és a családban levő vállalkozó megléte mellett a vállalkozói oktatás is pozitívan befolyásolják a vállalkozásindítási szándékot. A klaszterelemzés rámutatott arra, hogy a vállalkozói szándékok, az erre ható tényezők, továbbá a választott szak és más demográfiai tényezők szempontjából a hallgatók meglehetősen heterogének. _______ The search for the determining factors to become an entrepreneur is something like searching for the Holy Grail: After many decades we do not even know if these factors exist or not. The research is difficult because the questionnaires are self esteem, the potential influential factors are numerous, and the motivations do vary across the different cohorts of population. It is easier to conduct a survey amongst university students since this sample is relatively homogenous. At the same times, the determining factors to become an entrepreneur cannot be really tested; the authors can examine mostly the attitudes and the intentions. The conceptual model of entrepreneurial intentions, developed in the paper, based on Bandura, Shaper and Ajzen. The paper is testing eight hypotheses about the influential factors of entrepreneurial intentions such as entrepreneurial traits, the university environment, and the family background. For testing the hypothesis they use a sample of 5224 Hungarian students from the GUESSS 2011 survey. According to the multinomial regression, entrepreneurial intentions are positively influenced by certain entrepreneurial traits, entrepreneur in the family, and entrepreneurship courses at the higher education institutions. The cluster analysis results underline the heterogeneity of the students in terms of entrepreneurial intentions, gender, and the major field of studies

The conflict resolution behaviors of occupational therapy students as a function of the personality types, demographic characteristics and contextual factors

Interpersonal conflicts have the potential for detrimental consequences if not managed successfully. Understanding the factors that contribute to conflict resolution has implications for interpersonal relationships and the workplace. Researchers have suggested that personality plays an important and predictable role in conflict resolution behaviors (Chanin & Schneer, 1984; Kilmann & Thomas, 1975; Mills, Robey & Smith, 1985). However, other investigators have contended that contextual factors are important contributors in triggering the behavioral responses (Shoda & Mischel, 2000; Mischel & Shoda, 1995). The purpose of this study was to investigate the relationships among personality types, demographic characteristics and contextual factors on the conflict resolution behaviors reported by graduate occupational therapy students (n = 125). ^ The study design was correlational. The Myers Briggs Type Indicator (MBTI) and the Thomas-Kilmann (MODE) Instrument were used to establish the personality types and the context independent conflict resolution behaviors respectively. The effects of contextual factors of task vs. relationship and power were measured with the Conflict Case Scenarios Questionnaire (CCSQ). One-way ANOVA and linear regression procedures were used to test the relationships between personality types and demographic characteristics with the context independent conflict behaviors. Chi-Square procedures of the personality types by contextual conditions ascertained the effects of contexts in modifying the resolution modes. Descriptive statistics established a profile of the sample. ^ The results of the hypotheses tests revealed significant relationships between the personality types of feeling-thinking and sensing-intuition with the conflict resolution behaviors. The contextual attributes of task vs. relationship orientation and of peer vs. supervisor relationships were shown to modify the conflict behaviors. Furthermore, demographic characteristics of age, gender, GPA and educational background were shown to have an effect on the conflict resolution behaviors. The knowledge gained has implications for students' training, specifically understanding their styles and use of effective conflict resolution strategies. It also contributes to the knowledge on management approaches and interpersonal competencies and how this might facilitate the students' transition to the clinical role. ^

Adolescent readers' self-perceptions of affective factors related to performance on standardized tests

The purpose of this study was to investigate which affective factors of adolescent high school readers were related to high-level readers, middle-level readers and low-level readers. The research problem was to determine the relationship between adolescent high school students' self-perceived reading self-efficacy factors and the students' reading performance on a standardized reading assessment considering demographic factors of age, gender and socio-economic status as covariates. The research design was ex post facto making inferences without direct intervention. The sample was obtained from one large, diverse, urban high school, consisting of 9th and 10th grade adolescent students (N = 176). Students voluntarily completed a self-report, reading self-efficacy survey. School records were used to obtain standardized reading level scores, age, gender, and socio-economic status data. An exploratory factor analysis of the self-efficacy survey responses resulted in the identification of 7 underlying factors. The striving (low-level) readers had significantly lower self-perceptions on 5 of the 7 affective factors than the middle-level readers, and strong (high-level) readers, p < .05. The 5 affective factors on which the striving readers had significantly lower self-perceptions were: (a) Observational Comparison, (b) Progress, (c) Lack of Progress, (d) Lack of Anxiety, and (e) Positive Social Feedback. The 2 affective factors which were not significantly different for reader level were Anxiety and Negative Social Feedback. Girls had significantly less anxiety than boys for both of the factors in the Anxiety category. Statistical results showed that none of the demographic covariates tested; age, gender, or socio-economic status, moderated the relationship between affective reader self-efficacy factors and reader level. This study concluded that there were distinguishable differences for striving, middle, and strong readers' self-efficacy factors. Determining affective factors related to reading can be used to create better instructional environments and instruction for adolescent students.

Patterns of local R&D cooperation of foreign subsidiaries in an intermediate country: innovative and structural factors

We attempt to contribute to a better understanding of cooperative innovation patterns of foreign subsidiaries (FS) in Spain as a representative intermediate country, going deeply into three main aspects: firstly, a sectoral taxonomy which combines international technological dynamism and revealed technological advantage as a way to understand such patterns. Secondly we focus our attention on innovative intensive subsidiaries, assuming they are the most important ones for hosting countries. Thirdly, we combine innovation and structural-competitive variables to explain local cooperation. We found more intense cooperation of FS with local agents in dynamic specialization sectors, as well as the fact that this is mostly carried out in a complementary mode with inner knowledge capabilities of the companies. Cooperative activities are influenced by economicstructural factors of the Spanish economy, particularly in highly innovative companies. Cooperative strategies of domestic firms might also have an influence on those of foreign subsidiaries.