Suivi postnatal à domicile après un congé précoce : Critères de sélection et Appréciation du délai

Aujourd’hui, la satisfaction des utilisateurs des services de santé est reconnue comme une mesure de la qualité des soins. Au Québec, le congé précoce en obstétrique constitue la norme pour les mères ayant donné naissance à un bébé en santé. Selon la littérature, cette pratique n’entraîne pas de répercussions négatives pour la santé des mères et de leur nouveau-né à condition qu’un suivi adéquat soit assuré. D’autre part, bien qu’il semble que la diminution de la durée du séjour hospitalier soit appréciée par les mères, peu de données sont disponibles relativement aux caractéristiques menant à l’appréciation du suivi postnatal. Objectifs : Cette étude s’intéresse principalement à la première visite à domicile effectuée par une infirmière suite au congé précoce en obstétrique. Dans un premier temps, elle vise à tracer un portrait des mères en fonction du délai de la première visite à domicile et, dans un second temps, à connaître les facteurs associés à l’appréciation, par les mères, du délai de cette visite. Méthode : Les données de cette étude ont été recueillies au Québec, entre janvier 2002 et janvier 2003, lors d’une enquête téléphonique effectuée auprès de mères de bébés nés en santé, un mois suivant leur accouchement vaginal sans complication (n=1548). Pour nos analyses, nous avons retranché les mères ayant eu une durée de séjour de plus de 60 heures, une grossesse de moins de 37semaines et un bébé pesant moins de 2500 g à la naissance. Notre échantillon se compose donc de 1351 mères. Résultats : 86,2 % des mères ont reçu une offre de visite à domicile. La majorité (80.2 %) des mères ont reçu la visite dans les trois premiers jours suivant leur retour à la maison, dont près du tiers (28,1 %), dans les 24 premières heures. Comparativement aux mères visitées au deuxième ou troisième jour suivant le congé, celles visitées dans les 24 premières heures ont jugé la durée de séjour hospitalier trop courte (p=0,018) et reçu un appel de l’infirmière qui a duré plus longtemps (p=0, 009). De plus, au moment du congé, elles perçoivent leur bébé en moins bonne santé (p=0,029). Elles ont aussi accouché d’un bébé plus petit (p=0,052) qui a tendance à avoir présenté des signes d’ictères pendant le séjour hospitalier (p=0,100). D’autre part, la majorité des mères (86,4 %) disent que le délai de la première visite à domicile est adéquat alors que 11,6 % le jugent trop court et 2,3 % trop long. Pour les mères visitées au premier jour, l’analyse multivariée révèle que certaines caractéristiques et certains besoins sont associés à la perception que le délai de la visite est trop court : une seule visite postnatale, un revenu familial de plus de 40 000 $, la perception que la durée de séjour est trop longue et le fait de ne pas allaiter. Pour les mères qui reçoivent la visite au deuxième et troisième jour, ce sont, seulement, le fait d’avoir été au rendez-vous médical et le fait d’avoir reçu une seule visite qui sont associés à la perception que le délai de la visite est trop court. Pour conclure, au Québec, le programme de suivi postnatal universel semble en mesure d’offrir une visite à domicile dans les délais prescrits à une majorité de mères. Les résultats de cette étude suggèrent que le délai de la première visite à domicile n’est pas optimal pour toutes les mères et permettent d’envisager que certaines mères auraient souhaité recevoir une seconde visite plus tardivement au cours de la période postnatale. D’autres recherches devront être effectuées afin de parfaire nos connaissances relativement au moment idéal pour réaliser les interventions postnatales.Mots clefs : Satisfaction, appréciation des utilisateurs, qualité des soins, programme universel, suivi postnatal, congé précoce en obstétrique, visite à domicile, délai de la visite, provision des services.

Educational policy for citizenship in the early years in Australia

This paper explores how young children are constructed in educational policy for citizenship in Australia, investigating tensions between early childhood educational discourses that construct young children as active citizens and the broader discourses of citizenship in Australian educational policy. There is a widespread discourse within early childhood education that regards young children as citizens and democratic participants in their own lives. This view is a reflection of the oft cited Article 12 in the UN Convention on the Rights of the Child (UNCRC 1989). However, educational policy and curriculum for citizenship in Australia, by and large, adheres to age and stage understandings of children, implicitly deeming young children unable to conceptualise abstract ideas of what it means to ‘be a good citizen’. This paper is located in the borders and intersections between discourses of early childhood education, young children as active participants in their own lives and what it means to be an active citizen in Australia. We are concerned with the interweaving of these ideas and how they are played out in educational policy making. This is an important perspective to take for governing and policy making are exercises in harnessing existing ideas and discourses, thereby rendering strategies and tactics for managing populations thinkable and sayable (Rose 1999). The ‘views from the margins’ (Burman 2008, p. 7) can provide alternative perspectives on policymaking, illuminating discursive tactics and strategies.

New directions in intercultural early education in Australia

Early education in Australia encompasses both early education and care(ECEC) and the early years of school. Educational approaches to cultural and linguistic diversity have varied not only by sector but also by jurisdiction based on distinct curriculum frameworks and policies. In Australian early education, provision for cultural and linguistic diversity has been framed largely by multicultural discourse, as defined by a complex history of progressive, yet often superficial reforms. Current initiatives serve to change this trajectory and the positioning of stakeholders. The incorporation of intercultural rather than multicultural approaches offers new possibilities for early education and directs attention to real challenges for ECEC. They re-position Aboriginal and Torres Strait Islanders as the First Australians, and direct attention to both Australia’s social, cultural and linguistic diversity and to the role of early childhood educators in enacting more inclusive pedagogies. Challenges yet to be addressed include the cultural understanding of Australian early childhood educators, particularly those who identify as Anglo- Australian, deeper policy enactment in pedagogic practice and negotiation with diverse families and communities. This paper will address the historical and current policy contexts of intercultural early education in Australia, the development of intercultural initiatives, and emerging issues as national policies are introduced. The discussion draws on responses to intercultural early education in New Zealand and Canada to consider approaches to intercultural priorities in Australia. The paper will attend predominantly to Aboriginal and Torres Strait Islander perspectives as a core element of change in Australian early childhood policy, focusing on ECEC.

Long-term survival after intensive care unit discharge in Thailand : a retrospective study

Introduction Economic evaluations of interventions in the hospital setting often rely on the estimated long-term impact on patient survival. Estimates of mortality rates and long-term outcomes among patients discharged alive from the intensive care unit (ICU) are lacking from lower- and middle-income countries. This study aimed to assess the long-term survival and life expectancy (LE) amongst post-ICU patients in Thailand, a middle-income country. Methods In this retrospective cohort study, data from a regional tertiary hospital in northeast Thailand and the regional death registry were linked and used to assess patient survival time after ICU discharge. Adult ICU patients aged at least 15 years who had been discharged alive from an ICU between 1 January 2004 and 31 December 2005 were included in the study, and the death registry was used to determine deaths occurring in this cohort up to 31st December 2010. These data were used in conjunction with standard mortality life tables to estimate annual mortality and life expectancy. Results This analysis included 10,321 ICU patients. During ICU admission, 3,251 patients (31.5%) died. Of 7,070 patients discharged alive, 2,527 (35.7%) were known to have died within the five-year follow-up period, a mortality rate 2.5 times higher than that in the Thai general population (age and sex matched). The mean LE was estimated as 18.3 years compared with 25.2 years in the general population. Conclusions Post-ICU patients experienced much higher rates of mortality than members of the general population over the five-year follow-up period, particularly in the first year after discharge. Further work assessing Health Related Quality of Life (HRQOL) in both post-ICU patients and in the general population in developing countries is needed.

Enhancing social work interprofessional learning through across university and industry collaboration : early steps in the Advanced Health Directives Project

There is ongoing interest in strategies for enhancing the reciprocal benefit derived from social work placements by students, host agencies, and universities. There is also recognition that interprofessional learning is an important aspect of social work education,and that field education placements have a role to play in this learning. This article reports on an innovation in community-engaged learning undertaken between a major public hospital and a university, where a team of social work and law students contributed to a focused inquiry into a socio-legal practice challenge faced by the hospital, namely the use of Advanced Health Directives (AHDs).Various collaborative processes involved in the early phase of the AHD project are reflected on by participants.A preliminary evaluation supports the value of taking a systematic approach to university–industry engagement where interprofessional collaboration occurs vertically and horizontally within and across university and placement hosting agencies.

Design, construction and evaluation of systems to predict risk in obstetrics

We present a systematic, practical approach to developing risk prediction systems, suitable for use with large databases of medical information. An important part of this approach is a novel feature selection algorithm which uses the area under the receiver operating characteristic (ROC) curve to measure the expected discriminative power of different sets of predictor variables. We describe this algorithm and use it to select variables to predict risk of a specific adverse pregnancy outcome: failure to progress in labour. Neural network, logistic regression and hierarchical Bayesian risk prediction models are constructed, all of which achieve close to the limit of performance attainable on this prediction task. We show that better prediction performance requires more discriminative clinical information rather than improved modelling techniques. It is also shown that better diagnostic criteria in clinical records would greatly assist the development of systems to predict risk in pregnancy. We present a systematic, practical approach to developing risk prediction systems, suitable for use with large databases of medical information. An important part of this approach is a novel feature selection algorithm which uses the area under the receiver operating characteristic (ROC) curve to measure the expected discriminative power of different sets of predictor variables. We describe this algorithm and use it to select variables to predict risk of a specific adverse pregnancy outcome: failure to progress in labour. Neural network, logistic regression and hierarchical Bayesian risk prediction models are constructed, all of which achieve close to the limit of performance attainable on this prediction task. We show that better prediction performance requires more discriminative clinical information rather than improved modelling techniques. It is also shown that better diagnostic criteria in clinical records would greatly assist the development of systems to predict risk in pregnancy.

Serum testosterone levels during the menstrual-cycle and early-pregnancy in the bonnet monkey (macaca-radiata)

Abstract is not available.

How weed control and fertilisation influence tree physiological processes and growth at early establishment in an exotic F1 hybrid pine plantation of subtropical Australia

Purpose This study investigated how nitrogen (N) nutrition and key physiological processes varied under changed water and nitrogen competition resulting from different weed control and fertilisation treatments in a 2-year-old F1 hybrid (Pinus elliottii Engelm var. elliottii × P. caribaea var. hondurensis Barr. ex Golf.) plantation on a grey podzolic soil type, in Southeast Queensland. Materials and methods The study integrated a range of measures including growth variables (diameter at ground level (DGL), diameter at breast height (DBH) and height (H)), foliar variables (including foliar N concentration, foliar δ13C and δ15N) and physiological variables (including photosynthesis (An), stomatal conductance (gs), transpiration (E), intrinsic water use efficiency (WUEi) (A/gs) and xylem pressure potential (ΨXPP)) to better understand the mechanisms influencing growth under different weed control and fertilisation treatments. Five levels of weed control were applied: standard (routine), luxury, intermediate, mechanical and nil weed control, all with routine fertilisation plus an additional treatment, routine weed control and luxury fertilisation. Relative weed cover was assessed at 0.8, 1.1 and 1.6 years after plantation establishment to monitor the effectiveness of weed control treatments. Soil investigation included soil ammonium (NH4 +-N), nitrate (NO3 −-N), potentially mineralizable N (PMN), gravimetric soil moisture content (MC), hot water extractable organic carbon (HWETC), hot water extractable total N (HWETN), total C, total N, stable C isotope composition (δ13C), stable N isotope composition (δ15N), total P and extractable K. Results and discussion There were significant relationships between foliar N concentrations and relative weed cover and between tree growth and foliar N concentration or foliar δ15N, but initial site preparation practices also increased soil N transformations in the planting rows reducing the observable effects of weed control on foliar δ15N. A positive relationship between foliar N concentration and foliar δ13C or photosynthesis indicated that increased N availability to trees positively influenced non-stomatal limitations to photosynthesis. However, trees with increased foliar N concentrations and photosynthesis were negatively related to xylem pressure potential in the afternoons which enhanced stomatal limitations to photosynthesis and WUEi. Conclusions Luxury and intermediate weed control and luxury fertilisation positively influenced growth at early establishment by reducing the competition for water and N resources. This influenced fundamental key physiological processes such as the relationships between foliar N concentration, A n, E, gs and ΨXPP. Results also confirmed that time from cultivation is an important factor influencing the effectiveness of using foliar δ15N as an indicator of soil N transformations.

Comment on “Whole-genome analyses resolve early branches in the tree of life of modern birds”

Jarvis et al. (Research Articles, 12 December 2014, p. 1320) presented molecular clock analyses that suggested that most modern bird orders diverged just after the mass extinction event at the Cretaceous-Paleogene boundary (about 66 million years ago). We demonstrate that this conclusion results from the use of a single inappropriate maximum bound, which effectively precludes the Cretaceous diversification overwhelmingly supported by previous molecular studies.

Effect of ICSH on Early Pregnancy in Hypophysectomized Pregnant Rats

Moudgal and co-workers1-3 recently reported that the administration to intact pregnant rats of rabbit antiserum ovine interstitial cell stimulating hormone (ICSH) on any one day between the eighth and twelfth days of pregnancy resulted in resorption of foetuses and termination of pregnancy. This effect was readily reversed by the simultaneous administration of progesterone but not by oestradiol-17β. These observations suggested that ICSH was involved in progesterone synthesis and as such is a luteotropic factor in the rat.

A monoclonal antibody recognizing the C-terminal region of chicken egg white riboflavin carrier protein terminates early pregnancy in mice

In order to identify the functionally relevant epitopes on chicken riboflavin carrier protein, we have raised monoclonal antibodies to the vitamin carrier. One of these, 6B2C12, was found to interact specifically with a synthetic oligopeptide corresponding to the C-terminal 17 amino acid residues of the chicken egg white riboflavin carrier protein, which is missing in part in the egg yolk riboflavin carrier protein. This epitope is conserved through evolution in mammals including humans. Administration of the ascites fluid of 6B2C12 to pregnant mice intraperitoneally, resulted in the termination of pregnancy indicating that this epitope is involved in or closely associated with the transplacental transport of the vitamin from the maternal circulation to the growing fetus.

A Study of Early Afterdepolarizations in a Model for Human Ventricular Tissue

Sudden cardiac death is often caused by cardiac arrhythmias. Recently, special attention has been given to a certain arrhythmogenic condition, the long-QT syndrome, which occurs as a result of genetic mutations or drug toxicity. The underlying mechanisms of arrhythmias, caused by the long-QT syndrome, are not fully understood. However, arrhythmias are often connected to special excitations of cardiac cells, called early afterdepolarizations (EADs), which are depolarizations during the repolarizing phase of the action potential. So far, EADs have been studied mainly in isolated cardiac cells. However, the question on how EADs at the single-cell level can result in fibrillation at the tissue level, especially in human cell models, has not been widely studied yet. In this paper, we study wave patterns that result from single-cell EAD dynamics in a mathematical model for human ventricular cardiac tissue. We induce EADs by modeling experimental conditions which have been shown to evoke EADs at a single-cell level: by an increase of L-type Ca currents and a decrease of the delayed rectifier potassium currents. We show that, at the tissue level and depending on these parameters, three types of abnormal wave patterns emerge. We classify them into two types of spiral fibrillation and one type of oscillatory dynamics. Moreover, we find that the emergent wave patterns can be driven by calcium or sodium currents and we find phase waves in the oscillatory excitation regime. From our simulations we predict that arrhythmias caused by EADs can occur during normal wave propagation and do not require tissue heterogeneities. Experimental verification of our results is possible for experiments at the cell-culture level, where EADs can be induced by an increase of the L-type calcium conductance and by the application of I-Kr blockers, and the properties of the emergent patterns can be studied by optical mapping of the voltage and calcium.

The effect of carbon encapsulation on the magnetic properties of Ni nanoparticles produced by arc discharge in de-ionized water

Despite intensive research on optimizing the methods for depositing carbon encapsulated ferromagnetic nanoparticles, the effect of the carbon cages remains unclear. In the present work, the effect of the graphitic cages on the magnetization of the ferromagnetic core has been studied by comparing the magnetic properties of pure and carbon encapsulated Ni particles of the same size. The carbon encapsulated Ni particles were formed using an electric arc discharge in de-ionized water between a solid graphite cathode and an anode consisting of Ni and C in a mass ratio of Ni:C = 7:3. This method is shown to have potential for low cost production of carbon encapsulated Ni nanoparticle samples with narrow particle size distributions. X-ray diffraction (XRD) and high resolution transmission electron microscopy (HRTEM) analysis were used to study the crystallography, morphology, and size distribution of the encapsulated and pure Ni nanoparticle samples. The availability of encapsulated particles with various sizes allowed us to elucidate the role of carbon cages in size-dependent properties. Our data suggest that even though encapsulation is beneficial for protection against hostile chemical environments and for avoiding low proximity phenomena, it suppresses the saturation magnetization of the Ni cores.