Search results for: early pregnancy assessment

Authors: Sajia Islam, T. Tahsina, S. Raihana, M. M. Rahman, Q. S. Rahman, T. M. Huda, S. E. Arifeen, M. J. Dibley

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Early neonatal sepsis accounts for more than two-thirds of all deaths in the first year of life. This study assessed the counseling during antenatal, perinatal, post natal periods and its association with possible sepsis in rural Bangladesh. Method: Data were collected from a large community-based trial in Bangladesh where pregnant women were enrolled from 2013-2015 covering 29,497 newborns. Sepsis was defined using neonatal danger signs reported by 'The Young-Infants Clinical Science Study Group. 'Result: Signs of sepsis was found among 15% of the neonates. Neonatal sepsis was higher among those who did not receive advice on TT vaccinations (15.4% vs. 11%, p < 0.05) and danger signs (14.8% vs. 12.8%, p < 0.05) during pregnancy. Advice on delivering in well-lit place was significantly associated with lower incidence of sepsis (12.7% vs. 14.8% p < 0.05). Sepsis was lower among neonates whose mothers were counseled on immediate newborn care for bathing after 3 days of delivery (13.4% vs. 15.2% p=0), breastfeeding within 1hr of birth (13.82 % vs. 15.28% p=0), apply nothing on the cord (11.54 vs. 15.06 p=0), immediate drying of child (12.62% vs. 14.89%, p=0). Neonatal sepsis was lower among children whose mothers received 2-4 advice [OR=0.91(95% CI: 0.85-0.97)] compared to neonates whose mothers received only 1 or none. Overall, children to mothers who received ≥ 5 advice had lowest incidence of sepsis [OR=0.83 (95% CI: 0.71-0.97)] Conclusion: Advice on antenatal, prenatal and post natal is significantly reduced with early newborn sepsis. Further research is required to identify specific type of counseling messages that translate into practices and reduce pathways towards early-newborn morbidities.

Keywords: ante natal care, counseling, neonatal sepsis, post natal care

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Authors: Chia-Ching Sun, Li-Yin Chien, Chun-Ting Hsiao

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Background: Appropriate gestation weight gain benefits pregnant women and their children; however, excessive weight gain could raise the risk of adverse health outcomes and chronicle diseases. Nevertheless, there is currently limited evidence on the effect of physical activities on pregnant women’s gestational weight gain. Purpose: This study aimed to explore the correlation between the level of physical activity and gestation weight gain during the second and third trimester of pregnancy. Methods: This longitudinal study enrolled 800 healthy pregnant women aged over 20 from six hospitals in northern Taiwan. Structured questionnaires were used to collect data twice for each participant during 14-27 and 28-40 weeks of gestation. Variables included demographic data, maternal health history, and lifestyle. The International Physical Activity Questionnaire-short form was used to measure the level of physical activity from walking and of moderate-intensity and vigorous-intensity before and during pregnancy. Weight recorded at prenatal checkups were used to calculate average weight gain in each trimester of pregnancy. T-tests, ANOVA, chi-squared tests, and multivariable logistic regression models were applied to determine the predicting factors for weight gain during the second and third trimester. Result: Participants who had achieved recommended physical activity level (150 minutes of moderate physical activity or 75 minutes of vigorous physical activity a week) before pregnancy (aOR=1.85, 95% CI=1.27-2.67) or who achieved recommended walking level (150 minutes a week) during the second trimester of pregnancy (aOR=1.43, 95% CI= 1.00-2.04) gained significantly more weight during the second trimester. Compared with those who did not reach recommended level of moderate-intensity physical activity (150 minutes a week), women who had reached that during the second trimester were more likely to be in the less than recommended weight gain group than in the recommended weight gain group (aOR=2.06, CI=1.06-4.00). However, there was no significant correlation between physical activity level and weight gain in the third trimester. Other predicting factors of excessive weight gain included education level which showed a negative correlation (aOR=0.38, CI=0.17-0.88), whereas overweight and obesity before pregnancy showed a positive correlation (OR=3.97, CI=1.23-12.78). Conclusions/implications for practice: Participants who had achieved recommended physical activity level before pregnancy significantly reduced exercise during pregnancy and gained excessive weight during the second trimester. However, women who engaged in the practice of physical activity as recommended could effectively control weight gain in the third trimester. Healthcare professionals could suggest that pregnant women who exercise maintain their pre-pregnancy level of physical activity, given activities requiring physical contact or causing falls are avoided. For those who do not exercise, health professionals should encourage them to gradually increase the level of physical activity. Health promotion strategies related to weight control and physical activity level achievement should be given to women before pregnancy.

Keywords: pregnant woman, physical activity, gestation weight gain, obesity, overweight

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Authors: Eftah Bte. Moh Hj Abdullah, Izazol Binti Idris, Abd Aziz Bin Abd Shukor

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This study aims to identify the understanding expectations of school administrators concerning school assessment. The researcher utilized a qualitative descriptive study on 19 administrators from three secondary schools in the North Kinta district. The respondents had been interviewed on their understanding expectations of school assessment using the focus group discussion method. Overall findings showed that the administrators’ understanding expectations of school assessment was weak; especially in terms of content focus, articulation across age and grade, transparency and fairness, as well as the pedagogical implications. Findings from interviews indicated that administrators explained their understanding expectations of school assessment from the aspect of school management, and not from the aspect of instructional leadership or specifically as assessment leaders. The study implications from the administrators’ understanding expectations may hint at the difficulty of the administrators to function as assessment leaders, in order to reduce their focus as manager, and move towards their primary role in the process of teaching and learning. The administrator, as assessment leaders, would be able to reach assessment goals via collaboration in identifying and listing teacher assessment competencies, how to construct assessment capacity, how to interpret assessment correctly, the use of assessment and how to use assessment information to communicate confidently and effectively to the public.

Keywords: assessment leaders, assessment goals, instructional leadership, understanding expectation of assessment

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Authors: Nazihe Sedighi, Mohsen Nokhbatolphoghaei

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Bisphenol A (BPA) is a monomer used in the manufacture of polycarbonate plastics. Due to having properties such as transparency, heat and impact resistance, it is used widely in medicine, sorts, electronic components, and food containers. It is also used in the production of resins which is applied for lining cans. BPA releases from resins and polycarbonate when it is heated or continuously used the containers from which BPA can enter the body. There are several reports indicating the presence of BPA in the placenta, amniotic fluid, and the embryo itself. While researchers investigated the teratogenic effect of BPA on embryos, very limited work has been done on the effects of BPA when applied from early stages of development. In this study, The teratogenic effect of BPA was investigated at earliest preimplantation (day zero) through day 15.5 of the development of Balb/C mouse embryos. After ensuring the pregnancy via observing vaginal plug, Pregnant mice were divided into five groups. For the three experimental groups, the amount of 500, 750, and 1000 mg/kg/d Bisphenol A was given orally according to body weight. The sham group that was treated with sesame oil, which was used as vehicle and control group remained intact. On day 18.5 of gestation, embryos were removed from the uterus. Randomly half of the embryo were fixed in Bouin for tissue analysis. The other half were prepared for skeletal system staining using Alizarin Red and alcian blue dies. The results showed that the embryonic weight and the crown-rump length of embryos decreased significantly (P < 0.05) in all experimental groups compared to the control group and the sham. In this study, skeletal abnormalities such as delay in ossification of skull and limbs as well as the deviation in the backbone were seen. This research suggests that pregnant mothers need to be aware of possible teratogenic effects of BPA at any stage of pregnancy especially from early to mid stages. In this case, pregnant mothers may need to stop using any manufacture of polycarbonate plastics, as a container for food or drinking.

Keywords: bisphenol A, development, polycarbonate plastic, skeletal system, teratogenicity

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Authors: Zhidong Zhang, Zhi-Chao Zhang

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This study focuses on early adolescent externalizing behavioral problems which specifically concentrate on rule breaking behavior and aggressive behavior using the instrument of Achenbach System of Empirically Based Assessment (ASEBA). The purpose was to analyze the relationships between the externalizing behavioral problems and relevant background variables such as sports activities, hobbies, chores and the number of close friends. The stratified sampling method was used to collect data from 1975 participants. The results indicated that several background variables as predictors could significantly predict rule breaking behavior and aggressive behavior. Further, a hierarchical modeling method was used to explore the causal relations among background variables, breaking behavior variables and aggressive behavior variables.

Keywords: aggressive behavior, breaking behavior, early adolescence, externalizing problem

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Authors: Tahamina Begum, Wan Nor Azlen Wan Mohamad, Faruque Reza, Wan Rosilawati Wan Rosli

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To assess auditory perception and cognitive function during pregnancy is necessary as the pregnant women need extra effort for attention mainly for their executive function to maintain their quality of life. This study aimed to investigate neural correlates of cognitive and behavioral processing during mid trimester pregnancy. Event-Related Potentials (ERPs) were studied by using 128-sensor net and PAS or COWA (controlled Oral Word Association), WCST (Wisconsin Card Sorting Test), RAVLTIM (Rey Auditory Verbal and Learning Test: immediate or interference recall, delayed recall (RAVLT DR) and total score (RAVLT TS) were tested for neuropsychology assessment. In total 18 subjects were recruited (n= 9 in each group; control and pregnant group). All participants of the pregnant group were within 16-27 (mid trimester) weeks gestation. Age and education matched control healthy subjects were recruited in the control group. Participants were given a standardized test of auditory cognitive function as auditory oddball paradigm during ERP study. In this paradigm, two different auditory stimuli (standard and target stimuli) were used where subjects counted silently only target stimuli with giving attention by ignoring standard stimuli. Mean differences between target and standard stimuli were compared across groups. N100 (auditory sensory ERP component) and P300 (auditory cognitive ERP component) were recorded at T3, T4, T5, T6, Cz and Pz electrode sites. An equal number of electrodes showed non-significantly shorter amplitude of N100 component (except significantly shorter at T3, P= 0.05) and non-significant longer latencies (except significantly longer latency at T5, P= 0.008) of N100 component in pregnant group comparing control. In case of P300 component, maximum electrode sites showed non-significantly higher amplitudes and equal number of sites showed non-significant shorter latencies in pregnant group comparing control. Neuropsychology results revealed the non-significant higher score of PAS, lower score of WCST, lower score of RAVLTIM and RAVLTDR in pregnant group comparing control. The results of N100 component and RAVLT scores concluded that auditory perception is mildly impaired and P300 component proved very mild cognitive dysfunction with good executive functions in second trimester of pregnancy.

Keywords: auditory perception, pregnancy, stimuli, trimester

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Authors: Yu Chen Su

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Introduction: Gestational diabetes mellitus (GDM) refers to impaired glucose tolerance in pregnant women, impacting both the mother and newborn with short and long-term effects. It increases risks of preeclampsia, hypertension, type 2 diabetes, cesarean section, and preterm birth. GDM is associated with fetal macrosomia, shoulder dystocia, neonatal hypoglycemia, and future type 2 diabetes risk. A study on 6,421 pregnant women found 12% experienced high stress, linked to maladaptive coping and depressive emotions. Women with high-risk pregnancies may experience greater stress and depression. Research suggests GDM increases depression prevalence. A study on 632 Hispanic women with GDM showed severe stress and depression tendencies. Involving 95 women with GDM, 33.4% exhibited depression symptoms. Another study compared 180 GDM women to 186 with normal glucose levels, revealing higher depression levels in GDM women. They found GDM women were 1.85 times more likely to receive antidepressants during pregnancy and 1.69 times more likely to experience postpartum depression. Maternal stress and depressive symptoms during pregnancy are significant factors. Early identification by healthcare professionals can greatly benefit GDM women, their infants, and their families. Objectives: The purpose of this study was to investigate the association between gestational diabetes mellitus (GDM) and the risk of depression. Methods: This study reviewed and analyzed relevant literature on gestational diabetes mellitus (GDM) and depression in 6,876 patients. The literature search followed PRISMA guidelines and included databases like Embase, PubMed, MEDLINE, CINAHL, and Cochrane Library. Prospective or retrospective studies with relevant risk ratios and estimates were included, using a random-effects model for the analysis of depression risk correlation. Studies without depression data or relevant risks were excluded. The search period extended until October 2022. Results: Systematic review of 7 studies (6,876 participants) found a significant association (OR = 8.77, CI: 7.98-9.64, p < 0.05) between gestational diabetes mellitus (GDM) and higher depression risk compared to healthy pregnant women. Conclusions: Pregnancy is a significant life transition involving physiological, psychological, and social changes. Gestational diabetes poses challenges to women's physical and mental well-being. Sensitive healthcare professionals identifying issues early can greatly benefit women, babies, and the family.

Keywords: gestational diabetes, depression, systematic review, neta-analysis

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Authors: Karimeh Alnuaimi, Manal Kassab, Reem Ali, Khitam Mohammad, Kholoud Shattnawi

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Aim: To compare pregnancy outcomes of Syrian refugee women and Jordanian women. Background and introduction: The current conflict in Syria continues to displace thousands to neighboring countries, including Jordan. Pregnant refugee women are therefore facing many difficulties are known to increase the prevalence of poor reproductive health outcomes and antenatal complications. However, there is very little awareness of whether Syrian refugee women have different risks of pregnancy outcomes than Jordanian women. Methods: Using a retrospective cohort design, we examined pregnancy outcomes for Syrian refugee (N = 616) and Jordanian women (N = 644) giving birth at two governmental Hospitals in the north of Jordan, between January 1, 2014, and December 31, 2014. A checklist of 13 variables was utilized. The primary outcome measures were delivery by Caesarean section, maternal complications, low birth weight (< 2500 g), Apgar score and preterm delivery (< 37 weeks' gestational age). Results: Statistical analysis revealed that refugee mothers had a significant increase in the rate of cesarean section and the higher rate of anemia, a lower neonates’ weight, and Apgar scores when compared to their Jordanian counterparts. Discussion and Conclusion: Results were congruent with findings from other studies in the region and worldwide. Minimizing inequalities in pregnancy outcomes between Syrian refugees and Jordan women is a healthcare priority. Implications for nursing and health policy: The findings could guide the planning and development of health policies in Jordan that would help to alleviate the situation regarding refugee populations. The action is required by the policy makers, specifically targeting public and primary health care services, to address the problem of adequately meeting the need for antenatal care of this vulnerable population.

Keywords: pregnancy, Syrian refugee, Jordanian women, comparative study

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Authors: Zhidong Zhang, Zhi-Chao Zhang

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This study focused on early adolescent rule-breaking behavioral problems using the instrument of Achenbach System of Empirically Based Assessment (ASEBA). The purpose was to analyze the relationships between the rule-breaking behavioral problems and relevant background variables such as sports activities, hobbies, chores and the number of close friends. The stratified sampling method was used to collect data from 2532 participants. The results indicated that several background variables as predictors could significantly predict rule breaking behavior and aggressive behavior. Further, a path analysis method was used to explore the correlational and causal relationships among background variables and breaking behavior variables.

Keywords: ASEBA, rule-breaking, path analysis, early adolescent

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Authors: Abdulla Al Hmoudi

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The impacts and costs of natural disasters on people, properties and the environment is often severe when they occur on a large scale or when not prepared for. Factors such as impacts of climate change, urban growth, poor planning to mention a few, have continued to significantly increase the frequencies and aggravate the impacts of natural hazards across the world; the United Arab Emirates (UAE) inclusive. The lack of deployment of an early warning system, low risk and hazard knowledge and impact of natural hazard experienced in some communities in the UAE have emphasised the need for more effective early warning systems. This paper focuses on the collaborative approach taken to instituting and implementing an early warning system. Using mixed methods 888 people completed the questionnaire and eight people were interviewed in Abu Dhabi. The results indicate that the collaborative approach to early warning system is UAE is needed, but lacks essential principles of the early warning system and currently underutilised. It is recommended that the collaborative early warning system is applied at every stage of the early warning system with the specific responsibility of each stakeholder and actor.

Keywords: community, early warning system, emergency management, UAE

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Authors: Yibeltal T. Bayou, Yohana S. Mashalla, Gloria Thupayagale-Tshweneagae

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Background: Maternal mortality has been shown to be lower in urban areas than in rural areas. However, disparities for the fast-growing population of urban poor who struggle as much their rural counterparts to access quality healthcare are masked by the urban averages. The aim of this paper is to report on the findings of antenatal adequacy among slum residents in Addis Ababa, Ethiopia. Methods and Materials: A quantitative and cross-sectional community-based study design was employed. A stratified two-stage cluster sampling technique was used to determine the sample and data was collected using structured questionnaire administered to 837 women aged 15-49 years. Binary logistic regression models were employed to identify predictors of adequacy of antenatal care. Results: The majority of slum residents did not have adequate antenatal care services i.e., only 50.7%, 19.3% and 10.2% of the slum resident women initiated early antenatal care, received adequate antenatal care service contents and had overall adequate antenatal care services. Pregnancy intention, educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.9 times more likely to have overall adequate care compared to those with no formal education. Similarly, women whose last pregnancy was intended and clients of private healthcare facilities were 1.8 and 2.8 times more likely to have overall adequate antenatal care compared to those whose last pregnancy was unintended and clients of public healthcare facilities respectively. Conclusion: In order to improve ANC adequacy in the study area, the policymaking, planning, and implementation processes should focus on the poor adequacy of ANC among the disadvantaged groups in particular and the slum residents in general.

Keywords: Addis Ababa, adequacy of antenatal care, slum residents, maternal mortality

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Authors: Sadia Munir

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Preeclampsia is the contributor to the worldwide maternal mortality of approximately 100,000 deaths a year. It complicates about 10% of all pregnancies and is the first cause of maternal admission to intensive care units. Predicting preeclampsia is a major challenge in obstetrics. More importantly, no major progress has been achieved in the treatment of preeclampsia. As placenta is the main cause of the disease, the only way to treat the disease is to extract placental and deliver the baby. In developed countries, the cost of an average case of preeclampsia is estimated at £9000. Interestingly, preeclampsia may have an impact on the health of mother or infant, beyond the pregnancy. We performed a systematic search of PubMed including the combination of terms such as preeclampsia, biomarkers, treatment, hypoxia, inflammation, oxidative stress, vascular endothelial growth factor A, activin A, inhibin A, placental growth factor, transforming growth factor β-1, Nodal, placenta, trophoblast cells, microRNAs. In this review, we have summarized current knowledge on the identification of potential biomarkers for the diagnosis of preeclampsia. Although these studies show promising data in early diagnosis of preeclampsia, the current value of these factors as biomarkers, for the precise prediction of preeclampsia, has its limitation. Therefore, future studies need to be done to support some of the very promising and interesting data to develop affordable and widely available tests for early detection and treatment of preeclampsia.

Keywords: activin, biomarkers, growth factors, miroRNA

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Authors: Ronelle Prinsloo

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Teenage pregnancy in South African schools is a growing concern. In South Africa, many young female learners end their schooling permanently, not because they have completed their studies, but due to pregnancy. The admission policy of public schools is determined by the governing body of such a school, and this policy can determine that a pregnant leaner may not attend school during pregnancy and for a certain period after the birth of the child. This can be seen as an infringement of the rights of the teenage mother to be allowed to attend school. It can also be argued that this conflicts with the best interest of the child as well as the rights of the governing body to determine policy in accordance with the mandate as given to them by the parents and community served by the school. A pregnant learner can argue that the admission policy of a school is discriminatory if it does not allow the pregnant learner to continue her schooling. She may also argue that she is being unfairly discriminated against based on gender because in many instances, the baby’s father is still allowed to go to school. The Constitution (Constitution of the Republic of South Africa, Act 108 of 1996), provides in section 9, that everyone is equal before the law; it goes on to provide that equality includes the full and equal enjoyment of all rights and freedoms and provides those grounds on which one may not be discriminated against including, gender, sex, and pregnancy. Schools should be encouraged to re-enroll students if they have a support system available to assist with the necessary childcare when they attend school. To dramatically increase the number of young people enrolled in alternative pathways such as Further Education and Training or Adult Basic Education and Training must be provided. In addition, alternative systems must offer viable exit opportunities for participants by cohering with further education and economic opportunities.

Keywords: admission policy, Constitution of South Africa, human rights, teenage pregnancy

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Authors: Kailash Ghimire, Manoj Thapa

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This study focuses on early identification of deficiencies in pre-required areas of students who are enrolled in College Algebra and Calculus I classes. The students were given pre-diagnostic tests on the first day of the class before they are provided with the syllabus. The tests consist of prerequisite, uniform and advanced content outlined by the University System of Georgia (USG). The results show that 48% of students in College Algebra are lacking prerequisite skills while 52% of Calculus I students are lacking prerequisite skills but, interestingly these students are prior exposed to uniform content and advanced content. The study is still in progress and this paper contains the outcome from Fall 2017 and Spring 2018. In this paper, early intervention used in these classes: two days vs three days meeting a week and students’ self-assessment using exam wrappers and their effectiveness on students’ learning will also be discussed. A result of this study shows that there is an improvement on Drop, Fail and Withdraw (DFW) rates by 7%-10% compared to those in previous semesters.

Keywords: student at risk, diagnostic tests, identification, intervention, normalization gain, validity of tests

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Authors: Samira Akdader-Oudahmane, Assia Kamel, Lynda Lakabi, Michael Bruce Zimmermann, Zohra Hamouli-Said, Djamila Meskine

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Background: Iodine is a trace element whose adequate intakes are essential during pregnancy to promote the correct growth and development of the fetus. Iodine deficiency is the cause of several disorders in foetal development, and thyroid disorders during pregnancy are associated with an increased risk of miscarriage or premature birth. The aim of this study was to assess the iodine status and thyroid function of pregnant women (PW) in northern Algeria. Methods: Healthy PW were recruited from an urban area (Algiers). Spot urine and venous blood samples were collected to assess iodine status (urinary iodine concentration, UIC) and serum thyroid hormones (TSH, FT4), and anti-thyroid peroxidase antibodies (TPO-Ab) concentrations. Results: The median UIC for the PW (n=172) in Algiers was 246,74µg/L, 244,68 µg/L, and 220,63µg/L, respectively, during the first, second, and third trimesters of pregnancy. Mean TSH and FT4 concentrations were within reference ranges in all groups of women. Among PW, 72.7%, 75.4%, and 75.5% in the first, second and third trimester were TPO-Ab+. Among PW, 14%, 10%, and 10% in the first, second and third trimester, respectively, with TPO -Ab+ had subclinical hypothyroidism. An analysis of the variations in the levels of the serum parameters (FT4, TSH and anti-TPO antibodies) was analyzed according to the UIC intervals admitted and show that these marker are predictive of thyroid function. Conclusion: In northern Algeria, median UICs indicate iodine sufficiency in PW. About 75% of PW are TPO-Ab+ and the prevalence of subclinical hypothyroidism is high.

Keywords: thyroid, pregnant woman, urinary iodine, subclinical hypothyroidism

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Authors: Henrique Veras De Paiva Fonseca

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This paper investigates the long-term relationship between early life exposure to malaria and adult socioeconomic outcomes in Brazil. The identification strategy relies on exogenous variation in the risk of malaria outbreaks in different states and seasons of the year to identify early life exposure according to the timing and location of birth. Furthermore, Brazil has undergone a successful campaign of malaria eradication during the late 1950s, which allows for comparing outcomes of birth cohorts born just prior to and just after eradication to identify the extent of in utero exposure. Instrumental variables estimates find consistent negative treatment effects of in utero exposure to malaria on socioeconomic outcomes, such as educational attainment and health status. The effects are stronger for exposure during the first trimester of pregnancy than during other periods of gestation. Additionally, consistent with previous findings, men are more likely to exhibit larger long-term effects.

Keywords: malaria, exposure, eradication, instrumental variables, education, health

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Authors: Alejandra Cardenas, Ona Flores, Fabiola Gretzinger

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Since the 1990s, legal strategies for the promotion and protection of maternal health rights have achieved significant gains. Successful litigation in courts around the world have shown that these rights can be judicially enforceable. Governments and international organizations have acknowledged the importance of a human rights-based approach to maternal mortality and morbidity, and obstetric violence has been recognized as a human rights issue. Despite the progress made, maternal mortality has worsened in some regions of the world, while progress has stagnated elsewhere, and mistreatment in maternal care is reported almost universally. In this context, issues of maternal autonomy and decision-making during pregnancy, labor, and delivery as a critical barrier to access quality maternal health have been largely overlooked. Indeed, despite the principles of autonomy and informed consent in medical interventions being well-established in international and regional norms, how they are applied particularly during childbirth and pregnancy remains underdeveloped. National and global legal standards and decisions related to maternal health were reviewed and analyzed to determine how maternal autonomy and decision-making during pregnancy, labor, and delivery have been protected (or not) by international and national courts. The results of this legal research and analysis lead to the conclusion that a few standards have been set by courts regarding pregnant people’s rights to make choices during pregnancy and birth; however, most undermine the agency of pregnant people. These decisions recognize obstetric violence and gender-based discrimination, but fail to protect pregnant people’s autonomy, privacy, and their right to informed consent. As current human rights standards stand today, maternal health is the only field in medicine and law in which informed consent can be overridden, and patients can be forced to submit to treatments against their will. Unconsented treatment and loss of agency during pregnancy and childbirth can have long-term physical and mental impacts, reduce satisfaction and trust in health systems, and may deter future health-seeking behaviors. This research proposes a path forward that focuses on the pregnant person as an independent agent, relying on the doctrine of self-determination during pregnancy and childbirth, which includes access to the necessary conditions to enable autonomy and choice throughout pregnancy and childbirth as a critical step towards our approaches to reduce maternal mortality, morbidity, and mistreatment, and realize the promise of access to quality maternal health as a human right.

Keywords: autonomy in childbirth and pregnancy, choice, informed consent, jurisprudential analysis

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Authors: Ya-Ping Chang

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Starting from the early stages of pregnancy, parents begin to form hopes and dreams about the future of their child. They will think about the appearance and personality of their child and may even develop many expectations. The patient in this study experienced a successful pregnancy following multiple attempts at artificial insemination. However, due to arrested embryonic development, and based on the physician’s evaluation, a caesarean section was performed at week 25. However, the baby suffered from infections and subsequently died from multiple organ failures. This study collected and analyzed objective and subjective data through observation, interviews, recording, and interactions with the patient. The following nursing issues of the patient were identified: anxiety, anticipatory grief, and adjustment disorder. The psychology of caring as proposed in Watson’s theory was applied to address these nursing issues. Comprehensive and continuous care was provided to the patient on the basis of mutual trust and individual nursing guidelines in order to alleviate the patient’s anxiety, help her to cope with grief, and prepare her for the eventual death of her child. The author helped the patient to say goodbye to her child and accept the child’s death calmly, such that she had no regrets about the experience. This nursing experience may serve as a reference to nurses managing similar cases in the future.

Keywords: dying baby, mother, grief, Watson’s theory

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Authors: Alexander Kelíšek, Denisa Janasová, Veronika Mitašová

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Weak signals using is often associated with early warning. It is possible to find a link between early warning, respectively early problems detection and risk management. The idea of early warning is very important in the context of crisis management because of the risk prevention possibility. Weak signals are likened to risk symptoms. Nowadays, their usefulness as a tool of proactive problems solving is emphasized. Based on it, it is possible to use weak signals not only in strategic planning, project management, or early warning system, but also as a subsidiary element in risk management. The main question is how to effectively integrate weak signals into risk management. The main aim of the paper is to point out the possibilities of weak signals using in small and medium enterprises risk management.

Keywords: early warning system, weak signals, risk management, small and medium enterprises (SMEs)

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Authors: Jamal Alkoteesh, Mohammed Zeki, Mouza Alnaqbi

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Objective: To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. Design: Retrospective study. In this study, most women opted for UFE as a fertility treatment after failure of myomectomy or in vitro fertilization, or because hysterectomy was the only suggested option. Background. Myomectomy is the standard approach in patients with fibroids desiring a future pregnancy. However, myomectomy may be difficult in cases of numerous interstitial and/or submucous fibroids.In these cases, UFE has the advantage of embolizing all fibroids in one procedure. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids. Study Methods: A retrospective study of 210 patients treated with UFE for symptomatic uterine fibroids between 2011-2016 was performed. UFE was performed using ((PVA; Embozen, Beadblock) (500-900 µm in diameter). Pregnancies were identified using screening questionnaires and the study database. Of the 210 patients who received UFE treatment, 35 women younger than the age of 40 wanted to conceive and had been unable. All women in our study were advised to wait six months or more after UFE before attempting to become pregnant, of which the reported time range before attempting to conceive was seven to 33 months (average 20 months). RESULTS: In a retrospective chart review of patients younger than the age of 40 (35 patients,18 patients reported 23 pregnancies, of which five were miscarriages. Two more pregnancies were complicated by premature labor. Of the 23 pregnancies, 16 were normal full-term pregnancies, 15 women had conceived once, and four had become pregnant twice. The remaining patients did not conceive. In the study, there was no reported intrauterine growth retardation in the prenatal period, fetal distress during labor, or problems related to uterine integrity. Two patients reported minor problems during pregnancy that were borderline oligohydramnios and low-lying placenta. In the cohort of women who did conceive, overall, 16 out of 18 births proceeded normally without any complications (86%). Eight women delivered by cesarean section, and 10 women had normal vaginal delivery. In this study of 210 women, UFE had a fertility rate of 47%. Our group of 23 pregnancies was small, but did confirm successful pregnancy after UFE. The 45.7% pregnancy rate in women below the age of 40 years old who completed a term pregnancy compares favorably with women who underwent myomectomy via other method. Of the women in the cohort who did conceive, subsequent birth proceeded normally (86%). Conclusion: Pregnancy after UFE is well-documented. The risks of infertility following embolization, premature menopause, and hysterectomy are small, as is the radiation exposure during embolization. Fertility rates appear similar to patients undergoing myomectomy.UFE should not be contraindicated in patients who want to conceive and they should be able to choose between surgical options and UFE.

Keywords: fibroid, pregnancy, therapeutic embolization, uterine artery

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Authors: Somaye Ghafarpour, Kamran Yazdanbakhsh, Mohamad Reza Zarbakhsh, Simin Hosseinian, Samira Ghafarpour

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Unsatisfactory sleep quality is one of the most common complications of pregnancy, which can predispose mothers to postpartum depression, requiring implementing effective psychological interventions to prevent and modify behaviors accentuating sleep problems. This study was a randomized clinical controlled trial with a pre-test/post-test design aiming to investigate the effectiveness of sleep behavioral interventions during the third trimester of pregnancy on sleep quality and postpartum depression. A total of 50 pregnant mothers in the 26-30 weeks of pregnancy suffering from sleep problems (based on the score obtained from the Pittsburgh Sleep Questionnaire) were randomized into two groups (control and intervention, n= 25 per group). The data were collected using interviews, the Pittsburgh Sleep Quality Index (PSQI), and the Edinburgh Postnatal Depression Scale (EPDS) were used. The participants in the intervention group received eight 60-minute sessions of combinational training for behavioral therapy techniques. At the end of the intervention and four weeks after delivery, sleep quality and postpartum depression were evaluated. Considering that the Kolmogorov Smirnov test confirmed the normal distribution of the data, the independent t-test and analysis of covariance were used to analyze the data, showing that the behavioral interventions were effective on the overall sleep quality after delivery (p=0.001); however, no statistically significant effects were observed on postpartum depression, the sub-scales of sleep disorders, and daily functioning (p>0.05). Considering the potential effectiveness of behavioral interventions in improving sleep quality and alleviating insomnia symptoms, it is recommended to implement such measures as an effective intervention to prevent or treat these problems during prenatal and postnatal periods.

Keywords: behavioral interventions, sleep quality, postpartum depression, pregnancy, delivery

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Authors: Shunsuke Saito, Kazuho Yoshimoto, Shunichi Ohmori, Sirawadee Arunyanart

Abstract:

In this paper, we suggest a mechanism of assessment that rater and Ratee (or employees) to convince. There are many problems exist in the personnel assessment. In particular, we were focusing on the three. (1) Raters are not sufficiently recognized assessment point. (2) Ratee are not convinced by the mechanism of assessment. (3) Raters (or Evaluators) and ratees have empathy. We suggest 1: Setting of "understanding of the assessment points." 2: Setting of "relative assessment ability." 3: Proposal of two-way assessment mechanism to solve these problems. As a prerequisite, it is assumed that there are multiple raters. This is because has been a growing importance of multi-faceted assessment. In this model, it determines the weight of each assessment point evaluators by the degree of understanding and assessment ability of raters and ratee. We used the ANP (Analytic Network Process) is a theory that an extension of the decision-making technique AHP (Analytic Hierarchy Process). ANP can be to address the problem of forming a network and assessment of Two-Way is possible. We apply this technique personnel assessment, the weights of rater of each point can be reasonably determined. We suggest absolute assessment for Two-Way assessment by ANP. We have verified that the consent of the two approaches is higher than conventional mechanism. Also, human resources consultant we got a comment about the application of the practice.

Keywords: personnel evaluation, pairwise comparison, analytic network process (ANP), two-ways

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Authors: Adrita Banerjee, Ajeet Kumar Singh

Abstract:

Antenatal care (ANC) from a skilled provider is important to monitor the pregnancy and reduce the risk of morbidity for mother and baby during pregnancy and delivery. The quality of antenatal care can be monitored through the content of services received and the kind of information mothers are given during their visit. Objective: The paper tries to examine the association between ANC check-ups and size/ birth weight. It also focuses on investigating the relationship between utilization of recommended prenatal care for mothers and its effect on infant survival in Nepal. Data and methods: This paper uses data from Nepal demographic Health Survey 2011. To understand the relationship bi-variate statistical analysis and logistic regressions has been done. Maternal health care utilization include ANC check-ups i.e. the type of ante-natal care providers, the number and timing of the visit. The various components of the check-ups include intake of iron tablets/syrups, intestinal parasitic drugs, etc. Results: The results show that women who had no antenatal care visits about 40% had small sized babies at the time of birth compared to women to had at least 3 ANC check up. Women who had at least 3 check-ups 17% of the babies have a small size. It has also been found that about 50 % of the women prefer ANC check-ups during pregnancies which have resulted in lowering the infant mortality by about 40% during 1996-2011. Conclusion: Ante natal care check is care and monitoring of the pregnant woman and her foetus throughout pregnancy. ANC checks have an effect on the infant health and child survival. A woman who had at least three check-ups the possibilities of adverse effect on infant health and infant survival was significantly lower. The findings argue for a more enhanced focus on ANC check-ups for improving the maternal and child health in Nepal.

Keywords: maternal, health, pregnancy, outcome

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Authors: Elyce Cardonick, Shistri Dhar, Linsdey Seidman

Abstract:

Background: When breast cancer is diagnosed during pregnancy, the prognosis is comparable to non-pregnant women matched for prognostic indicators when pregnant women receive treatment without delay. Chemotherapy, including taxanes, can be given during pregnancy with normal neonatal development in exposed fetuses. Methods: Cases of primary breast cancer were extracted from the Cancer and Pregnancy Registry and longitudinal study at Cooper Medical School, which collects cases of pregnant women diagnosed and treated for cancer into a single database. Obstetrical, oncology and pediatric records were reviewed, including annual neonatal developmental, behavioral and medical assessments. Results: 270 pregnant women were diagnosed with primary breast cancer at a mean gestational age of 14.7+9weeks. Mean maternal age at diagnosis 34.5+4.5 years. Receptor status is comparable to non-pregnant women of reproductive age. Forty-nine women were advised to terminate. Two hundred two women underwent surgery;244 women received chemotherapy in pregnancy after the first trimester; the majority of Doxorubucin/Cytoxan; 81 of the cases included a taxane. At a mean of 90 months, follow up obtained on 255 newborns.192/255 newborns are meeting developmental milestones. Respiratory illnesses, including asthma, and bronchiolitis, were reported in 64 newborns, the most common medical condition reported. Thirty-one children are undergoing treatment for GERD, 11 for urinary tract infections, and 7 are undergoing treatment for anemia. Twenty-six children with expressive or articulation language delays, 21/26 are mild. Eleven children with gross/ 7 with fine motor delays. Eight children are treated for ADHD, 4 for anxiety and 4 have social skill impairment. The majority of children with developmental, language or motor delays were born preterm. Conclusion: After chemotherapy exposure in utero for breast cancer, the majority of newborns are meeting developmental milestones and are medically healthy. The goal for treating pregnant women with breast cancer is to aim for delivery close to the term.

Keywords: breast cancer, pregnancy, chemotherapy, newborn

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Authors: Sudha Summarwar, Sudesh Agarwal, Deepali Lall, Nalini Kataria, Jyotsana Pandey

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Assessment of antioxidant status is an effective tool to appraise the presence of oxidative stress. A combination of assays can be used to evaluate the antioxidant status like serum catalase (CAT), superoxide dismutase (SOD) and monoamine oxidase (MAO). In human medicine pregnancy is known to be associated with oxidative stress. Oxidative stress produces harmful effects to the developing foetus. Several metabolic changes occur in the maternal body to meet the demand of energy of developing foetus. Due to these changes susceptibility of maternal body increases to oxidative stress. There is paucity of research work on this aspect in nondescript goats. Therefore, the present study was intended to appraise the oxidative stress in pregnant and non-pregnant non-descript goat. Blood samples were collected for serum separation in otherwise healthy pregnant and non-pregnant nondescript goats. Mean values of serum CAT, SOD and MAO were found on a higher side (p≤0.05) with serum SOD values showing a rise of 2.5 times higher than the control healthy value. Correlations among all the three parameters were found to be highly significant (p≤0.01) especially greatest in youngest group of pregnant animals. Illustration of result enlightened the veracity of bumped up production of free radicals in pregnant animals. Technical savoir-faire of oxidative stress supervision is essential for upholding of health status of foetus. The upshot of present study undoubtedly implied the development of oxidative stress in pregnant goats on the basis of altered antioxidant status. These findings conclude that initially the oxidative stress due to pregnancy is critically combated by the intricate defensive mechanism of natural antioxidant system of the body. It appears that this imbalance between oxidant and antioxidant must be checked in time to prevent cellular damage by regularly appraising the antioxidant status through laboratory methods.

Keywords: antioxidant, oxidative stress, pregnancy, serum catalase

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Authors: Choonsik Lee, Les Folio

Abstract:

Pregnant patients may undergo CT in emergencies unrelated with pregnancy, and potential risk to the developing fetus is of concern. It is critical to accurately estimate fetal organ doses in CT scans. We developed a fetal organ dose calculation tool using pregnancy-specific computational phantoms combined with Monte Carlo radiation transport techniques. We adopted a series of pregnancy computational phantoms developed at the University of Florida at the gestational ages of 8, 10, 15, 20, 25, 30, 35, and 38 weeks (Maynard et al. 2011). More than 30 organs and tissues and 20 skeletal sites are defined in each fetus model. We calculated fetal organ dose-normalized by CTDIvol to derive organ dose conversion coefficients (mGy/mGy) for the eight fetuses for consequential slice locations ranging from the top to the bottom of the pregnancy phantoms with 1 cm slice thickness. Organ dose from helical scans was approximated by the summation of doses from multiple axial slices included in the given scan range of interest. We then compared dose conversion coefficients for major fetal organs in the abdominal-pelvis CT scan of pregnancy phantoms with the uterine dose of a non-pregnant adult female computational phantom. A comprehensive library of organ conversion coefficients was established for the eight developing fetuses undergoing CT. They were implemented into an in-house graphical user interface-based computer program for convenient estimation of fetal organ doses by inputting CT technical parameters as well as the age of the fetus. We found that the esophagus received the least dose, whereas the kidneys received the greatest dose in all fetuses in AP scans of the pregnancy phantoms. We also found that when the uterine dose of a non-pregnant adult female phantom is used as a surrogate for fetal organ doses, root-mean-square-error ranged from 0.08 mGy (8 weeks) to 0.38 mGy (38 weeks). The uterine dose was up to 1.7-fold greater than the esophagus dose of the 38-week fetus model. The calculation tool should be useful in cases requiring fetal organ dose in emergency CT scans as well as patient dose monitoring.

Keywords: computed tomography, fetal dose, pregnant women, radiation dose

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Authors: Manahil Alfuraydan, Jodie Croxall, Lisa Hurt, Mike Kerr, Sinead Brophy

Abstract:

Autism Spectrum Disorder (ASD) is a developmental condition characterised by impairment in terms of social communication, social interaction, and a repetitive or restricted pattern of interest, behaviour, and activity. There is a significant delay between seeking help and a confirmed diagnosis of ASD. This may result in delay in receiving early intervention services, which are critical for positive outcomes. The long wait times also cause stress for the individuals and their families. Telehealth potentially offers a way of improving the diagnostic pathway for ASD. This review of the literature aims to examine which telehealth approaches have been used in the diagnosis and assessment of autism in children and adults, whether they are feasible and acceptable, and how they compare with face-to-face diagnosis and assessment methods. A comprehensive search of following databases- MEDLINE, CINAHL Plus with Full text, Business Sources Complete, Web of Science, Scopus, PsycINFO and trail and systematic review databases including Cochrane Library, Health Technology Assessment, Database of Abstracts and Reviews of Effectiveness and NHS Economic Evaluation was conducted, combining the terms of autism and telehealth from 2000 to 2018. A total of 10 studies were identified for inclusion in the review. This review of the literature found there to be two methods of using telehealth: (a) video conferencing to enable teams in different areas to consult with the families and to assess the child/adult in real time and (b) a video upload to a web portal that enables the clinical assessment of behaviours in the family home. The findings were positive, finding there to be high agreement in terms of the diagnosis between remote methods and face to face methods and with high levels of satisfaction among the families and clinicians. This field is in the very early stages, and so only studies with small sample size were identified, but the findings suggest that there is potential for telehealth methods to improve assessment and diagnosis of autism used in conjunction with existing methods, especially for those with clear autism traits and adults with autism. Larger randomised controlled trials of this technology are warranted.

Keywords: assessment, autism spectrum disorder, diagnosis, telehealth

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Authors: Thanooja Naushad, Meena Natarajan, Tushar Vasant Kulkarni

Abstract:

Background: The Lacey Assessment of Preterm Infants (LAPI) is used in clinical practice to identify premature babies at risk of neuromotor impairments, especially cerebral palsy. This study attempted to find the validity of the Lacey assessment of preterm infants to predict neuromotor outcomes of premature babies at 12 months corrected age and to compare its predictive ability with the brain ultrasound. Methods: This prospective cohort study included 89 preterm infants (45 females and 44 males) born below 35 weeks gestation who were admitted to the neonatal intensive care unit of a government hospital in Dubai. Initial assessment was done using the Lacey assessment after the babies reached 33 weeks postmenstrual age. Follow up assessment on neuromotor outcomes was done at 12 months (± 1 week) corrected age using two standardized outcome measures, i.e., infant neurological international battery and Alberta infant motor scale. Brain ultrasound data were collected retrospectively. Data were statistically analyzed, and the diagnostic accuracy of the Lacey assessment of preterm infants (LAPI) was calculated -when used alone and in combination with the brain ultrasound. Results: On comparison with brain ultrasound, the Lacey assessment showed superior specificity (96% vs. 77%), higher positive predictive value (57% vs. 22%), and higher positive likelihood ratio (18 vs. 3) to predict neuromotor outcomes at one year of age. The sensitivity of Lacey assessment was lower than brain ultrasound (66% vs. 83%), whereas specificity was similar (97% vs. 98%). A combination of Lacey assessment and brain ultrasound results showed higher sensitivity (80%), positive (66%), and negative (98%) predictive values, positive likelihood ratio (24), and test accuracy (95%) than Lacey assessment alone in predicting neurological outcomes. The negative predictive value of the Lacey assessment was similar to that of its combination with brain ultrasound (96%). Conclusion: Results of this study suggest that the Lacey assessment of preterm infants can be used as a supplementary assessment tool for premature babies in the neonatal intensive care unit. Due to its high specificity, Lacey assessment can be used to identify those babies at low risk of abnormal neuromotor outcomes at a later age. When used along with the findings of the brain ultrasound, Lacey assessment has better sensitivity to identify preterm babies at particular risk. These findings have applications in identifying premature babies who may benefit from early intervention services.

Keywords: brain ultrasound, lacey assessment of preterm infants, neuromotor outcomes, preterm

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Authors: Diriba Dereje

Abstract:

Background: Cardiac and renal disease are the most prevalent chronic non-communicable diseases (CNCD) affecting the community in a significant manner. The best and recommended method in halting CNCD is by working on prevention as early as possible. This is only possible if early surrogate markers are identified. As part of the stated solution, this study will identify an association between microalbuminuria (an early surrogate marker of renal and cardiac disease) and lung function test among adult in the community. Objective: The main aim of this study was to assess an association between microalbuminuria (an early surrogate marker of renal and cardiac disease) and lung function test among adult in the community. Methodology: Community based cross sectional study was conducted among 384 adult in Jimma town. A systematic sampling technique was used in selecting participants to the study. In searching for the possible association, binary and multivariate logistic regression and t-test was conducted. Finally, the association between microalbuminuria and lung function test was well stated in the form of figures and written description. Result and Conclusion: A significant association was found between microalbuminuria and different lung function test parameters.

Keywords: microalbuminuria, lung function, association, test

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Authors: Saadia Drissi

Abstract:

The cloud computing is an innovative paradigm that introduces several changes in technology that have resulted a new ways for cloud providers to deliver their services to cloud consumers mainly in term of security risk assessment, thus, adapting a current risk assessment tools to cloud computing is a very difficult task due to its several characteristics that challenge the effectiveness of risk assessment approaches. As consequence, there is a need of risk assessment model adapted to cloud computing. This paper requires a new risk assessment model based on multi-agent system and AHP model as fundamental steps towards the development of flexible risk assessment approach regarding cloud consumers.

Keywords: cloud computing, risk assessment model, multi-agent system, AHP model, cloud consumer

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