Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland. INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. FUNDING: Bill & Melinda Gates Foundation.

The establishment of the Judicial Appointments Commission in Malaysia to improve the constitutional method of appointing the judges of the superior courts : a critical study

The Judicial Appointments Commission was established in Malaysia in 2009 to ensure unbiased selection of judicial candidates for the consideration of the Prime Minister, who has the final say regarding the appointment of judges to the superior courts. But the provisions concerning Prime Minister’s power to appoint the majority of the members of the Commission and his unfettered power of removing four of the five appointed members without assigning any reason, have calculatedly been devised for ensuring the selection of judicial candidates having right political patronage in accordance with the covert wishes of the Prime Minister. Furthermore, the Prime Minister’s power of rejecting the Commission’s recommendations of multiple candidates renders the undertaking of a lengthy process of selection unproductive and useless. Thus the Judicial Appointments Commission has become a superfluous body with an ineffective modus operandi to attain the stipulated objectives of improving and complementing the constitutional method of appointing judges to the superior courts. Since the Federal Constitution of Malaysia has not empowered the Parliament to enact a law providing for the establishment of a Judicial Appointments Commission, it also appears that the Judicial Appointments Commission Act 2009 is an invalid piece of legislation.

ePortfolios in business education: a national study of ePortfolio implementation 2013 to 2015

To be launched in March 2016, this study explores the transformative potential of ePortfolios in business education. Educators and higher education institutions are increasingly looking for innovative ways to enhance learning outcomes through technology. Given their potential to aid in the development of engaged, reflective lifelong learners, and develop and showcase employability skills, ePortfolios are increasingly being used around the globe.

This study shares the experience of, and lessons learned from, the implementation of ePortfolios in one general business management course and three accounting related courses at three higher education institutions. The recommendations and principles proposed provide benchmarks for best practice and practical guidance for embedding ePortfolios into business curricula.

How national culture on consumers' decision-making styles: a comparative study among Americans, Brazilians, Chinese, and japanese in the purchase of cell phones.

The influence of the national culture on consumer decision-making styles is investigated using a sample of Americans, Brazilians, Chinese, and Japanese consumers who have purchased a cell phone in the past three years. To make the research possible, a survey was used as a method of data collection. It relates Hofstede’s cultural classification typology with Sproles and Kendall’s consumer style inventory (CSI). The multivariate analysis of variance (MANOVA) results indicate six decision-making styles together with other consumer behavioral characteristics that can be used to distinguish and profile consumers who purchase cell phones. Empirical findings reveal that among Americans, Brazilians, and Japanese; Americans are the most quality conscious, brand conscious, innovative, and hedonistic shoppers; Brazilians are the most loyal, and Japanese, the most confused by overchoice consumers. Conceptual contributions and managerial implications are discussed.

National accounts of Caribbean countries: methodologies, sources and quality, and a comparative Caribbean study

Includes bibliography

Report on National Workshop on women in development planning (budget study)

Informe del Taller que tuvo por objetivo promover la participacion de la comunidad en la planificacion del desarrollo, y en forma especifica, revisar el impacto de la asignacion de recursos presupuestarios en la situacion de la mujer.

Study of gender mainstreaming in the Caribbean

Includes bibliography

A study on energy issues in the Caribbean: potential for mitigating climate change

The United Nations Economic Commission for Latin America and the Caribbean (ECLAC) is seeking to provide support to the Governments of Guyana, Jamaica and Barbados in researching the potential for employing renewable energy technologies to mitigate climate change. This exercise involves the study of different types of renewable technologies and mitigative strategies, with the aim of making recommendations to the governments on the development of their renewable energy sector. The recommendations may also assist in achieving their long-term objectives of reducing poverty and promoting healthy economies and sustainable livelihoods in keeping with the Millennium Development Goals. Guyana, Jamaica and Barbados each face common and specific challenges in their efforts to adequately define and implement their energy and climate policies, in a way that allows them to contribute to the mitigation effort against climate change, while promoting sustainable development within their countries. Each country has demonstrated an understanding of the global and national challenges pertaining to climate change. They have attempted to address these challenges through policies and various programmes implemented by local and international agencies. Documented and undocumented policies have sought to outline the directions to be taken by each territory as they seek to deploy new technologies to address issues related to energy and the environment. While all territories have sought to deploy multiple alternate and renewable technologies simultaneously, it is clear that, given their sizes and resource limitations, no one territory can achieve excellence in all these areas. Guyana has demonstrated the greatest potential for hydro energy and should pursue it as their main area of expertise. The country also has an additional major strategy that includes forest credits and the Reduced Emissions from Deforestation and Degradation (REDD) programme. This approach will be brought to the negotiation table in the upcoming climate change meeting in Copenhagen in December 2009. Of the three countries, Jamaica has the only active significant wind farm deployment, while Barbados has a long tradition in solar energy. Each country might then supplement their energy and fuel mix with other energy and fuel sources and draw from the experience of other countries. Given the synergies that might accrue from adopting a regional approach, the Caribbean Community Climate Change Centre (CCCCC) might be well positioned to play a coordinating role. This focus on renewable energy and biofuels should yield good, long-term results as it relates to mitigation against climate change, and good, short- and medium-term results as it relates to the development of sustainable economies. Each country might also achieve energy security, reduced oil dependence, significant reduction in harmful emissions and better foreign exchange management if they pursue good policies and implementation practices. Human and financial resources are critical to the success of planned interventions, and it will be necessary to successfully mobilize these resources in order to be effective in executing key plans.

The study of cardiovascular risk in adolescents - ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Availability and Use of Audiovisual and Electronic Resources by Distance Learning Students in Nigerian Universities: a Case Study of National Open University of Nigeria (NOUN), Ibadan Study Centre

This study investigated the availability and use of audiovisual and electronic resources by distance learning students at the National Open University of Nigeria (NOUN). A questionnaire was administered tothe distance learning students selected across the various departments of the NOUN. The findings revealed that even though NOUN made provision for audiovisual and electronic resources for students' use, a majority of the audiovisual and electronic resources are available through personal provision by the students.The study also revealed regular use of audiovisual and electronic resources by the distance learning students. Constraints on use include poor power supply, poor infrastructure, lack of adequate skill, and high cost of access.

Applying the National Institute for Clinical Excellence criteria to patients treated with the Genous (TM) Bio-engineered R stent (TM): a sub-study of the e-HEALING (Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth) worldwide registry

The National Institute for Clinical Excellence (NICE) guidelines recommend the use of bare-metal stents (BMS) in non-complex lesions with a low risk of restenosis (diameter a parts per thousand yen3 mm and lesion length a parts per thousand currency sign15 mm) and the use of drug-eluting stents (DES) in more complex lesions with a high risk of restenosis (diameter < 3.0 mm or lesion length > 15 mm). However, the guidelines were created based on studies evaluating BMS and DES only. We performed an analysis of patients undergoing non-urgent percutaneous coronary intervention with the novel endothelial cell capturing stent (ECS). The ECS is coated with CD34(+) antibodies that attract circulating endothelial progenitor cells to the stent surface, thereby accelerating the endothelialization of the stented area. We analyzed all patients enrolled in the worldwide e-HEALING registry that met the NICE criteria for either low-risk or high-risk lesions and were treated with a parts per thousand yen1 ECS. The main study outcome was target vessel failure (TVF) at 12-month follow-up, defined as the composite of cardiac death or MI and target vessel revascularization (TVR). A total of 4,241 patients were assessed in the current analysis. At 12-month follow-up, TVF occurred in 7.0% of the patients with low-risk lesions and in 8.8% of the patients with high-risk lesions (p = 0.045). When evaluating the diabetic patients versus the non-diabetic patients per risk group, no significant differences were found in TVF, MI or TVR in either risk group. The ECS shows good clinical outcomes in lesions carrying either a high or a low risk of restenosis according to the NICE guidelines with comparable rates of cardiac death, myocardial infarction, and stent thrombosis. The TVF rate with ECS was slightly higher in patients with high-risk lesions, driven by higher clinically driven TLR. The risk of restenosis with ECS in patients carrying high-risk lesions needs to be carefully considered relative to other risks associated with DES. Furthermore, the presence of diabetes mellitus did not influence the incidence of TVF in either risk group.

Physical activity counseling in primary health care in Brazil: a national study on prevalence and associated factors

Abstract Background The aim of this study was to determine the prevalence and correlates of physical activity counseling among physicians and nurses working in primary health care in Brazil. Methods A phone survey was carried out in 2011 with professionals working in primary health care in Brazil. The target sample consisted of 1,600 randomly selected primary care units covering all regions of the country. We successfully interviewed 529 professionals within the sampled units; 182 physicians and 347 nurses. The overall response rate was 49.6%. Multivariable logistic regression was used to estimate correlates of counseling in the whole sample and separately for physicians and nurses. Results The prevalence of regular physical activity counseling for at least six months was 68.9% (95% CI 64.9; 72.8) and was significantly higher among physicians compared to nurses (p < 0.05). Most professionals (93.2%) interviewed were unfamiliar with current physical activity recommendations for health. In the adjusted analysis, physical activity counseling was more frequent among those who report assessing patient’s physical activity (OR = 2.16; 95% CI 1.41; 3.29), those reporting that lack of time was not a barrier for counseling (OR = 0.62 95% CI 0.42-0.93), those who felt prepared to provide physical activity counseling (OR = 2.34; 95% CI 1.50-3.66), and those working at primary care units offering physical activity programs for patients (OR = 2.06; 95% CI 1.33-3.20). In the stratified analysis, only assessing patient’s physical activity was a significant correlate among physicians whereas assessing patient’s physical activity, feeling prepared to provide counseling and working in units with physical activity interventions were significant correlates among nurses. Conclusions Physicians and nurses deemed physical activity counseling of great importance in primary health care in Brazil. However, in order to increase the quality of counseling and the number of professionals engaging in this activity, these health teams require greater knowledge about physical activity (global recommendations for health) as well as training on the application of instruments for assessing physical activity. Moreover, sufficient time must be allowed during consultations for the counseling process, and physical activity promotion programs should be implemented within the primary health care units.