The influence of OLR1 and PCSK9 gene polymorphisms on ischemic stroke: Evidence from a meta-analysis

It has been reported that both OLR1 and PCSK9 genes are related to various vascular diseases such as atherosclerosis, cardiovascular disease, peripheral artery disease and stroke, in particular ischemic stroke. The prevalence of PCSK9 rs505151 and OLR1 rs11053646 variants in ischemic stroke were 0.005 and 0.116, respectively. However, to date, association between OLR1 rs11053646 and PCSK9 rs505151 polymorphisms and the risk of ischemic stroke remains unclear and inconclusive. Therefore, this first meta-analysis was carried out to clarify the presumed influence of genetic polymorphisms on ischemic stroke, by analyzing the complete coverage of all relevant studies. All eligible case-control and cohort studies that met the search term were retrieved in multiple scientific databases. Data of interest such as demographic data and genotyping methods were extracted from each study, and the meta-analysis was performed using RevMan 5.3 and Metafor R 3.2.1. The pooled odd ratios (ORs) and 95% confidence intervals (CIs) were calculated using both fixed- and random-effect models. A total of seven case-control studies encompassing 1897 ischemic stroke cases and 2119 healthy controls were critically evaluated. Pooled results from the genetic models indicated that OLR1 rs11053646 dominant (OR=1.33. 95%CI:1.11-1.58) and co-dominant models (OR=1.24, 95%CI:1.02-1.51) were significantly associated with ischemic stroke. For PCSK9 rs505151 polymorphism, the OR of co-dominant model (OR=1.36, 95%CI:1.01-1.58) was found to be higher among ischemic stroke patients. In conclusion, the current meta-analysis highlighted that variant allele of OLR1 rs11053646 G>C and PCSK9 rs505151 A>G may contribute to the susceptibility risk of ischemic stroke.

Detection and progression of chronic allograft nephropathy : A study based on protocol biopsies

Background. Kidney transplantation (KTX) is considered to be the best treatment of terminal uremia. Despite improvements in short-term graft survival, a considerable number of kidney allografts are lost due to the premature death of patients with a functional kidney and to chronic allograft nephropathy (CAN). Aim. To investigate the risk factors involved in the progression of CAN and to analyze diagnostic methods for this entity. Materials and methods. Altogether, 153 implant and 364 protocol biopsies obtained between June 1996 and April 2008 were analyzed. The biopsies were classified according to Banff ’97 and chronic allograft damage index (CADI). Immunohistochemistry for TGF-β1 was performed in 49 biopsies. Kidney function was evaluated by creatinine and/or cystatin C measurement and by various estimates of glomerular filtration rate (GFR). Demographic data of the donors and recipients were recorded after 2 years’ follow-up. Results. Most of the 3-month biopsies (73%) were nearly normal. The mean CADI score in the 6-month biopsies decreased significantly after 2001. Diastolic hypertension correlated with ΔCADI. Serum creatinine concentration at hospital discharge and glomerulosclerosis were risk factors for ΔCADI. High total and LDL cholesterol, low HDL and hypertension correlated with chronic histological changes. The mean age of the donors increased from 41 -52 years. Older donors were more often women who had died from an underlying disease. The prevalence of delayed graft function increased over the years, while acute rejections (AR) decreased significantly over the years. Sub-clinical AR was observed in 4% and it did not affect long-term allograft function or CADI. Recipients´ drug treatment was modified along the Studies, being mycophenolate mophetil, tacrolimus, statins and blockers of the renine-angiotensin-system more frequently prescribed after 2001. Patients with a higher ΔCADI had lower GFR during follow-up. CADI over 2 was best predicted by creatinine, although with modest sensitivity and specificity. Neither cystatin C nor other estimates of GFR were superior to creatinine for CADI prediction. Cyclosporine A toxicity was seldom seen. Low cyclosporin A concentration after 2 h correlated with TGF- β1 expression in interstitial inflammatory cells, and this predicted worse graft function. Conclusions. The progression of CAN has been affected by two major factors: the donors’ characteristics and the recipients’ hypertension. The increased prevalence of DGF might be a consequence of the acceptance of older donors who had died from an underlying disease. Implant biopsies proved to be of prognostic value, and they are essential for comparison with subsequent biopsies. The progression of histological damage was associated with hypertension and dyslipidemia. The augmented expression of TGF-β1 in inflammatory cells is unclear, but it may be related to low immunosuppression. Serum creatinine is the most suitable tool for monitoring kidney allograft function on every-day basis. However, protocol biopsies at 6 and 12 months predicted late kidney allograft dysfunction and affected the clinical management of the patients. Protocol biopsies are thus a suitable surrogate to be used in clinical trials and for monitoring kidney allografts.

Male-biased adult sex ratios and their significance for cooperative breeding in dhole, Cuon alpinus, packs

Two free-ranging packs of dholes (Asiatic wild dog, Cuon alpinus) were monitored for a period of 6 yr (Sep. 1990-Sep. 1996) in the Mudumalai sanctuary, southern India. Demographic data on age structure, litter-size, sex ratio and age and sex specific dispersal were collected. Behavioural data on social interactions and reproductive behaviour among pack members were obtained to determine the frequencies of dominant and subordinate behaviours shown by malt: and female pack members and a measure of each male's reproductive access to females. Behaviours displayed by pack members at dens were recorded to determine whether any age- or sex-specific role specialization existed during pup care. Tenures for dominant males and females within the pack were calculated to ascertain the rate of breeding vacancies occurring within packs. Approximate levels of genetic relatedness within packs were determined by studying pedigrees. In most years one study pack had a male-biased adult sex ratio. This was caused by almost twofold higher dispersal of adult females over adult males. A considerable variance existed in the percentage of sub-adults dispersing from the two packs. Differences existed in the frequencies of dominant and subordinate behaviours shown by males. For males, dominance ranks and ranks based on submissive behaviours were not correlated with frequencies of reproductive behaviours. Subordinate males also displayed reproductive behaviours. In packs, dominant males had lower tenures than dominant females indicating that among males breeding vacancies arose more quickly. The litter size was found to be negatively correlated with the age of the breeding female. There were no significant differences across individuals of varying age or sex classes in the display of pup care behaviours. Significant differences did exist among individual adults. Genetic relatedness among packs tended to vary temporally as a consequence of possible mating by subordinate animals and immigration of new males into the pack. In conclusion, it appears that males delay dispersal and cooperate within their natal packs because of the variety of reproductive strategies they could pursue within. A combination of ecological constraints and the difficulties of achieving breeding status within non-natal packs may make early dispersal and independent breeding less beneficial.

SPATIO-TEMPORAL DYNAMICS ALONG THE TERRAIN GRADIENT OF DIVERSE LANDSCAPE

Land use (LU) land cover (LC) information at a temporal scale illustrates the physical coverage of the Earth's terrestrial surface according to its use and provides the intricate information for effective planning and management activities. LULC changes are stated as local and location specific, collectively they act as drivers of global environmental changes. Understanding and predicting the impact of LULC change processes requires long term historical restorations and projecting into the future of land cover changes at regional to global scales. The present study aims at quantifying spatio temporal landscape dynamics along the gradient of varying terrains presented in the landscape by multi-data approach (MDA). MDA incorporates multi temporal satellite imagery with demographic data and other additional relevant data sets. The gradient covers three different types of topographic features, planes; hilly terrain and coastal region to account the significant role of elevation in land cover change. The seasonality is another aspect to be considered in the vegetation dominated landscapes; variations are accounted using multi seasonal data. Spatial patterns of the various patches are identified and analysed using landscape metrics to understand the forest fragmentation. The prediction of likely changes in 2020 through scenario analysis has been done to account for the changes, considering the present growth rates and due to the proposed developmental projects. This work summarizes recent estimates on changes in cropland, agricultural intensification, deforestation, pasture expansion, and urbanization as the causal factors for LULC change.

Calidad de la dieta, sobrepeso y obesidad en estudiantes universitarios

Este trabajo se encuentra bajo la licencia Creative Commons Attribution 3.0.

Fatores associados a transtornos mentais comuns e desejo de engravidar em gestantes adolescentes

De acordo com a Organização Mundial da Saúde, o período da adolescência é aquele compreendido entre os 10 e os 19 anos de idade, a população de adolescentes é crescente e um em cada cinco indivíduos encontra-se nessa faixa etária. Anualmente, 60 em cada mil jovens se tornam mães, o que faz da gravidez na adolescência tema de interesse por parte de pesquisadores de todo o mundo. No município do Rio de Janeiro, observou-se o acompanhamento da tendência nacional de aumento de gravidez precoce, com maior variação positiva encontrada na faixa etária de 10 a 14 anos. O objetivo no Artigo I: Determinar a prevalência de transtornos mentais comuns (TMC) em uma população de adolescentes grávidas e avaliar sua associação com características da gravidez e fatores socioeconômicos, demográficos e de rede social de apoio. Artigo II: Determinar a prevalência de desejo de engravidar em uma população de gestantes adolescente, verificar possíveis associações com fatores socioeconômicos, demográficos e de rede social de apoio e avaliar o papel da idade como modificador de efeito dessas associações. Foram utilizados nos Artigos I e II o método de estudo seccional de base ambulatorial realizado com 232 adolescentes grávidas, em qualquer trimestre gestacional, regularmente atendidas nos serviços de pré-natal de dois hospitais públicos especializados do município do Rio de Janeiro, de maio a outubro de 2007. Foi utilizado questionário autopreenchível para a avaliação das características da gravidez, rede social de apoio, idade, renda, escolaridade, abandono escolar, situação conjugal, raça/cor e trabalho. As análises dos TMC foram conduzidas através do GHQ-12. Os resultados no Artigo I foram, a prevalência de TMC foi de 45,3%. O modelo final ajustado mostrou associação com TMC para as seguintes variáveis: renda familiar menor que três salários mínimos (RP = 2,32; IC 95% 1,15 - 4,67), não ter apoio familiar (RP = 2,18; IC 95% 1,69-2,81), não ter amigas para conversar (RP = 1,48; IC 95% 1,13-1,92) e não ter religião (RP = 1,72; IC 95% 1,25 - 2,36). No Artigo II, foram a prevalência de desejo de engravidar entre as gestantes adolescentes foi de 46,2%. No modelo final ajustado, as variáveis que apresentaram razões de prevalência (RP) estatisticamente significantes para associação com desejo de engravidar foram: ser casada ou viver em união estável (RP = 1,80; IC 95% 1,27-2,56), não ter amigas ou amigos com quem conversar (RP = 1,48; IC 95% 1,15-1,90). Adolescentes entre 12 e 16 anos e cursando o primeiro grau desejavam menos a gravidez (RP = 0,57; IC 95% 0,38- 0,88). Artigo I: Os resultados encontrados mostram que, frente à forte associação entre TMC e gravidez em adolescentes, temos a necessidade de implementação de políticas públicas que busquem minimizar os danos decorrentes das gestações em adolescentes, através da promoção de programas que incentivem a participação familiar no processo de aceitação da gravidez, bem como propiciando espaços para discussão, onde essas jovens possam ser ouvidas e orientadas. Artigo II: Os resultados deste estudo comprovam que a gravidez na adolescência não é necessariamente indesejada. Assim, fatores como viver em união estável e não ter amigas(os) para conversar aumentam o desejo de engravidar. Por outro lado, ter entre 12 e 16 anos e ainda estar no primeiro grau diminui este desejo. Tais achados podem ajudar os profissionais de saúde que lidam com essa faixa etária a identificar possíveis situações de risco para a gravidez e assim direcionar sua orientação de forma precisa e adequada.

Evolução temporal e fatores climáticos relacionados à leishmaniose visceral em municípios endêmicos brasileiros no período de 2001 a 2008

Este é um estudo ecológico misto onde o perfil de distribuição de chuvas e das variações térmicas foi relacionado à variação sazonal das taxas de incidência de leishmaniose visceral em vinte municípios brasileiros de transmissão intensa da doença, no período de 2001 a 2008. O objetivo foi identificar similaridades e diferenças entre os municípios estudados quanto à tendência temporal e sazonalidade da doença e à possível relação entre variações climáticas e a distribuição sazonal da doença. Os dados de incidência de leishmaniose visceral foram obtidos do Sistema de Informação de Agravos de Notificação (Sinan), os dados demográficos foram obtidos do Departamento de Informática do Sistema Único de Saúde (DATASUS), os dados pluviométricos e de temperatura foram obtidos do Sistema de Monitoramento Agrometeorológico do Ministério da Agricultura (AGRITEMPO). Os resultados são apresentados graficamente e mostram que a distribuição sazonal da incidência e períodos prováveis de transmissão são diferentes em vários municípios e acompanham as diferenças climáticas, sugerindo que as intervenções que visem diminuir a incidência devem ser pontuais, obedecendo às características de cada município.

Aplicación de metodología estadística para predecir la mortalidad de pacientes con neumonía

[es]Con esta memoria se pretende crear una herramienta de trabajo que ayude a los médicos a clasificar a los pacientes que padecen neumonía en distintos grupos de riesgo dependiendo de su gravedad. Para ello, hemos estudiado la regresión logística, que relaciona la variable respuesta mortalidad con el resto de variables (datos demográficos, antecedentes médicos y datos clínicos y exploratorios del paciente). Una vez creado el score a partir del modelo de regresión, hemos querido validarlo y compararlo con otros dos que utilizan los neumólogos: el CURB-65 y el FINE.

Metas de socialização e práticas educativas de mães de crianças com câncer: um estudo comparativo com mães de crianças sem diagnóstico de doença

Sistemas parentais são construídos através das interações no cotidiano dos pais com seus filhos e com base nos padrões culturais vigentes, dentro de um perfil socioeconômico e da história de vida dos indivíduos. Importantes componentes dos sistemas parentais são as metas de socialização e as práticas educativas. As metas de socialização se referem a como os pais desejam que seus filhos sejam no futuro, àquilo que eles esperam que sua criação ajude a promover em seus filhos. Já as práticas educativas são as práticas de comunicar à criança a forma correta com que se espera que ela se comporte. A revisão bibliográfica evidencia que as metas de socialização e práticas educativas são afetadas pelo ambiente cultural dos cuidadores e por variáveis socioeconômicas, mas não há estudos a respeito de possíveis impactos causados por situações de vida particularmente difíceis. A presente dissertação se propôs a examinar as metas de socialização e práticas educativas de mães cujos filhos estão em tratamento oncológico, contrastando-as com as de mães de crianças saudáveis. Nesse sentido, o objetivo estabelecido foi o de investigar se havia particularidades nas metas de socialização e formas de cuidado de mães com filhos que tenham câncer devido à situação específica vivida de um tratamento oncológico. Hipotetizou-se que a vivência da experiência do câncer e a inserção em uma instituição de tratamento, no caso, o Instituto Nacional do Câncer (INCA), teriam impacto no sistema de cuidados e metas parentais. Participaram deste estudo 20 mães de crianças de três a cinco anos que estavam em tratamento oncológico no INCA e 20 mães de crianças na mesma faixa etária sem problemas de saúde diagnosticados. Todas assinaram o Termo de Consentimento Livre e Esclarecido. Foram aplicados os formulários "Dados de identificação" e "Dados sociodemográficos", e o Questionário de Metas de Socialização. Foi também realizada com as mães uma entrevista semiestruturada, com questões abertas que buscaram investigar práticas educativas. A análise de dados contemplou uma parte de análises quantitativas em que os dados foram tratados descritivamente (médias, percentuais etc.) e empregados testes não-paramétricos para comparação entre os grupos de mães. Análises qualitativas, voltadas para as respostas ao questionário de metas de socialização e à entrevista sobre práticas de cuidado educativas foram realizadas através do método de análise de conteúdo temático-categorial. Encontrou-se que as metas de socialização das mães de crianças em tratamento oncológico apresentaram diferenças em relação às das mães de crianças sem diagnóstico de doença, refletindo uma tendência mais individualista. Também foram encontradas diferenças entre os dois grupos nas ações para atingir as metas, sendo visto um uso menor da estratégia educar e orientar por parte do grupo das mães de crianças em tratamento no INCA, refletindo uma tendência mais pragmática. Quanto às práticas educativas não foram encontradas diferenças significativas entre os dois grupos. Espera-se que esse estudo traga contribuições para a formulação de programas de intervenção, para pais e cuidadores, através da melhor compreensão das metas e práticas maternas utilizadas nesta situação particular e de grande dificuldade para as crianças e suas famílias

A prática e a representação social do tabagismo entre fumantes, ex-fumantes e não fumantes

Atualmente o tabagismo é considerado pela Organização Mundial da Saúde (OMS) como um fator de risco à vida a ser combatido com alta prioridade. No entanto, um processo maciço de propaganda e marketing parece ter sido historicamente decisivo para dar à prática de fumar uma representação positiva, através de uma associação sistemática entre o consumo de derivados do tabaco e o ideal de auto-imagem, como beleza, sucesso, saúde e liberdade. Essa transformação da imagem do cigarro de símbolo de status e saúde para uma séria doença a ser combatida evidencia a importância de analisar o tabagismo como um fenômeno psicossocial. O objetivo geral desta investigação consiste, portanto, em analisar comparativamente as representações sociais acerca do tabagismo construídas por grupos de indivíduos que se incluam diferencialmente nas condições de fumantes, ex-fumantes e não-fumantes. A pesquisa foi realizada com uma amostra de 500 (quinhentos) participantes residentes no Estado do Rio de Janeiro, de ambos os sexos, podendo pertencer às categorias de fumantes, ex-fumantes e não-fumantes. A coleta de dados foi realizada por meio eletrônico, através da aplicação de um questionário, que em parte focaliza os dados sóciodemográficos dos participantes e, em outra, apresenta questões abertas e fechadas, incorporando ainda uma tarefa de evocação livre ante o termo indutor tabagismo ou prática de fumar. Os resultados da análise estrutural da representação social do tabagismo possibilitou verificar uma unanimidade quanto à significação controversa que é atribuída a ele. De um lado, verificam-se dimensões negativas desta prática, que são objetivadas pelas implicações e repercussões na saúde dos fumantes ativos e passivos e, por outro lado, existem as dimensões positivas, que representam as funções sociais do tabagismo, e as sensações prazerosas que ele provoca nos fumantes. Observa-se o processo de construção de uma nova representação social do tabagismo, onde é estabelecida uma conexão entre uma velha representação do tabagismo enquanto hábito de vida, estilo de vida, com uma nova representação, o tabagismo como vício/dependência, criando novos significados e imagens do objeto. Para concluir, vale ressaltar que as representações sociais dos ex-fumantes e dos não-fumantes mostraram-se bastantes próximas, ressaltando essencialmente os aspectos negativos do tabagismo, enquanto que a dos fumantes diferenciam-se um pouco ao apresentar elementos como prazer. Mas de modo geral, as representações não mostraram-se tão distintas, revelando que os próprios fumantes vivenciam uma relação muito antagônica com o tabagismo, manifestando em diversos momentos vontade de tornarem-se ex-fumantes. Parece que a representação do tabagismo como um hábito glamoroso não mais existe e que de fato a política de controle a ele vem obtendo êxito com suas medidas restritivas o que é algo extremamente positivo para nossa sociedade do ponto de vista da saúde pública. No entanto, na esfera social, parece necessário que essa atmosfera de temor e asco envolta no tabagismo seja pensada e refletida, para que não resulte em discriminação social com os tabagistas, tornando-os novamente vítima, mas de uma nova situação social

Experimental study of trophic cascade effect of silver carp (Hypophthalmichthys molitrixon) in a subtropical lake, Lake Donghu: on plankton community and underlying mechanisms of changes of crustacean community

An enclosure experiment was carried out to test trophic cascade effect of filter-feeding fish on the ecosystem: growth of crustacean zooplankton, and possible mechanism of changes of crustacean community structure. Four fish biomass levels were set as follows: 0, 116, 176 and 316 g m(-2), and lake water ( containing ca. 190 g m(-2) of filter-feeding fishes) was comparatively monitored. Nutrient levels were high in all treatments during the experiment. Lowest algal biomass were measured in fishless treatment. Algal biomass decreased during days 21-56 as a function of fish biomass in treatments of low (LF), medium (MF) and high (HF) fish biomass. Crustaceans biomass decreased with increasing fish biomass. Small-bodied cladocerans, Moina micrura, Diaphanosoma brachyurum and Scapholeberis kingii survived when fish biomass was high whilst, large-bodied cladocerans Daphnia spp. and the cyclopoids Theromcyclops taihokuensis, T. brevifuratus, Mescyclops notius and Cyclops vicinus were abundant only in NF enclosures. Evasive calanoid Sinodiaptomus sarsi was significantly enhanced in LF, but decreased significantly with further increase of fish biomass. Demographic data indicated that M. micrura was well developed in all treatments. Our study indicates that algal biomass might be controlled by silver carp biomass in eutrophic environment. Changes of crustacean community are probably affected by the age of the first generation of species. Species with short generation time were dominant and species with long generation time survived less with high fish biomass. Evasive calanoids hardly developed in treatments with high fish biomass because of the ( bottle neck) effect of nauplii. Species abundance were positively related to fish predation avoidance. Other than direct predation, zooplankton might also be suppressed by filter-feeding fish via competition.

Ecology of frontier populations of the invasive grey squirrel (Sciurus carolinensis) in Ireland

The rise in invasive species, together with habitat destruction, is associated with worldwide declines in biodiversity and ecosystem functioning. Management of invasive species, as well as amelioration of invasion impacts, provide challenges to species and ecosystem ecologists and conservation managers. Although any species can become invasive if it is transported to, establishes in and spreads in a new environment outside of its native range, rodents are a particularly frequent invader. Rodent introductions are often inadvertent but are also commonly intentional as these animals are traded and transported as pets and may escape from captivity. Tree squirrel species are attractive to humans and are able to establish populations with only a few founding individuals, making them a group well suited to performing the role of biological invaders. The eastern grey squirrel (Sciurus carolinensis) is the most commonly introduced squirrel species worldwide. This research addressed the grey squirrel invasion and frontier population biology. Novel results were generated through diverse research techniques. Public sighting surveys and hairtube surveys were used to locate the southern frontier of grey squirrel range expansion in Ireland. A 22-month intensive live trapping study of two frontier populations facilitated the collection of personality and demographic data from squirrels in increasing populations. A systematic literature search on grey squirrel demography provided context for the studied populations, among frontier and established introduced populations, as well as those in the native range. Advanced spatially explicit population modeling techniques predicted future range expansion and objectively compared the outcomes of 12 grey squirrel management strategies. The methods and results are discussed in both a basic scientific and applied invasion management context. An improved understanding of the behaviour, population dynamics, and future scenarios at the frontier of species invasions is crucial for managers worldwide and this is provided here for the grey squirrel in Ireland.

Time use, daily activities, and health-related quality of life of school-going late adolescents in Cork city and county: A cross-sectional study

Aim: This thesis examines a question posed by founding occupational scientist Dr. Elizabeth Yerxa (1993) – “what is the relationship between human engagement in a daily round of activity (such as work, play, rest and sleep) and the quality of life people experience including their healthfulness” (p. 3). Specifically, I consider Yerxa’s question in relation to the quotidian activities and health-related quality of life (HRQoL) of late adolescents (aged 15 - 19 years) in Ireland. This research enquiry was informed by an occupational perspective of health and by population health, ecological, and positive youth development perspectives. Methods: This thesis is comprised of five studies. Two scoping literature reviews informed the direction of three empirical studies. In the latter, cross-sectional time use and HRQoL data were collected from a representative sample of 731 school-going late adolescents (response rate 52%) across 28 schools across Cork city and county (response rate 76%). In addition to socio-demographic data, time use data were collected using a standard time diary instrument while a nationally and internationally validated instrument, the KIDSCREEN-52, was used to measure HRQoL. Variable-centred and person-centred analyses were used. Results: The scoping reviews identified the lack of research on well populations or an adolescent age range within occupational therapy and occupational science; limited research testing the popular assumption that time use is related to overall well-being and quality of life; and the absence of studies that examined adolescent 24-hour time use and quality of life. Established international trends were mirrored in the findings of the examination of weekday and weekend time use. Aggregate-level, variable-centred analyses yielded some significant associations between HRQoL and individual activities, independent of school year, school location, family context, social class, nationality or diary day. The person-centred analysis of overall time use identified three male profiles (productive, high leisure and all-rounder) and two female profiles (higher study/lower leisure and moderate study/higher leisure). There was tentative support for the association between higher HRQoL and more balanced time use profiles. Conclusion: The findings of this thesis highlight the gendered nature of adolescent time use and HRQoL. Participation in daily activities, singly and in combination, appears to be associated with HRQoL. However, the nature of this relationship is complex. Individually and collectively, adolescents need to be educated and supported to create health through their everyday patterns of doing.

Caregiver burden and resilience among Malaysian caregivers of individuals with severe mental illness

Little research has focused on caregiver burden experienced by Malaysian caregivers of individuals with mental illness, despite the fact that data in the Asian region shows almost threequarter of patients with mental illness live with family members. The aim of this research was to examine the levels of caregiver burden and resilience of caregivers of individuals with severe mental illness and to determine the influencing factors on caregiver burden. A quantitative, cross sectional, correlational design was used to measure burden and resilience and to explore the relationship between demographic variables, caregiver stressors, resilience and caregiver burden. This study was guided by the model of Carer Stress and Burden. Data collection was conducted over two months in summer 2014. A self-administered questionnaire that consisted of four sections measuring demographic data, primary stressors, caregiver burden and resilience was used to collect data. Two hundred and one caregivers of individuals with mental illness attending Psychiatric Outpatient Clinics in Malaysia were recruited. Samples were selected using non-probability, consecutive sampling. Factors that were found to be significantly associated with caregiver burden were caregivers’ age, gender, ethnic group, employment status, having a medical condition and current health status. The primary stressors found to be significantly associated with caregiver burden include the time spent for caregiving tasks, unavailability of support with caregiving tasks, lack of emotional support and patients’ behavioural disturbances. In addition, it was found that caregivers who were less resilient reported a higher level of caregiver burden. Findings from hierarchical multiple regression indicated that caregivers’ marital status, current health status, time spent for caregiving and resilience predicted caregiver burden. This research provides insight into caregiver burden among caregivers of individuals with mental illness in Malaysia. It highlights the important factors associated with caregiver burden and the significant role of resilience in reducing caregiver burden.

Prevalence and predictors of giving birth in health facilities in Bugesera District, Rwanda.

BACKGROUND: The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of the highest maternal mortality ratios in the world, estimated between 249-584 maternal deaths per 100,000 live births. The objectives of this study were to quantify secular trends in health facility delivery and to identify factors that affect the uptake of intrapartum healthcare services among women living in rural villages in Bugesera District, Eastern Province, Rwanda. METHODS: Using census data and probability proportional to size cluster sampling methodology, 30 villages were selected for community-based, cross-sectional surveys of women aged 18-50 who had given birth in the previous three years. Complete obstetric histories and detailed demographic data were elicited from respondents using iPad technology. Geospatial coordinates were used to calculate the path distances between each village and its designated health center and district hospital. Bivariate and multivariate logistic regressions were used to identify factors associated with delivery in health facilities. RESULTS: Analysis of 3106 lifetime deliveries from 859 respondents shows a sharp increase in the percentage of health facility deliveries in recent years. Delivering a penultimate baby at a health facility (OR = 4.681 [3.204 - 6.839]), possessing health insurance (OR = 3.812 [1.795 - 8.097]), managing household finances (OR = 1.897 [1.046 - 3.439]), attending more antenatal care visits (OR = 1.567 [1.163 - 2.112]), delivering more recently (OR = 1.438 [1.120 - 1.847] annually), and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km) were independently associated with facility delivery. CONCLUSIONS: The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a health facility, possession of health insurance, greater financial autonomy, more recent interactions with the health system, and proximity to a health center. Recent structural interventions in Rwanda, including the rapid scale-up of community-financed health insurance, likely contributed to the dramatic improvement in the health facility delivery rate observed in our study.